Persian translation and validation of the Back Pain Functional Scale

Background: Patient-reported questionnaires provide important tools that can be utilized for the assessment of treatment efficacy in clinic and research. This study aimed to translate, cross-culturally adapt, and validate the Back Pain Functional Scale into Persian (BPFSp). Methods: In this cross-sectional and prospective cohort of adult patients with low back pain (LBP), the translation and adaptation was performed according to standardized guidelines and pretested (n = 30). Psychometric testing was conducted with 100 patients with LBP and 50 healthy subjects. Fifty patients with LBP recompleted the BPFSp at least 7 days later for test–retest reliability. Results: The Persian adapted version of the BPFS was produced and validated. No floor and ceiling effects were revealed. The Cronbach’α coefficient for internal consistency was 0.895. The test–retest reliability was excellent (ICC_agreement = 0.88, CI 95%: 0.80–0.93). The standard error of measurement and smallest detectable change were 9.9% and 27.5%, respectively. Construct convergent validity was demonstrated with the Persian Functional Rating Index (r = ?0.77). Criterion validity was established with the Numerical Pain Rating Scale (r = ?0.67). Total BPFSp scores discriminated between patients with LBP and healthy subjects. Factor structure showed two latent factors explaining a total variance of 60.1%. Conclusion: The BPFSp presented excellent reliability and validity for assessing the functional status in Persian speaking patients with LBP.     

The Wheelchair Use Confidence Scale: Italian translation,adaptation, and validation of the short form

Objective: We developed an Italian version of the Wheelchair Use Confidence Scale for Manual Users-Short Form (WheelCon-M-I-short form) and examined its reliability and validity.

Methods: The original scale was translated from English to Italian using the “Translation and Cultural Adaptation of Patient Reported Outcomes Measures–Principles of Good Practice” guidelines. The WheelCon-M-I-short form was administered to experienced manual wheelchair users who had a variety of diagnoses. Its internal consistency and test–retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair Outcome Measure (WhOM-I) and the Italian version of the Barthel index (BI).

Results: The WheelCon-M-I-short form was administered to 31 subjects. The mean?±?SD of the WheelCon-M-I-short form score was 7.5?±?1.9. All WheelCon-M-I-short form items were either identical or similar in meaning to the WheelCon-M-short form items. Cronbach’s α for the WheelCon-M-I-short form was 0.95 (p?p?p?p?Conclusions: The WheelCon-M-I-short form was found to be reliable and a valid outcome measure for assessing manual wheelchair confidence in the Italian population.

• Implication for Rehabilitation

• The WheelCon-M-I-short form is a valid outcome measure available for assessing wheelchair confidence, according to Bandura’s social cognitive theory, self-efficacy is a better predictor of future behavior than skill itself.

• Translation of the WheelCon-M-short form into the WheelCon-M-I-short form provides a new tool for Italian professionals.

• Clinicians now have a method to measure this invisible barrier to wheelchair use, and they will be able to make informed decisions when prescribing the use of manual wheelchairs and when training clients in their use.

• The WheelCon-M-I-short form also provides researchers with a tool in an important and relevant area of study for future research.

     

French translation and validation of the “Anterior Knee Pain Scale” (AKPS)

Purpose: To linguistically and cross-culturally translate the Anterior Knee Pain Scale into French and to evaluate the reliability and validity of this translated version of the questionnaire.

Methods: The translation part was performed in six stages, according to international guidelines: (i) two initial translations from English to French; (ii) synthesis of the two translations; (iii) backward translations into the original language; (iv) expert committee to compare the backward translations with the original questionnaire; (v) pre-final version testing and (VI) expert committee appraisal. To validate the French version of the Anterior Knee Pain Scale, we assessed its validity, reliability and floor/ceiling effects. To do this, volunteer patients from the French part of Belgium and from France, with patellofemoral pain were asked to answer the French version of the Anterior Knee Pain Scale at baseline and after 7?days, as well as the generic SF-36 questionnaire.

Results: The Anterior Knee Pain Scale was translated without any major difficulties. A total of 101 subjects aged 34.5?±?11.4?years (58.4% of women) were included in this study. Results indicated an excellent test-retest reliability (Intra-class correlation coefficient (ICC)?=?0.97, 95%CI: 0.96–0.98), a high internal consistency (Cronbach’s alpha = 0.87), a consistent construct validity (high correlations with the SF-36 questionnaire were found with domains related to physical function (r?=?0.80), physical role (r?=?0.70) and pain (r?=?0.64)) and low or moderate correlations with domains related to mental health (r?=?0.26), vitality (r?=?0.32) and social function (r?=?0.41). Moreover, no floor/ceiling effects have been found.

Conclusions: A valid French version of the Anterior Knee Pain Scale is now available and can be used with confidence to better assess the disease burden associated with patellofemoral pain. It was successfully cross-culturally adapted into French.

• Implications for rehabilitation

• The results on psychometric properties of the French Anterior Knee Pain Scale are comparable with six validated versions obtained for the Finnish, the Turkish, the Chinese, the Dutch, the Thai and the Persian populations.

• The French translated version of the Anterior Knee Pain Scale is a reliable and valid instrument for assessing the functional limitations associated with patellofemoral pain.

• The test–retest reliability of the French Anterior Knee Pain Scale was excellent, the internal consistency was high and the construct validity was consistent. There were no floor/ceiling effects.

     

Edmonton symptom assessment scale: Italian validation in two palliative care settings

In the palliative care setting, the Edmonton Symptom Assessment Scale (ESAS) was developed for use in daily symptom assessment of palliative care patients. ESAS considers the presence and severity of nine symptoms common in cancer patients: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath plus an optional tenth symptom, which can be added by the patient. The aim of this study was to validate the Italian version of ESAS and to evaluate an easy quality of life monitoring system that uses a patients self-rating symptom assessment in two different palliative care settings: in-patients and home patients. Eighty-three in-patients and 158 home care patients were enrolled. In the latter group, the Italian validated version of the Symptom Distress Scale (SDS) was also administered at the admission of the patients. The two groups of patients have similar median survival, demographic and clinical characteristics, symptom prevalence and overall distress score at baseline. ESAS shows a good concurrent validity with respect to SDS. The correlation between the physical items of ESAS and SDS was shown to be higher than the correlation between the psychological items. The association of ESAS scores and performance status (PS) showed a trend: the higher the symptom score was, the worse was the PS level. Test–retest evaluation, applied in the in-patient group, showed good agreement for depression, well-being and overall distress and a moderate agreement for all the other items. In conclusion, ESAS can be considered a valid, reliable and feasible instrument for physical symptom assessment in routine palliative care clinical practice with a potentially different responsiveness in different situations or care settings.     

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings

ContextThe Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest.ObjectivesTo crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer.MethodsA cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested.ResultsThe CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74–0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33–0.36, respectively).ConclusionThe study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.     

The adult carer quality of life questionnaire (AC-QoL): comparison with measures of burden and well-being,and Italian validation

Purpose: Family caregivers are essential assets in the rehabilitation process, and their psychophysical health should represent a concern for healthcare services. This study aims to investigate the psychometric properties of the Adult Carer Quality of Life Questionnaire, Italian version, and its convergent-discriminant validity with measures of caring burden, resilience, health, and well-being.

Materials and Methods: Participants were 591 parents (89.2% females; aged 25–69) of children treated as outpatients in 14 centers of “Istituto Medea – La Nostra Famiglia”, an Italian rehabilitation institution. They completed: Adult Carer Quality of Life Questionnaire, a 40-item scale assessing care-related challenges, resources, and benefits; Caregiver Burden Inventory; Resilience Scale for Adults; Satisfaction With Life Scale; Health Survey SF-36. The psychometric properties of the Adult Carer Quality of Life Questionnaire were investigated through exploratory and confirmatory factor analyses and reliability evaluation; correlation coefficients assessed convergent and discriminant validity with burden and well-being measures.

Results: The original eight-factor structure of the Adult Carer Quality of Life Questionnaire showed good adequacy and internal consistency; convergent and discriminant validity with measures of burden, resilience, satisfaction, physical and mental health were satisfactory.

Conclusions: The Italian version of the Adult Carer Quality of Life Questionnaire is a reliable and valid instrument to assess caregivers’ perceived challenges and resources. As a parsimonious and easily administrable tool, it can be used to evaluate caregivers’ quality of life and related interventions.

• Implications for Rehabilitation

• Family caregivers are essential assets for the rehabilitation process, and their challenges and resources need to be considered by healthcare services.

• Information on caregivers’ frailties to be reduced and strengths to be empowered allows to design interventions promoting well-being and social integration of people with disabilities and their families.

• The Adult Carer Quality of Life is a comprehensive measure of burden and well-being dimensions that can be easily administered to caregivers of any age.

     

The Italian version of the Sickness Impact Profile-Roland Scale for chronic pain: cross-cultural adaptation,reliability, validity and sensitivity to change

Purpose.?As no adapted form of the 23-item Sickness Impact Profile (SIP)-Roland Scale for patients with chronic pain has ever been validated in the Italian population, the aim of this study was to translate, culturally adapt and validate an Italian version.

Methods.?The development of the Italian version involved translation and back-translation, a final review by an expert committee and the testing of the pre-final version to establish its correspondence with the original. The psychometric testing included testing reliability by internal consistency (Cronbach's α) and test-retest repeatability (intraclass coefficient correlation; ICC), construct validity by comparison with an 11-point pain intensity numerical rating scale (NRS; Pearson's correlation) and the Short Form Health Survey (SF-36; Pearson's correlation) and sensitivity to change by calculating the minimum detectable change (MDC).

Results.?It took 3 months to obtain a shared version of the scale, which was administered to 243 subjects and proved to be satisfactorily acceptable. It had a high degree of internal consistency (α == 0.860) and test-retest reliability (ICC == 0.972). Construct validity testing revealed a moderate correlation with the NRS (r == 0.418), close correlations with the SF-36 physical subscales and moderate-poor correlations with the mental and social subscales; the MDC was 2.33.

Conclusions.?The SIP-Roland scale was successfully translated into Italian, showing satisfactory psychometric properties. The measure can be recommended for use in research and clinical practice to improve the assessment of physical dysfunction in subjects with chronic pain.     

Validation of the Italian version of the Discomfort Scale - Dementia of Alzheimer Type

Title. Validation of the Italian version of the Discomfort Scale – Dementia of Alzheimer Type. Aim. This paper is a report of a study to validate the Discomfort Scale – Dementia of Alzheimer Type in Italian. Background. Dementia is a long and highly debilitating illness with a slow course and a steadily rising prevalence. Improving the quality of life of patients with dementia requires instruments to measure their problems and symptoms, because they are unable to communicate and interact with others. In Italy, there are no validated scales to assess discomfort for this population. The Discomfort Scale – Dementia of Alzheimer Type was developed in the USA and has been further tested there as well as in Germany. Methods. The data were collected by 21 nurses during 2006 in five nursing homes with 71 patients with severe dementia. Face and content validity were evaluated in a focus group. Discriminant validity was assessed with the opposite‐group approach and internal consistency and inter‐rater reliability were measured. Results. The discriminant validity of the Italian Discomfort Scale – Dementia of Alzheimer Type showed its ability to detect patients with high and low levels of discomfort. Reliability testing gave positive results: the internal consistency level was satisfactory (0·814) and comparisons of overall discomfort scores across nurses show good reliability. Conclusion. These findings support the use of Discomfort Scale – Dementia of Alzheimer Type in a clinical setting for people with severe dementia for both research and practice. Its ease of use and comprehensibility, and the limited time required to observe patients renders the Discomfort Scale – Dementia of Alzheimer Type a practical instrument for assessment and choosing care interventions.     

Psychometric properties of the Swedish Diabetes Empowerment Scale

OBJECTIVE: This study was conducted to determine the psychometric properties of the Swedish version of the Diabetes Empowerment Scale (Swe-DES-23). RESEARCH DESIGN AND METHODS: A convenience sample of 195 patients with type 1 and type 2 diabetes completed the Swe-DES-23 questionnaire. To establish discriminant validity, Swe-DES subscales were compared with the Semantic Differential in Diabetes scale (SDD) and a general health scale (EVGFP). Construct validity was tested using factor analyses. To determine unidimensionality of the subscales, inter-item correlations were calculated. Internal consistency was tested by the use of the Crohnbach-alpha coefficient. RESULTS: The factor analysis resulted in four factors (empowerment subscales) with eigenvalues >1.0, explaining 60% of the variance. The four empowerment subscales: goal achievement, self-awareness, stress management and readiness to change showed Crohnbach-alpha values ranging from 0.68 to 0.91. Patients with good self-reported health and low burden of diabetes scored significantly higher on almost all empowerment subscales. Only weak correlations were found between metabolic control and the empowerment subscales. CONCLUSIONS: The SWE-DES-23 scale had acceptable validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Further testing is needed to shorten the questionnaire.     

Drug Avoidance Self Efficacy Scale (DASES): A cultural adaptation and validation study

Background: Drug avoidance self efficacy has always been an important issue in substance abuse treatment and its important has emphasized in specific models of addiction. This study describes the process of cultural adaptation, validation and dimensionality of the Persian version of “Drug Avoidance Self Efficacy Scale”.

Methods: Cultural adaptation process followed the procedure outlined by Beaton et al. Psychometric properties and dimensionality of the scale were assessed using sample of Iranian addicts (n?=?317). The DASES was subject to independent exploratory (n?=?157, mean age 29.40?±?7.26) and confirmatory (n?=?160, mean age 27.99?±?5.70) factor analysis. Internal consistency of the questionnaire also was assessed using Cronbach’s alpha.

Results: There was no eliminated item in the cultural adaptation process. Results of exploratory factor analysis revealed a two-factor 14-item structure for the DASES. Secondary order, two-factor model provided a good statistical and conceptual fit for the data. The analysis of internal consistency of DASES was very satisfactory (α?=?0.809).

Conclusions: Although culturally adapted DASES is a potentially reliable and valid measure of substance users’ perceptions of avoidance self-efficacy, the findings should be viewed as preliminary in nature. Future research needs to determine to what extent substance users’ perceptions of avoidance self efficacy impact on treatment outcomes.     

The Rehabilitation Complexity Scale – extended version: detection of patients with highly complex needs

Purpose: To describe the extended Rehabilitation Complexity Scale (RCS-E) and its factor structure, and to determine whether it provides added value over the RCS-version 2 to identify patients with highly complex rehabilitation needs. Method: A cohort analysis of prospectively-collected routine clinical data from 331 patients with complex neurological disabilities undergoing inpatient rehabilitation in a tertiary specialist neurorehabilitation unit in the UK. RCS-E and RCS-v2 scores were recorded in parallel by the multi-disciplinary team (MDT) at fortnightly intervals, alongside the Northwick Park nursing (NPDS) and therapy (NPTDA) dependency scales, capturing nursing care and therapy interventions in staff hours/week. Results: Very strong correlations were found between total RCS-v2 and RCS-E scores (ρ?=?0.954); the RCS-E “Care & nursing” subscale and care/nursing hours/week (ρ?=?0.838, p < 0.001); and the RCS-E “Therapy” subscale and total therapy hours/week (p?=?0.697, p < 0.001). The RCS-E showed better discrimination for complex therapy needs than the RCS-v2, but not for complex care/nursing needs. The RCS-E factor structure was similar to the RCS-v2, with moderate internal consistency overall, separating into two distinct dimensions (“Nursing/medical care + Equipment” and “Therapy”). Conclusion: The RCS-E provides an equivalent measure of complexity to the RCS-v2, but offers added value in identifying patients with highly complex therapy and equipment needs.

Implications for Rehabilitation

• Assessing complexity of rehabilitation needs presents a challenge throughout the world.

• The Rehabilitaton Complexity Scales provide a simple measure of complexity of rehabilitation needs, which take account of basic care, specialist nursing, therapy and medical interventions.

• The extended version (RCS-E) presented here may offer a more sensitive tool for detecting patients with highly complex needs for therapy and equipment in specialist rehabilitation settings.

     

Perceived stress in survivors of suicide: psychometric properties of the Perceived Stress Scale

The purpose of this study was to evaluate the psychometric properties of three versions of the Perceived Stress Scale (PSS; American Sociological Association) in adults who had survived the death of a family member or significant other by suicide. Reliability and validity were examined. Exploratory factor analysis was conducted to assess dimensionality of the underlying constructs. All three versions of the PSS demonstrated acceptable reliability. Two shorter versions retained good psychometric properties and demonstrated convergent and concurrent validity with measures of posttraumatic stress symptoms and mental health quality of life. Factor analysis provided further evidence of their usefulness as brief and valid measures of perceived stress in acutely bereaved adult survivors of suicide. In a sub-sample of closely related survivors, the psychometric properties of the 4-item version of the PSS were retained.     

Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study

AIM: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors. BACKGROUND: The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences. METHODS: Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005. RESULTS: In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale. CONCLUSION: The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.