Cross-cultural adaptation and measurement properties of the Nepali version of the DASH (disability of arm, shoulder and hand) in patients with shoulder pain

Abstract

BackgroundPatient-reported outcome measures (PROMs) are important tools in both clinical practice and research. However, no upper extremity PROM to assess physical disability is available in Nepali. The most commonly used and recommended questionnaire for the shoulder is the Disability of Arm, Shoulder and Hand (DASH). Therefore, the aim of the study was to translate and cross-culturally adapt the DASH into Nepali and determine its measurement properties.MethodsThe translation and cultural adaptation process followed international standard procedures. The translated Nepali version of the questionnaire (DASH-NP) was completed by 156 patients with shoulder pain from three Nepali hospitals at an initial assessment and by 121 at follow-up. A Nepali version of Global Rating of Change (GROC-NP) was completed at follow-up to dichotomise improved and stable participants. Measurement properties testing included: internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient, ICC), Minimal Detectable Change (MDC), construct validity - factor analysis, hypothesis testing with the Shoulder Pain and Disability Index (SPADI) (Pearson Correlation = r) and responsiveness - Area Under the Curve with minimal important change.ResultsSignificant adaptations such as changing measurement units, activities and terminology were incorporated to improve cultural relevance. Internal consistency (α = 0.92) and test-retest reliability (ICC = 0.97, 95% CI: 0.94–0.98, p < 0.001) were excellent. The MDC was 11 out of 100 points. There were moderate-high positive correlations with the SPADI pain and disability items (rs = 0.63 and 0.81, P < 0.001). Four factor solution was retrieved for the DASH-NP. The Area Under the Curve was 0.69 (95% CI: 0.57 - 0.81, p < 0.001) with minimal important change of 11.2/100 points.ConclusionsThe Nepali translation of the DASH is comprehensible, easy to administer via self-report or interview. It is found to be a reliable, valid, and responsive measure in patients with shoulder pain in Nepal. The DASH-NP can be used to assess shoulder pain related disability in Nepal for clinical practice or research.Electronic supplementary materialThe online version of this article (10.1186/s12955-019-1105-1) contains supplementary material, which is available to authorized users.

Translation, cross-cultural adaptation, and measurement properties of the Nepali version of the central sensitization inventory (CSI)

“…We were unable to analyze reliability separately for face-to-face and telephone interviews. In a previous and similar validation study, we found no differences in test-retest reliability of the Nepali Disability of Arm, Shoulder, and Hand Questionnaire [ 56 ]. Further studies may assess the reliability separately for face-to-face administration of CSI-NP.…”

Translation and cross-cultural adaptation of Nepali versions of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Intensity, Pain Interference, Pain Behavior, Depression, and Sleep Disturbance short forms in chronic musculoskeletal pain

“…Similarly, another instrument with reverse coded items, the Life Orientation Test -Revised (LOT-R) [42], has been translated into Nepali and found to be poorly interpreted reflected by poor internal consistency in a large sample. We have had good success in translation of PROMs to produce reliable and valid instruments in Nepali in the past for the PROMs which do not have reverse coded response options [33][34][35][36][37][38][39][40]. Simplifying PROMs for target populations with low-levels of literacy, such as Nepali, is very important because the participants' ability to interpret the meaning of the and responses is dependent on educational level of the individual [35,43].…”

“…The translation project manager (TPM), the lead author of the paper (SS), performed a thorough review of all translations. The TPM also has a great deal of experience translating, cross-culturally validating PROMs from English into Nepali[33][34][35][36][37][38][39][40]. The TPM noted the consistencies and discrepancies in the translations and added notes or comments for the reviewers (see below) and the PROMIS instrument developer representative to consider.Three independent reviews.…”

The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire – Assessing shoulder function in patients with subacromial pain

“…The DASH is reported being valid, reliable, and responsive for patients with shoulder pain. 2 , 13 , 40 , 41 The DASH 7 is reported responsive for patients with subacromial pain with an effect size (Cohens d ) of 0.93. 34 …”