Cultural Adaptation and Reliability Analysis of the Modified Dyspnea Index for the Brazilian Culture

Abstract

This study aims to present the cross-cultural adaptation process of the Modified Dyspnea Index to the Brazilian culture and to investigate its content validity and reliability. This process included the steps of translation, back translation and review by two experts to assess semantic, conceptual, idiomatic, cultural and metabolic equivalence. The Index of Content Validity was used to evaluate the extent of inter-observer agreement. A Guide to implement the Modified Dyspnea Index was developed and validated. Two different professionals assessed the reliability of the Brazilian version of the Modified Dyspnea Index, according to the inter-observer equivalence criterion, with 31 patients, indicating a Kappa coefficient=0.960 (p<0.001). In conclusion, the Brazilian version of MDI presented evidence of interobserver equivalence when applied by different health professionals in the population of cardiac patients. Adaptación cultural y análisis de la confiabilidad del instrumentoModified Dyspnea Index para la cultura brasileña Este estudio presenta el proceso de adaptación cultural del Modified Dyspnea Index para la cultura brasileña y la evaluación de su validad de contenido y confiabilidad. Este proceso incluyó las etapas de traducción, retrotraducción y evaluación de la equivalencia semántica, idiomática, conceptual, cultural/experimental y metabólica. El Índice de Validad de Contenido fue utilizado para evaluar la proporción de concordancia entre los jueces. Fue desarrollado y validado un guión para orientar la aplicación del Modified Dyspnea Index. Dos diferentes profesionales evaluaron la confiabilidad de la versión brasileña del Modified Dyspnea Index, de acuerdo con el criterio de la equivalencia interobservador, en 31 pacientes, apuntando para un coeficiente Kappa=0,960 (p<0,001).La versión brasileña del Modified Dyspnea Index presentó pruebas de equivalencia interobservador en una muestra de pacientes cardíacos. The study of dyspnea is complicated, due to the difficulties to precisely define the physical stimulus that triggers it. In an attempt to assess and quantify dyspnea more objectively, different instruments have been developed, including structured interviews, self-report questionnaires, visual analogue scales, which assess dyspnea in both qualitative and quantitative terms.Specifically in the context of cardiopulmonary diseases, dyspnea has been assessed using instruments that measure the intensity of the symptom: the Horizontal Visual Analogue Scale (HVAS) (4) , Borg Scale (5) , Modified Borg Scale (5) , and the Numeric Rating Scale (6) Profile (CLASP) (7) , Chronic Heart Failure Questionnairedyspnea subscale (CHQ-D) (8) ; the Oxygen Cost Diagram (OCD) (9) and the Baseline Dyspnea Index (BDI) (10) .In 1986, the Modified Dyspnea Index (MDI) was proposed, as an adaptation of the BDI, which incorporated additional criteria for evaluation of dyspnea, contributing to the greater accuracy of the measure (11) .The MDI was developed in English, focused on the North American culture, and has been applied ...

Adaptação Transcultural De Instrumentos De Pesquisa Conduzida Pela Enfermagem Do Brasil: Uma Revisão Integrativa

“…The most-used methodological framework for CCA, in 20 articles analyzed, was that with Beaton as either the main author or as a contributing author, published in different years. [9][10][11][12][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29][30] Regarding the stages of the CCA process, in 14 of the articles analyzed [11][12][14][15][16][18][19][20][21]24,[26][27][29][30] the following sequence was adopted: translation, synthesis of the translations, back-translation, analysis by a committee of specialists, and pretesting of the adapted version. 1 In the other studies [9][10]13,17,[22][23]25,28 this sequence of the process was altered.…”

“…16,21,26 In four of the articles, however, there was no information on the nationality of the translators 11,17,20,28 responsible for the stages of translation and/or back-translation of the instrument. In six 21,23,25,27,[29][30] articles analyzed, there was either a partial or total absence of information on the obligatory characteristics or criteria for selecting the translators responsible for the stages of initial translation and back-translation, or the recommendations regarding these criteria were not followed.…”

“…Regarding the description of the procedures adopted in the stages of CCA it was observed that in 20 articles [9][10][11][12][13][14][15][16][17][19][20][21][23][24][25][26][27][28][29][30] the authors were concerned with giving a detailed description of the largest part of the process, evidencing the attention given to the methodological rigor adopted. 3 The description of the process of selecting the experts who made up the specialist committees was observed in 18 articles.…”

“…3 The description of the process of selecting the experts who made up the specialist committees was observed in 18 articles. 9,[11][12][13][14][15][16][17]19,22,[24][25][26][27][28]30 In 17 studies [9][10][12][13][14][17][18][19][21][22][23][24][25][26][27][28]30 the evaluation of the psychometric properties of the instruments was undertaken, along with the validation of the qualitative and quantitative content (the expert committee), with a description of the statistical analysis used. Among the statistical tests used in the psychometric evaluation, the Alfa Cronbach test deserves to be highlighted, used in the analysis of the instrument's internal consistency (reliability), given that this was undertaken in 09 [9][10]12,14,18,[24][25]28 of the 17 articles ( Table 2).…”

Conceptual framework for research and clinical practice concerning cardiovascular health-related behaviors

“…These studies first focused on the development and refinement of measurement instruments and, later, exploratory studies focused on understanding the relationships among the model components, such as quality of life, symptoms, and clinical and genetic profiles. Predictive studies were used to identify determinants of healthrelated behaviors (11)(12)(13)(14) .…”