UCSD Performance-Based Skills Assessment (UPSA): validation of a Brazilian version in patients with schizophrenia

Abstract

The UCSD Performance-based Skills Assessment (UPSA) is a measure of Functional Capacity and assesses skills involved in community tasks. It has good psychometrics properties, and is currently recommended as a co-primary assessment of cognition in the MATRICS Project. To our knowledge so far, there are no studies in western developing countries concerning Functional Capacity in Schizophrenia. The aims of this study were to translate, culturally adapt and validate the UPSA to assess Functional Capacity in community-dwelling patients with Schizophrenia living in Brazil. Eighty-two subjects (52 patients, 30 controls) were evaluated using: the Brazilian version of the UPSA (UPSA-1-BR), PANSS, Personal and Social Performance (PSP) and Global Assessment of Functioning (GAF). In the reliability test, UPSA-1-BR showed good Internal Consistency (Cronbach’s alpha of 0.88) and strong correlation between test and retest (4-month gap; r = 0.91; p < 0.01). Spearman’s rho values showed a moderate correlation between UPSA-1-BR and both PSP (0.50; p < 0.01) and GAF (0.46; p < 0.01) scores. UPSA-1-BR is capable of differentiating people with and without Schizophrenia. Patients scored lower than controls (58.9 versus 79.1), with an AUC of 0.79 (95%IC: 0.69–0.89). Sensitivity and specificity values of 0.71 and 0.70, respectively, were found in the cut-off point of 73.5, for separation of patients and controls, with predictive values of 80% (positive) and 58% (negative). UPSA-B-BR was also evaluated. UPSA-1-BR and its brief version presented adequate psychometric properties and proved to be valid and reliable instruments in the assessment of Functional Capacity in subjects with Schizophrenia.

Construct validity, sensitivity and specificity of the USCD Performance-based Skill Assessment 2 in a mixed Portuguese sample

“…Moreover, while the convenience sampling method used in the current study requires caution in the generalization of findings. Nevertheless, it is important to highlight that the general psychometric characteristics and functional milestones in the current study is similar to those found in several UPSA studies in Western countries, particularly to those using samples of inand outpatients with schizophrenia and controls in studies (Garcia-Portilla et al, 2013;Keefe et al, 2016;Mantovani et al, 2015;Mausbach et al, 2016;Patterson et al, 2001). Overall findings suggest a good integrity and robustness of the UPSA set measures in general, and the UPSA-2-PT.…”

“…Despite the UPSA-1 being validated and made available in Brazilian Portuguese (Mantovani, Machado-de-Sousa, & Salgado, 2015), to the best of our knowledge, the UPSA-2 was never translated and adapted to Portuguese. In addition, more important than the language nuances between Portuguese native-speakers, it is important to emphasize the need to adapt the tasks as much as possible to the cultural specificities and daily routines, which can differ considerably between European and American countries.…”

“…Previous studies have shown the importance of using the translated and adapted tasks when assessing participants from different cultural backgrounds or in their native language (Garcia-Portilla et al, 2013;Mantovani et al, 2015;Mausbach et al, 2016), and studying their psychometric properties in different populations is an important step in assuring scores comparability and test integrity across versions. Most studies on the validity of the UPSA did not include inter-rater reliability, an important aspect that should be excluded from the factors that may influence variability in scores across different versions of the UPSA and few have analyzed the sensitivity and specificity of scores and suggested possible cutoff points to functional capacity (Becattini-Oliveira et al, 2018).…”

Construct validity, sensitivity and specificity of the USCD Performance-based Skill Assessment 2 in a mixed Portuguese sample

“…Despite the UPSA-1 being validated and made available in Brazilian Portuguese 10 , to the best of our knowledge, the UPSA-2 was never translated and adapted to Portuguese. In addition, more important than the language nuances between Portuguese native-speakers, it is important to emphasize the need to adapt the tasks as much as possible to the cultural specificities and daily routines, which can differ considerably between European and American countries.…”

The role of functional capacity in the prediction of occupational status in schizophrenia

“…Individuals answered socio-demographic questions of a semi-structured questionnaire, including the current occupational status. Functional capacity was assessed through the Brazilian version of the UPSA (UPSA-1-BR) ( Mantovani et al, 2015 ), including all five subdomains, as follows: comprehension and planning, financial skills, communication, mobility and household managing. Individuals were separated in two groups, considering the current occupational status: Working Group (currently working or retired [service retirement]) and Not-working Group (unemployed or permanently disabled due to mental illness [disability retirement]).…”