Translation, Cultural Adaptation and Validation of “PROMIS GI - Disrupted Swallowing” Scale for the Portuguese Language
Keywords:Deglutition Disorders, Portugal, Reproducibility of Results, Surveys and Questionnaires, Translation
Introduction: Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient’s personal and professional lives. Patient-reported outcomes allow patients to directly quantify their experience regarding dysphagia and evaluate its true impact on quality of life. Among the scales available, Patient-Reported Outcomes Measurement Information System Gastrointestinal (PROMIS GI) Disrupted Swallowing stands out because it is a robust instrument that can be applied regardless of the type and etiology of dysphagia. The aim of this study was to translate, culturally adapt and validate PROMIS GI Disrupted Swallowing scale for the Portuguese-speaking population.
Material and Methods: Firstly, the seven items of the scale were translated and transculturally reviewed following the systematic method proposed by the Functional Assessment of Chronic Illness Therapy (FACIT). Afterwards, the pre-test version of the questionnaire was administered to a convenience sample (n = 6) for semantic evaluation, with the aim of detection and subsequent correction of possible problems in the translation. The final translated and certified version of the scale was administered to 200 voluntary adult participants (n = 123 healthy; n = 77 dysphagia) in Portugal, for evaluation of reliability and validity.
Results: The Portuguese version of PROMIS GI Disrupted Swallowing presented acceptable internal consistency (coefficient of Cronbach’s α of 0.919) and adequate test-retest reliability (intraclass correlation coefficient of 0.941). The translated version of the scale revealed a strong correlation with both Eckardt score (p < 0.001; ρ = 0.782) and the quality-of-life questionnaire EuroQol-5D (p < 0.001; ρ = -0.551), demonstrating evidence of convergent validity.
Conclusion: The Portuguese version of PROMIS GI Disrupted Swallowing scale presented conceptual, semantic, cultural and measurement equivalence relatively to the original items. The results attained demonstrated that the translation of this scale to Portuguese is reliable and valid for use both in clinical practice and for research purposes.
Johnston BT. Oesophageal dysphagia: a stepwise approach to diagnosis and management. Lancet Gastroenterol Hepatol. 2017;2:604-9. DOI: https://doi.org/10.1016/S2468-1253(17)30001-8
Chilukuri P, Odufalu F, Hachem C. Dysphagia. Mo Med. 2018;115:206–10.
Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Marbella AM, et al. US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–80. DOI: https://doi.org/10.1007/BF01303162
Thiyagalingam S, Kulinski AE, Thorsteinsdottir B, Shindelar KL, Takahashi PY. Dysphagia in older adults. Mayo Clin Proc. 2021;96,488–97. DOI: https://doi.org/10.1016/j.mayocp.2020.08.001
Campbell BH, Spinelli K, Marbella AM, Myers KB, Kuhn JC, Layde PM. Aspiration, weight loss and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg. 2004;130:1100–3. DOI: https://doi.org/10.1001/archotol.130.9.1100
Queirós A, Moreira S, Silva A, Costa R, Lains J. Contributo para a adaptação e validação da Eat Assessment Tool (EAT-10) e da Functional Oral Intake Scale (FOIS). Rev Soc Port Med Fisic Reabil. 2013;24:25-30.
Antunes EB, Vieira D, Dinis-Ribeiro M. Linguistic and cultural adaptation into European Portuguese of SWAL-QOL and SWAL-CAR E outcomes tool for adults with oropharyngeal dysphagia. Arq Med. 2015;29:6-10.
Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17:139–46. DOI: https://doi.org/10.1007/s00455-001-0113-5
Patel DA, Krishnaswami S, Steger E, Conover E, Vaezi MF, Ciucci MR, et al. Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus. 2018;31:1-7. DOI: https://doi.org/10.1093/dote/dox131
Farneti D, Consolmagno P. The swallowing centre: rationale for a multidisciplinary management. Acta Otorhinolaryngol Ital. 2007;27:200–7.
Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, et al. Impact of dysphagia on quality of life after treatment of head and neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:772–8. DOI: https://doi.org/10.1016/j.ijrobp.2004.06.017
Zhong C, Tan S, Ren Y, Lü M, Peng Y, Fu X, et al. Quality of life following peroral endoscopic myotomy for esophageal achalasia: a systematic review and meta-analysis. Ann Thorac Cardiovasc Surg. 2020;26:113-24. DOI: https://doi.org/10.5761/atcs.ra.19-00273
Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res. 2019;31:799–805. DOI: https://doi.org/10.1007/s40520-019-01128-3
Vaz-Carneiro A, Luz R, Borges M, Costa J. Indicadores (outcomes)p e secundários em ensaios clínicos oncológicos: definição e usos. Acta Med Port. 2014;27:498-502. DOI: https://doi.org/10.20344/amp.5286
Patel DA, Sharda R, Hovis KL, Nichols EE, Sathe N, Penson DF, et al. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus. 2017;30:1-23. DOI: https://doi.org/10.1093/dote/dow028
Zumpano CE, Mendonça TM, Silva CH, Correia H, Arnold B, Pinto RM. Adaptação transcultural e validação da escala de Saúde Global do PROMIS para a língua portuguesa. Cad Saúde Pública. 2017;33:e00107616. DOI: https://doi.org/10.1590/0102-311x00107616
Spiegel BM, Hays RD, Bolus R, Melmed GY, Chang L, Whitman C, et al. Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal Symptom Scales. Am J Gastroenterol. 2014;109:1804-14. DOI: https://doi.org/10.1038/ajg.2014.237
Urbach DR, Tomlinson GA, Harnish JL, Martino R, Diamant NE. A measure of disease-specific health-related quality of life for achalasia. Am J Gastroenterol. 2005;100:1668–76. DOI: https://doi.org/10.1111/j.1572-0241.2005.50141.x
Lagergren P, Fayers P, Conroy T, Stein HJ, Sezer O, Hardwick R, et al. Clinical and psychometric validation of a questionnaire module, the EORTC QLQOG25, to assess health-related quality of life in 11 patients with cancer of the oesophagus, the oesophago-gastric junction and the stomach. Eur J Cancer. 2007;43:2066–73. DOI: https://doi.org/10.1016/j.ejca.2007.07.005
Manor Y, Giladi N, Cohen A, Fliss DM, Cohen JT. Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson’s disease. Mov Disord. 2007;22:1917–21. DOI: https://doi.org/10.1002/mds.21625
Dellon ES, Irani AM, Hill M, Hirano I. Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis. Aliment Pharmacol Ther. 2013;38:634–42. DOI: https://doi.org/10.1111/apt.12413
Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25:3186-91. DOI: https://doi.org/10.1097/00007632-200012150-00014
Eremenco SL, Cella D, Arnold BJ. A comprehensive method for the translation and cross-cultural validation of health status. Eval Health Prof. 2005;28:212-32. DOI: https://doi.org/10.1177/0163278705275342
Ferreira PL, Ferreira LN, Pereira LN. Contributos para a validação da versão portuguesa do EQ-5D. Acta Med Port. 2013;26:664-75. DOI: https://doi.org/10.20344/amp.1317
Comrey AL, Lee HB. A first course in factor analysis. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1992.
Gockel I, Junginger T. The value of scoring achalasia: a comparison of current systems and the impact on treatment--the surgeon’s viewpoint. Am Surg. 2007;73:327-31. DOI: https://doi.org/10.1177/000313480707300403
McHorney CA, Ware Jr JE, Lu JF, Sherbourne CD. The MOS 36-item short-form healthy survey (SF-36): III. Test of data quality, scaling assumptions and reliability across diverse patient groups. Med Care. 1994;32:40-66. DOI: https://doi.org/10.1097/00005650-199401000-00004
Nunnally J, Bernstein I. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
Cohen JW. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
How to Cite
Copyright (c) 2023 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.