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Clinimetric Testing of Three Self-report Outcome Measures for Low Back Pain Patients in Brazil: Which One Is the Best?

Costa, Leonardo Oliveira Pena, PT, MSc*†; Maher, Chris G., PT, PhD*; Latimer, Jane, PT, PhD*; Ferreira, Paulo Henrique, PT, PhD‡§; Ferreira, Manuela Loureiro, PT, PhD†‡; Pozzi, Giovanni Campos, PT; Freitas, Ludmilla Motta Andrade, PT

doi: 10.1097/BRS.0b013e3181849dbe
Health Services Research

Study Design. Translation, cross-cultural adaptation, and clinimetric testing of self-report outcome measures.

Objective. The aims of this investigation were to perform the translation and cross-cultural adaptation of the Patient-Specific Functional Scale (PSFS) into Brazilian-Portuguese and to perform a head-to-head comparison of the clinimetric properties of the Brazilian-Portuguese versions of the PSFS, the Roland-Morris Disability Questionnaire (RMDQ) and the Functional Rating Index (FRI).

Summary of Background Data. To date, there is no Brazilian-Portuguese version of the PSFS available and no head-to-head comparison of the Brazilian-Portuguese versions of the PSFS, RMDQ, and FRI has been undertaken.

Methods. The PSFS was translated and adapted into Brazilian-Portuguese. The PSFS, the RMDQ, and the FRI were administered to 99 patients with low back pain to evaluate internal consistency, reproducibility, ceiling and floor effects, construct validity, internal and external responsiveness. To fully test the construct validity and external responsiveness of these measures, it was necessary to cross-culturally adapt the Pain Numerical Rating Scale and the Global Perceived Effect Scale.

Results. All measures demonstrated high levels of internal consistency (Cronbach's α range = 0.88–0.90) and reproducibility (Intraclass Correlation Coefficient2,1 range = 0.85–0.94). High correlations among the disability-related measures were observed (Pearson's r ranging from 0.51 to 0.71). No ceiling or floor effects were detected. The PSFS was consistently more responsive than the other measures in both the internal responsiveness and external responsiveness analyses.

Conclusion. The results from this study demonstrate that the Brazilian-Portuguese versions of the RMDQ, the FRI and the PSFS have similar clinimetric properties to each other and to the original English versions. Of allthe measures tested in this study the PSFS seems the most responsive. These measures will enable international comparisons to be performed, and encourage researchers to include Portuguese speakers in their clinical trials.

The aims of this study were to cross-culturally adapt the Patient-Specific Functional Scale to Brazilian-Portuguese and to perform a head-to-head comparison of its clinimetric properties with those of the Roland-Morris Disability Questionnaire and the Functional Rating Index. The 3 measures were shown to have similar clinimetric properties however, the Patient-Specific Functional Scale was the most responsive.

From the *Musculoskeletal Division, The George Institute for International Health, School of Medicine, The University of Sydney, NSW, Australia; †Pontifícia Universidade Católica de Minas Gerais, Brazil; ‡School of Physiotherapy, The University of Sydney, Australia; and §Universidade Federal de Minas Gerais, Departmento de Fisioterapia, Belo Horizonte, Brazil.

Acknowledgment date: January 2, 2008. Revision date: May 22, 2008. Acceptance date: May 26, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Leonardo Costa is a PhD student supported by CAPES—Ministério da Educação—Brazil and Pontifícia Universidade Católica de Minas Gerais—Brazil; Chris Maher holds a research fellowship funded by the National Health and Medical Research Council of Australia.

Address correspondence and reprint requests to Leonardo Oliveira Pena Costa, PT, MSc, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.