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w w w . r e u m a t o l o g i a . c o m . b r

REVISTA

BRASILEIRA

DE

REUMATOLOGIA

Original

article

Translation

and

validation

of

Neck

Bournemouth

Questionnaire

to

Brazilian

Portuguese

Danilo

Harudy

Kamonseki

,

Luísa

Cedin,

Jaqueline

Tavares-Preto,

Beatriz

de

Oliveira

Peixoto,

Sandro

Rostelato-Ferreira

UniversidadePaulista,InstitutodeCiênciasdaSaúde,Sorocaba,SP,Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received2March2016 Accepted7September2016 Availableonline3January2017

Keywords:

Translation Questionnaire Neck

Outcomeassessment

a

b

s

t

r

a

c

t

Objective:TotranslatetheNeckBournemouthQuestionnairetoBrazilianPortuguese, cross-culturallyadapt,andtoverifyitsvalidityanditsreliability.

Methods:ThedevelopmentoftheBrazilianversionofNeckBournemouthQuestionnaire (Brazil-NBQ) was based on the guideline proposed by Guillemin. The applied process consisted of translation, back-translation, committee review and pre-test. Sixty-one volunteerspresentingneckpainparticipatedinthisstudy.Thirty-fiveofthemparticipated duringpre-testingphasetoverifytheinstrumentcomprehension,andtheremaining26 tookpartduringpsychometricanalysis.Psychometricevaluationincludedinterraterand intraraterreliabilityandconstructvalidity(correlationamongBrazil-NBQ,SF-36,Numerical ratingscoreandNeckDisabilityIndex).

Results:Sometermsandexpressionswerechangedtoobtainculturalequivalencefor Brazil-NBQduringthetranslationphase.TheNBQshowedanintraraterICCof0.96andinterrater ICCof0.87.ConstructvalidityanalysisshowedmoderatecorrelationswithSF-36andstrong correlationwithNumericalratingscoreandNeckDisabilityIndex.

Conclusion: Neck Bournemouth Questionnaire wastranslated and culturallyadapted to Portugueselanguage,anditdemonstratedtobevalidandreliabletoevaluatepatients’neck pain.

©2016ElsevierEditoraLtda.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Traduc¸ão

e

validac¸ão

do

Neck

Bournemouth

Questionnaire

para

o

português

do

Brasil

Palavras-chave:

Traduc¸ão Questionário Cervical

Avaliac¸ãodedesfecho

r

e

s

u

m

o

Objetivo:TraduziroNeckBournemouthQuestionnaireparaoportuguêsdoBrasil,adaptá-lo culturalmenteeverificarasuavalidadeeconfiabilidade.

Métodos:OdesenvolvimentodaversãobrasileiradoNeckBournemouthQuestionnaire (NBQ-Brasil)foibaseadonasdiretrizespropostasporGuillemin.Oprocessoaplicadoconsistiuem traduc¸ão,retrotraduc¸ão,revisãoporumcomitêepré-teste.Participaramdesteestudo61

Correspondingauthor.

E-mail:fisiot.danilo@hotmail.com(D.H.Kamonseki).

http://dx.doi.org/10.1016/j.rbre.2016.11.006

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voluntáriosqueapresentavamdorcervical;35delesparticiparamduranteafasede pré-testeparaverificaracompreensãodoinstrumentoe os26 restantesdurantea análise psicométrica.Aavaliac¸ãopsicométricaincluiuaanálisedaconfiabilidadeinteravaliadores eintra-avaliadoredavalidadedoconstruto(correlac¸ãoentreoNBQ-Brasil,oSF-36,aEscala NuméricadeDoreoNeckDisabilityIndex).

Resultados: Algunstermosealgumasexpressõesforamalteradosparaseobterequivalência culturalcomoNBQ-Brasildurantea fase detraduc¸ão. ONBQmostrou umaCCI intra-avaliadorde0,96eCCIinteravaliadoresde0,87.Aanálisedavalidadedoconstrutomostrou correlac¸õesmoderadascomoSF-36ecorrelac¸ãofortecomaEscalaNuméricadedoreo

NeckDisabilityIndex.

Conclusão: ONeckBournemouthQuestionnairefoitraduzidoeadaptadoculturalmentepara oidiomaportuguêse demonstrouserválidoeconfiávelparaavaliaradorcervicaldos pacientes.

©2016ElsevierEditoraLtda.Este ´eumartigoOpenAccesssobumalicenc¸aCC BY-NC-ND(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction

Pathologies thatcause neck pain are frequentlytreated by health professionals and they are found in 22–70%of the population showing higher predominance in older people. Around 30% ofthe patients presentingchronic symptoms, whichmeanssymptomslastinglongerthansixmonths,and about5%ofthesymptomaticpatientsbecomeincapableof workingleadingtoworkfaultsandhighertreatmentcosts.1–3

Awideanalysisofthediseaserequiresstandardizedtools thatmeasurepatientconditionswithprecisionandqualityto followtheclinicprogressionandtoverifytreatmentefficacy andqualityofliferelatedtoself-perspectiveofhealth.Among measurementtools,questionnairesandfunctionalscalesare importantforclinicalpracticeandscientificresearchdueto theirsubjectiveinformationthatmeasureinanefficientand trustfulmannerwithlowcost.4–6

Questionnairescreatedinotherlanguagesmustbe trans-lated and culturally adaptedto the environment inwhich they will be used. Later, psychometric properties of the questionnairemustbeevaluatedtoensurethistoolpossesses exactlythesamecharacteristics,validityandreliabilityofthe originalversion.7

Complex and subjective nature ofneck pain comprises morethanjustaresponsetoanociceptivestimulustoatissue lesion,butalsoamultidimensionalexperiencedescribedby thebiopsychosocialmodelthatincludespain,disability, cog-nitiveandaffectivedomains.4,8

Neck Bournemouthquestionnaire(NBQ) was created by BoltonandHumphreys4duetothenecessityofanevaluation

measuretovarioushealthdomains,suchaspain,function, incapacityandpsychologicaland socialaspectsofpatients with neck pathologies. This tool is easily applied, repro-ducibleand responsivetoclinicalalterations, whichmakes it adequate to be used for scientific research and clinical practicetomonitorthepathologyprogressionand toassist treatmentplanning.9–11Originalversionofthistooliswritten

inEnglish,however,ithasbeentranslated,culturallyadapted andlargelyusedasanevaluationtoolinseveralstudiesandin differentcountriessuchasGermany,Denmark,Netherlands andFrance.8,12–14However,thisquestionnairehad notbeen

translatedtoPortugueseand,inordertobeusedinBrazil,it isnecessarytobetranslatedandculturallyadapted.

Inthiscontext,theaimofthepresentstudy isto trans-lateandculturallyadaptNeckBournemouthquestionnaireto BrazilianPortuguese,andtoevaluateitsreliabilityandvalidity tobeappliedinneckpainBrazilians’patients.

Materials

and

methods

Participants

Sixty-onevolunteerswithneckpainparticipatedinthisstudy. Thirty-fiveofthemparticipatedduringpre-testingphaseand the remaining26took partduringpsychometricproperties analysis.Participantswereeligibletoparticipateinthestudy iftheyhadneckpainandaged18–60years.Volunteersusing immobilizationonupperlimborpresentinganycognitiveand neurological disorders that would impairon questionnaire appliancewereexcludedfromthestudy.

questionnaire

original version author authorized this study and confirmed the originality by electronic correspondence. This study received approval from the Human Research Ethics Committee of the Universidade Paulista (CAAE: 31477314.0.0000.5512) and written consent clarifying the experimentalprotocolwasobtainedfromeachvolunteer.

Procedures

Theproceduresfollowedtranslation,culturaladaptationand validationprocessesaccordingtoGuilleminandBombardier15

andBeatonandBombardier7whichconsistedoftranslation,

back-translation(thetranslationbacktoitsoriginallanguage), committeeanalysesandpre-test(Fig.1).

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Initial translation

Two Brazilians translators

T1 T2

BT1 BT2

Committee analysis

Back-translation

Two American translators

Committee review

Original questionnaire +T1+T2+T12+BT1+BT2 T12 - Consensual Version

V1

Pre-test

Brazil - NBQ final version

Neck bournemouth questionnaire brazilian portuguese version was sent to the author

Fig.1–Studyflowchart.

andanothertwoEnglish-fluenttranslatorswithnoprevious participationin this study. If there was any disagreement, alterations to elaborate the consensual Portuguese version (T12)weremade,maintainingthemaincharacteristicsofthe originalquestionnaire.

T12 version was translated back to English by two independent andEnglish native translators(BT1 and BT2), whodidnotpossessedaccesstotheoriginalquestionnaire.

In the sequence, committeemembers participated in a secondmeetinginwhichtheypointedthedifferencesamong translatedversions(T1,T2,T12,BT1andBT2)andtheoriginal questionnaire. They verified semantics, idiomaticand cul-turalequivalence,andtheymodifiedoreliminatedirrelevant, inadequateorambiguoustopics.Thesecondmeetingresulted inapre-finalversion(V1)whichwasusedforpre-test.

Pre-testwasperformedtoverifythecomprehensionand acceptabilityofthequestionsandanswers.Researcherread the content of the questionnaire out loud to each volun-teerandtheywereaskedtoanswerif theycomprehended, to comment about what they understood and to suggest modificationsincasetherewasanytopicmistaken.16Allthe

topicsshowedcomprehensionlevelhigherthan90%bythe volunteers.Afterpre-testphase,finalversion(Brazil-NBQ)was senttotheNBQauthorforapproval(Fig.2).

Scorecalculation

NBQcomprisessevenquestions,eachrepresentingadifferent dimensionoftheneckpain.Theseventopicsinclude(1)pain intensity, (2) functional statusindaily livingand (3) social activities,affectivedimensionsof(4)anxietyand(5) depres-sion,cognitiveaspectsof(6)fear-avoidancebehaviorand(7) painlocusofcontrol.EachtopicofNBQwasscoredusingan 11-pointNumericalRatingScale,withtotalscorerangingfrom 0to70,obtainedbytotalingthescoresofeachoftheseven top-ics,withhigherscoresreflectingmorepainanddisability.4,11,14

Reliability

Interrater andintraraterreliabilityanalysiswereperformed inordertoevaluatethereproducibilityofthequestionnaire. Brazil-NBQwasappliedbyaresearcherand,after1h,itwas appliedbyasecondresearcher(interrater).Inaperiodofthree to seven days, the first researcherapplied once again the questionnaire(intrarater).Furthermore,internalconsistency wasevaluated,whichappreciatestheinterrelationofdifferent topicsordomainsofatool,measuringthehomogeneityofthe relatedtopics.

Validation

Validityanalysiswasperformedthroughassociationamong Brazil-NBQ and other questionnaires that measure pain, qualityofliveandfunction.

TheShortFormHealthSurvey36(SF-36)isanassessment toolthatmeasuresqualityoflife.Itiscomposedof36 top-ics divided into eight domains: Physical Functioning, Role Physical, Bodily Pain, General Health,Vitality, Social Func-tioning,RoleEmotional,andMentalHealth.17Thecorrelation

amongBrazil-NBQ topics and their domainswas based on validityprocessofNBQoriginalversion.4

TheNeckDisabilityIndex(NDI)isatoolcomposedof10 topicsthatevaluatepainanddisabilityinpatientspresenting neckpain.NDIisscoredusingapercentageofthemaximal painanddisabilityscore.18

Numerical Rating Scale (NRS) was used for neck pain assessment,anditisan11-pointscaleconsistingofnumbers from0(Nopain)through10(Worstimaginablepain).19

Statisticalanalysis

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Este questionário foi desenvolvido para saber sobre a sua dor no pescoço e como ela o afeta. Por favor, responda TODAS

as questões circulando UM número em CADA pergunta que melhor descreve o que você sente:

1. Durante a última semana, qual foi o nível de dor do seu pescoço

Nenhuma dor 0 1 2 3 4 5 6 7 8 9 10 Pior dor possível

10

0 1 2 3 4 5 6 7 8 9

10

0 1 2 3 4 5 6 7 8 9

10

0 1 2 3 4 5 6 7 8 9

10

0 1 2 3 4 5 6 7 8 9

10

0 1 2 3 4 5 6 7 8 9

10

0 1 2 3 4 5 6 7 8 9

2. Durante a última semana, quanto a sua dor no pescoço prejudicou nas suas atividades diárias (trabalho de casa,

tomar banho, colocar roupa, levantar, ler e dirigir)?

Não prejudicou Incapaz de desenvolver atividades

3. Durante a última semana, quanto a sua dor no pescoço prejudicou nas suas atividades recreativas, sociais e

familiares?

Incapaz de realizar atividades Não prejudicou

4. Durante a última semana, você sentiu-se ansioso (tenso, nervoso, irritado, com dificuldade para se

concentrar/relaxar)?

Muito ansioso Não ansioso

5. Durante a última semana, você sentiu-se deprimido (“para baixo”, triste, pessimista, infeli

z)?

Muito deprimido Não deprimido

6. Durante a última semana, quanto a sua dor no pescoço piorou (ou poderia ter piorado) com o trabalho (tanto em

casa como fora)?

Piorou muito Não piorou

7. Durante a última semana, quanto você conseguiu controlar (reduzir) sozinho a sua dor no pescoço?

Controlei completamente

Nenhum tipo de controle

Fig.2–FinalversionofNeckBournemouthquestionnaire(Brazil-NBQ).

meanandstandarddeviationandthecategoriesare demon-stratedinfrequencyandpercentage.

Test–retesting reliability was evaluated by intraclass correlation coefficient (ICC) with 95% confidence intervals (95% CI). Interrater and intrarater relative reliability was evaluated.InternalconsistencyofBrazil-NBQdomainswere measuredbyCronbach’salphacoefficient.Inorderto evalu-atethevalidity,Pearson’scoefficientcorrelationwasusedto verifytherelationamongBrazil-NBQwithVAS,NDIandSF-36.

Results

Modifications, made by the committee during the first meeting,focusedongrammaticalstructureofthequestions andadaptationstoensureequivalenceamongwordsandalso focusedon culturalcontext. As a result, followingT1 and T2versionsanalysis,T12consensualversionwaselaborated (Table1).

After back-translation, committee reunited in a second meeting to discuss the differences among all of the ver-sionsandthe originalquestionnaire.Thus,V1 versionwas elaboratedandthenitwasusedatpre-test(Table2).These

versions were sent to theoriginal questionnaireauthor by electronicmail.

Atpre-testphase,22women(62.8%)and13menanswered the new version of the questionnaire (V1). Among these volunteers,four(11.4%)didnotcompleteelementaryschool andseven(20%)completedit.Twenty(57.1%)ofthevolunteers completedhighschoolandfour(11.4%)hadgraduationdegree. Atthisphase,therewasnosuggestionaboutthetopicsfrom theparticipantsneitherdifficultiesontopicscomprehension. Allofthequestionsshowedcomprehensionlevelhigherthan 90%,withnonecessarymodifications.

Twenty-six volunteers participated at reliability and validityanalysisphase.Thevolunteersaged33.6±13.4years; 18 of them (69.3%) were women; three (11.5%) had not completed elementaryschool, three(11.5%) completed ele-mentaryschool,17(65.3%)completedhighschoolandthree (11.5%)graduatedfromcollege.

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Table1–Translationandmodificationtotheconsensualversion.

Questiontopic “T1andT2” Modificationto“T12”consensualversion

1.Overthepastweek,onaveragehowwould yourateyourneckpain?

Nopain/worstpainpossible

T1–Duranteaúltimasemana,emmédia,como vocêclassificariasuadornopescoc¸o?Nenhuma dor/Piordorpossível

T2–Naúltimasemanacomoéque,emmédia,você classificaograudedorquesentiunopescoc¸o? Nenhumador/Piordorpossível

Duranteaúltimasemana,qualfoi oníveldedordoseupescoc¸o? Nenhumador/Piordorpossível

2.Overthepastweek,howmuchhasyour neckpaininterferedwithyourdailyactivities (housework,washing,dressing,lifting, reading,driving)?

Nointerference/unabletocarryoutactivities

T1–Duranteaúltimasemana,quantosuadorno pescoc¸ointerferiunassuasatividadesdiárias (trabalhodecasa,lavar,vestir,levantar,ler,dirigir)? Nenhumainterferência/Incapazdedesenvolver atividades

T2–Naúltimasemana,emquemedidaasuador cervical(pescoc¸o)interferiuemsuasatividades diárias(limparacasa,tomarbanho,vestir-se, levantar,leredirigir)?Nenhuma

interferência/Incapazderealizaratividades

Duranteaúltimasemana,quanto asuadornopescoc¸oprejudicou nassuasatividadesdiárias (trabalhodecasa,tomarbanho, colocarroupa,levantar,lere dirigir)?

Nãoprejudicou/Incapazde desenvolveratividades

3.Overthepastweek,howmuchhasyour neckpaininterferedwithyourabilitytotake partinrecreational,social,andfamily activities?Nointerference/unabletocarry outactivities

T1–Duranteaúltimasemana,quantosuadorno pescoc¸ointerferiucomsuacapacidadedetomar parteematividadesrecreativas,sociaisefamiliares? Nenhumainterferência/Incapazdedesenvolver atividades

T2–Naúltimasemana,emquemedida,asuador cervical(pescoc¸o)interferiunassuasatividades recreativas,sociaisefamiliares?Nenhuma interferência/Incapazderealizaratividades

Duranteaúltimasemana,quanto asuadornopescoc¸oprejudicou nassuasatividadesrecreativas, sociaisefamiliares?

Nãoprejudicou/Incapazderealizar atividades

4.Overthepastweek,howanxious(tense, uptight,irritable,difficultyin

concentrating/relaxing)haveyoubeen feeling?

Notatallanxious/extremelyanxious

T1–Duranteaúltimasemana,quãoansioso(a) (tenso(a),nervoso,irritável,dificuldadeemse concentrar/relaxar)vocêtemsesentido?Nada ansioso(a)/Extremamenteansioso(a)

T2–Naúltimasemana,sentiu-seansioso(tenso, nervoso,irritado,comdificuldadesparase concentrar/relaxar)?Nãoansioso/Extremamente ansioso

Duranteaúltimasemana,você sentiu-seansioso(tenso,nervoso, irritado,comdificuldadeparase concentrar/relaxar)?

Nãoansioso/Muitoansioso

5.Overthepastweek,howdepressed (down-in-the-dumps,sad,inlowspirits, pessimistic,unhappy)haveyoubeenfeeling? Notatalldepressed/extremelydepressed

T1–Duranteaúltimasemana,quãodepressivo(a) (deprimido(a),triste,melancólico(a),pessimista, infeliz)vocêtemsesentido?Nadadeprimido (a)/Extremamentedeprimido(a)

T2–Naúltimasemana,sentiu-sedeprimido(“pra baixo”,triste,pessimista,infeliz)?Não

deprimido/Extremamentedeprimido

Duranteaúltimasemana,você sentiu-sedeprimido(“parabaixo”, triste,pessimista,infeliz)? Nãodeprimido/Muitodeprimido

6.Overthepastweek,howhaveyoufeltyour work(bothinsideandoutsidethehome)has affected(orwouldaffect)yourneckpain? Havemadeitnoworse/havemadeitmuch worse

T1–Duranteaúltimasemana,comovocêsentiu queseutrabalho(tantodentrocomoforadecasa) afetou(ouafetaria)suadornopescoc¸o?Nãofez piorar/Tornoumuitopior

T2–Naúltimasemana,sentiuqueoseutrabalho (tantoemcasacomofora)piorou(oupoderiater piorado)asuadorcervical(pescoc¸o)?Não piorou/Piorou

Duranteaúltimasemana,quanto asuadornopescoc¸opiorou(ou poderiaterpiorado)como trabalho(tantoemcasacomo fora)?

Nãopiorou/Pioroumuito

7.Overthepastweek,howmuchhaveyou beenabletocontrol(reduce/help)yourneck painonyourown?

Completelycontrolit/nocontrolwhastsoever

T1–Duranteaúltimasemana,quantovocêfoi capazdecontrolar(reduzir/ajudar)porsimesmo(a) suadornopescoc¸o?Controlei

completamente/Nenhumcontroleabsolutamente T2–Naúltimasemana,conseguiucontrolar (reduzir)sozinho(a)suadorcervical(pescoc¸o)? Controletotal/Nenhumtipodecontrole

Duranteaúltimasemana,quanto vocêconseguiucontrolar(reduzir) sozinhoasuadornopescoc¸o? Controlei

completamente/Nenhumtipode controle

T1,firsttranslation;T2,secondtranslation.

Discussion

Neck pain is a common condition that leads to disability, however,therearefewmeasurementtoolstoevaluatethese patients,andtheexistingonesmeasureonlypainintensity

and incapacity level.4,20 NBQ is a short multidimensional

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Table2–Back-translationphase.DifferencesbetweenBT1andBT2andtheoriginalversion.

NeckBournemouthquestionnaire DifferencesbetweenBT1andBT2versions

1.Overthepastweek,onaveragehowwouldyourateyour neckpain?

BT1:Inthepastweek,whatwaspainlevelofyourneck? BT2:Overthepastweek,howwouldyourateyourneckpain? 2.Overthepastweek,howmuchhasyourneckpaininterfered

withyourdailyactivities(housework,washing,dressing, lifting,reading,driving)?

Nointerference/unabletocarryoutactivities

BT1:Inthepastweek,howmuchdidyourneckpainaffectyour activitiesofdailyliving(housework,takingabath,washingclothes, standingup,readinganddriving)?Notatall/Unabletoperform activities

BT2:Overthepastweek,howmuchhasyourneckpaininterfered withyourdailyactivities(housework,washing,dressing,lifting, readinganddriving)?Nointerference/Unabletocarryoutactivities 3.Overthepastweek,howmuchhasyourneckpaininterfered

withyourabilitytotakepartinrecreational,social,andfamily activities?

Nointerference/unabletocarryoutactivities

BT1:Inthepastweek,howmuchdidyourneckpainaffectyour recreational,socialandfamilyactivities?Notatall/Unabletoperform activities

BT2:Overthepastweek,howmuchhasyourneckpaininterfered withyourrecreational,socialandfamilyactivities?No

interference/Unabletocarryoutactivities 4.Overthepastweek,howanxious(uptight,irritable,difficulty

inconcentrating/relaxing)haveyoubeenfeeling?

BT1:Inthepastweek,didyoufeelanxious(irritate,withdifficulty concentrating/relaxing)?

BT2:Overthepastweek,howanxioushaveyoufelt(irritated,with difficultyinconcentrating/relaxing)?

5.Overthepastweek,howdepressed(down-in-thedumps) haveyoubeenfeeling?Notatalldepressed/extremely depressed

BT1:Inthepastweek,didyoufeeldepressed(“low”)?Not depressed/Verydepressed

BT2:Overthepastweek,howdepressed(“down”)haveyoufelt?Not depressed/Verydepressed

6.Overthepastweek,howhaveyoufeltyourwork(both insideandoutsidethehome)hasaffected(orwouldaffect) yourneckpain?

Havemadeitnoworse/havemadeitmuchworse

BT1:Inthepastweek,howmuchdidyourneckpaingetworse(or couldhavebecomeworse)withwork(insideoroutsidethehome)? Didnotgetworse/Gotverymuchworse

BT2:Overthepastweek,howmuchhasyourneckpainworsened(or couldithaveworsened)withwork(bothathomeandawayfrom home)?Didnotworsen/Worsenedalot

7.Overthepastweek,howmuchhaveyoubeenabletocontrol (reduce/help)yourneckpainonyourown?

BT1:Inthepastweek,towhatextentwereyouabletocontrol (reduce)yourneckpainbyyourself?

BT2:Overthepastweek,howmuchhaveyoumanagedtocontrol (reduce)yourneckpainbyyourself?

BT1,firstback-translation;BT2,secondback-translation.

necksymptomsinBrazilianpatientsinresearchandclinical practice.

Thecross-culturaladaptedquestionnairetouseinanother country,cultureand languagerequires theuseofaunique method to guarantee equivalence between the original questionnaireand thenewadaptedversion.Measurements thatareappliedindifferentcultures,requiretobetranslated linguistically well and culturally adapted to maintain the validity of the tool content at a conceptual level across

different cultures.7 The translation and the cross-cultural

adaptation methodsused inthis study havebeen consoli-datedinliteratureandappliedinseveralstudies,7,15including

otherversionsofNBQthatareusedinothercountries.8,12

Beaton and Bombardier7 recommend that at least two

translated versions from the original language should be elaborated, whereas, oneofthe translators mustbe aware of the concepts being examined in the questionnaire in ordertoprovideareliableequivalencyfrom amoreclinical

Table3–IntraraterandinterraterreliabilityofBrazil-NeckBounemouthquestionnaire.

Items Intrarater Interrater

ICC 95%IC ICC 95%IC

NBQ1 0.88 0.76–0.94 0.79 0.59–0.9

NBQ2 0.91 0.81–0.95 0.87 0.73–0.94

NBQ3 0.91 0.82–0.96 0.86 0.72–0.93

NBQ4 0.92 0.84–0.96 0.87 0.74–0.94

NBQ5 0.93 0.85–0.96 0.89 0.78–0.95

NBQ6 0.83 0.67–0.92 0.62 0.31–0.81

NBQ7 0.77 0.55–0.89 0.66 0.37–0.83

Totalscore 0.96 0.91–0.98 0.87 0.73–0.93

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Table4–CorrelationbetweenBrazil-NeckBounemouth questionnaireandSF-36.

Brazil-NQB SF-36scales Pearson’scoefficient correlation

r p-value

NBQ1 Bodilypain −0.665 0.001

NBQ2 Physicalfunctioning −0.439 0.025

NBQ3 Socialfunctioning −0.502 0.009

NBQ4 Role-emotionalscale −0.460 0.017

NBQ5 Mentalhealthscale −0.509 0.008

NBQ6 Question8 −0.587 0.002

NBQ7 Generalhealthscale −0.443 0.024

NBQ,NeckBournemouthquestionnaire;SF-36,ShortFormHealth Survey36.

Table5–CorrelationamongBrazil-NeckBounemouth questionnaire,NumericalRatingScaleandNeck DisabilityIndex.

Variables NeckBournemouth

questionnaire

r p

Numericalratingscore 0.70 0.001

NeckDisabilityIndex 0.79 0.001

perspective.Thesecondtranslatorshouldneitherbeaware norinformedoftheconceptsinordertoofferatranslation thatreflectsthelanguageusedbythepopulation, highlight-ingambiguousmeaningsintheoriginalquestionnaire.The backtranslationphaseisavalidityprocessthatthetranslated versionisreflecting the sametopic contentas theoriginal versionandithighlightsgrossinconsistenciesorconceptual errorsinthetranslation.

In the translation initial phase of Brazil-NBQ version, T12 consensual version was elaborated in order to avoid ambiguous or hard-comprehensive words such as ‘média’, ‘interferência’, ‘melancólico’ and ‘extremamente’, which were present in at least one of the translations. In the back-translation phase, there was no difference between translation meanings with the original version, indicating thattheadaptationsperformedatinitialphasedidnotalter topicsmeanings.Inthepre-testphase,allofBrazil-NBQ top-icsobtainedcomprehensionhigherthan90%,whichindicates thatthisquestionnairenewversioniseasilyunderstood.

After translation and cultural adaptation of a questionnaire, it is essential to evaluate psychometric propertiesofthetranslatedversion.TheBrazil-NBQshowed resembling psychometrics proprieties than other versions ofNBQ.Test–retestreliabilityoforiginalNBQhasIntraclass CorrelationCoefficient(ICC)of0.65,whiletheDutchversion NBQ ranged from 0.83 to 0.99, French version showed an ICCof0.9, DanishICCwas 0.96and German ICCwas 0.99. The internal consistency of original NBQ was Cronbach’s alphacoefficientof0.9andtheGermanversionwas0.79and Danish was 0.89.8,12–14 Clinically significant improvement

of NBQ was verified by Bolton,21 who found for the total

score13ormorepoints,knowingthatapercentagechange inthescoresof36%ormorewereassociatedwithclinically

significant improvement. Futures studies should verify the responsivenessofNBQBrazilianVersion.

Conclusion

Neck Bournemouth questionnaire was translated and culturally adapted to Portuguese language in a compre-hensive version, that demonstrated to be quick, easy to understand,validandreliabletoevaluatepatients’neckpain.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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Imagem

Fig. 1 – Study flowchart.
Table 1 – Translation and modification to the consensual version.
Table 3 – Intrarater and interrater reliability of Brazil-Neck Bounemouth questionnaire.
Table 4 – Correlation between Brazil-Neck Bounemouth questionnaire and SF-36.

Referências

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