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
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).
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
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.
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
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
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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