Translation and cross-cultural adaptation of the "Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema"

Abstract

Objective: We conducted a cross-sectional study to translate and culturally adapt into Portuguese (Brazil) the "Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL)". Methods: The process of translation and adaptation of the instrument was carried out in five phases: translation, back translation, revision of a committee of experts, pre-test and final translation. Two independent translators with experience in oncology and lymphology, aware of the research objectives, performed the initial translation of the English version into Portuguese (T1 and T2) that were combined into a single version (T1 / T2). The combined version was submitted to back-translation from Portuguese into English by two independent translators (BT1 and BT2), without knowledge of the research objectives. A committee of experts compared BT1 and BT2 with the original text and identified possible failures in translation. It was then built by consensus, the first Brazilian version (VB1). The "not applicable" was added to all instrument questions and the questions that already had the item "not applicable", the option was added "did not understand the question." This was a VB1 pre-test in 10 patients with lymphedema secondary leg to cancer treatment. Questions marked as difficult to understand were evaluated by expert committee regarding the semantic, idiomatic equivalence, cultural, and conceptual. The proportion of agreement of the Committee's answers was presented by the Content Validity Index (CVI). Leading researchers, by consensus, the Committee reviewed the answers and made the final changes of the translated instrument, being considered as the Brazilian version of the final translation (VBF). Results: The presented results, it was found that translations T1 and T2 title and questionnaire instructions were similar and did not get change when transformed in the combined version (T1 / T2). The opposite occurred in the back-translation process with respect to the symptoms of lymphedema, as had minor modifications in the reference meaning. These differences regarding idiomatic equivalence were slightly modified, but without losing the general meaning. After an evaluation of the expert committee, changes were made in the Q1 / T2, resulting in the first version (VB1). At the end of the application of pre-test, the Committee evaluated the issues marked as difficult to understand by CVI, where most of the issues were evaluated as relevant and representative. Five questions were reviewed, and completed the final Brazilian version (VBF). Conclusion: Based on the results obtained after the process of translation and cultural adaptation, enabled the creation of satisfactory evaluation measures. It is recommended its application in future studies in the Brazilian population with lymphedema of the lower limbs of different causes in order to provide more specific results.