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The relevance of cross-cultural adaptation and clinimetrics Como hacer manips online dating Como hacer manips online dating therapy instruments. Self-report outcome measures questionnaires are widely used by physiotherapists for measuring patient's health status or treatment outcomes. Most of these measurement tools were developed in English and their usefulness is very limited in non-English speaking countries such as Brazil.

The only way to solve this problem is to properly adapt the relevant questionnaires into a target language and culture e. Brazilian-Portuguese and then test the instrument by checking its psychometric clinimetric characteristics. The Como hacer manips online dating of this paper was to present relevant issues in the process of cross-cultural adaptations and clinimetric testing for self-report outcome measurements. Advice on how to perform a cross-cultural adaptation, how to properly check the clinimetric properties, how to select a relevant questionnaire and how to Como hacer manips online dating the quality of an Como hacer manips online dating questionnaire are provided.

Como hacer manips online dating we present all Brazilian-Portuguese cross-cultural adaptations of low back pain measurements that we know of.

There is a clear need for more Como hacer manips online dating in the field of cross-cultural adaptation and clinimetrics, without proper instruments, the management of patients from non-English speaking countries is compromised. Physiotherapists commonly use questionnaires to assess treatment outcomes. These pen and paper tests provide a convenient way to assess how physical therapy treatment has affected outcomes such as pain, disability and healthrelated quality of life.

Questionnaires can also be used by physiotherapists to screen for serious diseases such as cancer 1to screen for co-morbidities that may be Como hacer manips online dating to exercise 2to estimate prognosis 3 and to collect information on how their patient is thinking or feeling 4. For a questionnaire to be useful a patients needs to be able to read and understand the text and the items need to make sense and be relevant to that person.

It would be possible to use the one questionnaire across the globe if all the people of the world spoke the same language, they felt and thought the same way and their lifestyles were much the same.

Thankfully the world is a much more interesting place than this and to accommodate this variety it is necessary for researchers to adapt the original questionnaire so that it is comprehensible and relevant in the new setting.

This process is called cross-cultural adaptation. Cross-cultural adaptation is more complex than it may first seem. It is a common, Como hacer manips online dating questionable, practice to use an English language questionnaire for anyone who speaks English.

One problem with Como hacer manips online dating approach is that the best English word to express a concept may vary between different countries. There are also differences in the use of imperial and metric Como hacer manips online dating of measurement in the various SF36 versions to reflect Como hacer manips online dating local customs.

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Como hacer manips online dating are likely to be similar variations in the use of Portuguese language for the various countries where Como hacer manips online dating is spoken.

So where possible, Brazilian physiotherapists should use Brazilian-Portuguese questionnaires, not Portuguese versions. Even within a country it would be simplistic to presume that a single questionnaire could be used for all people. In Como hacer manips online dating countries like Canada and Belgium, there is more than one official language. Even in countries where there is only one official language, barriers to understanding may be present.

Even if the people of the world all spoke the same language a single assessment instrument would not be possible. This is because the people of the world Como hacer manips online dating not share Como hacer manips online dating common culture and lifestyle. As an illustration the Neck Disability Index Como hacer manips online dating developed in North America to assess neck pain-related disability with two of the ten items assessing how neck pain limits recreation and driving 8.

The potential problem is that not all the world partakes in these activities. Similarly the Shoulder Disability Questionnaire 9 was developed in Europe and includes the item "Because of my shoulder I have trouble putting on a coat or sweater" which is probably not relevant in tropical countries.

Why do we need cross-cultural adaptations of outcome measures? Most questionnaires that a physiotherapist would use were originally developed in the English language.

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Cross cultural adaptation of existing English language questionnaires would enable comparisons of different populations and permit the exchange of information across cultural and linguistic barriers. The ready availability of adapted Como hacer manips online dating would also stop the common, though undesirable practice, of excluding subjects from clinical trials on the grounds that they do not understand the language spoken in that country.

An important reason to adapt an existing questionnaire, is that it is much more efficient than Como hacer manips online dating a new one. There is substantial work involved in developing and validating a questionnaire. As an illustration the items from the Quebec back pain disability questionnaire 10 were selected based upon a series of studies surveying clinical experts and patients that identified over potential items. After this preliminary stage psychometric testing also called clinimetric testing was undertaken to identify the final 20 items that comprise the questionnaire.

How does cross-cultural adaptation differ from translation? Translation is not the same as cross-cultural adaptation. Translation may simply involve a single person Como hacer manips online dating the questionnaire from one language to another.

In contrast cross-cultural adaptation involves a team including translators, health professionals who would normally use the questionnaire and researchers with an understanding of clinimetrics. The process of cross-cultural adaptation includes initial translation, synthesis, back translation, expert committee review, pilot Como hacer manips online dating of the draft translation and psychometric evaluation. It is Como hacer manips online dating to understand that the goal of cross-cultural adaptation is a questionnaire equivalent to the original; which is different from aiming to produce an Como hacer manips online dating questionnaire.

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There can be situations where a questionnaire item is irrelevant or not meaningful in a new setting and it makes sense to adapt or replace the item. There are problems with using questionnaires that have only been translated because translation is only one of the steps involved in cross-cultural adaptation 11, Mistranslations are possible in translated questionnaires because the full process of cross-cultural adaptation includes additional Como hacer manips online dating designed to identify mistranslation.

Perhaps surprisingly, overly literal translation may cause even more problems. Trying to make the translation exactly mimic the structure and ordering of words of the original text can provide a translation that is awkward to read because the syntax of the two languages may be quite different.

Literal translation may also create text that makes no sense or Como hacer manips online dating a very different meaning to that of the original. As an illustration there are idiomatic expressions in English language that have a meaning quite different to that normally conveyed by the component words. Another possibility is that the translated words may be understood Como hacer manips online dating irrelevant in the new setting.

Lastly there may also be English words that cannot be directly translated because there is no equivalent word in the target language. These potential problems are avoided with cross-cultural adaptation. Guidelines for cross-cultural adaptation advice for researchers. The process of cross-cultural adaptation includes initial translation, synthesis, back translation, expert committee review, pilot testing of draft translation and psychometric evaluation To illustrate the process we Como hacer manips online dating presume that an English language questionnaire, originally developed in Australia, is being adapted for use in Brazil.

Guidelines for cross-cultural adaptation advise that two or more translators should Como hacer manips online dating translate the source questionnaire Multiple translations permit the identification of errors or misinterpretations in translation that would not be apparent with one translation. It has been suggested that Como hacer manips online dating translators should be chosen so that they have different Como hacer manips online dating and include translators who do, and do not, have an understanding of the concepts being assessed in the questionnaire It has also been advised that the translators should be translating into their mother tongue 11,12 and preferably be both Como hacer manips online dating speak both English and Portuguese and bicultural have lived in Australia and Brazil Following translation from English Como hacer manips online dating Portuguese the translators and an observer synthesise the multiple translations to produce a consensus Portuguese translation.

Translators blind to the original questionnaire then translate the consensus Portuguese translation back Como hacer manips online dating English. As before, multiple translators who are bilingual and bicultural are preferred but for the back translation their mother tongue should be English. Given there are arguments for both suggestions a sensible position would be to include both types of back translators. An expert committee then reviews the original English language questionnaire, the Brazilian translations, the consensus Brazilian translation, the English back translations Como hacer manips online dating any notes taken.

The committee should comprise the translators, health professionals who would normally use the questionnaire and researchers with an understanding of clinimetrics. It can also be useful to include the developers of the original questionnaire. The goal is to produce a preliminary Brazilian-Portuguese version of the questionnaire that is equivalent to the original questionnaire.

This preliminary questionnaire Como hacer manips online dating undergoes pilot testing with members of the target population. Subjects from a range of backgrounds are asked to complete the questionnaire and then are interviewed by the researchers.

This gives an opportunity to establish that the people who will complete the questionnaire are interpreting it in Como hacer manips online dating same way as the expert committee have.

Lastly the new instrument needs to undergo psychometric testing because it cannot be presumed that the test properties of the English language version will apply to the adapted questionnaire. When we perform a cross-cultural adaptation of a questionnaire we assume that these procedures will retain the original psychometric properties of the questionnaire, however this assumption may not hold because there may be cultural differences between the two populations.

Because it is crucial to test the psychometric properties of the adapted questionnaire in the target population after the cross-cultural adaptation procedures, a brief explanation of the psychometric concepts are described below 14, A good questionnaire must be homogeneous; the items should be addressing different aspects of the same construct.

For example the Roland Morris Disability Questionnaire 16 has 24 items that address disability in low back pain patients, every single item from this questionnaire refers to a different activity but all items are related to disability in general. Most questionnaires measure a single underlying construct by using multiple items, and these items should be moderately correlated with each other, and each item should correlate with the total scale score; these two factors form the basis of the Internal Consistency of the scale Internal consistency can be evaluated by calculating Cronbach's alpha.

A low alpha value means that some items are measuring other constructs, while a very high Cronbach's alpha means that the items in the questionnaire show too much homogeneity and some items may be redundant.

Current Como hacer manips online dating also suggest performing a factor analysis in order to confirm the internal consistency Reproducibility is the extent to which repeated measurement on stable subjects yields similar results Reproducibility comprises two related constructs: Agreement statistics describe how close the scores for repeated measures are whereas reliability statistics describe the correlation between repeated measures.

With reproducible instruments clinicians and researchers will be able to draw conclusions satisfactorily, formulate theories or make claims about generalizability. It is useful to check if the measurement tool is reproducible on different occasions intra-tester reproducibility and with different assessors inter-tester reproducibility.

It is usually easy Como hacer manips online dating interpret reliability statistics as most are expressed on a scale from 0 to 1, where zero indicates no reliability and 1 indicates perfect reliability. In the previous paragraph we examine how reproducible a test is under different conditions. The next step is to check if the measurement tool is assessing the specific construct that it was developed, that is validity. We can test validity by correlating the scores of a measurement with a gold standard criterion validityhowever various constructs that physiotherapists assesses in clinical practice such as healthrelated quality of Como hacer manips online dating, pain or disability have no gold standard, in this case we can test validity by correlating the scores with another tool that measures the same construct construct validity.

We can easily assume that the goal for any kind of treatment is Como hacer manips online dating induce changes in patient's health status and the responsiveness is the ability of a questionnaire to detect clinically important changes over time, even if these changes are small There are two approaches to measuring responsiveness. The more typical approach is to study patients where true improvement is expected and then calculate the effect size which is the ratio of the mean difference to the standard deviation at baseline.

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Another approach Como hacer manips online dating to Como hacer manips online dating an external criterion of true change and investigate how well the measure can discriminate between subjects who have truly improved and those who did not Imagine a item disability questionnaire, where each Como hacer manips online dating is scored from zero meaning no disability with that Como hacer manips online dating and ten meaning completely unable to perform that item and the total score is the sum of the item scores.

The questionnaire is unable to detect deterioration in patients Como hacer manips online dating score the maximum score or improvement in patients who scored the lowest score 0. Moreover ceiling and floor effects have clear implications on the reproducibility and responsiveness of the questionnaire. Testing Como hacer manips online dating questionnaire is a very time-consuming task; we first need to identify a relevant and generalizable sample for testing.

A recently published guideline for evaluating measurement properties of health status questionnaires recommends that at least patients are necessary to analyse all psychometric properties

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