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Validation of scales and questionnaires

Address of information system with evidences of research contribution and evidences of societal impact

Evaluated entity

Institute of Health Sciences, College of Medical Sciences, University of Rzeszow

Scientific discipline

Health Sciences

Social impact description title

Introducing reliable tools into clinical and social practice and scientific research - questionnaires and scales for assessing functional status, physical activity, disability and quality of life.

1. Contribution of scientific activities

Adaptation of questionnaires and scales from other countries is carried out for two reasons: to use the questionnaire in accordance with its proper methodology and to be able to make international comparisons. A significant part of the tools used in clinical, social and scientific work was created in English-speaking countries, so using them in a country with a different culture and language, requires researchers to carry out the process of cultural and linguistic adaptation. This process involves a reliable, multi-stage translation of the questionnaire, in which translators and a team of professionals from a given field of science take part. In the translation process, cultural differences, that may occur in the country in which the adaptation is carried out, are also taken into account. The purpose of this process is to create a questionnaire / scale equivalent to the original, but also fully understandable for people from different cultures or who speak different languages. The use of international standards in the process of cultural and linguistic adaptation increases the quality of translation, despite the fact that this process is time consuming and laborious. The questionnaire / scale adapted to the new language and culture should have semantic, idiomatic, experimental and conceptual equivalence. According to the literature guidelines, after completing this process, an indispensable step is to check the measurement properties of the tools obtained. This is done by attestation tests determining reliability, accuracy and sensitivity to changes in the newly created questionnaire.

A properly conducted process of cultural and linguistic adaptation and assessment of psychometric properties allows to obtain a tool that, depending on the purpose for which it was created, will reliably allow the assessment of functional and health status, the progress of treatment of patients, assessment of physical activity, degree of disability or quality of life.

The ongoing research was aimed at introducing into clinical and social practice and scientific research reliable tools - questionnaires and scales that were not available in Poland so far:

The Oxford Shoulder Score (OSS) questionnaire was created by Dawson J. et al. (University of Oxford). It consists of 12 items that are used to assess pain and function in patients with problems within the shoulder complex, except for instability. The process of cultural adaptation and validation was carried out in accordance with the guidelines sent by Oxford University Innovation. Publication in the journal of IF, distinction during the 11th International Rehabilitation Days, 2019.
• Bejer Agnieszka - project coordinator / researcher
• Team members: Szczepanik Magdalena, Szymczyk Daniel, Pop Teresa

2. Spine Functional Index (SFI) was created by Gabel et al. (University of Sunshine Coast, Australia). It includes 25 items that are used to reliably assess the impact of back pain on performing daily activities. In cooperation with the author of the questionnaire, a process of cultural adaptation and validation of the Polish version of SFI was carried out, the results of which were published in the scientific journal with Impact Factor.
• Bejer Agnieszka - project coordinator / researcher

3. Western Ontario Shoulder Instability Index (WOSI) was created by Griffin S. I et al. (University of Western Ontario, Canada). The questionnaire contains 21 questions divided into four sections. The authors undertook this research due to the lack of research tools in Poland to assess the quality of life of people with shoulder joint instability. Publication in a Polish journal.
• Bejer Agnieszka - project coordinator / researcher
• Team members: Domka-Jopek Elżbieta

4. Western Ontario Rotator Cuff Index (WORC) was created by Griffin S. et al. (University of Western Ontario, Canada). It is a specific research tool (contains 21 items grouped in 5 areas) to assess the quality of life of patients with various problems within the rotator cuff patients in Poland. Publication in a journal with IF.
• Bejer Agnieszka - project coordinator / researcher
• Team members: Domka-Jopek Elżbieta

5. Knee Outcome Survey Activities of Daily Living (KOS-ADL) was created by J. J. Irgang et al. (University of Pittsburgh School of Health and Rehabilitation Sciences, USA). It is used to recognize, assess and monitor the symptoms and restrictions experienced by patients with knee dysfunction (meniscal injuries, ligamentous, degenerative disease). Defense of the doctoral dissertation of M. Szczepanik - UR 2017, published in the journal with IF.
• Szczepanik Magdalena - project coordinator
• Team members: Bejer Agnieszka, Szymczyk Daniel, Majewska Joanna

6. Stroke Specific-Quality of Life Scale (SSQoL) - by Williams LS et al. (Indiana University School of Medicine in Indianapolis, USA). It belongs to the scales specific for the assessment of the quality of life conditioned by the state of health after cerebral stroke (2 areas, 12 subscales, 49 items). Defense of the doctoral dissertation A. Bejer (University of Physical Education in Warsaw, 2010, distinction), publication.
• Agnieszka Bejer - project coordinator / researcher

7. Wisconsin Gait Scale (WGS) - formed by Rodriguez AA et al. (University of Wisconsin-Madison Medical School, USA). Until now, there was no specific, pediatric scale allowing for a multifactorial, descriptive assessment of both time-space and kinematic parameters of gait in children with spastic hemiplegia of cerebral palsy. An attempt was made to use the WGS scale, originally intended to assess the gait of adults after cerebral stroke, in a group of children with hemiplegia of cerebral palsy, was successful. A new pediatric version of the WGS scale was introduced. Publication in a journal with IF.
• Agnieszka Guzik - project coordinator / researcher
• Team members: Drużbicki Mariusz, Przysada Grzegorz, Bazarnik-Mucha Katarzyna, Szczepanik Magdalena, Wolan-Nieroda Andżelina

8. World Health Organization Disability Assessment Schedule (WHODAS 2.0). As a result of cooperation with the WHO and the ICF Council at the Center for Healthcare Information Systems (CSIOZ) in Warsaw, it was translated in accordance with WHO guidelines and its psychometric values were assessed. The WHODAS questionnaire based on the International Classification of Functioning Disability and Health (ICF), is intended for disability assessment. Publication in a journal with IF.
• Agnieszka Ćwirlej-Sozańska - project coordinator / researcher
• Team members: Bernard Sozański

9. Youth Physical Activity Questionnaire - created by Kowalski KC et al. (University of Saskatchewan, Canada). One of the most important factors determining human health is physical activity. It was necessary to provide a reliable method to assess the level of physical activity of young people, which is also a non-invasive, fast, easy and inexpensive method. Until now, there was no standardized questionnaire in Poland to assess the level of physical activity of young people. Therefore, the goal of the actions taken was the implementation of language adaptation and assessment of the repeatability and reliability of the Polish version of the Youth Physical Activity Questionnaire.
• Justyna Wyszyńska - project coordinator / researcher
• Research staff: Justyna Podgórska-Bednarz, Joanna Baran, Katarzyna Dereń.

2. Evidence of the contribution of scientific activities (maximum 5 references to documents / publications from 1996–2020 with an indication of the main authors who were employees of the evaluated entity reporting the impact description, and the period of conducting scientific activity whose results show the evidence of the contribution of scientific activity):

Publications:

Bejer A, Probachta M, Kulczyk M, Griffin S, Domka-Jopek E, Płocki J. Validation of the Polish Version of the Western Ontario Rotator Cuff Index in Patients Following Arthroscopic Rotator Cuff Repair. BMC Musculoskeletal Disorders 2018; 19: 333. https://doi.org/10.1186/s12891-018-2238-9
Szczepanik M, Bejer A, Szymczyk D, Snela S, Jabłoński J, Majewska J. Polish cross-cultural adaptation and validation of the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) in the group of patients undergoing total knee arthroplasty. Medical Science Monitor 2018; July 24:5309-5319.https://doi.org/10.12659/MSM.908094
Agnieszka Ćwirlej-Sozańska, Anna Wilmowska-Pietruszyńska, Bernard Sozański. Validation of the Polish version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in an elderly population (60-70 years old). International Journal of Occupational Safety and Ergonomics 2018;24(3):386-394.https://doi.org/1080/10803548.2017.1316596
Guzik A, Drużbicki M, Kwolek A, Przysada G, Bazarnik-Mucha K, Szczepanik M, Wolan-Nieroda A, Sobolewski M. The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study. BMC Pediatrics 2018;15;18(1):301. https://doi.org/10.1186/s12887-018-1273-x
Justyna Wyszyńska, Piotr Matłosz, Justyna Podgórska-Bednarz, Jarosław Herbert, Krzysztof Przednowek, Joanna Baran, Katarzyna Dereń, Artur Mazur. „Adaptation and validation of the Physical Activity Questionnaire for Adolescents (PAQ-A) among Polish adolescents – cross-sectional study”. BMJ Open 2019;9:e030567. doi:10.1136/ bmjopen-2019-030567. https://www.ncbi.nlm.nih.gov/pubmed/31740466

3. Characteristics of social impact

The Act of 25 September 2015 on the profession of physiotherapist imposed on physiotherapists the obligation to performing functional diagnostics of the patient or issuing opinions and rulings regarding the functional state of persons undergoing physiotherapy. At the same time, in accordance with the Regulation of the Minister of Health of 13 December 2018 on guaranteed services from therapeutic rehabilitation, a physiotherapist performs a physiotherapy visit before starting outpatient physiotherapy procedures. During the visit, he performs assessment and description of the recipient's functional status before and after the provision of benefits. The physiotherapist is obliged to provide the referring physician with information on the achieved effects of the therapy. Increasingly, a physiotherapist in clinical practice uses subjective assessment questionnaires (Patient-Reported Outcome Measures (PROMs), i.e. those in which the patient himself determines his health. Questionnaires of this type allow to gather the patient's opinion on the severity of ailments related to the disease or injury, the impact of these ailments on the level of the patient's daily activity and quality of life. Research tools constructed in this way help in monitoring the progress of patient treatment, facilitate communication between the doctor - physiotherapist - patient and can lead to the improvement of the quality of patient’s care.

Our teams undertook to introduce appropriate questionnaires on Polish soil in order to fill the gap and provide clinicians with the possibility of using reliable tools. Each of them was properly constructed in the English version, which was confirmed in scientific publications. They also have numerous language versions that allow international comparisons. Each of the adapted questionnaires provides the opportunity to assess specific patient groups: Stroke Specific-Quality of Life Scale – patients after cerebral stroke; Oxford Shoulder Score - patients with problems within the shoulder complex, except for instability; Spine Functional Index - patients with back pain; Western Ontario Shoulder Instability Index - patients with shoulder joint instability or surgery because of it; Western Ontario Rotator Cuff Index - patients with various problems within the rotator cuff; Knee Outcome Survey Activities of Daily Living - patients with knee dysfunction (meniscal injuries, ligamentous, degenerative disease). With their help, you can assess the patient's functional condition or quality of life. The World Health Organization Disability Assessment Schedule questionnaire is used to assess disability in various patient groups. The above tools are also sensitive to clinical changes, so you can use them to assess the progress of physiotherapy or other forms of treatment - pharmacological, surgical). The Wisconsin Gait Scale - the pediatric version is used to assess gait and monitor changes in it, both in terms of time-space and kinematic parameters, in children with the hemiplegic form of cerebral palsy. On the other hand, the Youth Physical Activity Questionnaire allows for easy and quick tests of the level of physical activity carried out both individually and on a large scale. Thanks to this, it is easier to monitor the level of physical activity of Polish youth, and based on the results of research, designing interventions, as well as comparing results between countries, because the created physical activity questionnaire is used in many countries (including the USA, Great Britain, the Netherlands, Spain, Iran, Vietnam).

Team members also disseminate knowledge on international guidelines related to the process of cultural and linguistic adaptation and validation of research tools, and the need to undertake such research to use reliable questionnaires and scales in their scientific papers or professional and social practice. An example would be the lectures of a team member - Bejer A. “Clinimetry methods in sports injuries and assessment of a patient with selected shoulder and knee injuries” during a visit to the Instituto Politecnico do Porto in Portugal as part of the Erasmus program. Team members (including Bejer A, Szczepanik M, Domka-Jopek E) also edited the chapter for the monograph UR edited by Prof. Lidia Perenc (2020) titled “Guidelines for the process of translation and cultural adaptation of questionnaires (Patient-Reported Outcomes Measures - PROMs)” applicable in clinical practice and for conducting research in health sciences.

Team members are constantly increasing their scientific, clinical and social achievements in order to achieve further promotions. In 2017, one member of the team (Szczepanik M.) obtained the title of doctor of health sciences, and our team member (Bejer A) was also an assistant supervisor in this process. In 2019, a doctoral dissertation was initiated - Sabina Mastej, MA, “Polish adaptation and validation of the Boston Carpal Tunnel Questionnaire” at the Faculty of Medicine of UR, whose supervisor and auxiliary supervisor are also members of our team (Prof. Teresa Pop and dr Agnieszka Bejer).

4. Evidence of social impact (maximum 5 evidence from 2017-2020) together with the date of evidence:

• As a result of many years of center experience in the field of reliable cultural and linguistic adaptation and the process of validation of the obtained versions of research tools. Magdalena Szczepanik, MA, prepared and defended her doctoral dissertation on: “Polish adaptation of the Knee Outcome Survey Activities of Daily Living (KOS-ADL) scale”. Faculty of Medicine, University of Rzeszów, Supervisor: Prof. dr hab. n. med. Sławomir Snela, assistant supervisor: Dr Agnieszka Bejer, 2017.
• Polish versions of questionnaires (OSS, WOSI, WORC, KOS-ADL, SFI) were introduced to the standard assessment of the patient during the implementation of the physiotherapeutic diagnosis procedure as part of the benefit for the NFZ - outpatient physiotherapy and for patients admitted outpatiently in New Medical Techniques - the Specialist Hospital Holy Family in Rudna Mała near Rzeszów; 2020 year.
• Planned introduction of the Wisconsin Gait Scale as a standard tool for gait assessment of children with the form of spastic hemiplegia of cerebral palsy at the Clinical Regional Rehabilitation and Education Center in Rzeszów - plan for 2020.

Justification for the interdisciplinary nature of scientific activity of crucial importance for the development of science

Focusing research at the Institute of Health Sciences on the process of cultural and linguistic adaptation and validation of research tools is one of the most extensive projects in this field in Poland. Currently, another 8 studies are being conducted in this area, regarding questionnaires for functional assessment, quality of life and disability of patients with orthopedic and neurological problems. The interdisciplinary nature of our scientific activity is associated with close cooperation with researchers from another scientific discipline - medical sciences, physical culture sciences and cooperation with other scientists from universities in Poland (University of Information Technology and Management, Rzeszów) and abroad (University of Oxford; University of Sunshine Coast, Australia; Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, Canada). We consider establishing cooperation in the validation of the Lower Limb Functional Index (LLFI) questionnaire with prof. Dr. Markus Melloh from the School of Health Professions, Zurich University of Applied Sciences, Switzerland, which is a recognized authority in the field of creating and adapting research tools, as a significant achievement.

Works on the adaptation of questionnaires and scales from other countries are carried out, among others, in order to be able to make cross-center and international comparisons. The tools introduced by our teams can be used in clinical and social practice and to conduct scientific research by students, clinicians or scientists from various fields and scientific disciplines: in the field of medical sciences and health sciences (health sciences, medical sciences, physical culture sciences) and in the field of social sciences (sociological sciences or psychology).