ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Adel Gomnam   M. (1)
Kamali   M. (*)
Mobaraki   H. (1)
Saeedi   H. (2)






(*) Rehabilitation Management Department, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran
(1) Rehabilitation Management Department, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran
(2) Orthosis & Prosthesis Department, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran

Correspondence

Address: Rehabilitation Faculty, Madad Karan Street, Shahid Shah Nazari Street, Madar Square, Mirdamad Boulevard, Tehran, Iran
Phone: +982122221577
Fax: +982122220946
kamali@mkamali.com

Article History

Received:  January  7, 2016
Accepted:  March 9, 2016
ePublished:  April 3, 2016

BRIEF TEXT


Annually for different reasons such as illness, trauma and birth defects, there is about 200 to 500 million amputation in the whole world that approximately 85% of this number is in lower limb [1-3].

… [4-12] Prosthesis Evaluation Questionnaire (PEQ) was designed in 1998 by - Legro et al. [13] in prosthesis research studies center in Seattle in order to eliminate the need for a comprehensive self-report tool for under limb amputation. The aim of designing this questionnaire was designing a self-report tool that it is firstly specific to limb amputation and secondly measures the minor differences in prosthesis performance and main dimensions of life related to prosthesis performance [10-13]. … [14-24].

The aim of this study was equivalence and validation of prosthesis evaluation questionnaire in standard way from English to Persian version.

This study was conducted in both qualitative and quantitate methods.

The study research society included under limb amputation individuals who visited Kosar Orthotics and prosthesis center. From April to August in 2015, a sample of 70 persons were chosen from the visitors of Kosar Orthotics and prosthesis center.

Sampling was based on non-random simple method. One-way amputee of ankle level or higher, having enough ability of reading and writing, passing of at least one year of amputation time and using prosthesis for at least 5 days in a week were entrance criterion into the study [13]. Having two-sided under lamb amputation or upper lamb, psychopathy or other problems that prevents correct using of prosthesis and at last having personal unwillingness in amputee for any reason for continuing the participation in the study, were among exit criterion of the study [13, 24].

Translation: The questionnaire was translated according to standard way of International Evaluating Life Quality (IQOLA), according to Iranian language and culture. The IQOLA protocols includes forward translation steps, translation quality evaluation, backward translation and comparing English version of questionnaire with Persian version [25]. Based on this protocol, the original version of the questionnaire was translated to Persian by two translators with Persian native language (translators 1 and 2). Then in a meeting with researcher, experts and translators, discussing the differences between translations and their documentation, an original translation from the questionnaire was prepared and after that a bilingual translator (translator 3) evaluated the quality of the first translation in terms of clarity, conceptual equivalence, the use of a common language and acceptability. In this stage, scoring was done with the use of a 100-sores scale that zero score was indicative of a completely undesirable quality and 100 score was indicative a completely desirable quality. Decision-making criteria about the quality of the translated questions, was the score lower than 80 for undesirable quality, 80 to 90 for rather desirable quality and higher than 90 for desirable quality. The first translation was translated to English by two other translators with English mother tongue (translators 4 and 5) and at the end versions were obtained by expert committee includes translators, research group and experts. Then a field test was conducted to examine the translation quality of the questionnaire as a pilot on a small group of individuals with qualified lower limb amputation. Eventually, the obtained English version was sent to the primary designers of the questionnaire and it was examined and verified because of inaccessibility to the primary designers by valid reference in that domain, in terms of conception. The primary version of PEQ that is a self-report questionnaire includes 82 questions and 9 scales. The scale that has 42 questions includes movement, the prosthesis appearance, sounds, efficiency, the health of remaining members, disappointment, the received answer, social burden and welfare. The remaining 40 questions was related to the other parts of evaluation and were not grouped in scales that includes questions for evaluating satisfaction, pain, prosthesis caring, transference, efficacy and importance. The questionnaire questions were included in 7 different groups;1) prosthesis, 2) exclusive senses of body,3) social and emotional aspects of using prosthesis, 4) the ability of movement and mobility, 5) satisfaction,6) efficacy and 7) importance. These questions evaluate the individuals' condition in last 4 weeks. The answering format of 76 questions of this questionnaire is analog linear scale (VAS) that longitude of each VAS scale is 100 millimeter and it measures from left side. Two appropriate ending for each question was provided with the most negative answer on the left and most positive answer on the right. The score for each question was calculated by measuring the distance of intersecting of intended line of amputee with VAS line from left side that whatever the gained amount is larger, it means individuals' more positive answer and agreement to that question. In addition, the score of each scale was obtained by calculating the mean of the questions score related to the scale and in order to calculate the mean, it is necessary that the responder answer at least half questions of each scale [10, 13, 16]. Validity: examining the validity of the questionnaire was conducted in two stages of face validity and content validity. In order to examine face validity, the questionnaire was handed to 17 individuals who had lower limb amputation and visited Kosar Orthotics and prosthesis center. In order to specify the score of the effect of questionnaire questions, the participants were asked to specify the importance of each item in the questionnaire in a spectrum with a five sections Likret scale from one (it does not matter at all) to 5 ( it is totally important). Only questions with score more than 1.5 are acceptable from in terms of face validity. To evaluate the content validity, the questionnaire was handed to 15 specialist and experts of prosthesis and they were asked to submit their corrective perspectives in expanded and written form after the carful study of the tool [26, 27]. … [28-30]. Reliability: In order to gather data, the questionnaire of prosthesis evaluation along with personal information form to examine demographic variables was handed to individuals which includes age, gender, marital status, job status, educational level, ability or disability of drivers as a result of prosthesis problems, amputation level (upper the knee, on knee, under the knee and wrist amputation), amputation reason (trauma, chronic disease, tumor and congenital problems) and the period of time after amputation and also permission letter of participating in the study. The period of time completing the questionnaire by amputee was 15 minutes on average. To examine the repeatability, the reliability method test-retest was used. With average distance of two weeks after completing the first questionnaire, the same questionnaire was handed to 22 individuals of respondents for the second time. In order to examine the repeatability, the Relative Repeatability Coefficient (ICC) was used. Also, Cronbach' Alpha coefficient was used to evaluate the internal consistency measures. The desirable level for ICC and Cronbach' Alpha coefficient amounts were specified equal or higher than 0.7 [28, 31]. The data was analyzed by statistical software SPSS 21.

Translation: from 82 questions of prosthesis evaluation questionnaire, 52 question (63%) had a simple and a rather straightforward translation according to first stage translators' opinions (translator 1 and 2). In addition, translator 3 gave favorable scores to the translation quality of the questions of the questionnaire. The obtained results from the field test on a group with to members from lower limb amputees to examine the quality of the translation showed that most questions had enough clarity. Question 1, 7 and 19 in the first group and question number 3 in the fifth group and explanations about introducing senses and pains in the beginning of the second group had less clarity that were replaced by clearer and more expressive expressions. Validity: the obtained score of effect for face validity of the questionnaire for all questions was more than favorable of 1.5 and its amounts were between 1.58 and 3. Content validity of the questionnaire was conducted qualitatively and after applying participants' opinions and corrections, final questionnaire for the study was obtained. Reliability: among 70 individuals, 22 persons completed the questionnaire that among these 70 persons, 67 persons (95.7%) were men and the rest (4.3%) were women. The mean age range of this group was 47.24±6.75 years with age range of 28-60 years and mean time of after their amputation was 26.64±8.39 years with age range of 2-34 years. The reason for amputation in most individuals (95.7%) was war trauma and the amputation reason for 2 remaining individuals was trauma caused by accident and one by disease (Table 1). The Relative Repeatability Coefficient (ICC) for all scales of prosthesis evaluation questionnaire was more than the desirable 0.7 and between 0.71 and 0.89. The obtained Cronbach' Alpha coefficient amounts for all scales except face validity scale was more than desirable level 0.7 Among these amounts, the least amount was given to face scale and the most amount to movement scale (Table 2).

In 2015 Safer et al. [24] and Benavent at al. [22] conducted studies for preparing versions of prosthesis evaluation questionnaire in Turkish and Spanish languages. Safer et al. with reporting the desirable internal consistency for all scales except received respond scale, mentioned the reason for lower Cronbach' Alpha coefficient of this scale was the existence a special type of questions that did not let the respondents to answer the questions [24]. The mentioned reason by Safer for lower Cronbach' Alpha coefficient for the scale of received respond can also be attributed to the reason for lower Cronbach' Alpha coefficient for the scale of face in the current study.

For following studies, the use of SF36 questionnaire to evaluate the content validity of movement and social burden scales in in prosthesis evaluation questionnaire is suggested [31].

The dominance of the number of men to women and lack of variety in amputation reasons were among the limitations.

The Persian version of prosthesis evaluation questionnaire had desirable validity and reliability and was usable for prosthesis evaluation and main dimensions of Farsi language amputees' life quality.

Respectful management and the staff of Kosar Orthotics and prosthesis center who cooperated in conducting of this study are appreciated.

Non-declared

This study was confirmed ethically by Research Deputy of Iran University of Medical Sciences and the written permission letter was taken from every participants.

This study was conducted by financial support of Iran University of Medical Sciences.

TABLES and CHARTS

Show attach file


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