Hindi version of the lower extremity functional scale: a study of translation, validation and cross-cultural adaptation

Authors

DOI:

https://doi.org/10.17267/2238-2704rpf.2024.e5736

Keywords:

Lower Extremity, Musculoskeletal Conditions, Patient Reported Outcome Measures, Scale Validation, Language

Abstract

BACKGROUND: Lower Extremity Function Scale (LEFS) serves as a patient-reported outcome measure, used to evaluate the functional status of lower extremity in different musculoskeletal conditions. It was originally developed in English language (E-LEFS) and numerous translations in different languages are available to measure its usability among different cultures. OBJECTIVES: To translate the English version of the Lower Extremity Function Scale (E-LEFS) into Hindi language and to evaluate its content validity, cross-cultural adaptation along with the concurrent validity and reliability. METHOD: Process of forward and backward translation was carried out by two bilingual translators and a physiotherapist after obtaining developer’s approval, for which the Beaton guidelines were used. For the content validation, Delphi method of was employed in which 12 field experts of more than 5 years of experience participated. Cultural adaptation procedures were then carried out with 12 patients, who reported in out-patient department of the hospital through convenience sampling who were asked about whether the H-LEFS was well understood by the patients. Their responses were recorded as positive and negative responses. This process was followed by concurrent validation which was conducted by comparing the scores with the SF-36 scale, involving 30 patients with activity limitation in their daily life. Lastly, 50 patients were recruited for intra-rater reliability testing. RESULT: The scale was successfully translated and verified by the bi-lingual language experts. Content validity came out to be significant with each item scoring more than 0.92. Nearly all items, excluding item no. 8, 16, 17, 18, and 19 received universal agreement with a content validity ratio of 1. The average scale-level validity stood at 0.98, indicating excellent level of validity and the scale was found to be well adapted by the native people as out of 12 patients, 10 patients provided 100% positive response. Concurrent validation using Pearson’s correlation coefficient came out excellent with the values of 0.993 for E-LEFS and 0.890 for SF-36. Cronbach's alpha and ICC values were calculated as 1.00 for Intra-rater reliability. CONCLUSION: LEFS was well translated into Hindi language with an excellent content and concurrent validity and is found to be highly reliable. Hence, it is recommended for the usage of native Hindi speaking population.

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References

(1) Binkley JM, Stratford PW, Lott SA, Riddle DL, North American Orthopaedic Rehabilitation Research Network. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. J. Phys. Ther. 1999;79(4):371-83. https://doi.org/10.1093/ptj/79.4.371 DOI: https://doi.org/10.1037/t35109-000

(2) Negahban H, Hessam M, Tabatabaei S, Salehi R, Sohani SM, Mehravar M. Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders. Disabil. Rehabil. 2014;36(1):10-5. https://doi.org/10.3109/09638288.2013.775361 DOI: https://doi.org/10.3109/09638288.2013.775361

(3) Repo JP, Tukiainen EJ, Roine RP, Ilves O, Järvenpää S, HäkkinenA. Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS). Disabil. Rehabil. 2017;39(12):1228-34. https://doi.org/10.1080/09638288.2016.1193230 DOI: https://doi.org/10.1080/09638288.2016.1193230

(4) Naal FD, Impellizzeri FM, Torka S, Wellauer V, Leunig M, von Eisenhart-Rothe R. The German Lower Extremity Functional Scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement. Qual. Life Res. 2015;24(2):405-10. https://doi.org/10.1007/s11136-014-0777-6 DOI: https://doi.org/10.1007/s11136-014-0777-6

(5) Pereira LM, Dias JM, Mazuquin BF, Castanhas LG, Menacho MO, Cardoso JR. Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS-BRAZIL. Braz. J. Phys. Ther. 2013;(17):272-80. https://doi.org/10.1590/S1413-35552012005000091 DOI: https://doi.org/10.1590/S1413-35552012005000091

(6) Bolarinwa OA. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger. Postgrad. Med. J. 2015;22(4):195-201. PMID: 26776330 DOI: https://doi.org/10.4103/1117-1936.173959

(7) Stasi S, Papathanasiou G, Anagnostou M, Galanos A, Chronopoulos E, Baltopoulos PI, et al. Lower Extremity Functional Scale (LEFS): Cross-cultural adaption into Greek and reliability properties of the instrument. J. HEALTH Sci. 2012;6(4):750-56. Available from: https://www.researchgate.net/publication/231406735_Lower_Extremity_Functional_Scale_LEFS_Cross-Cultural_Adaption_into_Greek_and_Reliability_Properties_of_the_Instrument

(8) Alnahdi AH, Alrashid GI, Alkhaldi HA, Aldali AZ. Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale. Disabil. Rehabil. 2016;38(9):897-904. https://doi.org/10.3109/09638288.2015.1066452 DOI: https://doi.org/10.3109/09638288.2015.1066452

(9) Metsavaht L, Leporace G, Riberto M, Sposito MM, Del Castillo LN, Oliveira LP, et al. Translation and cross-cultural adaptation of the lower extremity functional scale into a Brazilian Portuguese version and validation on patients with knee injuries. J Orthop Sports PhysTher. 2012;42(11):932-9. https://www.jospt.org/doi/10.2519/jospt.2012.4101 DOI: https://doi.org/10.2519/jospt.2012.4101

(10) Citaker S, Kafa N, HazarKanik Z, Ugurlu M, Kafa B, Tuna Z. Translation, cross-cultural adaptation and validation of the Turkish version of the Lower Extremity Functional Scale on patients with knee injuries. ArchOrthop Trauma Surg. 2016; 136(6):389-95. https://doi.org/10.1007/s00402-015-2384-6 DOI: https://doi.org/10.1007/s00402-015-2384-6

(11) Hoogeboom TJ, de Bie RA, den Broeder AA, van den Ende CH. The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study. BMC Musculoskelet. Disord. 2012;13:3-10. https://doi.org/10.1186/1471-2474-13-117 DOI: https://doi.org/10.1186/1471-2474-13-117

(12) Yunus MA, Musa R, Nazri MY. Construct and criterion validity of the Malaysia version of lower extremity functional scale (LEFS). ASMAR 2017;10:8-11. https://doi.org/10.1016/j.asmart.2017.09.002 DOI: https://doi.org/10.1016/j.asmart.2017.09.002

(13) Cruz-Diaz D, Lomas-Vega R, Osuna-Pérez MC, Hita-Contreras F, Fernández ÁD, Martínez-Amat A. The Spanish lower extremity functional scale: a reliable, valid and responsive questionnaire to assess musculoskeletal disorders in the lower extremity. Disabil. Rehabil. 2014;36(23):2005-2011. https://doi.org/10.3109/09638288.2014.890673 DOI: https://doi.org/10.3109/09638288.2014.890673

(14) Cacchio A, De Blasis E, Necozione S, Rosa F, Riddle DL, di Orio F, et al. The Italian version of the lower extremity functional scale was reliable, valid, and responsive. J. Clin. Epidemiol. 2010;63(5):550-7. https://doi.org/10.1016/j.jclinepi.2009.08.001 DOI: https://doi.org/10.1016/j.jclinepi.2009.08.001

(15) Brahmbhatt BG, Sheth MS. Translation, Cross-Cultural Adaptation and Reliability of the Lower Extremity Functional Scale into a Gujarati Version and Validation. JCDR. 2018;12(8):9-12. https://doi.org/10.7860/JCDR/2018/35965.11876 DOI: https://doi.org/10.7860/JCDR/2018/35965.11876

(16) Zhang C, Liu Y, Yuan S, Yang T, Gao Y, Zhu C, et al. Cross-Cultural Adaptation and Validation of the Simplified Chinese Version of the Lower Extremity Functional Scale. Biomed Res. Int. 2020;(9):2-7. https://doi.org/10.1155/2020/1421429 DOI: https://doi.org/10.1155/2020/1421429

(17) Sosa KE, Chavez FT, Bagsic LJ, Dato MS, Cruz LM, Manongsong WM, et al. Translation, Cross-Cultural Adaptation of the Lower Extremity Functional Scale into Filipino, and Analysis of its Psychometric Properties: A Study Protocol [Internet]. PJAHS. 2022;(5):9:57-63. Available from: https://www.researchgate.net/publication/358618945_Translation_Cross-Cultural_Adaptation_of_the_Lower_Extremity_Functional_Scale_into_Filipino_and_Analysis_of_its_Psychometric_Properties_A_Study_Protocol DOI: https://doi.org/10.36413/pjahs.0502.009

(18) The Hindu. What percentage of people prefer to speak Hindi across States? [Internet]. The Hindu; 2019. Available from: https://www.thehindu.com/data/what-percentage-of-people-prefer-to-speak-hindi-across-states/article27451589.ece

(19) Gance-Cleveland B, Leiferman J, Yates S, Williams AT, Amura CR, Roberts M, et al. Spanish translation of StartSmartTM using the Beaton process to ensure tech equity. Journal of Health Care for the Poor and Underserved. 2021;32(2):85-105. https://muse.jhu.edu/article/789659 DOI: https://doi.org/10.1353/hpu.2021.0052

(20) Grime MM, Wright G. Delphi method. Wiley statsref: Statistics reference online. 2016;1:1-6. https://doi.org/10.1002/9781118445112.stat07879 DOI: https://doi.org/10.1002/9781118445112.stat07879

(21) Sürücü L, Maslakçı A. Validity And Reliability In Quantitative Research. BMIJ. 2020;8(3):2694-2726. https://doi.org/10.15295/bmij.v8i3.1540 DOI: https://doi.org/10.15295/bmij.v8i3.1540

(22) Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Res. Social Adm. Pharm. 2019;15(2):214-21. https://doi.org/10.1016/j.sapharm.2018.03.066 DOI: https://doi.org/10.1016/j.sapharm.2018.03.066

(23) Vowell MP, Roller CL. Function and Movement of the Lower Extremity. In: Vowel MP, Roller CL. Kinesiology for the Occupational Therapy Assistant. Routledge; 2024. p. 123-147. DOI: https://doi.org/10.4324/9781003524748-6

(24) Lucas JW, Connor EM, Bose J. Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019. NCHS data brief. 2021;(415):1–8. PMID: 34473621 DOI: https://doi.org/10.15620/cdc:107894

(25) Hou WH, Yeh TS, Liang HW. Reliability and validity of the Taiwan Chinese version of the Lower Extremity Functional Scale. Journal of the Formosan Medical Association. 2014;113(5):313-20. https://doi.org/10.1016/j.jfma.2012.07.032 DOI: https://doi.org/10.1016/j.jfma.2012.07.032

(26) Modarres M, Groth K. Reliability and Risk Analysis. Boca Raton: CRC Press; 2023. https://doi.org/10.1201/9781003307495 DOI: https://doi.org/10.1201/9781003307495

Published

11/08/2024

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Original Articles

How to Cite

1.
Sandhu YK, Sharma N, Jaiswal A, Kaur S. Hindi version of the lower extremity functional scale: a study of translation, validation and cross-cultural adaptation. Rev Pesq Fisio [Internet]. 2024 Nov. 8 [cited 2024 Nov. 23];14:e5736. Available from: https://journals.bahiana.edu.br/index.php/fisioterapia/article/view/5736

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