TRANSLATION AND CULTURAL ADAPTATION OF THE VESTIBULAR ACTIVITIES AVOIDANCE INSTRUMENT FOR THE PORTUGUESE POPULATION

S. Da Silva^1,2, M. Le Lay¹, P.M. Dunlap³, Â.M. Pereira^1,4,5, A.R. Póvoa^1,6, C.M. Costa^1,7,5

¹Escola Superior de Saúde Egas Moniz, Department of Physiotherapy, Almada, Portugal, ²Vitória FC Andebol, Department of Physiotherapy, Setubal, Portugal, ³University of Pittsburgh, Department of Physical Therapy, Pittsburgh, PA, United States, ⁴Centro de Investigação Interdisciplinar Egas Moniz, Almada, Portugal, ⁵Hospital Garcia de Orta, Almada, Portugal, ⁶Clinica Joaquim Chaves Saúde, Department de Otorrinolaringologia, Algès, Portugal, ⁷Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal

Background: Fear-avoidance beliefs are associated with disability and can predict limitations in daily activities¹, often experienced by persons with vestibular disorders. The Vestibular Activities Avoidance Instrument–9 items (VAAI-9) measures fear-avoidance beliefs associated with physical activity, household, social, and work responsibilities among persons with dizziness². As the Portuguese population is also affected by dizziness and experience fear avoidance beliefs it is important to translate this instrument for clinical use in this population.

Purpose: To translate and adapt the VAAI-9 item for the Portuguese language and culture.

Methods: The translation and transcultural adaptation were based on Tsang et al.³ and Beaton et al.⁴ guidelines, following five stages: 1) Initial translations, 2) Synthesis of the translation, 3) Consensus by a panel of experts through a Delphi process, 4) Back translation, and 5) Pre-test. The expert committee was composed of 5 experts in vestibular disorders (physiotherapists and an otorhinologist). In the Delphi process, a questionnaire was administered to the experts using the Google Forms platform. It was composed of a sample caracterization questionnaire followed by a section evaluating agreement with the translation of the items. The level of agreement was measured using a Likert Scale ranging from 0 to 5, with 0 signifying "completely disagree" and 5 signifying "completely agree." The consensus was considered to have been achieved at a minimum of 70% agreement among responses, with 100% being considered as indicating perfect consensus. The experts' suggestions were reconciled, and a revised version of the VAAI-9 scale was produced. The pre-test was carried out in a tertiary clinic in Lisbon. Informed consent was obtained from participants. Fifteen participants (11 females), older than 18 years, diagnosed with a vestibular disorder and on a vestibular rehabilitation program, were enrolled. The VAAI-9 score Portuguese version was recorded, as well as the comprehension form, with quantitative and open questions to assess the comprehension of all items. A mixed quantitative-qualitative analysis was done to obtain face validity and linguistic equivalence.

Results: In the Delphi process, one round was conducted to obtain equivalence in both cultures. The minimum level of agreement was 70%, and the average for all items was 88,9%. The pretest level of comprehension was 96% (4 items with 100% and 5 items with 93,3%), indicating a very good understanding of the instrument. The average 9-item VAAI score was 24,7 (±14.3). In the open questions, some comments were raised, but few regarding the linguistic aspects, which had little impact on the result.

Conclusions: The Portuguese version of the VAAI–9 item presents the linguistic equivalence to the original, as well as the face validity to be used in Portugal. More work is being done to address the other psychometric properties in this population.

Implications: Persons with vestibular disorders often develop maladaptive mechanisms, namely fear-avoidance beliefs. Having a tool that monitors these beliefs can help in the development of strategies to prevent these behaviors and optimize the vestibular rehabilitation outcomes.

Funding acknowledgements: The work was unfunded.

Keywords:
Fear avoidance assessment
Translation and adaptation study
Vestibular physiotherapy

Topics:
Research methodology, knowledge translation & implementation science
Neurology

Did this work require ethics approval? Yes

Institution: Escola Superior de Saúde Egas Moniz

Committee: Egas Moniz Ethics Committee 

Ethics number: Process n. 1085 of 24/03/2022