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   2017| May  | Volume 11 | Issue 5  
    Online since May 25, 2017

 
 
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REVIEW ARTICLE
Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine
Siny Tsang, Colin F Royse, Abdullah Sulieman Terkawi
May 2017, 11(5):80-89
DOI:10.4103/sja.SJA_203_17  
The task of developing a new questionnaire or translating an existing questionnaire into a different language might be overwhelming. The greatest challenge perhaps is to come up with a questionnaire that is psychometrically sound, and is efficient and effective for use in research and clinical settings. This article provides guidelines for the development and translation of questionnaires for application in medical fields, with a special emphasis on perioperative and pain medicine. We provide a framework to guide researchers through the various stages of questionnaire development and translation. To ensure that the questionnaires are psychometrically sound, we present a number of statistical methods to assess the reliability and validity of the questionnaires.
  9,107 1,080 -
ORIGINAL ARTICLES
Development and validation of Arabic version of the Hospital Anxiety and Depression Scale
Abdullah Sulieman Terkawi, Siny Tsang, Ghadah Jumaan AlKahtani, Sumaya Hussain Al-Mousa, Salma Al Musaed, Usama Saleh AlZoraigi, Esraa M Alasfar, Khalid S Doais, Anas Abdulrahman, Khaild Ali Altirkawi
May 2017, 11(5):11-18
DOI:10.4103/sja.SJA_43_17  
Introduction: The Hospital Anxiety and Depression Scale (HADS) is widely used to predict and diagnose hospital anxiety and depression. It has been translated and validated in many languages, but the existing Arabic version was not validated in hospitalized patients. The aim was to translate, culturally adapt, and validate the HADS Questionnaire into Arabic language for in-patient use, especially for surgical wards. Methods: A systematic translation process was used to translate the original English HADS into Arabic. After the pilot study, we validated our version in surgical patients at two tertiary care centers. We tested the reliability of our version using internal consistency. We examined the validity by assessing construct validity, concurrent validity (by testing the associations between HADS, Generalized Anxiety Disorder 7-item scale [GAD-7], and Major Depression Inventory [MDI]), and face validity. The questionnaire was administered before and after surgery to examine responsiveness. Results: A total of 110 patients (22 men, 88 women) were included in the study. Cronbach's αs for the HADS anxiety subscale were 0.83 (95% confidence interval: 0.79– 0.88) and for the HADS depression subscale were 0.77 (0.7–0.83). Nearly 36% of the patients reported symptoms indicative of borderline or case anxiety before surgery, which decreased to 25% 1 week after surgery. HADS anxiety score was strongly correlated with GAD-7, and HADS depression score was strongly associated with MDI. Patients with higher American Society of Anesthesiologists Physical Status and those who remained hospitalized for more than 5 days were more likely to report depression symptoms. Most patients found the HADS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their hospital anxiety and depression. Conclusions: Our Arabic version of HADS is a reliable and valid tool to assess the mood states in hospitalized patients.
  2,913 235 -
Development and validation of Arabic version of the Short-Form Mcgill Pain Questionnaire
Abdullah Sulieman Terkawi, Siny Tsang, Abdullah Abolkhair, Mohammed Alsharif, Mousa Alswiti, Adwa Alsadoun, Usama Saleh AlZoraigi, Saleh F Aldhahri, Tariq Al-Zhahrani, Khaild Ali Altirkawi
May 2017, 11(5):2-10
DOI:10.4103/sja.SJA_42_17  
Introduction: The Short-Form McGill Pain Questionnaire (SF-MPQ) is a widely used tool for qualitative and quantitative pain assessment. Our aim was to translate, culturally adapt, and validate the SF-MPQ in Arabic. Methods: A systematic translation process was used to translate the original English SF-MPQ into Arabic. After the pilot study, we validated our version in patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations between SF-MPQ, Brief Pain Inventory [BPI], and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), and face validity. The questionnaire was administered twice to examine responsiveness. Results: A total of 142 participants (68 men and 74 women) were included in this study. Cronbach's α was 0.85 (95% confidence interval: 0.81– 0.89), and interclass correlation coefficients were 0.71 (0.62–0.79) for the whole scale. SF-MPQ was moderately associated with patients' present pain (r = 0.55, P< 0.001) and the numerical rating scale (r = 0.42, P< 0.001). The total pain score was moderately correlated with pain severity and interference assessed with the BPI (rs = 0.39 to 0.49, all Ps < 0.001). SF-MPQ total pain score was weakly associated with neuropathic pain assessed with S-LANSS (r = 0.26, P< 0.01). Most patients found the SF-MPQ questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their pain. Conclusion: Our translated version of SF-MPQ was reliable and valid for use among Arabic-speaking patients. The SF-MPQ is a good qualitative and quantitative assessment tool for pain but is only weakly associated with neuropathic pain.
  2,403 162 -
Development and validation of Arabic version of the Neuropathic Pain Questionnaire-Short Form
Abdullah Sulieman Terkawi, Miroslav Misha Backonja, Abdullah Abolkhair, Sameeh Almaharbi, Jaya Joy, Farida Foula, Mousa Alswiti, Yazzed Sulieman Terkawi, Tariq Al-Zhahrani, Faris Saeed Alghamdi, Siny Tsang
May 2017, 11(5):53-62
DOI:10.4103/sja.SJA_86_17  
Introduction: The Neuropathic Pain Questionnaire-Short Form (NPQ-SF) is the shortest diagnostic tool for the assessment of neuropathic pain, designed with the goal to differentiate between neuropathic and nonneuropathic pain. The aim of this study was to translate, culturally adapt, and validate the NPQ-SF questionnaire in Arabic. Methods: A systematic translation process was used to translate the original English NPQ-SF into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. Reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficient (ICC). We examined the validity of the Arabic NPQ-SF via construct validity, concurrent validity (associations with the numeric pain scale, Brief Pain Inventory, and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated NPQ-SF questionnaire was administered twice among the same group of patients. Results: A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's α were 0.45 (95% CI: 0.29, 0.61) and 0.48 (95% CI: 0.33, 0.63), and the ICC was 0.78 (95% CI: 0.72, 0.85). The NPQ-SF was moderately to strongly associated with the S-LANSS questionnaire. Results showed our Arabic NPQ-SF to have good diagnostic accuracy, with area under the curve of 0.76 (95% CI: 0.67, 0.84). Results from the receiver operating characteristic analysis identified a cut-off score of ≥0.52 as the best score to distinguish between patients with or without neuropathic pain, which was higher than the recommended cut-off score (≥0) in the original study. With both sensitivity and specificity of 71%. Most patients found the NPQ-SF questionnaire to be clear and easy to understand. Conclusion: Our translated version of NPQ-SF is reliable and valid for use, thus providing physicians a new tool with which to evaluate and diagnose neuropathic pain among Arabic-speaking patients.
  1,544 107 -
Development and validation of Arabic version of the pain catastrophizing scale
Abdullah Sulieman Terkawi, Michael Sullivan, Abdullah Abolkhair, Tariq Al-Zhahrani, Rayan Suliman Terkawi, Esraa M Alasfar, Shadi Sharif Abu Khait, Ahmed Elkabbani, Nasib Kabbani, Khaild A Altirkawi, Siny Tsang
May 2017, 11(5):63-70
DOI:10.4103/sja.SJA_130_17  
Introduction: The pain catastrophizing scale (PCS) is the most widely used tool to assess pain catastrophizing. The aim of this study was to translate, culturally adapt, and validate the PCS questionnaire in Arabic. Methods: A systematic translation process was used to translate the original English PCS into Arabic. After the pilot study, we validated our version among patients with chronic pain at two tertiary care centers. We tested the reliability of our version using internal consistency and test-retest reliability. We examined the validity by assessing construct validity, concurrent validity (by investigating the associations with Brief Pain Inventory [BPI]), and face validity. Results: A total of 113 subjects (50 men, 63 women) were included in the study. Cronbach's α was 0.94 (95% confidence interval [CI]: 0.92–0.96), and interclass correlation coefficients was 0.83 (95% CI: 0.77–0.89) for the total scale. There was no statistically significant difference in the total PCS scores between patients who reported experiencing current pain and those who did not. Among patients who reported having current pain, pain severity was weakly associated with the total PCS scores (r = 0.22, P = 0.03). PCS and its subscales were not statistically significantly associated with any of the BPI items. Nonetheless, patients who were diagnosed with neuropathic pain had statistically significantly higher scores on the total PCS, rumination, and helplessness subscales. Most patients found the PCS questions to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain catastrophizing. Conclusion: Our translated version of PCS is reliable and valid for use among Arabic-speaking patients.
  1,512 94 -
EDITORIAL
In anesthesia and pain medicine, do we need Arabic version of the English language questionnaires?
Abdelazeem Eldawlatly
May 2017, 11(5):1-1
DOI:10.4103/sja.SJA_294_17  
  1,497 101 -
ORIGINAL ARTICLES
Development and validation of Arabic version of the douleur neuropathique 4 questionnaire
Abdullah Sulieman Terkawi, Abdullah Abolkhair, Bouhassira Didier, Tariq Alzhahrani, Mazen Alsohaibani, Yazzed Sulieman Terkawi, Yousuf Almoqbali, Yasser Younis Tolba, Evelyn Pangililan, Farida Foula, Siny Tsang
May 2017, 11(5):31-39
DOI:10.4103/sja.SJA_97_17  
Introduction: The douleur neuropathique 4 (DN4) questionnaire is a widely used tool for diagnosis of neuropathic pain (NP). The aim was to translate, culturally adapt, and validate the DN4 questionnaire in Arabic. Methods: A systematic translation process was used to translate the original English DN4 into Arabic. After the pilot study, the Arabic version was validated among patients with chronic pain in two tertiary care centers. The reliability of the translated version was examined using internal consistency, test-retest reliability, and intraclass correlation coefficients. We examined the validity of the Arabic DN4 via construct validity, concurrent validity (associations with the numeric rating scale, brief pain inventory, and Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS]), face validity, and diagnostic validity. To investigate the responsiveness, the translated DN4 was administered twice among the same group of patients. Results: A total of 142 subjects (68 men, 74 women) were included in the study. Cronbach's α was 0.67 (95% confidence interval [CI]: 0.59–0.75), and interclass correlation coefficients was 0.81 (95% CI: 0.76–0.87). The DN4 was moderately associated with the S-LANSS questionnaire. Results showed our Arabic DN4 to have good diagnostic accuracy, with area under the curve of 0.88 (95% CI: 0.82–0.94). As with the original version, a score of ≥4 was found to be the best cut-off for the diagnosis of NP, with a sensitivity of 88.31%, specificity of 74.47%, a positive predictive value of 85%, and a negative predictive value of 80%. Most patients found the DN4 questionnaire to be clear and easy to understand, and thought the questionnaire items covered all their problem areas regarding their pain. Conclusion: Our Arabic version of the DN4 is a reliable and valid screening tool that can be easily administered among patients to differentiate between NP and non-NP.
  1,468 90 -
Development and validation of Arabic version of the postoperative quality of recovery scale
Abdullah Sulieman Terkawi, Siny Tsang, Waleed Riad, Sumaya Nemer Nassar, Maissa Mahmoud, Ghadah Jumaan AlKahtani, Hanin Hussain Alsharif, Khalid S Doais, Fatima Jaina Sala, Anas Abdulrahman, Colin F Royse
May 2017, 11(5):19-30
DOI:10.4103/sja.SJA_68_17  
Introduction: The postoperative quality of recovery scale (PostopQRS) is a widely used tool to assess the postoperative quality of recovery. Our aim was to translate, culturally adapt, and validate the PostopQRS questionnaire in Arabic. Methodology: A systematic translation process was used to translate the original English PostopQRS into Arabic. After the pilot study, the translated version was validated among patients who underwent different types of surgeries. We examined the reliability (using internal consistency) and validity of the translated version. To examine the responsiveness of the translated PostopQRS, the questionnaire was administered 6 times among the same group of patients (once before surgery as baseline measure, and 5 times after surgery, up to 1 week after surgery). Results: A total of 190 patients (10 men, 180 women) were included. Internal consistencies vary across each domain and overtime, with mostly good to excellent reliability. Most patients found the PostopQRS questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their quality of recovery. In general, patients showed recovery across all five domains starting from postoperative day 1 (POD1). Patients showed the fastest recovery in the emotional domain, and the proportion of recovered patients remained stable over time. Most patients were recovered in the cognitive domain by POD1. Although only a small proportion of patients were recovered in the physiological and activities of daily living domains in POD1, most patients were recovered by POD3. The proportion of patients recovered in the nociceptive domain declined initially, but more patients showed recovery by POD3 and most were recovered by POD7. Furthermore, quality of recovery was related to the extent of surgery (major vs. minor). Conclusion: Our translated version of PostopQRS was reliable and valid for use among Arabic-speaking patients. In addition, we showed that the PostopQRS was able to track the changes in recovery among patients in our study.
  1,456 101 -
The burden of chronic pain after major head and neck tumor therapy
Abdullah Sulieman Terkawi, Siny Tsang, Anwar S Alshehri, Dhaifallah S Mulafikh, Abdulrahman A Alghulikah, Saleh F AlDhahri
May 2017, 11(5):71-79
DOI:10.4103/sja.SJA_162_17  
Introduction: Little is known about the burden of chronic pain after major head and neck tumors' therapy. In this study, we aimed to estimate the prevalence of chronic pain, explore the factors associated with the presence of chronic pain, and assess the consequences of chronic pain on the patients' quality of life. Methodology: This was a cross-sectional survey among patients who had completed their therapy (e.g., surgery, radiotherapy, and chemotherapy) for major head and neck (larynx, nasopharynx, oropharynx, hypopharynx, oral cavity, tongue, and sinuses) tumors after at least 3 months. We collected relevant demographic and clinical data and administered the Brief Pain Inventory-Short Form, Neuropathic Pain Questionnaire-Short Form, and Pain Catastrophizing Scale questionnaires. Possible risk factors were explored using a classification tree model. Results: A total of 102 patients (59 men, 42 women) were enrolled in this study between 3 and 72 months after tumor treatment. 30% of the patients reported having chronic pain after their major head and neck tumors' therapy. The average pain score in the last 24-hr was 3.4 (standard deviation = 2.7). The prevalence of patients with chronic pain was higher (42%) among those who had surgery. Factors associated with chronic pain were female sex, older age, surgery, advanced cancer stage, and radiotherapy. Patients who reported having chronic pain also reported having a lower quality of life manifested by impairments in general activity, mood, walking ability, normal work, and sleeping. Patients who reported having chronic pain had higher Pain Catastrophizing Scale scores. Conclusion: Our study highlighted the high burden of chronic pain after therapy for major head and neck tumors. We identified demographic and clinical factors that are associated with the presence of chronic pain. Further studies are required to better understand the risk factors to implement strategies to prevent, alleviate, and treat chronic pain associated with major head and neck tumor therapies.
  1,424 82 -
Development and validation of Arabic version of the postoperative quality of recovery-40 questionnaire
Abdullah Sulieman Terkawi, Paul S Myles, Waleed Riad, Sumaya Nemer Nassar, Maissa Mahmoud, Ghadah Jumaan AlKahtani, Fatima Jaina Sala, Anas Abdulrahman, Khaled S Doais, Rayan Suliman Terkawi, Siny Tsang
May 2017, 11(5):40-52
DOI:10.4103/sja.SJA_77_17  
Introduction: The postoperative quality of recovery-40 (QoR-40) is one of the most frequently used tools to assess the quality of recovery after surgery. The aim of the current study was to translate, culturally adapt, and validate the QoR-40 questionnaire in Arabic. Methods: A systematic translation process was used to translate the original English QoR-40 into Arabic. After the pilot study, the translated version was validated among patients who underwent different types of surgeries. The reliability (using internal consistency) and validity of our translated Arabic version was examined. To investigate the responsiveness of the translated QoR-40, the questionnaire was administered five times among the same group of patients (once before surgery as baseline measure, and four times after surgery, up to 1 week after surgery). Results: A total of 182 participants (7 men, 175 women) were included in the study. The QoR-40 total scale and all subscales showed excellent internal consistencies over time, with the exception of the QoR-40 pain subscale at postoperative day 1. The QoR-40 total and subscale scores were inversely associated with patients' self-report pain scores but positively correlated with patients' self-report recovery scores. Patients' QoR-40 total, comfort, emotions, and physical subscale scores increased over time after surgery, indicating a general trend of recovery over time. Patients' scores in the QoR-40 pain and support subscales remained stable over time, suggesting no substantial changes were reported in these two domains. Quality of recovery was also found to be related to patients' ages, American Society of Anesthesiologists Physical Status, and the extent of surgery (major vs. minor). Most patients found the Arabic QoR-40 questions to be clear and easy to understand and thought the questionnaire items covered all their problem areas regarding their quality of recovery. Conclusion: Our translated version of QoR-40 was reliable and valid for use among Arabic-speaking patients. In addition, the QoR-40 was able to assess the quality of recovery in several domains among patients who underwent surgical procedures.
  1,338 80 -
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