Cross-cultural adaptation and measurement properties of the brazilian portuguese version of two scales which measure function and disability in people with achilles tendinopathy

Abstract

Background. Achilles tendinopathy can be disabling and is one of the most common chronic lesions among conditions affecting athletes’ feet and ankles. The clinical recommendation to measure self-reported limitations and functional capacity of patients with Achilles tendinopathy suggests the use of the Victorian Institute of Spor Assessment-Achilles (VISA-A) for pain and stiffness and the Foot and Ankle Ability Measure (FAAM) or the Lower Extremity Functional Scale (LEFS) to assess activity and participation. The Tendon Grading System and the Classification System for the Effect of Pain on Athletic Performance together measure the basic outcomes of VISA-A, FAAM, and LEFS, but is short, concise, and can be applied quickly in clinical practice. However, the scales were not adapted and validated for a Brazilian Portuguese version. The purpose of the present study is to validate and culturally adapt these scales to the Brazilian Portuguese language. Methods. A cross-cultural adaptation and validation study were performed. The recommendations presented on standardized methods for the cross-cultural adaptation of self-administered questionnaires was followed. The recommendations define this process in six phases: Translation, synthesis, back translation, expert committee review, pretesting, and a Delphi study to obtain the consensus of a group of experts on the quality of translation. The construct validity was tested in 17 non-athletes and asymptomatic participants, 50 amateur and professional athletes who are practitioners of modalities that place a great demand on the Achilles tendon, and 39 amateur and professional athletes diagnosed with Achilles tendinopathy. Results. The Spearman correlation between the Tendon Grading System and VISA-ABr was - 0.79 (p = 0.001); between Tendon Grading System and LEFS, - 0.72 (p = 0.001); and between Classification System for the Effect of Pain on Athletic Performance and LEFS - 0.68 (p = 0.001), demonstrating a strong correlation in both comparisons. The results between Classification System for the Effect of Pain on Athletic Performance and VISA-A-Br were - 0.81 (p = 0.001), indicating a very strong correlation. Conclusions. The Tendon Grading System and Classification System for the Effect of Pain on Athletic Performance are similar to their original versions. The scales were valid for assessing pain and stiffness (Tendon Grading System) and activity and participation (Classification System for the Effect of Pain on Athletic Performance) in a Brazilian population with Achilles tendinopathy.