Tradução, adaptação transcultural e validação do Upper Limb Functional Index (ULFI) para o português brasileiro

Abstract

Objective: The purpose of this study was to translate, cross-cultural adapt and validate the Upper Limb Functional Index (ULFI) into Brazilian Portuguese. Methods: The translation and cross-cultural adaptation of the ULFI was performed according to international recommendations and the pre-final version of the ULFI was answered by 30 patients with upper limb musculoskeletal disorders to assess questionnaire understanding. The final version of ULFI was applied to 200 patients to verify structural validity. The other questionnaires of the study, i.e., Quick Disabilities of the Arm, Shoulder and Hand (QuickDash), 36-item Short Form Health Survey (SF-36) and Numerical Pain Scale (NPS) were answered by 180 patients to assess its construct validity using the Spearman correlation (rho). The internal structure of the ULFI was evaluated by exploratory and confirmatory factor analysis with fit indices Chi-square (X2), Chi-square/degrees of freedom (X2/df), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker Lewis Index (TLI). A subsample of 51 patients answered ULFI after a mean of 9 days to assess test-retest reliability using intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was assessed by Cronbach's alpha (). Floor

and ceiling effects were also assessed. Results: During translation and cross- cultural adaptation process, no item in the pre-final version of the questionnaire

was misunderstood by more than 20% of patients, resulting in the final version of ULFI. Factor analysis identified a unidimensional structure with acceptable fit indices (RMSEA = 0.063, CFI = 0.918, TLI = 0.910). ULFI showed excellent reliability (CCI = 0.909) and adequate internal consistency ( = 0.897). SEM was 6.11 and the MDC was 14.26. ULFI demonstrated high correlation with QuickDash (rho = -0,721), moderate correlation with NPS (rho = -0,529), and physical function (rho = 0,529), role physical (rho = 0,572), pain (rho = 0,562), general health status (rho = 0,505), social function (rho = 0,557) domains of SF-36, and low correlation with vitality (rho = 0,361), role emotional (rho = 0,440) and mental health (rho = 0,309) domains of SF-36. There were no floor and ceiling effects. Discussion: As hypothesized, ULFI demonstrated high reliability, adequate internal consistency and high correlation with QuickDash, another region-specific instrument that also assesses function of the entire upper limb. The ULFI is a practical and easy to understand measure, which can be used to assess function of the entire upper limb of patients with musculoskeletal disorders, especially those with more than one segment affected. Conclusion: The translated, cross-cultural adapted and validated Brazilian Portuguese version of ULFI has adequate reliability, internal consistency and construct validity with a unidimensional structure.