Outcome measures (OMs): Translation Process, barriers and facilitators to use of OMs
•
7 likes•1,942 views
Use of outcome measure is critical in clinical practice and research. To highlight this need, and to convey message about barriers and facilitators for the use of outcome measures and strategies to improve the use of outcome measures, I made this presentation with other 3 colleagues from different continents at World Confederation for Physical Therapy Conference in Cape Town in 2017.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Outcome measures (OMs): Translation Process, barriers and facilitators to use of OMs
Similar to Outcome measures (OMs): Translation Process, barriers and facilitators to use of OMs (20)
More from Saurab Sharma
More from Saurab Sharma (20)
Recently uploaded
Recently uploaded (20)
Outcome measures (OMs): Translation Process, barriers and facilitators to use of OMs
- 1. How to… Seminar Outcome Measures (OMs) Saurab Sharma PhD Candidate | School of Medicine | University of Otago, New Zealand Assistant Professor (Physiotherapy) | Kathmandu University School of Medical Sciences, Nepal
- 2. Objectives At the end of the session, participants will be able to: • understand translation and cross-cultural adaptation process • identify barriers and facilitators to the use of outcome measures in developing nations • identify and utilize strategies to facilitate the use of outcome measures in developing nations 2
- 3. Translation Process Beaton et al., 2000, Spine 3
- 4. Translation Process: Stage 1, 2, 3 Forward Translation 1 (FT1) Informed (Medical Background) Forward Translation 2 (FT2) Uninformed (Non-medical background) Stage 1: Forward Translations Synthesis (T12) Stage 2: Synthesis Back Translation 1 (BT1) Back Translation 2 (BT2) Stage 3: Back Translation Beaton et al 2000 4
- 5. Translation Process: Stage 4 • Methodologist • Language experts • Translators • Developer Stage 4: Expert committee meeting Discussion Consensus Pre-final version Beaton et al 2000, Spine 5
- 6. Translation Process: Stage 5 N = 30 – 40 Stage 5: Pre-testing Administer the translated version Probe the meaning of each item Beaton et al 2000, Spine 6
- 7. Cultural adaptations: Examples 1: GROC Sharma et al, Submitted 2017 7
- 8. Cultural adaptations: Example 2: NPRS Sharma et al, Submitted 2017 Worst Imaginable Pain Nepali Translation Intolerable painMaximum pain 8
- 9. Cultural adaptations: Example 3 • Pain quality Measures – Difficult to translate – Most common Nepali words to describe pain do not translate to English – Interviewed 101 patients with chronic pain – Counted frequencies of the commonly used words Sharma et al, JPR, 2016 9
- 10. Which outcome measures to translate? • Identify core outcome sets for your area of practice • Consider Bio-Psycho-Social model • Example, Chronic Pain (IMMPACT recommendation, 2005) – Pain – NPRS, pain quality, pain behavior – Physical function – PSFS, pain interference – Psychological function – Depression, anxiety, sleep, resilience, optimism – Global improvement – GROC 10
- 11. Choosing correct outcome for specific culture Pathak et al, manuscript in preparation 11
- 12. Barriers to use of outcome measures Barriers Students (13) Interns (6) Physio- therapists (14) Total (33) Time constraint 4 1 8 13 Unavailability of measures (free) 3 5 2 10 Language barrier 5 - 1 6 Patients don’t understand 1 - 4 5 Hard to explain 3 - 2 5 Irrelevant to Nepalese context - - 2 2 Measures too long - - 2 2 12
- 13. Key Problems identified 1. OMs are NOT available 2. Problems with validity of measures 3. Low or no education level of patients 4. Longer OMs for limited time of assessment 5. Lack of knowledge among clinicians 1. Lack of knowledge about measures: 82% and 75% 2. Limited availability of measures: 51% and 50% 3. Lack of time: 52% and 55% Mayo et al 1993, Cole et al 1995 13
- 14. Facilitators to use outcome measures Facilitators Frequency Availability as a shorter version 4 Availability in Nepali 4 (Free) Access to outcome measures 2 Easy to use if clear explanation is included 2 Measure that are easy to understand 2 Increasing research in outcome measures 2 Educating students and physiotherapists 2 Make available as hard copies in the clinics 1 Single website with all available outcome measures 1 14
- 15. Strategies to improve use of outcome measures (OMs) • Research – Translate, adapt and validate OMs to local language • Translate/ create shorter versions than longer versions • Educate physiotherapists/ clinicians and students • Make it available in clinics- paper/ electronic forms • Verbal administration for uneducated – e.g., NPRS and 15
- 16. Strategies to improve use of outcome measures (OMs) 16 www.linkphysio.com
- 17. Take home message - Identify useful OM - Translate - Validate Educate - PTs - Students - Community - Make OM available in clinic - Encourage the use 17
Editor's Notes
- I am Saurab Sharma from Nepal and currently doing my PhD at University of Otago under the supervision of Dr. Haxby Abbott. After my Masters degree in MSK physiotherapy/ manual therapy, I was fascinated by various options for pain management strategies and Research and wanted to conduct clinical trials in Nepal. No valid outcome measures were available for use in Nepali for physiotherapy research. Likewise, for assessing efficacy of clinical outcome also, we did not have any self reported measures available for Nepali. Thus, I collaborated with experts from all over the globe and took up the initiative of translating outcome measures in Nepali. I have now completed translations of 15 outcome measures related to Pain, physical and psychological function to Nepali and also helped others translate.
- Based on my experiences of translation of outcome measures, I will speak on translation process, barriers and facilitators to the use of outcome measures, and finally speak on the strategies to facilitate the use of outcome measures in developing nations.
- Beaton 2000 guideline -- 3945 (almost 4000) citations in Google Scholar– June 23, 2017. This algorithm may not be visible, so I will describe this over the next 3 slides.
- Forward translators should be the native speakers of target language. First forward translator has a medical background who understands the medical ground of the measure whereas second translator is uninformed and does not have a medical background. This will assure that the measure translated is understood by someone who is a non medical person. If both the translators are medical professionals, you will still have a new translation, but most likely will not be understood by patients as they do not understand medical jargons. In the second stage, these two translators discuss and synthesize a single Nepali version, which holds the medical meaning and is understood by a non-medical persons. Then, the synthesized version is back translated by a naïve native English speaker who are unaware of the original versions who should ideally be a native speaker of the source language in the third stage. This back translation assures content validity of the translated Nepali version that if it retains original meaning of the items.
- In the fourth stage, an expert committee meeting is called which consists of all the translators, language experts if available, developer and methodologist, where the experts meet to discuss the different versions of translations. Developer is in close contact with the committee. Make sure to produce a simple version that is understood by most if not all than to produce a measure that sounds good with complicated words. This step is crucial to achieve cross-cultural equivalence. Role of the committee is to consolidate all the versions and develop pre-final version for the field testing. Full written documentation should be done at all the stages. Decisions will need to be made by this committee to achieve equivalence between the source and target version in four areas: Semantic Equivalence. Do the words mean the same thing? Are their multiple meanings to a given item? Are there grammatical difficulties in the translation? Idiomatic Equivalence. Colloquialisms, or idioms, are difficult to translate. The committee may have to formu Experiential Equivalence. Items are seeking to capture and experience of daily life; however, often in a different country or culture, a given task may simply not be experienced (even if it is translatable). The questionnaire item would have to be replaced by a similar item that is in fact experienced in the target culture. An example might be in an item worded: Do you have difficulty eating with a fork? when that was not the utensil used for eating in the target country. Conceptual Equivalence. Often words hold different conceptual meaning between cultures (for instance the meaning of “seeing your family as much as you would like” would differ between cultures with different concepts of what defines “family”—nuclear versus extended family).
- Example: First item in CD – Resilience scale, “I am able to adapt to changes” translates to “ma paristhiti sanga dhalna sakchu”. Dhalna also mean fainting. So, many patients understood this item as fainting so we added “pariwartan” in parenthesis for clarification.
- Global rating of change is a measure that is used to track improvement after treatment. It is also widely used in research to categorize the research participants into improved group and stable group such that psychometric analyses for test- retest reliability and responsiveness can be performed. We started translation of a 15 item GROC. In expert committee meeting it was decided that the Nepali version of GROC with 15 items did not reflect true meaning and did not retain the ordinal property. Thus, in the cultural adaptation, 15 item GROC was reduced to 7 item GROC. Before doing this, we also reviewed the literature if 7 item scale was used.
- In the translation of Numerical Pain Rating Scale, as per IMMPACT recommendation for chronic pain published in 2005, attempted the translation of right side anchor “Worst imaginable pain”. Upon translation, the phrase did not sound natural and sounded funny. This is not the way Nepalese describe their worst pain. Thus, we proposed two other alternatives (based on the literature), that translated to English as Maximum pain and intolerable pain. We used all the 3 right anchors in the pre-testing. More than half of the patients did not understand what “worst imaginable pain” meant. Alternatively they understood and thus preferred the “Maxmimum pain and intolerable pain.
- Some times translation and
- Translation of generic measures are valued as they can be used for a variety of conditions. Translation of QoL measure can never go wasted.
- Translation of measure is just not enough. The measure has to be valid for the population. For example, many participants who are elderly and uneducated do not understand the concept of numbers example in Numerical pain rating scale. Thus, appropriate measure has to used in the population. We asked 204 participants with musculoskeletal pain for their preference of pain rating scales of the four pain rating scales. Majority of the participants preferred Faces Pain Rating Scale followed by Verbal rating scale. NPRS had the most number of incorrect responses.
- To identify barriers to use of outcome measures, we asked 33 physiotherapists, students and interns open ended question i.e. “What do you think are the barriers to use of outcome measures in clinical practice”. We analysed the responses and coded. Time constrain and unavailability of measures and language barriers appear to be the most frequent barriers.
- Not everyone needs to be a researcher, but every clinician should help active researcher in achieving the data they need for the research. Beck Depression inventory – 21 items - later translated 8 Item PROMIS Depression Scale IRT model CAT Shorter items are as good as longer versions. Educate physiotherapists/ clinicians and students about available OM and value of using it Teach OM in physiotherapy schools, facilitate its use in clinical placements
- Identify Core outcome sets- pick appropriate measure culturally acceptable for your language, translate, assess if they are valid. Educate clinicians and students and community Bring these measures to the clinics and encourage the use.