Transcultural adaptation and new proposal for the nursing outcome, Physical condition (2004)

ABSTRACT Objectives: cross-culturally adapt to the Spanish context and make a new proposal for the nursing outcome, Physical Condition (2004), of the Nursing Outcomes Classification (NOC) for its precise use in clinical practice. Method: a cross-cultural adaptation study and a proposal for the nursing outcome, Physical Condition, was conducted and supported by the opinion of 26 experts. The data was obtained through an electronic form, and a quantitative analysis was conducted, using the SPSS software. Results: the version adapted to the Spanish context was obtained and the proposal of the outcome, Physical Condition, received agreement from 26 experts, with a mean score greater than 7.6 for adequacy of the outcome definition and its indicators, and 8.5 for the relevance of the indicators. Conclusions: the version adapted to the Spanish context and a new proposal for Physical Condition were obtained. The results obtained indicate a high level of adequacy and relevance, an instrument of great utility in the clinic, and research was obtained to evaluate the interventions directed to the improvement of the physical condition.

the proposed outcome, Physical Condition Related to Health, to be important because it is determinant that an instrument adapted cross-culturally is adequately developed and validated through the analysis of satisfactory psychometric properties (15) . The existing nursing outcome, Physical condition (2004), is linked to the health field and is composed of 13 indicators related to the health status of a person that can be assessed with a 5-point Likert scale, in which a «5» is the best possible score and a «1» is the worst possible score (16) .
The objectives of this study were to cross-culturally adapt the nursing outcome, Physical Condition (2004), of the 5th edition of the NOC, to the Spanish context and to make a consensus proposal by expert opinion of the nursing outcome, Physical Condition Related to Health.

Method
The study that was conducted was a cross-cultural adaptation of the nursing outcome, Physical Condition, and of its indicators, from the NOC classification, 5th edition (17) and a new proposal of said outcome, based on the opinion of experts between January of 2015 and September of 2016.
Thus, to achieve the objectives, the study was conducted in two different phases: In this first stage, the researchers and the translators compared both translations, and the discrepancies that arose were agreed upon. The translations were Rojas J, Echevarría P, Leal Costa C.
performed by two bilingual translators whose mother tongue was Spanish, and who had different professional profiles. Translator 1 was a health sciences and physical education professional, specifically, a graduate in psychology and a professional athlete with knowledge about the concepts that the measuring instrument evaluates. Translator 2 was a graduate professional in English studies, who had no knowledge of the concepts of the instrument, and was not related to health sciences or physical activity. 2) Synthesis of the translations: in this stage, starting from the two translations into Spanish (T1 and T2) and the original version, we made a synthesis of these translations to obtain a common and back-translation 2 (RT2). In the third stage, the two translators that produced the back translations, RT1 and RT2, were two people whose mother tongue was English and who did not have knowledge about the concepts explored in the measuring instrument, nor were they trained in the health sciences or in physical activity; in particular, they were graduates in English philology who worked as teachers and researchers at the Catholic , a quantitative analysis was conducted through a consultation with a group of experts. The group of experts was comprised of professionals who met the following inclusion criteria: graduates in a discipline such as medicine, nursing, physiotherapy, or physical activity and sport sciences; professional experience in teaching, research or another health care field for at least two years; scientific academic production in the field of physical exercise and health, or nursing taxonomies.
The exclusion criterion was not meeting all the inclusion criteria. The experts collaborated voluntarily. The type of sampling five to ten experts from each professional group referred to above (20) . Specifically, we had a

Ethical aspects
The present study was approved by the Clinical

Research Ethics Committee of the Hospital Clínico
Universitario Virgen de la Arrixaca, belonging to Health Area 1 (Murcia-West).    Rojas J, Echevarría P, Leal Costa C.     (3.85% -11.54%). However, body fat percentage was the indicator that had the highest score (11.54%) and was included in the proposal, due to its significance in the assessment of physical condition in the health field (21) .

Results
Regarding the star indicator raised by the group of experts, the cardiorespiratory capacity indicator was the one with the highest assigned score (34.62%), therefore, since it is an essential component of Physical Condition Related to Health (22) , we consider that this indicator is a priority in the study of the construct object of the present investigation.
As a final result of the study, the proposal of the nursing outcome, Physical Condition Related to Health, was developed and agreed to by 26 experts, comprised of seven indicators; this proposal is presented next to the original version, in Figure 3.

Condición física relacionada con la salud (cross-culturally adapted version, revised and proposed)
Definition: performance of physical activities with vigor.

Discussion
The vigor (17) , but also reflects the ability to perform the basic activities of daily life and maintain good health (9) .
Expert judgment is a fundamental procedure that would be framed within the content validity (24) . In addition to content validity, evidence of consensus validity is obtained that is obtained by feedback from the experts, and achieving agreement on the contents of the instrument. Mentioning the indicators of the nursing outcome studied, and according to the opinion of the experts consulted, since it is considered that the evaluation process conducted by a committee of experts on the content of the items demonstrates content validity of the adapted instrument for the other culture (25)(26) , two indicators of the original version have been preserved: muscle strength and body mass index, as they are all components of the physical condition in the health field (27) . On the other hand, six indicators existing in the original version were eliminated: performance of physical activities, performance of routine exercise, physical conditioning, blood pressure, target heart rate during exercise, and resting heart rate, since, although some authors (10) consider that the blood pressure indicator is a component of the physical condition related to health, it is not considered as a main component, as well as the other components (9,19) . Likewise, the components, and there is currently a deficit of instruments and studies written in Spanish that assess it (28) . Physical condition is an independent marker for cardiovascular disease risk (29) , although it can be immensely influenced by lifestyle (30) .
Currently there are few instruments that allow us to evaluate physical condition in a simple, economic, and accurate way (28) . Several authors have described easy-to-use instruments that do not require the use of highly sophisticated technological equipment, and that have been validated by questionnaires (31)(32) . However,