Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire – Current Short (QUIP-CS) – Translation and validation of content of Portuguese Version

Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire – Current Short (QUIP-CS) – Tradução e validação de conteúdo em português do Questionário para Avaliação de Distúrbios Impulsivo-Compulsivos na Doença de Parkinson

ABSTRACT

Objective

Parkinson’s disease (PD) management is usually successfully reached with proper pharmacological treatment. However, PD patients can manifest neuropsychiatric symptoms secondary to medical therapy, including impulse control disorders (ICD), presenting as pathological gambling, hypersexuality, compulsive buying, drinking or eating disorders. We translated and validated the Portuguese version of the gold-standard questionnaire Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire, or (QUIP) for identifying ICDs in PD patients.

Methods

Translation, back translation and submission to instrument developer was performed, that approved its new version comparing it to his original, validated version, with no loss of it’s original properties. Then, the Portuguese version was administered to 30 PD patients. They also were asked to rate from 1 to 5 the level of comprehensibility of the questions.

Results

The average level of comprehension was 4.06 ± 0.69 DP, considering 3 or more as acceptable. No patient has answered 1 or 2.

Conclusion

Our results on Portuguese version of QUIP-CS show that QUIP-CS translated and corrected version was easily understood and easily self-applied.

Parkinson’s disease (PD); impulse-control disorders (ICD); Portuguese validation questionnaire for PD ICD

RESUMO

Objetivo

O manejo da doença de Parkinson (DP) é usualmente alcançado com sucesso com o tratamento farmacológico apropriado. Entretanto, os pacientes com DP podem manifestar sintomas neuropsiquiátricos secundários à terapêutica, como a síndrome de descontrole dos impulsos (SDI), que se apresenta como o jogar patológico, a hipersexualidade, o comprar, beber ou comer compulsivos. Traduzimos e validamos a versão em português do questionário padrão-ouro para identificação de transtornos impulsivo-compulsivos na DP (QUIP-CS) para identificar nesses pacientes a presença de SDI.

Métodos

Foram realizadas a tradução, a retrotradução e a submissão do instrumento ao desenvolvedor deste, que aprovou a nova versão comparando esta à sua, que já está validada, sem a perda das suas propriedades originais. Após, a versão em português foi administrada a 30 pacientes com o diagnóstico de DP. Eles também foram solicitados a classificar o nível de compreensibilidade das questões, graduando-as de 1 a 5.

Resultados

O nível médio de compreensão foi 4,06 ± 0,69 DP, considerando-se 3 ou mais como aceitável. Nenhum paciente respondeu 1 ou 2.

Conclusão

Os nossos resultados para a versão em português da QUIP-CS mostraram que essa versão, traduzida e corrigida, foi facilmente compreendida e aplicada pelos próprios pacientes.

Doença de Parkinson (DP); síndrome de descontrole de impulsos (SDI); validação para português de questionário para DP e SDI

INTRODUCTION

Parkinson’s disease (PD) patients can manifest several neuropsychiatric symptoms¹ that are in many cases related to treatments used to control PD². Impulse control disorders (ICD), which can present as pathological gambling, hypersexuality, compulsive buying, drinking, or eating disorders, deserve special consideration because they can be devastating to patients and their families³-⁵. Therefore it is extremely important to identify the subjects who have developed these conditions in order to treat them properly and avoid devastating complications and/or consequences.

ICDs are a group of psychiatric disorders and their essential feature is the failure to resist an impulse, drive, or temptation to perform an act harmful to either the self or others⁶. Reported occurrences in PD patients include compulsive gambling, buying, sexual, and eating behaviors⁷. Because no comprehensive assessment instruments for impulse control disorders existed, Weintraub et al.⁸ created and validated a scale to identify PD patients that developed ICDs called the QUIP – Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease. They also validated its psychometric properties. QUIP is a self-administered screening questionnaire for ICDs and other compulsive behaviors in patients with PD. The authors developed a shorter version, the QUIP-CS (current symptoms, short form), composed of 13 questions. They recommend the use of this version as follows:

“The median completion time for the QUIP (30 questions total) was 5 minutes. We estimate that the median completion time for the QUIP-S (13 questions total) is 3 minutes. Although the shortened version was not formally tested, we do recommend it for routine use as the specific questions and overall structure of the instrument were not modified in any way. Clinicians or clinical researchers who want the additional information provided by the full questionnaire may choose to administer this version”⁸.

The term current means that it can be applied at the any moment during evaluation of a patient suffering from PD⁸.

With the ever increasing spread of information, the need to adapt already validated scales to other languages and cultures is also growing⁹-¹¹. Being that most questionnaires are developed in English-speaking countries¹², they must be adapted not only to new languages but also culturally adapted to maintain the content validity of the instrument at the conceptual level across different cultures¹³.

The aim of this study was to translate and validate the Portuguese content of the Portuguese version of the gold-standard scale for identifying PD ICDs, the Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire – Current Short (QUIP-CS)⁶.

METHODS

The process used for translation and adaptation of the Portuguese version was used by Bernstein¹⁴ and Grassi-Oliveira¹⁵. Because QUIP and its shortened version have already been validated, we intend to validate only the Portuguese version of the latter (QUIP-CS), in order to use it for Brazilian and other Portuguese-speaking PD patients.

The project of validation was approved by HCPA’s Institutional Review Board (IRB) and was registered at Plataforma Brasil, a Brazilian agency that regulates research involving humans subjects as well as clinical trials.

The initial step was translation to Portuguese by a professional translator, used by one of authors (GV who applied it in previous study)¹⁶. The second step was showing this first translation to 5 PD neurologist specialists in Movement Disorders. They were asked to state if the questions were comprehensible and, if not, provide the reason and to give suggested modifications. Four of them found it comprehensible, with only the fifth suggesting minor modifications. This new Portuguese revised version was then back translated to English by two independent native English speakers. They were both asked to compare each of their versions and check for differences. Subsequently, they contacted each other and produced a final back translated version. This was then sent to the original author (Daniel Weintraub), who approved this new version comparing it to his original validated version, with no loss of original properties.

Finally, after signing the informed consent form, the Portuguese corrected version was applied to 65 random patients undergoing Dopaminergic Agonist (DA) therapy at a PD ambulatory center at HCPA. Then 30 of these patients were asked to answer a number of questions that would determine their level of comprehension of the QUIP-CS questions. These 30 subjects were chosen according to guidelines previously mentioned⁹. The final Portuguese revised version is presented in Figure 1. The original QUIP-CS scale can be found in the original manuscript⁸.

Figure 1
Questionário para avaliação de distúrbios impulsivo-compulsivos na doença de Parkinson (em qualquer momento durante um curto episódio de DP) – Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire – Current Short (QUIP-CS)

The evaluation of the scale’s comprehension was rated as: 1) No understanding at all; 2) Little understanding; 3) Rough understanding; 4) Good comprehension, but some doubts; and 5) Perfect understanding with no doubts. Values from 3 to 5 were considered good responses. No patient answered 1 or 2.

Statistical analysis

Statistical analysis was preformed using SPSS version 17.0. Categorical values were described using absolute frequency and percent of relative frequency. Quantitative measures were described when they had symmetrical distribution, by mean and standard deviation.

RESULTS

Demographic data are presented in Table 1.

Table 1
Demographic data (n = 65 patients)

	Mean	SD
Age (years) Min 40 years/max 90 years	67.1	10.7
Gender Male (n = 35) Female (n = 30)	53.8% 43.2%
Time of PD* (years)	13.48	5.62
Time of DA** using (years)	12.8	5.7
Hoehn & Yahr (H & Y) min 2/max 4	2.62	0.94
Civil status Single Married Widowed	12.5% 56.3% 31.3%
Schoolarship Elementary school any level Elementary school complete High school any level Any other than above	45.5% 9.1% 46.4% 0%
Family income 1 to 5 minimun wage 5 to 10 minimun wage > 10 minimun wage	45.5% 9.1% 46.4%
Psychiatric diagnosis*** made before PD* diagnosis – Yes (total) Anxiety Depression Both (a & d) Unknown None	29.4% 10.1% 7% 7% 5.3% 70.6%
Smoking Yes No	40% 60%
Ilicit drugs use	0
Family history of psychiatric disease (anxiety, depression, bipolar disorder)*** Yes No	38.9% 61.1%
Use of DA* more than 6 months Yes No	96.6% 3.4%
MMSE+ Min 6/max 30	25.86	4.68
MoCA++ min 3/max 30	21.83	6.58

• DA = dopaminergic agonist; ** PD = Parkinson’s disease; *** Psychiatric diagnosis before PD collected on medical records.
• ⁺ MMSE = Mini Mental State Examination.
• ⁺⁺ MoCA = Montreal Cognitive Assessment.

Frequency of ICD found in individual questions is presented in Table 2.

Table 2
Frequency of ICD (n = 65 patients)

Question	Number of patients with positive answers (by item)
A1	1
A2	0
B1	0
B2	5
C1	7
C2	5
D1	9
D2	5
E1	6
E2	8
E3	0
F1	0
F2	0

The primary impulse control disorders identified were compulsive eating (13.84%), repetition of a certain motor activity (12.3%), compulsive buying (10.76% ), doing specific tasks (9.2%), followed by the desire to eat and buy (7.69% each).

The average level of comprehension of the questions was 4.06 ± 0.69 DP (n = 30 patients), considering three or more as acceptable. No patient answered 1 or 2.

DISCUSSION

As ICDs are often side-effects of PD treatments using dopamine replacement therapy, the patients affected must be quickly identified so they can be properly managed. The QUIP-CS is available for free, easy to access, fast, and a scientifically-tested method to do just this.

Information on these conditions are rare in Brazilian patients¹⁷. Thus, we believe it is underreported in Brazilian literature, due to the fact that there have not been any valid instruments to identify ICDs in affected individuals. The availability of this questionnaire should improve the assessment of this population.

Our results using the newly developed Portuguese version of QUIP-CS show that the QUIP-CS in its translated version was easily understood by Portuguese native speakers.

Our process measured content validity¹³ not testing for psychometric properties. As the psychometric properties of the QUIP were already tested as part of the validation process in English, we did not repeat the process here.

However, we do intend to translate and validate the content of this Portuguese version of the QUIP-CS in future research.

We also plan to disseminate research on this particular subject using this validated version, to reach a better understanding of our Portuguese-speaking population, considering regional and local differences.

A limitation of our study is that it does not test for psychometric properties, as previously discussed, as it was outside of the scope of this paper.

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Publication Dates

• Publication in this collection
  Apr-Jun 2017

History

• Received
  5 Jan 2017
• Accepted
  7 Jan 2017