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Translation and cultural adaptation of the King’s Brief Interstitial Lung Disease health status questionnaire for use in Brazil

ABSTRACT

Objective:

To translate the King’s Brief Interstitial Lung Disease (K-BILD) questionnaire to Portuguese and culturally adapt it for use in Brazil. The K-BILD quantifies the health status of patients with ILD.

Methods:

The process involved the following steps: authorization from the author of the original (English-language) questionnaire; translation of the questionnaire to Portuguese by three translators, working independently; merging of the translations by a committee of specialists; back-translation of the questionnaire to English; revision and readjustment of the back-translation by the committee of specialists; evaluation by the original author; revision of the back-translation; cognitive debriefing (verification of the clarity and acceptability of the Portuguese-language version in the target population-i.e., patients with ILD); and finalization of the Portuguese-language version.

Results:

In the cognitive debriefing step, 20 patients with ILD were interviewed. After the interviews, the clarity and acceptability index of each question was ≥ 0.8, which is considered acceptable.

Conclusions:

The Portuguese-language version of K-BILD appears to be easily administered to and understood by patients with ILD in Brazil. To our knowledge, this is the only instrument in Brazilian Portuguese that is designed to evaluate the impact that ILD has on the various aspects of the lives of those it affects.

Keywords:
Lung diseases, interstitial; Pulmonary fibrosis; Surveys and questionnaires

RESUMO

Objetivo:

Traduzir e adaptar culturalmente o King’s Brief Interstitial Lung Disease (K-BILD) health status questionnaire, utilizado para mensurar o estado de saúde em pacientes com doença pulmonar intersticial (DPI), para a língua portuguesa falada no Brasil.

Métodos:

As seguintes etapas foram realizadas: autorização do autor do instrumento original; preparação; tradução do K-BILD da língua inglesa para a língua portuguesa falada no Brasil por três tradutores independentes; unificação das traduções por um comitê de especialistas; retradução do português para o inglês; revisão e readequação da retradução pelo comitê de especialistas; avaliação do autor do original; revisão da versão em inglês; desdobramento cognitivo (observação da clareza e aceitabilidade do questionário traduzido na população-alvo); e elaboração da versão final em português.

Resultados:

Na etapa de desdobramento cognitivo foram entrevistados 20 pacientes com DPI. Após todas as entrevistas, o índice de clareza e aceitabilidade das questões foi igual ou maior que 0,8, indicando um índice de clareza aceitável para todas as questões.

Conclusões:

A versão do K-BILD mostrou ser compreensível e de fácil aplicação. Até onde sabemos, esse é atualmente o único instrumento disponível em português falado no Brasil dirigido à avaliação do impacto da DPI em vários aspectos da vida desses pacientes.

Descritores:
Doenças pulmonares intersticiais; Fibrose pulmonar; Inquéritos e questionários

INTRODUCTION

Interstitial lung disease (ILD) is a term that refers to a group of chronic and progressive conditions characterized by inflammation and fibrosis of the lung parenchyma, directly associated with mortality.11 Coelho AC, Knorst MM, Gazzana MB, Barreto SS. Predictors of physical and mental health-related quality of life in patients with interstitial lung disease: a multifactorial analysis. J Bras Pneumol. 2010;36(5):562-70. https://doi.org/10.1590/S1806-37132010000500007
https://doi.org/10.1590/S1806-3713201000...
According to a study from 1994, the incidence of ILD in New Mexico, USA, was 26-32 cases per 100,000 population per year.22 Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994;150(4):967-72. https://doi.org/10.1164/ajrccm.150.4.7921471
https://doi.org/10.1164/ajrccm.150.4.792...
In Brazil, a survey conducted by the Department of Informatics of the Unified Health System showed that, in 2010 alone, the incidence of idiopathic pulmonary fibrosis was 4.84 cases per 1,000,000 population.33 Rufino RL, Costa CH, Accar J, Torres FR, Silva VL, Barros NP, et al. Incidence and mortality of interstitial pulmonary fibrosis in Brazil. Am J Respir Crit Care Med. 2013;187:A1458.

As described in the literature, patients with ILD often present with dyspnea symptoms that limit their physical activity levels.44 Patel AS, Siegert RJ, Brignall K, Gordon P, Steer S, Desai SR, et al. The development and validation of the King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire. Thorax. 2012;67(9):804-10. https://doi.org/10.1136/thoraxjnl-2012-201581
https://doi.org/10.1136/thoraxjnl-2012-2...
The quality of life of those patients depends on various factors, such as the symptoms of the disease itself, the side effects of drug therapy, the natural progression of respiratory dysfunction, and morbidity-related functional limitations.55 Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia. J Bras Pneumol. 2012;38(Suppl 2):S1-S133. ILDs are characterized by symptoms such as dyspnea, reduced lung volume, reduced gas exchange, reduced tolerance to exercise, diaphragmatic weakness, expiratory muscle fatigue after maximal exercise, and impaired peripheral muscle function. The condition also reduces patient quality of life and survival.66 Baldi BG, Salge JM. Respiratory muscles in interstitial lung disease: poorly explored and poorly understood. J Bras Pneumol. 2016;42(2):82-3. https://doi.org/10.1590/S1806-37562016000200002
https://doi.org/10.1590/S1806-3756201600...

7 Fischer A. Interstitial lung disease in suggestive forms of connective tissue disease. J Bras Pneumol. 2013;39(6):641-3. https://doi.org/10.1590/S1806-37132013000600001
https://doi.org/10.1590/S1806-3713201300...

8 Lal C, Strange C. Is systemic sclerosis interstitial lung disease slowly progressive? J Bras Pneumol. 2011;37(2):142-3. https://doi.org/10.1590/S1806-37132011000200002
https://doi.org/10.1590/S1806-3713201100...
-99 Santana PV, Prina E, Albuquerque ALP, Carvalho CR, Caruso P, et al. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging. J Bras Pneumol. 2016;42(2):88-94. https://doi.org/10.1590/S1806-37562015000000266
https://doi.org/10.1590/S1806-3756201500...

ILDs are often diagnosed late,1010 Baldi BG, Pereira CA, Rubin AS, Santana NC, Costa AN, Carvalho CR, et al. Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases. J Bras Pneumol. 2012;38(3):282-91. https://doi.org/10.1590/S1806-37132012000300002
https://doi.org/10.1590/S1806-3713201200...
mainly because of the limited knowledge of health care professionals and the lack of local resources. Different ILDs have different prognoses and treatments, and it is difficult to establish accurate prognoses for patients with newly diagnosed ILD, because the natural history of the disease can vary.1111 Baddini-Martinez J, Baldi BG, Costa CH, Jezler S, Lima MS, Rufino R. Update on diagnosis and treatment of idiopathic pulmonary fibrosis. J Bras Pneumol. 2015;41(5):454-66. https://doi.org/10.1590/S1806-37132015000000152
https://doi.org/10.1590/S1806-3713201500...

12 Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788-824. https://doi.org/10.1164/rccm.2009-040GL
https://doi.org/10.1164/rccm.2009-040GL...
-1313 Martinez FJ, Safrin S, Weycker D, Starko KM, Bradford WZ, King TE Jr, et al. The clinical course of patients with idiopathic pulmonary fibrosis. Ann Intern Med. 2005;142(12 Pt 1):963-7. https://doi.org/10.7326/0003-4819-142-12_Part_1-200506210-00005
https://doi.org/10.7326/0003-4819-142-12...
The treatment of ILD aims to improve patient health in a broad sense. The impact of treatment can be measured by means of the support of specific questionnaires (disease-specific instruments), which are more responsive than generic instruments.1414 Juniper EF. Validated questionnaires should not be modified. Eur Respir J. 2009;34(5):1015-7. https://doi.org/10.1183/09031936.00110209
https://doi.org/10.1183/09031936.0011020...

There is a shortage of specific instruments to measure the health status of patients with ILD. With the objective of developing a brief, easy-to-administer, validated tool, Patel et al.44 Patel AS, Siegert RJ, Brignall K, Gordon P, Steer S, Desai SR, et al. The development and validation of the King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire. Thorax. 2012;67(9):804-10. https://doi.org/10.1136/thoraxjnl-2012-201581
https://doi.org/10.1136/thoraxjnl-2012-2...
developed ILD-specific instruments. One of those is the King’s Brief Interstitial Lung Disease (K-BILD) health status questionnaire, which was originally written in English but has already been translated into several languages and adapted for use in different countries. The lack of specific instruments and objectives for certain diseases affects their diagnoses, as well as the choice of therapies and interventions.1515 Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417-32. https://doi.org/10.1016/0895-4356(93)90142-N
https://doi.org/10.1016/0895-4356(93)901...
,1616 Reichenheim ME, Moraes CL. Operationalizing the cross-cultural adaptation of epidemiological measurement instruments [Article in Portuguese]. Rev Saude Publica. 2007;41(4):665-73.) The process of developing such instruments is thorough and time-consuming. Therefore, translating and culturally adapting a questionnaire that has already been validated in another language for use in different countries and cultures can be extremely valuable for the evaluation, follow-up, and diagnosis of the patients for whom it was developed.1515 Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417-32. https://doi.org/10.1016/0895-4356(93)90142-N
https://doi.org/10.1016/0895-4356(93)901...
,1717 Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure [Article in Portuguese]. Rev Bras Reumatol. 1999;39(3):143-50.

In this context, the need for translating and culturally adapting this specific instrument (K-BILD), which measures the health status of patients with ILD, to Brazilian Portuguese is justified. The objective of the present study was to translate and culturally adapt the K-BILD questionnaire to Brazilian Portuguese.

METHODS

Our study focuses on the cultural adaptation and translation of a specific instrument (K-BILD) that measures the health status of patients with ILD for use in Brazil. The study was approved by the Human Research Ethics Committee of the Universidade do Sul de Santa Catarina (protocol no. 2.296.776/2017). The study is in accordance with the ethical precepts on research involving humans of the Brazilian National Health Council (Resolution 466/2012).

A process of translation and cultural adaptation should always evaluate the clarity, acceptability, comprehensibility, and reproducibility of the instrument in its target population. This is the step we denominate cognitive debriefing. To this end, all ILD patients who were undergoing treatment and having routine appointments at the Pulmonology Outpatient Clinic of the Hospital Universitário Polydoro Ernani de São Thiago of the Universidade Federal de Santa Catarina, located in the city of Florianópolis, Brazil) between October of 2017 and March of 2018 were invited to participate in the study.

The inclusion criteria were having a clinical diagnosis of ILD; being older than 18 years of age; being literate; and having given written informed consent for participation.

For the interview with the study participants, we used version 4 of the K-BILD questionnaire, already translated and adapted, to assess the comprehensibility and acceptability of each question. All the comments made by the participants were registered. The participants also completed a clinical survey covering the following topics: sociodemographic data, age, gender, ethnicity, marital status, level of education, ILD diagnosis, comorbidities, the modified Medical Research Council Dyspnea Scale classification,1818 Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, Aguar MC, et al. Chronic obstructive pulmonary disease and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med 1997;127(12):1072-9. https://doi.org/10.7326/0003-4819-127-12-199712150-00003
https://doi.org/10.7326/0003-4819-127-12...
and CT and spirometry findings for the diagnosis of ILD. Participation in the study did not incur in any expenses for participants, nor did it change the proposed treatment.

The methodology for translating and culturally adapting a questionnaire to a foreign language, different from the one in which the instrument was originally written, encompasses several steps. The steps of the protocol used in the present study were: 1) preparation: author’s authorization for the study (rights to use, translate, and culturally adapt the instrument); 2) translation of the K-BILD from English to Brazilian Portuguese: three people performed a blind translation of the questionnaire (two native speakers of Portuguese with fluency in English and one native speaker of English with fluency in Portuguese); 3) merging: comparison and merging of the three Portuguese translations to create one single version in Portuguese, designated version 1; 4) back-translation: a literal back-translation of version 1 into English by a native speaker of English who was fluent in Portuguese and who was blinded to the original questionnaire. This version was designated version 2 (in English); 5) revision and readjustment of the back-translation: comparison of the back-translation with the original English version. Because the two English versions were very similar, no changes had to be made; 6) evaluation by the original author: version 2 was sent to the author of the K-BILD for analysis. The author made comments about items 3 and 6 of the questionnaire. Based on these observations, a new version was created: version 3 (in English); 7) revision of version 3: analysis of version 3 by the review committee and preparation of version 4 (in Portuguese); 8) cognitive debriefing: in this step we applied the questionnaire to 20 patients with ILD who agreed to participate in the study; the objective was to assess the clarity of the instrument as a whole so as to enhance it and improve its comprehensibility. All items were analyzed according to the instrument’s Likert scale, and all comments made by the participants were registered; and 9) preparation of the final version: meeting of the review committee for the production of the final version of the instrument adapted for use in Brazil. Figure 1 illustrates the steps of the process.

Figure 1
Summary of the process of translation and cross-cultural adaptation of the King’s Brief Interstitial Lung Disease (K-BILD) questionnaire to Brazilian Portuguese.

RESULTS

During the study period, 95 patients with ILD were seen at the pulmonology outpatient clinic of the institution. Of those, 20 were included in the cognitive debriefing step of the study. The age of the participants ranged from 32 to 77 years, whereas the level of education ranged from complete primary education (50%), to complete secondary education (40%), and complete higher education (10%). The most common complaint was shortness of breath when exercising and performing activities of daily living-mentioned by 17 participants (85%), who had scores > 2 in the modified Medical Research Council scale.1818 Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, Aguar MC, et al. Chronic obstructive pulmonary disease and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med 1997;127(12):1072-9. https://doi.org/10.7326/0003-4819-127-12-199712150-00003
https://doi.org/10.7326/0003-4819-127-12...
Table 1 describes the clinical and functional status of the study participants.

Table 1
Characteristics of the participants in the study (N = 20).a

The versions produced by the translators generated no doubts or corrections. A back-translation of the K-BILD was done and sent to the author for evaluation, who responded with the following remarks: 1) in item 3: the original term “severe” had been back-translated as “severity”. The committee gave the author a complete explanation of the concept in Portuguese and he decided that the term “gravidade” or “severity” be kept; 2) in item 6, the author questioned the use of the word “tired” or “cansado” in Portuguese clarifying that the term should refer to a feeling of low self-esteem related to depression or, in his words, “feeling low in mood, like depression”. The committee, then, suggested replacing the term “cansado” or “tired” with “incomodado”, which means “annoyed”, “bothered”. The suggestion was well received by the author, who considered the semantics of the term equivalent to that of the original version. The committee of specialists’ revision conducted after this step showed no grammatical errors; the formatting of the questionnaire with a horizontal Likert scale was kept.

In the cognitive debriefing step, we asked about the participants’ understanding of each statement and how appropriate they thought it was. We gave a clarity score between 1 and 10 for each item based on participants’ understanding of the wording of that statement. On that occasion, we defined that scores between 1 and 4 would indicate a confusing statement that should be rewritten; scores between 5 and 7 would indicate an unclear statement that should be clarified; and scores between 8 and 10 would indicate a clear statement. To assess the clarity, acceptability, and comprehensibility of the instrument, each participant was asked to comment on each item with a score below 8.2020 Pasquali L. Princípios de elaboração de escalas psicológicas. Rev Psiq Clin. 1998;25(5):206-13.,2121 Pasquali L. Instrumentação psicológica: fundamentos e prática. Porto Alegre: Artmed; 2010. Questions with a clarity index above 80% were accepted without further corrections.

The clarity index was defined by calculating the mean of the sum of the item scores given by the participants. The clarity index of each question was: 1) 9.50; 2) 9.15; 3) 9.50; 4) 9.60; 5) 9.05; 6) 9.15; 7) 8.80; 8) 9.30; 9) 9.65; 10) 9.40; 11) 9.45; 12) 9.20; 13) 9.30; 14) 9.25; and 15) 9.45. All means were above 8.0; therefore, we did not need to modify any of the terms, and version 4 in Portuguese was kept as the final version.

All data were registered in a separate record (available to those involved in the study) and will be kept for 15 years. All the study data will be filed in the archives of the pulmonology outpatient clinic of the institution and kept confidential, in accordance with the national and international good clinical research practice guidelines.

DISCUSSION

In the present study we described the process of translating the K-BILD-an instrument for the assessment of the health status and quality of life of patients with ILD44 Patel AS, Siegert RJ, Brignall K, Gordon P, Steer S, Desai SR, et al. The development and validation of the King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire. Thorax. 2012;67(9):804-10. https://doi.org/10.1136/thoraxjnl-2012-201581
https://doi.org/10.1136/thoraxjnl-2012-2...
-to Brazilian Portuguese and its cultural adaptation for use in Brazil. The Portuguese version of the K-BILD that we developed (Supplement S1) is technically and semantically equivalent to the original version.44 Patel AS, Siegert RJ, Brignall K, Gordon P, Steer S, Desai SR, et al. The development and validation of the King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire. Thorax. 2012;67(9):804-10. https://doi.org/10.1136/thoraxjnl-2012-201581
https://doi.org/10.1136/thoraxjnl-2012-2...
The challenges of culturally adapting an instrument are manifold, and, given Brazil’s huge territory, there are many regional and sociocultural differences to be taken into consideration, in addition to the problem of the significant illiteracy rates in certain regions, which makes it even more difficult to adapt instruments like this and make sure they are comprehensible and relevant in the entire country. During the process of cultural adaptation, the committee of specialists analyzed the different domains addressed by the original instrument in terms of their relevance and appropriateness to the new cultural context and concluded they were all pertinent.2222 Sala-Sastre N, Herdman M, Navarro L, de la Prada M, Pujol RM, Serra C, et al. Principles and methodology for translation and cross-cultural adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) to Spanish and Catalan. Contact Dermatitis. 2009;61(2):109-16. https://doi.org/10.1111/j.1600-0536.2009.01576.x
https://doi.org/10.1111/j.1600-0536.2009...
In this process, words of common usage in oral register were chosen, aiming to facilitate the understanding of the questions. It is widely known that the level of education as well as reading and interpreting skills are very important variables in this type of population studies, which they may affect the results.1515 Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417-32. https://doi.org/10.1016/0895-4356(93)90142-N
https://doi.org/10.1016/0895-4356(93)901...
) Therefore, simple vocabulary words and shorter sentences were used to facilitate the reading by people with limited vocabulary and lower levels of education. Region-specific terms commonly found in oral and written Brazilian Portuguese were avoided.

After translating and back-translating the original instrument, we asked the target population about their understanding of the concepts addressed by the questionnaire. Their inputs enabled the committee of specialists to have a more comprehensive approach to their considerations and gave them more confidence in the semantic equivalence of the final version, decreasing the likelihood of it including inappropriate or ambiguous terms and, thus, creating a version that would be a good fit to the socioeconomic background of the target population. This process enabled us to achieve semantic (actual meaning of words) and idiomatic (interpretation of colloquialisms) equivalence. By adopting a strict methodology to reduce regionalism and, at the same time, making the most of this myriad of aspects that make up the Brazilian culture, the present study contributes to the efforts to provide the scientific community with a useful tool for assessing the health status of patients with ILD.

We expect that, with the validation of the K-BILD questionnaire in Portuguese, it can be used as a reference by multidisciplinary teams in Brazil providing ILD patients with follow-up and treatment, and contribute to the improvement of their quality of life. This questionnaire will also enable further studies on ILD, as it is an appropriate and effective instrument for assessing the health status of patients with this condition.

In conclusion, the K-BILD questionnaire has been successfully translated to Brazilian Portuguese and culturally adapted for use in Brazil. To our knowledge, it is the only instrument available in Portuguese to assess the impact of ILD on different aspects of life in patients with the disease.

REFERENCES

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    Coelho AC, Knorst MM, Gazzana MB, Barreto SS. Predictors of physical and mental health-related quality of life in patients with interstitial lung disease: a multifactorial analysis. J Bras Pneumol. 2010;36(5):562-70. https://doi.org/10.1590/S1806-37132010000500007
    » https://doi.org/10.1590/S1806-37132010000500007
  • 2
    Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994;150(4):967-72. https://doi.org/10.1164/ajrccm.150.4.7921471
    » https://doi.org/10.1164/ajrccm.150.4.7921471
  • 3
    Rufino RL, Costa CH, Accar J, Torres FR, Silva VL, Barros NP, et al. Incidence and mortality of interstitial pulmonary fibrosis in Brazil. Am J Respir Crit Care Med. 2013;187:A1458.
  • 4
    Patel AS, Siegert RJ, Brignall K, Gordon P, Steer S, Desai SR, et al. The development and validation of the King's Brief Interstitial Lung Disease (K-BILD) health status questionnaire. Thorax. 2012;67(9):804-10. https://doi.org/10.1136/thoraxjnl-2012-201581
    » https://doi.org/10.1136/thoraxjnl-2012-201581
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    Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia. J Bras Pneumol. 2012;38(Suppl 2):S1-S133.
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    Baldi BG, Salge JM. Respiratory muscles in interstitial lung disease: poorly explored and poorly understood. J Bras Pneumol. 2016;42(2):82-3. https://doi.org/10.1590/S1806-37562016000200002
    » https://doi.org/10.1590/S1806-37562016000200002
  • 7
    Fischer A. Interstitial lung disease in suggestive forms of connective tissue disease. J Bras Pneumol. 2013;39(6):641-3. https://doi.org/10.1590/S1806-37132013000600001
    » https://doi.org/10.1590/S1806-37132013000600001
  • 8
    Lal C, Strange C. Is systemic sclerosis interstitial lung disease slowly progressive? J Bras Pneumol. 2011;37(2):142-3. https://doi.org/10.1590/S1806-37132011000200002
    » https://doi.org/10.1590/S1806-37132011000200002
  • 9
    Santana PV, Prina E, Albuquerque ALP, Carvalho CR, Caruso P, et al. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging. J Bras Pneumol. 2016;42(2):88-94. https://doi.org/10.1590/S1806-37562015000000266
    » https://doi.org/10.1590/S1806-37562015000000266
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    Baldi BG, Pereira CA, Rubin AS, Santana NC, Costa AN, Carvalho CR, et al. Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases. J Bras Pneumol. 2012;38(3):282-91. https://doi.org/10.1590/S1806-37132012000300002
    » https://doi.org/10.1590/S1806-37132012000300002
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    Baddini-Martinez J, Baldi BG, Costa CH, Jezler S, Lima MS, Rufino R. Update on diagnosis and treatment of idiopathic pulmonary fibrosis. J Bras Pneumol. 2015;41(5):454-66. https://doi.org/10.1590/S1806-37132015000000152
    » https://doi.org/10.1590/S1806-37132015000000152
  • 12
    Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788-824. https://doi.org/10.1164/rccm.2009-040GL
    » https://doi.org/10.1164/rccm.2009-040GL
  • 13
    Martinez FJ, Safrin S, Weycker D, Starko KM, Bradford WZ, King TE Jr, et al. The clinical course of patients with idiopathic pulmonary fibrosis. Ann Intern Med. 2005;142(12 Pt 1):963-7. https://doi.org/10.7326/0003-4819-142-12_Part_1-200506210-00005
    » https://doi.org/10.7326/0003-4819-142-12_Part_1-200506210-00005
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    Juniper EF. Validated questionnaires should not be modified. Eur Respir J. 2009;34(5):1015-7. https://doi.org/10.1183/09031936.00110209
    » https://doi.org/10.1183/09031936.00110209
  • 15
    Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417-32. https://doi.org/10.1016/0895-4356(93)90142-N
    » https://doi.org/10.1016/0895-4356(93)90142-N
  • 16
    Reichenheim ME, Moraes CL. Operationalizing the cross-cultural adaptation of epidemiological measurement instruments [Article in Portuguese]. Rev Saude Publica. 2007;41(4):665-73.
  • 17
    Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure [Article in Portuguese]. Rev Bras Reumatol. 1999;39(3):143-50.
  • 18
    Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, Aguar MC, et al. Chronic obstructive pulmonary disease and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med 1997;127(12):1072-9. https://doi.org/10.7326/0003-4819-127-12-199712150-00003
    » https://doi.org/10.7326/0003-4819-127-12-199712150-00003
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    Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis. 1981;123(6):659-64.
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    Pasquali L. Princípios de elaboração de escalas psicológicas. Rev Psiq Clin. 1998;25(5):206-13.
  • 21
    Pasquali L. Instrumentação psicológica: fundamentos e prática. Porto Alegre: Artmed; 2010.
  • 22
    Sala-Sastre N, Herdman M, Navarro L, de la Prada M, Pujol RM, Serra C, et al. Principles and methodology for translation and cross-cultural adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) to Spanish and Catalan. Contact Dermatitis. 2009;61(2):109-16. https://doi.org/10.1111/j.1600-0536.2009.01576.x
    » https://doi.org/10.1111/j.1600-0536.2009.01576.x
  • 1
    Study carried out at Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil.
  • Financial Support:

    None

Publication Dates

  • Publication in this collection
    16 Sept 2019
  • Date of issue
    2019

History

  • Received
    28 June 2018
  • Accepted
    15 Jan 2019
Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br