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ORIGINAL ARTICLE • Rev. bras. ortop. 51 (03) • May-Jun 2016 • https://doi.org/10.1016/j.rboe.2015.08.020   copy

Translation and transcultural adaptation of the Hip Fracture Recovery Score assessment tool☆ ☆ Study carried out at the Department of Orthopedics and Traumatology, Instituto Doutor José Frota de Fortaleza, Fortaleza, CE, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

The Hip Function Recovery Score questionnaire is an instrument that was developed for evaluating the functional recovery of patients over 60 years of age who undergo surgical treatment due to hip fractures. The objective of this study was to make a thorough transcultural translation of this questionnaire, with adaptation to the individual and cultural traits of the Brazilian population.

METHOD:

This translation method consisted of initial translation, back translation, drafting of a consensual version and pretesting with comments invited. Subsequently, a final version was drawn up after making the necessary adjustments, without altering the semantics of the questions in the original text.

RESULTS:

The consensual version was applied to thirty patients over the age of 60 years who had undergone surgical treatment due to hip fractures. However, some difficulties in understanding some words and expressions were observed, and these were then replaced with terms that were more easily understood. After the final version had been drawn up, this was applied to the same patients and full understanding was achieved among some of them, without altering the semantics of the questions of the original text.

CONCLUSION:

The transcultural translation of the Hip Function Recovery Score will have an immediate impact on functional evaluations on patients over 60 years of age who underwent surgery due to hip fracture. It will subsequently be possible for other Brazilian scientific studies to use this questionnaire, which has been standardized and adapted to Brazilian culture, in order to make comparisons between results, thereby enriching Brazilian scientific production.

Keywords:
Hip/surgery; Functional evaluation; Translation; Questionnaire

RESUMO

OBJETIVO:

O questionário Hip Function Recovery Score consiste em um instrumento desenvolvido para avaliação da recuperação funcional de pacientes acima de 60 anos submetidos a tratamento cirúrgico devido a fraturas do quadril. O objetivo deste estudo foi fazer a tradução transcultural de forma criteriosa do questionário e adaptá-lo às características individuais e culturais da população brasileira.

MÉTODO:

Este método consiste em tradução inicial, retrotradução, elaboração de uma versão de consenso e pré-teste comentado com posterior elaboração de uma versão final após as alterações necessárias sem modificar a semântica das perguntas do texto original.

RESULTADOS:

A versão de consenso foi aplicada em 30 pacientes, acima de 60 anos, que foram submetidos a tratamento cirúrgico devido a fraturas do quadril. Foram observadas, entretanto, algumas dificuldades no entendimento de algumas palavras e expressões, as quais foram substituídas por termos de mais fácil entendimento. Após a elaboração da versão final, reaplicou-se essa versão aos mesmos pacientes e obteve-se um entendimento total.

CONCLUSÃO:

A tradução transcultural do questionário terá impacto imediato na avaliação funcional dos pacientes com mais de 60 anos operados devido a fraturas do quadril e, posteriormente, outros trabalhos nacionais podem usar esse questionário padronizado e adaptado à nossa cultura para comparação de resultados e enriquecer a produção científica do Brasil.

Palavras-chave:
Quadril/cirurgia; Avaliação funcional; Tradução; Questionário

Introduction

Hip fractures include transtrochanteric, femoral head/neck and acetabulum fractures. This group of fractures occurs in all age groups and is a major problem for the Brazilian public health system. The most affected population is the geriatric group, as the incidence of hip fractures increases with age and doubles every 10 years after age 50.11. Skinner HB. Current diagnosis & treatment in orthopedics. 4th ed. Califórnia: Lange Medical Books/McGraw-Hill; 2006.

The increasing life expectancy of the population in recent decades, associated with a more active lifestyle of the elderly and comorbidities found in this population, such as the reduced lean mass, balance, reflexes and bone mineral density results in osteopenia and osteoporosis and has led to an increase in fractures in the geriatric population.22. Woo J, Hong A, Lau E, Lynn H. A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age Ageing. 2007;36(3):262-8.

Mortality after hip fractures is close to 10% in the first month and approximately 30% in one year. Among patients who survive, many develop a reduction in mobility and degree of independence.33. McBride TJ, Panrucker S, Clothier JC. Hip fractures: public perceptions. Ann R Coll Surg Engl. 2011;93(1):67-70.

Most studies have focused primarily on the mortality caused by these traumas. However, studies assessing morbidity, or loss of function post-fracture, are less common.44. Guimarães FAM, Lima RR, Souza AC, Livan B. Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur. Rev Bras Ortop. 2011;46 Suppl. 1:48-54. Surgical treatment of hip fractures is considered the gold standard, as it reduces some complications related to prolonged immobilization, such as thromboembolic events and pressure ulcers.55. Legnani C, Dondi A, Pietrogrande L. Conservative treatment of a femoral neck fracture following nail removal. J Midlife Health. 2013;4(3):191-4.

Due to the increasing incidence of hip fractures, and, consequently, a higher number of surgical procedures for this type of trauma, it becomes necessary to evaluate the degree of independence and quality of life of patients after they have undergone surgery. One way to evaluate the functional results after surgical treatment of hip fractures is through questionnaires, aiming to follow the improvement or not of daily functions in patients' life.

A study applied a questionnaire to 537 elderly patients with hip fracture with three parameters, self-care, transfers and locomotion, to measure the degree of patients' independence after the surgical repair.66. Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;(425):64-71. Subsequently, another study involved 154 fractures of the proximal third of the femur treated surgically and used the Hip Function Recovery Score questionnaire () created by Zuckerman et al.77. Zuckerman JD, Koval KJ, Aharonoff GB, Hiebert R, Skovron ML. A functional recovery score for elderly hip fracture patients: I. Development. J Orthop Trauma. 2000;14(1):20-5.,88. Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML. A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma. 2000;14(1):26-30.and99. Zuckerman JD. Hip fracture. N Engl J Med. 1996;334(23):1519-25. It consists of 11 questions related to the activities of daily living: four related to independence in basic activities, six to instrumental activities and one to mobility.1010. Guerra MTE, Thober TA, Bigolin AV, Souza MP, Echeveste S. Fratura do quadril: avaliação pós-operatória do resultado clínico e funcional. Rev Bras Ortop. 2010;45(6):577-82. However, this questionnaire was used in its original version, in the English language, after its literal translation.1010. Guerra MTE, Thober TA, Bigolin AV, Souza MP, Echeveste S. Fratura do quadril: avaliação pós-operatória do resultado clínico e funcional. Rev Bras Ortop. 2010;45(6):577-82.

We know the importance of the translation into Portuguese of questionnaires originally written in English and also the adaptation of these questionnaires to individual and cultural characteristics of the local population to make them appropriate to the cultural context of the target population.1111. Oliveira LP, Moura CT, Nunes CDC, Cavalheiro QM, Cavalli PG. Tradução e adaptação cultural do Hip Outcome Score para a língua portuguesa. Rev Bras Ortop. 2014;49(3):297-304.and1212. Marx FC, Oliveira LM, Bellini CG, Ribeiro MCC. Tradução e validação cultural do questionário algofuncional de Lequesne para osteoartrite de joelhos e quadris para a língua portuguesa. Rev Bras Reumatol. 2006;46(4):253-60. Therefore, a standardized translation of English language questionnaires into Portuguese is fundamental for an accurate assessment of the information extracted from these translated questionnaires, which allows a better comparison of scientific studies covering different surgical techniques and different rehabilitation programs in patients that suffered fractures involving the hip and submitted to surgical treatments.

Therefore, we aim to carry out the accurate cross-cultural translation of the Hip Function Recovery Score questionnaire prepared by Zuckeman et al.,77. Zuckerman JD, Koval KJ, Aharonoff GB, Hiebert R, Skovron ML. A functional recovery score for elderly hip fracture patients: I. Development. J Orthop Trauma. 2000;14(1):20-5.and88. Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML. A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma. 2000;14(1):26-30. and adapt it to individual and cultural characteristics of the Brazilian population.

Material and methods

The present is a cohort, qualitative, observational study, considering that no interventions were performed while patients were followed by the hospital trauma team. Thus, we provide only an evaluation of the questionnaires and assess the possible difficulties in understanding by those participating in the research.

The method of translation and cultural adaptation of the Hip Function Recovery Score questionnaire (Table 1) into Brazilian Portuguese used the criteria described by Guillemin et al.1313. 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. and Heruti et al.1414. Heruti RJ, Lusky A, Barell V, Ohry A, Adunsky A. Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Arch Phys Med Rehabil. 1999;80(4):432-6. and reviewed by Beaton et al.,1515. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross- cultural adaptation of self- report measures. Spine (Phila Pa 1976). 2000;25(24):3186-91. which consists in a standardized set of instructions for cultural adaptation of quality of life tools, which briefly include four steps: initial translation, back translation, consensus translation and pretest.

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Table 1
Translation of the Hip Function Recovery Score questionnaire.

This standardization aims to achieve a cultural adaptation of expressions so there is no loss of semantics during the translation process.1616. Carneiro MB, Alves DPL, Mercadante MT. Fisioterapia no pós-operatório de fratura proximal do fêmur em idosos. Revisão da literatura. Acta Ortop Bras. 2013;21(3):175-8. This method of translation consists of an initial translation, followed by a back translation and then an assessment of the versions followed by the development of a consensus version and commented pretest, followed by the creation of the final version.

Initially, the Hip Functional Recovery Score questionnaire, in its original version in English, was translated into Portuguese by two certified, independent and bilingual translators, whose native language is Portuguese and who are fluent in English (Table 1). Subsequently, both versions were compared and a consensus version was created. This version was then back-translated into English by two bilingual translators, whose native language is English and who are fluent in Portuguese and reside in Brazil (Table 2). The translators responsible for the back-translation had no knowledge of the original version of the questionnaire in English.

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Table 2
Back translation of the consensus version of the Hip Functional Recovery Score questionnaire.

Both obtained translated versions were assessed by a panel consisting of translators, medical researchers and a teacher of Portuguese, so that, by comparing it with the original text, discrepancies could be corrected and a consensus version created (Table 2).

The consensus version was used as pre-test and applied to 30 patients and caregivers of patients that suffered hip fractures older than 60 years, who underwent surgical treatment in a referral hospital in traumatology, to assess the understanding and acceptability of the tool and to estimate possible necessary changes due to difficulties found by researchers and patients when the questionnaire was applied. The questionnaire was not applied to patients or caregivers who did not have a reasonable degree of orientation and/or satisfactory cognition in response to the questionnaires, so that there was no interference on the results regarding the understanding of the questions.

All patients invited to participate in the study were instructed on the study principles and signed an informed consent form. The present study was assessed and approved by an Institutional Review Board and is in accordance with Resolution 466/12.

After a consensus version was applied, meetings were held with a hip surgeon, also a member of the team involved with the research, to assess the difficulties encountered by patients and those applying the consensus version. Based on the suggestions, the final Portuguese version of the Hip Function Recovery Score questionnaire () was created, including some explanations in brackets for those expressions considered difficult to understand.

Subsequently, the new questionnaire, after the necessary changes were made, was reapplied to the same patients.

Results

A great similarity was observed between the two translators' versions (T1 and T2). When the terms were not identical, we chose the translation we thought was easier to understand by the assessed individuals. Table 1 shows the original version together with the two translations made by certified translators.

Among the differences found in the translations, we chose the version of translator 1 for the item 'bath', as we realized that the bathtub is not present in the daily lives of most of the population. We chose the translation of "capacity to shower". For the item 'feeding', we choose translation 2, as we considered it easier to understand the expression "to handle food" instead of "food manipulation", in addition to choosing the term "enteral feeding" instead of "feeding tube", as it best characterizes the use of the tool that aids nutrition. We also realized that there were differences in the translation of the word bedpan and obtained as translations the words "aparador" and "comadre". We selected "aparador", as initially translated by translator 1. Another topic that generated discussion was the translation of the word "bending" in the item "housework", shown as "flexion" (T1) and "bow" (T2). In this case we chose the expression used by translator 1. Another important disparity occurred in the component "mobility", for which we chose translation 2, as it refers to walking outdoors, does not use the expression walking in the external environment.

After drafting the consensus version, we applied this version to 30 patients in order to assess comprehension, semantic equivalence, possible cultural discrepancies and analyzed the concept of the proposed translation. From the point of view of understanding the questionnaire, there was no difficulty in understanding the translated words. However, there was difficulty regarding some habits of the Brazilian population. Analyzing items that refer to "doing laundry", "housework" and "food preparation", we observed that elderly men are not used to doing domestic chores and have difficulty answering these items. In the item "buying food", we expanded the possibilities of shopping in stores to include shopping at the supermarket, bakery and grocery store because culturally, women in Brazil do more shopping in supermarkets, while men do the usual everyday shopping in bakeries and grocery stores (e.g., to buy bread).

In the item "domestic work", we chose to put between parentheses the words "lifting" and "bending" when referring to the words elevation and flexion, respectively, with the use of such words to increase understanding by the respondents.

After the suggested modifications were made in agreement with the authors during the application of the consensus version, the final version of the Hip Function Recovery Score questionnaire was drawn up. This version can be seen in and was applied to the 30 previously assessed patients. At the reapplication, full understanding was achieved by the patients with respect to the semantics.

Discussion

Orthopedists usually evaluate their surgical results based on parameters such as positioning of the synthesis material, bone healing rate, percentage of infection and range of motion. However, particularly in the elderly, a satisfactory surgical procedure, from the technical point of view, does not necessarily result in good functional results. Based on that fact, we aimed to bring to the Brazilian medical community the transcultural standardized translation of a globally well-known functional assessment questionnaire, which had several citations in national medical literature, previously used in its literal translation version, but without the concern to adapt it to the cultural reality of our country, which prevents the comparison between national articles.

Among the factors that most often influence the loss of functional capacity are: functional dependence prior to the fracture, number of comorbidities, advanced age, loss of cognitive ability and low functional capacity at the time of hospital discharge.1717. Guimarães FAM, Lima RR, Souza AC, Livani B, Belangero WD. Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur. Rev Bras Ortop. 2011;46 Suppl. 1:48-54. Factors such as female gender, absence of diabetes mellitus, capacity of independent ambulation and not living alone before the fracture can be factors of better prognosis.1818. Semel J, Gray JM, Ahn HJ, Nasr H, Chen JJ. Predictors of outcome following hip fracture rehabilitation. PMR. 2010;2(9):799-805.

Associated comorbidities have been recorded as precursors of mortality after hip fractures. The effect of comorbidity on mortality has been measured both by the number and the type of coexisting diseases. Patients with more coexisting diseases have a higher chance of dying.1919. Souza RC, Pinheiro RS, Coeli CM, Camargo Junior KR, Torres TZG. Aplicação de medidas de ajuste de risco para a mortalidade após fraturar proximal de fêmur. Rev Saúde Pública. 2007;41(4):625-31.

In this type study, we decided to alter the structure of the original tool as little as possible, by not including or excluding items of the questionnaire, so as not to promote major changes of the psychometric properties and allow the comparison of versions.

We sought to ensure homogeneity between the versions, changing only minor differences in cultural habits of life, which are relevant for the local population. Certified translators who participated in the work were interpreters/translators from different health areas, in order to minimize technical terms that could hinder the understanding by the general population.

In the pre-test, there were some difficulties in understanding some terms, which after further discussion and creation of the final version, showed easy reproducibility and understanding among patients after the new application.

Conclusion

The process of translation and cultural adaptation of questionnaires created in a foreign language must be carried out very carefully, as was done with the Hip Fracture Recovery Score questionnaire. We obtained an excellent understanding by the respondents of the questions after the preparation of the final Brazilian version. Subsequent scientific manuscripts will be able to use this standardized questionnaire, which can be used to compare the results in the assessment of several treatments and rehabilitation programs of elderly patients submitted to surgeries due to hip fractures and improve the national scientific production.

Acknowledgements

To all patients who contributed to this study.

References

  • 1
    Skinner HB. Current diagnosis & treatment in orthopedics. 4th ed. Califórnia: Lange Medical Books/McGraw-Hill; 2006.
  • 2
    Woo J, Hong A, Lau E, Lynn H. A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age Ageing. 2007;36(3):262-8.
  • 3
    McBride TJ, Panrucker S, Clothier JC. Hip fractures: public perceptions. Ann R Coll Surg Engl. 2011;93(1):67-70.
  • 4
    Guimarães FAM, Lima RR, Souza AC, Livan B. Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur. Rev Bras Ortop. 2011;46 Suppl. 1:48-54.
  • 5
    Legnani C, Dondi A, Pietrogrande L. Conservative treatment of a femoral neck fracture following nail removal. J Midlife Health. 2013;4(3):191-4.
  • 6
    Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;(425):64-71.
  • 7
    Zuckerman JD, Koval KJ, Aharonoff GB, Hiebert R, Skovron ML. A functional recovery score for elderly hip fracture patients: I. Development. J Orthop Trauma. 2000;14(1):20-5.
  • 8
    Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML. A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma. 2000;14(1):26-30.
  • 9
    Zuckerman JD. Hip fracture. N Engl J Med. 1996;334(23):1519-25.
  • 10
    Guerra MTE, Thober TA, Bigolin AV, Souza MP, Echeveste S. Fratura do quadril: avaliação pós-operatória do resultado clínico e funcional. Rev Bras Ortop. 2010;45(6):577-82.
  • 11
    Oliveira LP, Moura CT, Nunes CDC, Cavalheiro QM, Cavalli PG. Tradução e adaptação cultural do Hip Outcome Score para a língua portuguesa. Rev Bras Ortop. 2014;49(3):297-304.
  • 12
    Marx FC, Oliveira LM, Bellini CG, Ribeiro MCC. Tradução e validação cultural do questionário algofuncional de Lequesne para osteoartrite de joelhos e quadris para a língua portuguesa. Rev Bras Reumatol. 2006;46(4):253-60.
  • 13
    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.
  • 14
    Heruti RJ, Lusky A, Barell V, Ohry A, Adunsky A. Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Arch Phys Med Rehabil. 1999;80(4):432-6.
  • 15
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross- cultural adaptation of self- report measures. Spine (Phila Pa 1976). 2000;25(24):3186-91.
  • 16
    Carneiro MB, Alves DPL, Mercadante MT. Fisioterapia no pós-operatório de fratura proximal do fêmur em idosos. Revisão da literatura. Acta Ortop Bras. 2013;21(3):175-8.
  • 17
    Guimarães FAM, Lima RR, Souza AC, Livani B, Belangero WD. Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur. Rev Bras Ortop. 2011;46 Suppl. 1:48-54.
  • 18
    Semel J, Gray JM, Ahn HJ, Nasr H, Chen JJ. Predictors of outcome following hip fracture rehabilitation. PMR. 2010;2(9):799-805.
  • 19
    Souza RC, Pinheiro RS, Coeli CM, Camargo Junior KR, Torres TZG. Aplicação de medidas de ajuste de risco para a mortalidade após fraturar proximal de fêmur. Rev Saúde Pública. 2007;41(4):625-31.
  • ☆
    Study carried out at the Department of Orthopedics and Traumatology, Instituto Doutor José Frota de Fortaleza, Fortaleza, CE, Brazil.

Annex 1. Final version of the Hip Fracture Recovery Score questionnaire in Brazilian Portuguese

Banho
(P) Você pode tomar um banho ou ducha por si mesmo(a)?
(4) a. Capaz de tomar um banho, banho com esponja ou chuveiro (pode incluir o uso de acessórios: tamborete, banco, cadeira, corrimão);
(3) b. Precisa de ajuda com a lavagem de uma única parte do corpo (por exemplo, costas, extremidade deficiente ou pés) ou precisa de um observador;
(2) c. Precisa de ajuda para entrar e sair da banheira;
(1) d. Precisa de ajuda para lavar mais de uma parte do corpo;
(0) e. Sempre precisa ser banhado(a) por outras pessoas.
Vestir
(P) Você pode vestir-se por si mesmo(a)?
(4) a. Capaz de vestir as roupas, calçar sapatos, meias e lidar com botões/zíperes (exclui atar os cadarços);
(3) b. Precisa de ajuda com botões e zíperes;
(2) c. Precisa de ajuda com sapatos e meias (em uma ou ambas as pernas);
(1) d. Precisa de ajuda com até 3 itens;
(0) e. Sempre precisa ser vestido(a) por outras pessoas.
Alimentar-se
(Q) Você consegue se alimentar?
(4) a. Consegue apanhar a comida do prato, cortar e colocar na boca;
(3) b. Necessita de outros para pré-cortar sua carne;
(2) c. Necessita de assistência para manipular a comida (ex. passar manteiga no pão);
(1) d. Sempre necessita ser alimentado por outros;
(0) e. Não come nada, alimenta-se por via intravenosa ou alimentação por sonda;
Ir ao banheiro
(P) Você pode usar o banheiro por si mesmo(a)?
(4) a. Capaz de ir ao banheiro, sentar e levantar do sanitário, manusear as roupas e limpar os órgãos de excreção (pode incluir o uso de suportes mecânicos);
(3) b. Precisa de ajuda para sentar e levantar do sanitário; OU
c. Manuseia o próprio aparador (apenas para uso durante a noite);
(2) d. Precisa de ajuda com sentar e levantar do sanitário e ajustar as roupas;
(1) e. Precisa de ajuda com a limpeza dos órgãos de excreção;
(0) f. Veste fraldas ou usa um cateter, pinico ou aparador em todos os momentos.
Compra de alimentos
(P) Você pode comprar os seus próprios alimentos?
(4) a. Capaz de ir até a loja (supermercado, padaria e mercearia), escolher alimentos, colocar os itens no carrinho e carregar/mover sobre rodinhas os alimentos para casa;
(3) b. Precisa de ajuda para ir até a loja (supermercado, padaria e mercearia); OU
c. Capaz de fazer pequenas compras de forma independente; OU
d. Precisa de ajuda para levar os alimentos para casa; OU
e. O paciente é capaz de fazê-lo, mas outra pessoa o faz mesmo assim.
(2) f. Precisa de ajuda com a escolha dos alimentos: inseguro(a) sobre o que precisa comprar; OU
g. Sempre deve ser acompanhado(a) (por exemplo, deficiências físicas, psicológicas, visuais);
(1) h. Precisa de ajuda com duas ou mais tarefas associadas às compras de alimentos;
(0) i. Completamente incapaz de fazer compras.
Trabalho doméstico
(P) Você pode trabalhar por si mesmo(a)?
(4) a. Capaz de manter o lar sozinho(a) ou com ajuda ocasional (por exemplo, ajuda doméstica para limpeza pesada);
(3) b. Capaz de executar todas as tarefas de manutenção do lar com assistência (por exemplo, elevação [erguer-se]/flexão [curvar-se]); OU
c. Paciente é capaz de fazê-lo, mas outra pessoa o faz mesmo assim;
(2) d. Capaz de executar as tarefas diárias durante o dia que não requerem flexão (curva-se);
(1) e. Precisa de ajuda com as tarefas domésticas leves;
(0) f. Não pode participar em quaisquer tarefas de limpeza do lar.
Lavar a roupa
(Q) Você faz a lavagem de roupa sozinho?
(4) a. Consegue ir à lavanderia/área de serviço, carregar e descarregar a máquina de lavar e usar a máquina ou consegue lavar tudo a mão;
(3) b. Necessita de assistência para ir à lavanderia/área de serviço; OU
c. Necessita de assistência para pendurar a roupa (incapaz de alcançar); OU
d. O paciente conseguiria lavar a roupa se ele/ela tivesse máquina de lavar em casa; OU
e. O paciente é capaz de fazer isso, mas outra pessoa faz;
(2) f. Consegue roupas delicadas e pessoais à mão; OU
g. Necessita de assistência para carregar e descarregar a máquina de lavar;
(1) h. Consegue ir à lavanderia, mas precisa de outros para fazer todo o resto;
(0) i. Toda a lavagem de roupa deve ser feita por outros.
Preparar a comida
(Q) Você consegue preparar sua comida sozinho?
(4) a. Consegue ficar de pé ou sentar na cozinha e preparar uma pequena refeição ou sanduíche;
(3) b. O paciente consegue fazer isso, mas outra pessoa faz;
(2) c. Consegue preparar uma pequena refeição ou sanduíche se tiver os ingredientes à mão;
(1) d. Consegue apenas reaquecer comidas preparadas;
(0) e. Deve ter todas as refeições preparadas por outros.
Banco/Finanças
(P) Você pode fazer as suas próprias operações bancárias e cuidar de suas finanças?
(4) a. Capaz de gerir questões financeiras (vai ao banco, faz transações, lida com dinheiro e conta corrente e mantém o controle de renda);
(3) b. Precisa de ajuda para ir ao banco e voltar; OU
c. Faza pagamentos e operações bancárias por correio; OU
d. Não pode ir até o banco, mas é capaz de executar todas as outras tarefas financeiras; OU
e. Paciente é capaz de fazê-lo, mas outra pessoa o faz mesmo assim;
(2) f. Capaz de gerir as compras do dia a dia, mas precisa de ajuda com operações bancárias e grandes compras;
(1) g. Precisa ser levado até o banco e requer outras pessoas para lidar com transações e todas as outras necessidades financeiras;
(0) h. Incapaz de lidar com quaisquer questões financeiras.
Uso de transporte
(P) Você pode usar o ônibus, trem, carro ou táxi por si mesmo(a)?
(4) a. Capaz de viajar de forma independente no transporte público (ou seja, capaz de entrar e sair do ônibus ou trem) ou dirigir o próprio carro;
(3) b. Organiza a própria viagem de táxi, mas não usa ônibus ou trem; OU
c. Precisa de ajuda para subir e descer escadas;
(2) d. Deve estar sempre acompanhado(a) (por exemplo, deficiências físicas, psicológicas, visuais);
(1) e. Viagem limitada a ambulância, táxi ou carro com assistência;
(0) f. Totalmente incapaz de viajar.
Mobilidade
(Q) Você consegue caminhar ao ar livre/dentro de casa sozinho?
(4) a. Consegue caminhar ao ar livre sem uma bengala ou andador (inclui carrinho de compras, assistência pessoal);
(3) b. Consegue caminhar ao ar livre com uma bengala, muletas ou andador;
(2) c. Incapaz de caminhar ao ar livre, mas consegue caminhar em casa sem uma bengala, muletas ou andador;
(1) d. Incapaz de caminhar ao ar livre, mas consegue caminhar em casa com uma bengala, muletas ou andador;
(0) e. Totalmente incapaz de caminhar; usa uma cadeira de rodas para se movimentar ou fica na cama.

Publication Dates

  • Publication in this collection
    May-Jun 2016

History

  • Received
    23 July 2015
  • Accepted
    17 Aug 2015
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