Transcultural adaptation of the Amyotrophic Lateral Sclerosis Depression Inventory to Brazilian Portuguese

Address correspondence to: Tatiana Lins Carvalho. Rua Antônio de Castro, 150, ap. 601, Casa Amarela – 52070-080 – Recife, PE, Brazil. E-mail: tatiana.lcarvalho@gmail.com Dear Editor Depression symptoms in patients with Amyotrophic Lateral Sclerosis (ALS) has been investigated using instruments not specific and may interfere in results1-3. Given the evolution and physical impairment caused by ALS, the ALS Depression Inventory (ADI) was created in 2005 to assess depression symptoms in these individuals. Results have shown a reduction in 12 items also providing accurate measures of depression symptoms in severely paralyzed patients4,5. In light of the instrument’s accuracy in detecting depression symptoms at any stage of ALS, and since it has yet to be used in Brazil, it was necessary to translate and transculturally adapt the ADI-12 to Brazilian Portuguese. There are formal stages for translating and adapting instruments. Attention to linguistics must be given during translation, due to the different semantics between languages. The method proposed by Beaton et al.6 was used as a model. The pre-final version was applied to 15 patients diagnosed with ALS in accordance with El Escorial-R at the Neuromuscular Disease Outpatient Clinic of Oswaldo Cruz University Hospital (HUOC) of University of Pernambuco (UPE). Participants were questioned to determine whether the responses actually corresponded to what the individuals understood and if changes needed to be made to the document. All subjects were aged 18 years and older, of both sexes and gave their informed consent. The study was conducted between December 2013 and November 2014, after approval was obtained from the Research Ethics Committee of University of Pernambuco/PROPEGE (CAAE: 25749413.2.0000.5207). Table 1 shows the results of the versions of the ADI-12 according to the stages of transcultural adaptation. A number of subtle changes were made to conform with Brazilian Portuguese. For example the term “consists of ” is translated as “consta de”, but we preferred to translate it as “consiste em”, more commonly used in our language and therefore easier for the subjects to understand.


Dear Editor
Depression symptoms in patients with Amyotrophic Lateral Sclerosis (ALS) has been investigated using instruments not specific and may interfere in results [1][2][3] .
Given the evolution and physical impairment caused by ALS, the ALS Depression Inventory (ADI) was created in 2005 to assess depression symptoms in these individuals.Results have shown a reduction in 12 items also providing accurate measures of depression symptoms in severely paralyzed patients 4,5 .In light of the instrument's accuracy in detecting depression symptoms at any stage of ALS, and since it has yet to be used in Brazil, it was necessary to translate and transculturally adapt the ADI-12 to Brazilian Portuguese.
There are formal stages for translating and adapting instruments.Attention to linguistics must be given during translation, due to the different semantics between languages.The method proposed by Beaton et al. 6 was used as a model.The pre-final version was applied to 15 patients diagnosed with ALS in accordance with El Escorial-R at the Neuromuscular Disease Outpatient Clinic of Oswaldo Cruz University Hospital (HUOC) of University of Pernambuco (UPE).Participants were questioned to determine whether the responses actually corresponded to what the individuals understood and if changes needed to be made to the document.All subjects were aged 18 years and older, of both sexes and gave their informed consent.
The study was conducted between December 2013 and November 2014, after approval was obtained from the Research Ethics Committee of University of Pernambuco/PROPEGE (CAAE: 25749413.2.0000.5207).
Table 1 shows the results of the versions of the ADI-12 according to the stages of transcultural adaptation.A number of subtle changes were made to conform with Brazilian Portuguese.For example the term "consists of " is translated as "consta de", but we preferred to translate it as "consiste em", more commonly used in our language and therefore easier for the subjects to understand.In the clause "I can appreciate life", the verb "can" means ability and not permission; therefore the clause was translated as "eu consigo apreciar a vida" instead of "eu posso apreciar a vida".The term "get away from it" is best translated as "se desligar"; thus the clause "I can get away from it all" was translated as "eu consigo me desligar de tudo" instead of "eu consigo me livrar de tudo" or "eu consigo lidar com tudo".The remaining questions required less adaptation since their literal translation expressed their real intention and did not compromise the intended meaning.

Table 1. Original version (English), synthesis of the translation and final version of the ADI-12 in Portuguese
In this cultural adaptation process the patients encountered no difficulty during the application of any of the questions.Therefore, the ADI-12 was considered equivalent to the original English version in terms of semantics and expression of concepts, without requiring subsequent adjustments.
Translation of the ADI-12 to Brazilian Portuguese and its adaptation to the socioeconomic and cultural conditions of our people makes this instrument a useful additional parameter to help identify depression symptoms in patients with ALS, thereby improving the care provided to these individuals.A study with a larger sample size is needed to validate the instrument.