Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis

Sugizaki, Clara Sandra de Araujo; Braga, Clarice Carneiro; Freitas, Ana Tereza Vaz de Souza; Peixoto, Maria do Rosário Gondim

doi:10.1590/2175-8239-JBN-2019-0151

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Brasil

Brazilian Journal of Nephrology

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Original Article • J. Bras. Nefrol. 42 (2) • Apr-Jun 2020 • https://doi.org/10.1590/2175-8239-JBN-2019-0151 copy

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale’s psychometric properties for patients on hemodialysis (HD).

Methods:

The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach’s alpha was used to measure the scale’s internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC).

Results:

The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale’s internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001).

Conclusion:

Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Keywords:
Renal Dialysis; Thirst; Validation Studies; Translations; Surveys and Questionnaires

Original version	Brazilian Portuguese version	Version produced after input from the panel of experts	Final version
1) My thirst causes me discomfort.	Minha sede me causa desconforto.	Minha sede me causa desconforto.	Minha sede me causou desconforto.
2) My thirst bothers me a lot.	Minha sede me incomoda muito.	Minha sede me incomoda muito.	Minha sede me incomodou muito.
3) I am very uncomfortable when I am thirsty.	Eu fico muito desconfortável quando estou com sede.	Eu me sinto bastante desconfortável quando eu estou com sede.	Eu me senti bastante desconfortável quando eu estive com sede.
4) My mouth feels like cotton when I am thirsty.	Minha boca parece algodão quando estou com sede.	Minha boca fica seca como algodão quando eu estou com sede.	Minha boca ficou seca como algodão quando eu estive com sede.
5) My saliva is very thick when I am thirsty.	Minha saliva fica muito grossa quando estou com sede.	Minha saliva fica muito grossa quando eu estou com sede.	Minha saliva ficou muito grossa quando eu estive com sede.
6) When I drink less, my thirst gets worse.	Quando eu bebo menos, minha sede fica pior.	Quando eu bebo menos líquido, minha sede fica pior.	Quando eu bebi menos líquido, minha sede ficou pior.

Variables^* * Values presented as numbers (proportions), mean value ± standard error or median and interquartile interval.	Total
Sex
Male	77 (61.11%)
Female	49 (38.89%)
Age (years)	53.00 (± 16.59)
Time on hemodialysis (months)	44.50 (20.00-89.00)
KT/V ^ KT/V: pre-dialysis blood urea nitrogen/post-dialysis blood urea nitrogen	1.39 (± 0.23)
Etiology of chronic kidney disease
Hypertensive nephrosclerosis	40 (32.74%)
Glomerulonephritis	9 (7.14%)
Diabetic nephropathy	9 (7.14%)
Adult polycystic kidney disease	11 (8.75%)
Comorbidities
Diabetes mellitus II	15 (11.90%)
Systemic hypertension	102 (80.95%)
Body mass index (kg/m²)	24.85 (21.70-28.95)
Interdialytic weight gain (kg)	1.80 (± 0.90)
Biochemical tests
Hemoglobin (g/dL)	11.50 (10.40-13.00)
Transferrin (%)	33.00 (25.30-42.90)
Ferritin (ng/mL)	239.50 (25.00-354.40)
Albumin (g/dL)	3.70 (± 0.50)
Creatinine (mg/dL)	11.20 (± 3.10)
Pre-dialysis blood urea nitrogen (mg/dL)	126.00 (± 32.50)
Post-dialysis blood urea nitrogen (mg/dL)	29.50 (22.00-42.50)
Use of drugs that may cause dry mouth	102 (80.95%)

Final version of the scale	$\overset{´}{χ}$	SE	Total correlation	Cronbach’s alpha for each item deleted
1) Minha sede me causou desconforto.	2.86	1.59	0.77	0.80
2) Minha sede me incomodou muito.	2.88	1.60	0.84	0.79
3) Eu me senti bastante desconfortável quando eu estive com sede.	3.00	1.65	0.86	0.78
4) Minha boca ficou seca como algodão quando eu estive com sede.	3.50	1.54	0.74	0.82
5) Minha saliva ficou muito seca quando eu estive com sede.	2.76	1.75	0.68	0.83
6) Quando eu bebi menos líquido, minha sede ficou pior.	2.89	1.54	0.56	0.86

	Item 1	Item 2	Item 3	Item 4	Item 5	Item 6
Item 1	1.000
Item 2	0.783	1.000
Item 3	0.627	0.754	1.000
Item 4	0.456	0.482	0.594	1.000
Item 5	0.339	0.408	0.529	0.534	1.000
Item 6	0.317	0.348	0.353	0.268	0.229	1.000
a	100%	100%	100%	80%	80%	60%
b	0.504	0.555	0.571	0.467	0.408	0.303

Thirst intensity (EVA)	N (%)	TDS-BR
Thirst intensity (EVA)	N (%)	Mean*	p
Mild	24.60	12.13(±5.57)	< 0.001
Moderate	55.56	17.54(±6.11)
Severe	19.84	23.72(±4.81)

	Test	Retest	t^a	p	ICC (95% IC)
TDS-BR	18.28 (±7.22)	18.01 (±7.55)	0.84	0.201	0.87 (0.77- 0.97)^* * p < 0.001

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[1] Correspondence to: Maria do Rosário Gondim Peixoto E-mail: mrg.peixoto@uol.com.br