Abstracts
Objective:
To translate the Leicester Cough Questionnaire (LCQ) to Portuguese and adapt it for use in Brazil.
Methods:
Cross-cultural adaptation of a quality of life questionnaire requires a translated version that is conceptually equivalent to the original version and culturally acceptable in the target country. The protocol used consisted of the translation of the LCQ to Portuguese by three Brazilian translators who were fluent in English and its back-translation to English by another translator who was a native speaker of English and fluent in Portuguese. The back-translated version was evaluated by one of the authors of the original questionnaire in order to verify its equivalence. Later in the process, a provisional Portuguese-language version was thoroughly reviewed by an expert committee. In 10 patients with chronic cough, cognitive debriefing was carried out in order to test the understandability, clarity, and acceptability of the translated questionnaire in the target population. On that basis, the final Portuguese-language version of the LCQ was produced and approved by the committee.
Results:
Few items were questioned by the source author and revised by the committee of experts. During the cognitive debriefing phase, the Portuguese-language version of the LCQ proved to be well accepted and understood by all of the respondents, which demonstrates the robustness of the process of translation and cross-cultural adaptation.
Conclusions:
The final version of the LCQ adapted for use in Brazil was found to be easy to understand and easily applied.
Quality of life; Translations; Questionnaires; Cough
Objetivo:
Traduzir e adaptar culturalmente o Leicester Cough Questionnaire (LCQ) para a língua portuguesa falada no Brasil.
Métodos:
A adaptação cultural de um questionário de qualidade de vida envolve a tradução conceitualmente equivalente à versão original e culturalmente aceitável ao país em que será utilizado. O protocolo aplicado consistiu na tradução do LCQ para a língua portuguesa por três tradutores brasileiros com fluência na língua inglesa e sua retradução para a língua original por um tradutor nascido em um país de língua inglesa e com fluência na língua portuguesa. A versão retraduzida foi avaliada por um dos autores do questionário original para assegurar sua equivalência e, posteriormente, o questionário foi revisado por um comitê de especialistas que realizou ampla revisão do instrumento. O desdobramento cognitivo consistiu em testar a compreensão, clareza e aceitabilidade do questionário traduzido na população alvo, aplicando-o em dez pacientes portadores de tosse crônica. Com base nisso, foi realizada a formulação da versão brasileira final do LCQ após sua aprovação pelo comitê.
Resultados:
Poucos itens foram questionados pelo autor da versão original e revistos pelo comitê de especialistas. A versão portuguesa do LCQ apresentou boa aceitabilidade e compreensão por todos os entrevistados no desdobramento cognitivo, demonstrando a robustez do processo de tradução e adaptação cultural.
Conclusões:
A versão final traduzida e adaptada para uso no Brasil mostrou ser de fácil compreensão e aplicação.
Qualidade de vida; Traduções; Questionários; Tosse
Introduction
Cough is one of the most common symptoms in clinical practice. Typically, cough is acute
and self-limiting; however, in a significant proportion of patients, cough can present
as an isolated chronic symptom.(
11. Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J
Med. 2000; 343(23):1715-21. PMid:11106722
http://dx.doi.org/10.1056/NEJM200012073432308
http://dx.doi.org/10.1056/NEJM2000120734...
) Such patients suffer considerable physical and psychological
morbidity.(
22. French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough
on quality of life. Arch Intern Med. 1998;158(15):1657-61. PMid:9701100
http://dx.doi.org/10.1001/archinte.158.15.1657
http://dx.doi.org/10.1001/archinte.158.1...
) Chronic cough is defined as any cough lasting more than eight weeks, with
no concomitant clinical findings, and remaining without a definitive diagnosis after the
initial clinical evaluation.(
33. Canning BJ. Anatomy and neurophysiology of the cough reflex: ACCP
evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):33S-47S.
PMid:16428690 http://dx.doi.org/10.1378/chest.129.1_suppl.33S
http://dx.doi.org/10.1378/chest.129.1_su...
) Chief among the most common causes of cough are postnasal drip syndrome,
cough variant asthma, gastroesophageal reflux disease, and eosinophilic
bronchitis.(
44. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE,
et al. Diagnosis and management of cough executive summary: ACCP evidence-based
clinical practice guidelines . Chest. 2006; 129(1 Suppl):1S-23S. PMid:16428686
PMCid:PMC3345522 http://dx.doi.org/10.1378/chest.129.1.1
http://dx.doi.org/10.1378/chest.129.1.1...
,
55. II Brazilian guidelines for the management of chronic cough [Article
in Portuguese]. J Bras Pneumol. 2006;32 Suppl 6:S403-46. PMid:17420904
http://dx.doi.org/10.1590/S1806-37132006001000002
http://dx.doi.org/10.1590/S1806-37132006...
)
The impact of symptoms over a given period of time can be quantified and standardized by
means of generic quality-of-life questionnaires,(
66. Mahler DA, Mackowiak JI. Evaluation of the short-form 36-item
questionnaire to measure health-related quality of life in patients with COPD. Chest.
1995;107(6):1585-89. http://dx.doi.org/10.1378/chest.107.6.1585
http://dx.doi.org/10.1378/chest.107.6.15...
) or, more recently, by means of disease-specific questionnaires(
77. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete
measure of health status for chronic airway limitation. The St Georges's respiratory
questionnaire. Am Rev Respir Dis. 1992;145(6):1321-7. PMid:1595997
http://dx.doi.org/10.1164/ajrccm/145.6.1321
http://dx.doi.org/10.1164/ajrccm/145.6.1...
,
88. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of
life in asthma. Am Rer Respir Dis. 1993;147(4):832-8. PMid:8466117
http://dx.doi.org/10.1164/ajrccm/147.4.832
http://dx.doi.org/10.1164/ajrccm/147.4.8...
) or questionnaires designed to assess a specific problem, such as chronic
cough.(
99. French CT, Irwin RS, Fletcher KE, Adams TM. Evaluation of a cough
specific quality-of-life questionnaire. Chest. 2002;121(4):1123-31. PMid:11948042
http://dx.doi.org/10.1378/chest.121.4.1123
http://dx.doi.org/10.1378/chest.121.4.11...
,
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) Currently, there are two established questionnaires that assess quality of
life in patients with cough: the Cough Quality-of-Life Questionnaire,(
99. French CT, Irwin RS, Fletcher KE, Adams TM. Evaluation of a cough
specific quality-of-life questionnaire. Chest. 2002;121(4):1123-31. PMid:11948042
http://dx.doi.org/10.1378/chest.121.4.1123
http://dx.doi.org/10.1378/chest.121.4.11...
) developed by French et al.; and the Leicester Cough Questionnaire
(LCQ),(
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) developed and validated by Birring et al. with the purpose of assessing
this symptom and its impact on the health status of patients with chronic cough in a
simple objective way. The LCQ can also be used to assess the temporal course of cough
and monitor the response to treatment. The LCQ is self-administered and requires less
than five minutes for completion. It comprises 19 items divided into three domains:
physical (questions 1, 2, 3, 9, 10, 11, 14, and 15); psychological (questions 4, 5, 6,
12, 13, 16, and 17); and social (questions 7, 8, 18, and 19). Responses are given on a
Likert-type scale ranging from 1 to 7 points. To calculate the LCQ score, the points
assigned to each question in each domain must be aggregated and divided by the number of
questions in each respective domain. The total score is the sum of each domain score and
ranges from 3 to 21, with scores closer to 21 indicating better health status or a
weaker influence of cough on patient quality of life.
Because the LCQ is a measure originally developed in the English language, it should be
translated to the target language and adapted to the social and cultural circumstances
of the target country; otherwise, another such measure should be developed.(
1111. Leplege A, Hunt S. The problem of quality of life in medicine. JAMA.
1997;278(1):47-50.
http://dx.doi.org/10.1001/jama.1997.03550010061041
http://dx.doi.org/10.1001/jama.1997.0355...
) Therefore, cross-cultural adaptation of a psychometric measure is a complex
process that requires a translated version that is conceptually equivalent to the
original version and culturally acceptable in the target country. (
1212. Bryant-Comstock L, Conway K, Mear I, Cramer J. The process of
translation and cross-cultural adaptation of the quality of life epilepsy inventory
(QOLIE-31). Annual meeting of the American Epilepsy Society. San Francisco,
California, December 7-10, 1996. Abstracts. Epilepsia. 1996;37 Suppl
5:24.
) Technical and semantic equivalence should be sought between the source and
target versions in order to avoid misinterpretation of data in the future.
Cross-cultural adaptation of a measure will be complete when the psychometric properties
of the translated version have been evaluated.(
1313. Acquadro C, Janbom B, Ellis D, Marquis P. Language and translation
issues. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical
trials. 2nd ed. Philadelphia: Lippincott-Raven; 1996. p. 575-85.
)
To date, no health-related quality-of-life measure for patients with chronic cough has
been developed or validated for use in Brazil. Therefore, the purpose of the present
study was to translate the LCQ(
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) to Portuguese and adapt it for use in Brazil.
Methods
This was a methodological study involving the translation to Portuguese of a specific
health-related quality-of-life measure for patients with chronic cough, the
LCQ,(
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) and its cross-cultural adaptation for use in Brazil. The study was approved
by the Human Research Ethics Committee of the Universidade Federal de Santa
Catarina (UFSC, Federal University of Santa Catarina). The process of
translation and cross-cultural adaptation of the LCQ was performed as described by
Guillemin et al.(
1414. 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.
http://dx.doi.org/10.1016/0895-4356(93)90142-N
http://dx.doi.org/10.1016/0895-4356(93)9...
) and Wild et al.(
1515. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A,
et al. Principles of Good Practice for the Translation and Cultural Adaptation
Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force
for Translation and Cultural Adaptation. Value Health. 2005;8(2):94-104.
PMid:15804318 http://dx.doi.org/10.1111/j.1524-4733.2005.04054.x
http://dx.doi.org/10.1111/j.1524-4733.20...
)) In Brazil, Tavares et al. used this methodology to translate an asthma
control questionnaire to Portuguese and adapt it for use in Brazil. (
1616. Tavares MG, Pizzichini MM, Steidle LJ, Nazário NO, Rocha CC, Perraro
MC, et al. The Asthma Control Scoring System: translation and cross-cultural
adaptation for use in Brazil. J Bras Pneumol. 2010;36(6):683-92.
PMid:21225170
)
Figure 1 illustrates each phase of the study.
Summary of the process of translation and cross-cultural adaptation of the Leicester Cough Questionnaire (LCQ) for use in Brazil.
The study sample intentionally consisted of 10 male and female patients over 18 years of age who were literate, had chronic cough, and were receiving no specific treatment. Those patients, recruited from the Pulmonology Outpatient Clinic of the UFSC University Hospital and from a private practice in respiratory medicine in the city of Florianópolis, Brazil, were invited to participate in the cognitive debriefing phase of the process of cross-cultural adaptation of the LCQ. This phase was used to assess the acceptability, clarity, and understandability of the translated adapted version.
For the present study, chronic cough was defined as cough lasting more than eight weeks and remaining without a definitive diagnosis after the initial clinical evaluation, which included chest X-ray as well as complete spirometry and bronchodilator response testing. We excluded smokers, former smokers, patients with other lung diseases (cystic fibrosis, COPD, pneumonia, etc.), patients with severe diseases of other body systems, and patients on medications that could confound the results. Since the present study does not permit a statistical analysis, the data are reported as absolute numbers and proportions, as means and standard deviations, or as medians and interquartile ranges.
The phases of the cross-cultural adaptation process were performed strictly in
accordance with internationally accepted guidelines(
1414. 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.
http://dx.doi.org/10.1016/0895-4356(93)90142-N
http://dx.doi.org/10.1016/0895-4356(93)9...
): acquisition of permission for cross-cultural adaptation and of the rights
of use of the LCQ from the developer of the questionnaire; translation of the LCQ from
English to Portuguese; reconciliation; back-translation; review and harmonization of the
back-translation; acquisition of approval from the developer of the LCQ; review of the
Portuguese-language version of the LCQ by experts; cognitive debriefing; and
reconciliation and preparation of the final version.
In the English-to-Portuguese translation phase, three Brazilian translators who were fluent in English independently translated the LCQ. Subsequently, a review committee met to produce a first Portuguese-language version. This first version was back-translated to English by another translator who was a native speaker of English and fluent in Portuguese. The back-translation was then reviewed by the committee, which produced a back-translated English version and a matching Portuguese-language version of the LCQ. The back-translated version was sent to the author of the original LCQ for evaluation, and, once approved, its matching version was used to produce a third Portuguese-language version of the LCQ. This third version was reviewed by an expert committee, which consisted of two bilingual pulmonologists and a Portuguese teacher, and, subsequently, a fourth Portuguese-language version of the LCQ was produced. This fourth version was used in the cognitive debriefing phase, at the end of which a fifth version was produced. After reconciliation, the final Portuguese-language version of the LCQ was produced (Figure 1).
The purpose of cognitive debriefing was to identify problematic questions on the questionnaire and offer solutions to make such questions easier to understand. To that end, ten participants with chronic cough who showed good comprehension and language skills were interviewed. The cognitive debriefing process consisted of testing the understandability, clarity, and acceptability of the translated questionnaire in the target population. In this phase, individuals who met the inclusion criteria were consecutively scheduled for a single visit to the study site. During this visit, the study was explained in detail, and individuals who agreed to participate gave written informed consent. In addition, we collected demographic data and specific data on current and previous history of cough, duration and characteristics of cough, associated symptoms, final diagnosis (if defined), smoking history, and comorbidities. The questionnaire was administered to each participant by the principal investigator. Individuals were informed that they should not worry about the accuracy of their responses, but rather just report what they understood, the difficulty of each question or statement on the questionnaire, and their level of acceptance of the questionnaire. At the end, individuals were asked to make a general open comment about the questionnaire so that its overall acceptability, understandability, and clarity could be assessed. All comments were recorded on a specific form.
Finally, in the reconciliation phase, the review committee and the expert committee met to produce the final Portuguese-language version of the LCQ. To that end, the latest provisional version of the measure was analyzed item by item. The cognitive debriefing findings were discussed, and the relevant changes were made. Therefore, the final Portuguese-language version of the measure was produced.
Results
Of the ten patients interviewed in the cognitive debriefing phase, seven were female. All were White, were nonsmokers, and resided in the greater metropolitan area of Florianópolis, Brazil. Patient age ranged from 23 to 72 years, and patient educational level ranged from elementary school to college. Most patients had dry cough, which was associated with other symptoms, such as nasal obstruction, sneezing, and odynophagia, in 40% of the cases. Only two patients had no comorbidities, and the most common comorbidities were systemic arterial hypertension, type 2 diabetes mellitus, dyslipidemia, hypothyroidism, allergic rhinitis, and depression (Table 1).
Half of the patients interviewed were still undergoing diagnostic evaluation. For the remaining patients, one or more causes of cough had been found (Table 2).
In the phases of translation and back-translation, no questions or corrections were raised. However, in the phase of acquisition of approval from the author of the original LCQ, some items on the back-translated version were in part questioned by him because they showed a slight difference in wording. However, since the concept was preserved, no changes were made. The following items were questioned: "by sputum (phlegm) production when you cough?", which was back-translated as "by any phlegm you've coughed up?"; and "with the overall enjoyment of my life", which was back-translated as "with the enjoyment of my life".
The review performed by the expert committee indicated some grammatical errors and offered conceptual suggestions, all of which are described in Table 3. In addition, the questionnaire formatting was modified: the Likert-type scale with response choices arranged in horizontal sequence was placed within a single-row, seven-column table (Appendix 1; available in the online version of the Brazilian Journal of Pulmonology; http://www.jornaldepneumologia.com.br/imagebank/images/jbp_v40n3_anexo.pdf).
In the cognitive debriefing phase, three questions produced understandability difficulties. In addition, the title of the questionnaire was a source of difficulty for nearly half of the respondents. Therefore, in the final reconciliation phase, in which the review committee and the expert committee met, it was unanimously agreed that changes should be made to the title and to two of the questions. Table 4 shows the changes made after cognitive debriefing. The final version of the document incorporated those changes, as shown in Appendix 1.
Discussion
In the present study, a health-related quality-of-life measure for patients with chronic
cough was translated to Portuguese and adapted for use in Brazil. The original version
of the LCQ was developed primarily to assess patients in English, and, to date, only a
Dutch-language version has been produced and validated.(
1717. Huisman AN, Wu MZ, Uil SM, van den Berg JW. Reliability and validity
of a Dutch version of the Leicester Cough Questionnaire. Cough. 2007;3:3.
PMid:17313670 PMCid:PMC1804278
http://dx.doi.org/10.1186/1745-9974-3-3
http://dx.doi.org/10.1186/1745-9974-3-3...
) Cross-cultural adaptation is relevant because, currently, there is no other
quality-of-life measure for patients with chronic cough in Brazil. The decision to
culturally adapt the LCQ, rather than to develop a new measure, was based on the fact
that the adaptation of a previously described and validated measure, which has been
translated and validated to other languages, makes it possible to compare results across
studies conducted in different countries. In addition, this is a current trend that aims
to facilitate the use of such a measure in international multicenter studies and has
boosted the translation and cross-cultural adaptation of several generic and specific
instruments to several languages.(
1818. Cramer JA, Perrine K, Devinsky O, Bryant-Comstock L, Meador K,
Hermann B. Development and cross-cultural translations of a 31-item quality of life
in epilepsy inventory. Epilepsia. 1998;39(1):81-8.
http://dx.doi.org/10.1111/j.1528-1157.1998.tb01278.x PMid:9578017
http://dx.doi.org/10.1111/j.1528-1157.19...
,
1919. Güell R, Casan P, Sangenís M, Morante F, Belda J, Guyatt GH. Quality
of life in patients with chronic respiratory disease: the Spanish version of the
Chronic Respiratory Questionnaire (CRQ). Eur Respir J. 1998;11(1):55-60. PMid:9543270
http://dx.doi.org/10.1183/09031936.98.11010055
http://dx.doi.org/10.1183/09031936.98.11...
) Furthermore, the development of a new questionnaire would be a more
laborious, time-consuming, and costly process.
Kalpaklioglu et al.(
2020. Kalpaklioglu AF, Kara T, Kurtipek E, Kocyigit P, Ekici A, Ekici M.
Evaluation and impact of chronic cough: comparison of specific vs generic
quality-of-life questionnaire. Ann Allergy Asthma Immunol. 2005;94(5):581-5.
http://dx.doi.org/10.1016/S1081-1206(10)61137-4
http://dx.doi.org/10.1016/S1081-1206(10)...
) compared the LCQ with the Cough Quality-of-Life Questionnaire and showed
that there is a significant correlation between the measurements of the two
questionnaires. The present study aimed to translate and culturally adapt the LCQ
because it is a careful questionnaire, which consists of well-formulated questions and
is structured by domains. The methodology used in the development of the LCQ(
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) ensures proper validation of content. In addition, the LCQ is valid and
reproducible,(
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) as well as being discriminative(
2121. Birring SS, Matos S, Patel RB, Prudon B, Evans DH, Pavord ID. Cough
frequency, cough sensitivity and health status in patients with chronic cough. Respir
Med. 2006;100(6):1105-9. PMid:16266801
http://dx.doi.org/10.1016/j.rmed.2005.09.023
http://dx.doi.org/10.1016/j.rmed.2005.09...
) and responsive to longitudinal changes.(
1010. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID.
Development of a symptom specific health status measure for patients with chronic
cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799
PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
http://dx.doi.org/10.1136/thorax.58.4.33...
) Several studies have successfully used the LCQ to assess the response to
several therapies for cough, as has been shown by Ryan et al.(
2222. Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic
cough: a randomized, double-blind, placebo-controlled trial. Lancet.
2012;380(9853):1583-9.
http://dx.doi.org/10.1016/S0140-6736(12)60776-4
http://dx.doi.org/10.1016/S0140-6736(12)...
) for gabapentin therapy for refractory chronic cough and by Patel et
al.(
2323. Patel AS, Watkin G, Willig B, Mutalithas K, Bellas H, Garrod R, et
al. Improvement in health status following cough suppression physiotherapy for
patients with chronic cough. Chron Respir Dis. 2011;8(4):253-8 PMid:21990570
http://dx.doi.org/10.1177/1479972311422547
http://dx.doi.org/10.1177/14799723114225...
) for cough-suppression physiotherapy. Therefore, guidelines on the
management of chronic cough describe the LCQ as an important tool for quantification of
cough and assessment of patient quality of life,(
2424. Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF,
Widdicombe J, et al. The diagnosis and management of chronic cough. Eur Respir J.
2004;24(3):481-92. PMid:15358710
http://dx.doi.org/10.1183/09031936.04.00027804
http://dx.doi.org/10.1183/09031936.04.00...
25. Morice AH, McGarvey L, Pavord I; British Thoracic Society Cough
Guideline Group. Recommendations for the management of cough in adults. Thorax.
2006;61 Suppl 1:i1-24. PMid:16936230 PMCid:PMC2080754
http://dx.doi.org/10.1136/thx.2006.065144
http://dx.doi.org/10.1136/thx.2006.06514...
-
2626. Irwin RS. Assessing cough severity and efficacy of therapy in
clinical research: ACCP evidence-based clinical practice guidelines. Chest. 2006;
129(1 Suppl):232S-237S. PMid:16428716
http://dx.doi.org/10.1378/chest.129.1_suppl.232S
http://dx.doi.org/10.1378/chest.129.1_su...
) since there are few objective and well-validated instruments for
quantification of cough. In more recent studies, the LCQ has been validated for
assessment of chronic cough in the context of specific diseases(
2727. Berkhof FF, Boom LN, ten Hertog NE, Uil SM, Kerstjens HA, van den
Berg JW. The validity and precision of the Leicester Cough Questionnaire in COPD
patients with chronic cough. Health Qual Life Outcomes. 2012;10:4. PMid:22230731
PMCid:PMC3311606 http://dx.doi.org/10.1186/1477-7525-10-4
http://dx.doi.org/10.1186/1477-7525-10-4...
,
2828. Murray MP, Turnbull K, MacQuarrie S, Pentland JL, Hill AT.
Validation of the Leicester Cough Questionnaire in non-cystic fibrosis
bronchiectasis. Eur Respir J. 2009;34(1):125-31. PMid:19196812
http://dx.doi.org/10.1183/09031936.00160508
http://dx.doi.org/10.1183/09031936.00160...
) and for use in acute cough.(
2929. Yousaf N, Lee KK, Jayaraman B, Pavord ID, Birring SS. The assessment
of quality of life in acute cough with the Leicester Cough Questionnaire (LCQ-acute).
Cough. 2011;7(1):4. PMid:21767404 PMCid:PMC3169450
http://dx.doi.org/10.1186/1745-9974-7-4
http://dx.doi.org/10.1186/1745-9974-7-4...
)
One factor that ensures the applicability of the LCQ in Brazil is the methodology used
in the process of translation and cross-cultural adaptation of the questionnaire, which
has been shown to preserve the sensitivity of the measure,(
1414. 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.
http://dx.doi.org/10.1016/0895-4356(93)90142-N
http://dx.doi.org/10.1016/0895-4356(93)9...
) as well as promoting an appropriate level of equivalence between the
versions. In addition, it is known that the internal structure, semantics, and
psychometric characteristics of a measure may change when this measure is translated to
another language. This is more common if the process of cross-cultural equivalence is
not performed correctly. The need to take into account cultural influences on health and
disease is increasingly being recognized in multicenter and multinational studies. The
purpose of adapting a quality-of-life measure is to obtain health measurements that are
appropriate and valid in different cultural groups. This means developing a measure that
is conceptually equivalent in different cultures.(
3030. Guyatt GH. The philosophy of health-related quality of life
translation. Qual Life Res. 1993;2(6):461-5. PMid:8161980
http://dx.doi.org/10.1007/BF00422220
http://dx.doi.org/10.1007/BF00422220...
)
In the present study, the difficulties encountered in the translation phase resulted
from the need to produce a conceptual translation. There were no difficulties in
translating words referring to symptoms, physical activities, or activities of daily
living. However, some English-language idioms and phrases, such as "fed up" and "overall
enjoyment", were a matter of review and discussion. In addition, there was a need to
adjust the verb tense so that the addressed situation made sense in Portuguese. In the
phase of acquisition of approval from the original author, only two items were
questioned by him as to differences in the literal translation. However, since,
according to the original author himself, conceptual equivalence was preserved, no
changes were needed. Once the back-translated version was approved, an expert committee
met to evaluate its matching Portuguese-language version in order to detect errors, make
suggestions, and analyze content and structure. In this phase, it is of particular value
that the expert committee include bilingual members.(
1414. 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.
http://dx.doi.org/10.1016/0895-4356(93)90142-N
http://dx.doi.org/10.1016/0895-4356(93)9...
)
The first modification was to the questionnaire formatting. The original version uses a Likert-type scale with response choices arranged in horizontal sequence. In the Portuguese-language version, the same Likert-type scale was placed within a single-row, seven-column table. The modification made it easier to visualize all response choices. In order to achieve semantic, conceptual, and idiomatic equivalence, some expressions, words, prepositions, and verb tenses were changed. The difficulty lies in the fact that some English-language expressions have no literal equivalent in Portuguese, and, in such cases, conceptual equivalence is sought. Corrections of grammatical errors were made by the Portuguese-language expert, and the questionnaire version intended for use in the cognitive debriefing phase was then produced.
Cognitive debriefing is an essential phase in the cross-cultural adaptation process,
because even a detailed methodological process does not ensure equivalence between
target and source versions.(
1414. 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.
http://dx.doi.org/10.1016/0895-4356(93)90142-N
http://dx.doi.org/10.1016/0895-4356(93)9...
) The questionnaire was administered to ten participants in order to
determine its acceptability, clarity, and understandability. Although the participants
had varied educational levels, no significant difficulties that would prevent them from
understanding the questionnaire were identified. This demonstrates that the measure
produced can be administered to individuals from various socio-cultural classes. To
ensure that the entire translation was easy to understand, cognitive debriefing involved
an item-by-item review, rather than a random sample review. An analysis of the responses
given during the cognitive debriefing process showed that few items needed to be revised
because of understandability difficulties. This finding is of great relevance because it
shows the robustness of the process of translation and cross-cultural adaptation.
Therefore, the final version was produced after changes, which were unanimously agreed
by the review committee and the expert committee, were made to three items, among which
was the title of the questionnaire.
The respondents' comments on the questionnaire were very positive. All stated that, in general, the questionnaire was clear, easy to understand, and easy to answer, with simple and quick-to-follow instructions. In addition, the questionnaire was considered to be significantly relevant in the evaluation of chronic cough, being well adapted to that condition and covering its various aspects in detail.
In conclusion, the LCQ has been translated to Portuguese and adapted for use in Brazil. The final Portuguese-language version of the questionnaire, designated Questionário de Leicester sobre Tosse Crônica, was found to be easy to understand and easily applied, as well as being a single measure of health-related quality-of-life variables in patients with chronic cough.
Acknowledgments
We would like to thank the developer of the LCQ, Prof. Ian D Pavord, for his attention and cooperation in all phases of the process of translation and cross-cultural adaptation, as well as the research team of the Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas (NUPAIVA, Center for Research on Asthma and Airway Inflammation) and the UFSC.
References
-
1Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med. 2000; 343(23):1715-21. PMid:11106722 http://dx.doi.org/10.1056/NEJM200012073432308
» http://dx.doi.org/10.1056/NEJM200012073432308 -
2French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Arch Intern Med. 1998;158(15):1657-61. PMid:9701100 http://dx.doi.org/10.1001/archinte.158.15.1657
» http://dx.doi.org/10.1001/archinte.158.15.1657 -
3Canning BJ. Anatomy and neurophysiology of the cough reflex: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):33S-47S. PMid:16428690 http://dx.doi.org/10.1378/chest.129.1_suppl.33S
» http://dx.doi.org/10.1378/chest.129.1_suppl.33S -
4Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines . Chest. 2006; 129(1 Suppl):1S-23S. PMid:16428686 PMCid:PMC3345522 http://dx.doi.org/10.1378/chest.129.1.1
» http://dx.doi.org/10.1378/chest.129.1.1 -
5II Brazilian guidelines for the management of chronic cough [Article in Portuguese]. J Bras Pneumol. 2006;32 Suppl 6:S403-46. PMid:17420904 http://dx.doi.org/10.1590/S1806-37132006001000002
» http://dx.doi.org/10.1590/S1806-37132006001000002 -
6Mahler DA, Mackowiak JI. Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD. Chest. 1995;107(6):1585-89. http://dx.doi.org/10.1378/chest.107.6.1585
» http://dx.doi.org/10.1378/chest.107.6.1585 -
7Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airway limitation. The St Georges's respiratory questionnaire. Am Rev Respir Dis. 1992;145(6):1321-7. PMid:1595997 http://dx.doi.org/10.1164/ajrccm/145.6.1321
» http://dx.doi.org/10.1164/ajrccm/145.6.1321 -
8Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rer Respir Dis. 1993;147(4):832-8. PMid:8466117 http://dx.doi.org/10.1164/ajrccm/147.4.832
» http://dx.doi.org/10.1164/ajrccm/147.4.832 -
9French CT, Irwin RS, Fletcher KE, Adams TM. Evaluation of a cough specific quality-of-life questionnaire. Chest. 2002;121(4):1123-31. PMid:11948042 http://dx.doi.org/10.1378/chest.121.4.1123
» http://dx.doi.org/10.1378/chest.121.4.1123 -
10Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MD, Pavord ID. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax. 2003;58(4):339-43. PMid:12668799 PMCid:PMC1746649 http://dx.doi.org/10.1136/thorax.58.4.339
» http://dx.doi.org/10.1136/thorax.58.4.339 -
11Leplege A, Hunt S. The problem of quality of life in medicine. JAMA. 1997;278(1):47-50. http://dx.doi.org/10.1001/jama.1997.03550010061041
» http://dx.doi.org/10.1001/jama.1997.03550010061041 -
12Bryant-Comstock L, Conway K, Mear I, Cramer J. The process of translation and cross-cultural adaptation of the quality of life epilepsy inventory (QOLIE-31). Annual meeting of the American Epilepsy Society. San Francisco, California, December 7-10, 1996. Abstracts. Epilepsia. 1996;37 Suppl 5:24.
-
13Acquadro C, Janbom B, Ellis D, Marquis P. Language and translation issues. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven; 1996. p. 575-85.
-
14Guillemin 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. http://dx.doi.org/10.1016/0895-4356(93)90142-N
» http://dx.doi.org/10.1016/0895-4356(93)90142-N -
15Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94-104. PMid:15804318 http://dx.doi.org/10.1111/j.1524-4733.2005.04054.x
» http://dx.doi.org/10.1111/j.1524-4733.2005.04054.x -
16Tavares MG, Pizzichini MM, Steidle LJ, Nazário NO, Rocha CC, Perraro MC, et al. The Asthma Control Scoring System: translation and cross-cultural adaptation for use in Brazil. J Bras Pneumol. 2010;36(6):683-92. PMid:21225170
-
17Huisman AN, Wu MZ, Uil SM, van den Berg JW. Reliability and validity of a Dutch version of the Leicester Cough Questionnaire. Cough. 2007;3:3. PMid:17313670 PMCid:PMC1804278 http://dx.doi.org/10.1186/1745-9974-3-3
» http://dx.doi.org/10.1186/1745-9974-3-3 -
18Cramer JA, Perrine K, Devinsky O, Bryant-Comstock L, Meador K, Hermann B. Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory. Epilepsia. 1998;39(1):81-8. http://dx.doi.org/10.1111/j.1528-1157.1998.tb01278.x PMid:9578017
» http://dx.doi.org/10.1111/j.1528-1157.1998.tb01278.x -
19Güell R, Casan P, Sangenís M, Morante F, Belda J, Guyatt GH. Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ). Eur Respir J. 1998;11(1):55-60. PMid:9543270 http://dx.doi.org/10.1183/09031936.98.11010055
» http://dx.doi.org/10.1183/09031936.98.11010055 -
20Kalpaklioglu AF, Kara T, Kurtipek E, Kocyigit P, Ekici A, Ekici M. Evaluation and impact of chronic cough: comparison of specific vs generic quality-of-life questionnaire. Ann Allergy Asthma Immunol. 2005;94(5):581-5. http://dx.doi.org/10.1016/S1081-1206(10)61137-4
» http://dx.doi.org/10.1016/S1081-1206(10)61137-4 -
21Birring SS, Matos S, Patel RB, Prudon B, Evans DH, Pavord ID. Cough frequency, cough sensitivity and health status in patients with chronic cough. Respir Med. 2006;100(6):1105-9. PMid:16266801 http://dx.doi.org/10.1016/j.rmed.2005.09.023
» http://dx.doi.org/10.1016/j.rmed.2005.09.023 -
22Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomized, double-blind, placebo-controlled trial. Lancet. 2012;380(9853):1583-9. http://dx.doi.org/10.1016/S0140-6736(12)60776-4
» http://dx.doi.org/10.1016/S0140-6736(12)60776-4 -
23Patel AS, Watkin G, Willig B, Mutalithas K, Bellas H, Garrod R, et al. Improvement in health status following cough suppression physiotherapy for patients with chronic cough. Chron Respir Dis. 2011;8(4):253-8 PMid:21990570 http://dx.doi.org/10.1177/1479972311422547
» http://dx.doi.org/10.1177/1479972311422547 -
24Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF, Widdicombe J, et al. The diagnosis and management of chronic cough. Eur Respir J. 2004;24(3):481-92. PMid:15358710 http://dx.doi.org/10.1183/09031936.04.00027804
» http://dx.doi.org/10.1183/09031936.04.00027804 -
25Morice AH, McGarvey L, Pavord I; British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults. Thorax. 2006;61 Suppl 1:i1-24. PMid:16936230 PMCid:PMC2080754 http://dx.doi.org/10.1136/thx.2006.065144
» http://dx.doi.org/10.1136/thx.2006.065144 -
26Irwin RS. Assessing cough severity and efficacy of therapy in clinical research: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129(1 Suppl):232S-237S. PMid:16428716 http://dx.doi.org/10.1378/chest.129.1_suppl.232S
» http://dx.doi.org/10.1378/chest.129.1_suppl.232S -
27Berkhof FF, Boom LN, ten Hertog NE, Uil SM, Kerstjens HA, van den Berg JW. The validity and precision of the Leicester Cough Questionnaire in COPD patients with chronic cough. Health Qual Life Outcomes. 2012;10:4. PMid:22230731 PMCid:PMC3311606 http://dx.doi.org/10.1186/1477-7525-10-4
» http://dx.doi.org/10.1186/1477-7525-10-4 -
28Murray MP, Turnbull K, MacQuarrie S, Pentland JL, Hill AT. Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis. Eur Respir J. 2009;34(1):125-31. PMid:19196812 http://dx.doi.org/10.1183/09031936.00160508
» http://dx.doi.org/10.1183/09031936.00160508 -
29Yousaf N, Lee KK, Jayaraman B, Pavord ID, Birring SS. The assessment of quality of life in acute cough with the Leicester Cough Questionnaire (LCQ-acute). Cough. 2011;7(1):4. PMid:21767404 PMCid:PMC3169450 http://dx.doi.org/10.1186/1745-9974-7-4
» http://dx.doi.org/10.1186/1745-9974-7-4 -
30Guyatt GH. The philosophy of health-related quality of life translation. Qual Life Res. 1993;2(6):461-5. PMid:8161980 http://dx.doi.org/10.1007/BF00422220
» http://dx.doi.org/10.1007/BF00422220
-
*
Study carried out at the Polydoro Ernani de São Thiago University Hospital, Universidade Federal de Santa Catarina - UFSC, Federal University of Santa Catarina - Florianópolis, Brazil.
Publication Dates
-
Publication in this collection
May-Jun 2014
History
-
Received
27 Aug 2013 -
Accepted
05 Dec 2013