Brazilian version of the Hammersmith Functional Motor Scale Expanded: cross-cultural adaptation and validation

Moura, Ana Carolina Monteiro Lessa de; Carvalhais, Marina Belisário; Sampaio, Gabriela Palhares Campolina; Pinhati, Clara Catharino; Montes, Jacqueline; Gurgel-Giannetti, Juliana

doi:10.1055/s-0044-1788587

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Original Article • Arq. Neuro-Psiquiatr. 82 (07) • 2024 • https://doi.org/10.1055/s-0044-1788587 copy

Brazilian version of the Hammersmith Functional Motor Scale Expanded: cross-cultural adaptation and validation

Versão brasileira da Hammersmith Functional Motor Scale Expanded: adaptação transcultural e validação

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

The Hammersmith Functional Motor Scale Expanded (HFMSE) has been widely used to assess the motor function of patients with spinal muscular atrophy (SMA) older than 2 years, with the ability to sit and/or walk.

Objective

To translate, cross-culturally adapt and validate the HFMSE to Brazilian Portuguese.

Methods

The translation process and cross-cultural adaptation followed international guidelines recommendations. The reliability and applicability of the Brazilian version consisted of the application of the HFMSE (in Brazilian Portuguese) to 20 patients with types 2 and 3 SMA. Two examiners assessed the participants for interrater reliability, through the analysis of Kappa reliability agreement (k) and intraclass correlation coefficient (ICC).

Results

The HFMSE was successfully translated and cross culturally adapted to Brazilian Portuguese. Twenty participants with types 2 and 3 SMA were enrolled in the study (type 2 = 6; type 3 = 14). The ICC for the total score showed very high reliability (ICC =1.00), and the reliability of each of the items individually was considered excellent (Kappa > 0.80).

Conclusion

The Brazilian version of the HFMSE proved to be valid and reliable for the evaluation of SMA patients older than 2 years with the ability to sit and/or walk.

Keywords
Motor Activity; Muscular Atrophy, Spinal; Validation Study

	SMA 2 (N = 6)	SMA 3 (N = 14)	All participants (N = 20)
Sex (F:M)	1:5	11:3	12:8
Age (years)	9.2 ± 5.4 (3.0–17.0)	25.8 ± 11.6 (8.0–45.0)	15.8 ± 10.9 (3.0–45.0)
HFMSE application time (minutes) Mean ± SD. (min–max)	16.8 ± 7.1 (9.0–28.0)	23.7 ± 6.4 (8.0–34.0)	21.7 ± 7.2 (8.0–34.0)
Maximal motor function Walker/Non walker)	Walker: N = 0 (0%) Non walker: N = 6 (100%)	Walker: N = 10 (71.4%) Non walker: N = 4 (28.6%)	Walker: N = 10 (50%) Non walker: N = 10 (50%)
Functional rating Scale (1–10) Mean ± SD. (min–max)	2.0 ± 0.0 (2.0–2.0)	7.1 ± 1.9 (2.0–9.0)	5.9 ± 2.5 (2.0–9.0)

	HFMSE Final score
	Evaluator 1	Evaluator 2
Mean ± SD	20.1 ± 21.2	20.1 ± 21.1
Evaluator 1–2 (Mean ± SD)	-0.071 ± 0.38
ICC (95%CI)	1.00 (1.00–1.00)

Item	Kappa index	p	Item	Kappa index	p
1	1.00	< 0.001	18	1.00	< 0.001
2	1.00	< 0.001	19	1.00	< 0.001
3	1.00	< 0.001	20	1.00	< 0.001
4	1.00	< 0.001	21	1.00	< 0.001
5	0.94	< 0.001	22	0.94	< 0.001
6	0.94	< 0.001	23	1.00	< 0.001
7	1.00	< 0.001	24	1.00	< 0.001
8	1.00	< 0.001	25	1.00	< 0.001
9	1.00	< 0.001	26	1.00	< 0.001
10	1.00	< 0.001	27	1.00	< 0.001
11	1.00	< 0.001	28	1.00	< 0.001
12	1.00	< 0.001	29	1.00	< 0.001
13	1.00	< 0.001	30	1.00	< 0.001
14	0.93	< 0.001	31	1.00	< 0.001
15	1.00	< 0.001	32	1.00	< 0.001
16	1.00	< 0.001	33	1.00	< 0.001
17	1.00	< 0.001

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[1] Address for correspondence Juliana Gurgel Giannetti (email: gurgelgiannetti@gmail.com).