Brazilian Portuguese translation, cross-cultural adaptation and reproducibility assessment of the modified Bristol Stool Form Scale for children

Jozala, Debora Rodrigues; Oliveira, Isabelle Stefan de Faria; Ortolan, Erika Veruska Paiva; Oliveira, Wilson Elias de; Comes, Giovana Tuccille; Cassettari, Vanessa Mello Granado; Self, Mariella Marie; Lourenção, Pedro Luiz Toledo de Arruda

doi:10.1016/j.jped.2018.01.006

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Original articles • J. Pediatr. (Rio J.) 95 (3) • May-Jun 2019 • https://doi.org/10.1016/j.jped.2018.01.006 copy

Brazilian Portuguese translation, cross-cultural adaptation and reproducibility assessment of the modified Bristol Stool Form Scale for children^☆ ☆ Please cite this article as: Jozala DR, Oliveira IS, Ortolan EV, Oliveira Junior WE, Comes GT, Cassettari VM, et al. Brazilian Portuguese translation, cross-cultural adaptation and reproducibility assessment of the modified Bristol Stool Form Scale for children. J Pediatr (Rio J). 2019;95:321 -7.

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Abstract

Objective:

To translate and culturally adapt the modified Bristol Stool Form Scale for children into Brazilian Portuguese, and to evaluate the reproducibility of the translated version.

Methods:

The stage of translation and cross-cultural adaptation was performed according to an internationally accepted methodology, including the translation, back-translation, and pretest application of the translated version to a sample of 74 children to evaluate the degree of understanding. The reproducibility of the translated scale was assessed by applying the final version of Brazilian Portuguese modified Bristol Stool Form Scale for children to a sample of 64 children and 25 healthcare professionals, who were asked to correlate a randomly selected description from the translated scale with the corresponding representative illustration of the stool type.

Results:

The final version of Brazilian Portuguese modified Bristol Stool Form Scale for children were evidently reproducible, since almost complete agreement (k > 0,8) was obtained among the translated descriptions and illustrations of the stool types, both among the children and the group of specialists. The Brazilian Portuguese modified Bristol Stool Form Scale for children was shown to be reliable in providing very similar results for the same respondents at different times and for different examiners.

Conclusion:

The Brazilian Portuguese modified Bristol Stool Form Scale for children is reproducible; it can be applied in clinical practice and in scientific research in Brazil.

KEYWORDS
Translations; Reproducibility of results; Defecation; Constipation; Child

	6 -7 years (n = 21)		>8 years (n = 53)		p ^b b p-value on the Mann -Whitney test.
	% Of individuals with insufficient understanding	Median^a a Median (min/max) values based on the results obtained through the application of the numerical verbal scale.	% Of individuals with insufficient understanding	Median^a a Median (min/max) values based on the results obtained through the application of the numerical verbal scale.
Pre-final version	10%	5 (1 -5)	0%	5 (3 -5)	0.52
Description 1	15%	5 (1 -5)	11%	4 (1 -5)	0.83
Description 2	15%	4 (1 -5)	11%	4 (1 -5)	0.85
Description 3	5%	5 (2 -5)	7.5%	5 (1 -5)	0.98
Description 4	15%	4 (1 -5)	15%	4 (1 -5)	0.61
Description 5	5%	5 (2 -5)	5.6%	5 (1 -5)	0.91

Randomly selected descriptions	Illustrations of the stool types
	Type 1	Type 2	Type 3	Type 4	Type 5
Description 1	15	2	0	0	0
Description 2	1	12	0	3	0
Description 3	0	1	16	0	0
Description 4	0	0	2	14	5
Description 5	0	0	0	0	16

Randomly selected descriptions	Illustrations of the stool types
	Type 1	Type 2	Type 3	Type 4	Type 5
Description 1	7	0	0	0	0
Description 2	0	6	0	0	0
Description 3	0	0	4	0	0
Description 4	0	0	0	3	0
Description 5	0	0	0	1	4

Comparison between the responses obtained by different examiners	% Of agreement	Kappa index	p ^a a p-value on kappa index.
E1-E2	91	0.89	<0.001
E1-E3	91	0.89	<0.001
E1-E4	82	0.74	<0.001
E1-E5	82	0.74	<0.001
E2-E3	100	1.00	<0.001
E2-E4	91	0.89	<0.001
E2-E5	91	0.89	<0.001
E3-E4	91	0.89	<0.001
E3-E5	91	0.89	<0.001
E4-E5	100	1.00	<0.001

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[1] * Corresponding author. E-mail:lourencao@fmb.unesp.br (P.L. Lourenção).