New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties

Mancini, Marisa C.; Coster, Wendy J.; Amaral, Maíra F.; Avelar, Bruna S.; Freitas, Raphael; Sampaio, Rosana F.

doi:10.1590/bjpt-rbf.2014.0166

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 20 (06) • Nov-Dec 2016 • https://doi.org/10.1590/bjpt-rbf.2014.0166 copy

New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil.

Objectives

Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties.

Method

This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years).

Results

The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model.

Conclusion

The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research.

Keywords:
assessment; functioning; translation, cultural adaptation; psychometric properties; rehabilitation

DOMAIN	CONTENT ^* * Information available at: http://pedicat.com/category/domains/.	ITEM SCORING SCALE
Daily Activities	Getting Dressed, Keeping Clean, Home Tasks, and Eating and Mealtime	1) Unable = Cannot do, does not know how or is too young. 2) Hard = Performs with much help, extra time, or effort. 3) A little hard = Performs with a little help, extra time, or effort. 4) Easy = Performs with no help, extra time, or effort or the child’s skills are past this level. I Don’t Know.
Mobility	Basic Movement and Transfers, Standing and Walking, Steps and Inclines, Running and Playing, and Wheelchair
Social/Cognitive	Interaction, Communication, Everyday Cognition, and Self Management
Responsibility	Organization and Planning, Taking Care of Daily Needs, Health Management, and Staying Safe	1) Adult/caregiver has full responsibility; the child does not take any responsibility. 2) Adult/caregiver has most responsibility, and the child takes a little responsibility. 3) Adult/caregiver and child share responsibility approximately equally. 4) Child has most responsibility with a little direction, supervision, or guidance from an adult/caregiver. 5) Child takes full responsibility without any direction, supervision, or guidance from an adult/caregiver. I Don’t Know

PEDI-CAT DOMAIN ^* * Domains: DA: Daily Activities; MB: Mobility; SC: Social/Cognitive; RS: Responsibility.	PEDI-CAT ITEMS	STRATEGIES USED IN THE TRANSLATION ^ Strategies: EX: example; AD: addition, OM: omission; SUB: substitution; EXC: exclusion.					TOTAL
	PEDI-CAT ITEMS	EX	AD	OM	SUB	EXC	TOTAL
DA	68	7	5	4	0	0	16
MB	97	0	9	5	1	1	16
SC	60	0	5	0	1	0	6
RS	51	7	3	0	3	0	13
TOTAL	276	14	22	9	5	1	51

ITEM	ORIGINAL VERSION	TRANSLATED VERSION	STRATEGY
DA013	Pours liquid from a large carton into a glass	Despeja o líquido de uma caixa (por exemplo, de suco ou leite)^* * Parts in bold illustrate what was added, substituted and/or omitted in relation to the orginal item. em um copo	Example
DA021	Cuts with scissors to open hard plastic packaging	Abre uma embalagem de plástico duro (por exemplo, de brinquedo ou eletrônico)* usando tesoura	Example
MB095	Climbs on and off a climbing structure	Sobe e desce um brinquedo de escalar (trepa-trepa)^* * Parts in bold illustrate what was added, substituted and/or omitted in relation to the orginal item.	Addition
MB128	Walks 3 miles*/5 kilometers	Caminha por 5 quilômetros	Omission
SC019	Plays peek-a-boo or pat-a-cake^* * Parts in bold illustrate what was added, substituted and/or omitted in relation to the orginal item.	Brinca de “achou” ou jogos simples de bater palmas com as mãos^* * Parts in bold illustrate what was added, substituted and/or omitted in relation to the orginal item.	Substitution
RS015	Following a recipe or cooking instructions that includes 3-4 ingredients and steps, such as macaroni and cheese or brownies	Segue uma receita ou instruções de culinária que incluem 3-4 ingredientes e passos, tais como massa de bolo pronta, miojo, tapioca^* * Parts in bold illustrate what was added, substituted and/or omitted in relation to the orginal item.	Substitution
RS055	Identifying correct polling location; Understanding the voting process and rights; Requesting absentee ballots as needed	Identificar o local correto de votação; Compreender o processo e os direitos/deveres de votar; Requisitar formulário de justificativa quando necessário; Compreender os procedimentos necessários de uso da urna eletrônica^* * Parts in bold illustrate what was added, substituted and/or omitted in relation to the orginal item.	Addition

Sample Description and Information provided about the PEDI-CAT			0 to 7 years (n=367)	8 to 14 years (n=240)	15 to 21 years (n=203)	TOTAL (n=810)
Children/ Youth	Age ^* * Age: mean value (standard deviation).		3.78 (2.21)	11.17 (1.90)	17.36 (1.65)	9.37 (5.93)
	Sex ^ Sex: F: Female, M: Male, the values determine the frequency (percentage).	F	205 (56%)	131 (55%)	128 (63%)	464 (57%)
		M	162 (44%)	109 (45%)	75 (37%)	346 (43%)
Family socioeconomic information ^* ***** Family socioeconomic classification. The categories represent socioeconomic levels. They are defined from a standardized questionnaire that assigns points to items related to the presence and amount of certain home appliances, number of cars owned, and the level of formal education of the main family member (provider). The points are summed, and specific ranges are translated into categories, in which higher total scores refer to higher socioeconomic levels. Level A=46 to 35 points; B=23 to 34 points; C=14 to 22 points; and D=8 to 13 points.	Socioeconomic classification	A	52 (14%)	27 (11%)	31 (15%)	110 (14%)
		B	169 (46%)	94 (39%)	87 (43%)	350 (43%)
		C	122 (33%)	96 (40%)	73 (36%)	291 (36%)
		D	24 (7%)	23 (10%)	12 (6%)	59 (7%)
About the PEDI-CAT	Difficulty demonstrated in understanding items	None	342 (93%)	233 (97%)	193 (95%)	768 (95%)
		A little	22 (6%)	7 (3%)	10 (5%)	39 (5%)
		A lot	3 (1%)	0 (0%)	0 (0%)	3 (0%)
	Do items represent functioning?	Yes	359 (98%)	237 (99%)	195 (96%)	791 (98%)
	Do items represent functioning?	No	8 (2%)	3 (1%)	8 (4%)	19 (2%)

	0-7 years	8-14 years	15-21 years
Inter-examiner Reliability (95% CI)	0.86 (0.81-0.90)	0.83 (0.76-0.88)	0.89 (0.85-0.92)
Test-retest Reliability (95% CI)	0.96 (0.95-0.97)	0.97 (0.97-0.98)	0.97 (0.96-0.98)
Internal Consistency	0.99	0.99	0.99
Standard error of measurement	0.12	0.17	0.13

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[1] *Correspondence Marisa C. Mancini Universidade Federal de Minas Gerais Escola de Educação Física, Fisioterapia e Terapia Ocupacional Programa de Pós-graduação em Ciências da Reabilitação Avenida Antônio Carlos, 6627, Pampulha CEP 31270-010, Belo Horizonte, MG, Brazil e-mail: mcmancini@ufmg.br, marisacmancini@gmail.com