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Sebastian Turner
Sebastian Turner

Sf-36 Questionnaire Arabic Version Pdf Downloadl



Health Related Quality of Life (HRQOL) instruments need disease and country specific validation. In Arab countries, there is no specific validated questionnaire for assessment of HRQOL in chronic kidney disease (CKD) patients. The aim of this study was to present an Arabic translation, adaptation, and the subsequent validation of the kidney disease quality of life-short form (KDQOL-SFTM) version 1.3 questionnaire in a representative series of Egyptian CKD patients.




Sf-36 Questionnaire Arabic Version Pdf Downloadl



The KDQOL-SFTM version 1.3 combines the generic SF-36 instrument with the kidney disease specific instrument. The questionnaire consists of 80 items divided into 19 dimensions. The disease specific component of KDQOL-SFTM 1.3 includes 43 kidney disease targeted items. They comprise 11 domains, including: symptom/problem list (12 items), effects of kidney disease (8 items), burden of kidney disease (4 items), cognitive function (3 items), quality of social interaction (3 items), sexual function (2 items), sleep (4 items), social support (2 items), work status (2 items), patient satisfaction (1 item), and dialysis staff encouragement (2 items). SF-36 includes 36 items that measure eight domains of functioning and wellbeing on a 100 point scale. The eight domains are: physical function (10 items), role limitations caused by physical problems (4 items), role limitations caused by emotional problems (3 items), pain (2 items), general health perceptions (5 items), social function (2 items), emotional well-being (5 items), and energy/fatigue (4 items). The final item, the overall health rate item, asks the respondents to rate their health on a 0-10 response scale. Results from the SF-36 instrument are further summarized into a physical composite summary (PCS) score and a mental composite summary (MCS) score PCS aggregates items from physical function, role physical, pain, and general health. MCS aggregates items from role emotional, emotional wellbeing, energy, and social function [18]. According to Mapes et al., [19], items of the kidney disease targeted scale are also summarized into kidney disease composite summary (KDCS) score on a100 point scale.


Permission to translate the KDQOL-SFTM version 1.3 questionnaire into the Arabic language was obtained from its authors. After consulting the KDQOL working group, minimal modifications were introduced to make the questionnaire suitable for use among CKD (stage 1-4) patients. In brief, we excluded the questions about problems with access site (item 14L for hemodialysis) and catheter site (item 14M) for peritoneal dialysis, and about dialysis staff encouragement and support (items 24A and 24B). The question about satisfaction with care (item 23) was modified by changing "kidney dialysis" to "kidney disease." These modifications could potentially alter the psychometric properties of the questionnaire. Hence, there is a necessity for a new robust validation study.


In order to undertake field testing of the Arabic version of KDQOL-SFTM 1.3 questionnaire (Additional file 1), 100 pre-dialysis CKD patients were randomly selected from patients attending the out-patient Nephrology clinic, being the pool for all nephrology patients, at the Main Alexandria University Hospital. The Main Alexandria University Hospital serves patients from different regions of the country. Patients were interviewed after their informed consent. Inclusion criteria included patients aged 18 years and above, diagnosed as pre-dialysis CKD (stage1-4). Exclusion criteria included ESRD patients, those on dialysis, had previous renal transplantation, and those with cognitive impairment. Test re-test reliability was estimated, with a subsample of 50 consecutive CKD patients, by two interviews 7 days apart.


Exploratory factor analysis was used to evaluate the factor structure of the Arabic version of the KDQOL-SFTM 1.3 questionnaire. Exploratory factor analysis was performed by the principal component analysis on the 39 items (after modifications) of the kidney targeted scales (after modifications) to assess the factor structure of the questionnaire [24].


As regards the characteristics of the 100 CKD patients included in the validation of the Arabic version of the KDQOL-SFTM version 1.3 questionnaire, the median age of the study sample was 54 (42-60) years. Male patients constituted 54%. About one third of the CKD patients (34%) were university graduates and almost one fourth (24%) were illiterate. Around three fourths of the study patients (76%) were married, one fourth (25%) were current smokers, 42% were hypertensive, and 36% were diabetics. As regards the distribution of the patients by the stage of CKD, 44% of the patients were in stage 3 CKD while those in stage 4 constituted 56%.


Table 1 shows the distribution of the responses to each item of the Arabic version of KDQOL-SFTM version 1.3 questionnaire. Among the kidney disease targeted scales, work status had the highest proportion of both ceiling and floor effects (18% and 40 %, respectively). This was followed by the social support item with ceiling and floor effects of 17% and 6%, respectively. Sexual function also had a high proportion of floor effect (16%). In the SF-36 scales, role physical had the highest proportion of floor effect (48%). Role emotional had the highest proportion of ceiling effect (50%) and a high proportion of floor effect (24%).


Although the KDQOL-SFTM version 1.3 questionnaire was conceived for self administration, we tested the Arabic version of the KDQOL-SFTM 1.3 by interviewing 100 (stage 1-4) CKD patients. Almost one fourth (24%) of the study population were illiterate. Administrating the questionnaire by two methods, as self administration for those who could read and write, and as researcher-administered for those who were illiterate would have reduced the precision of HRQOL scores due to differences in the way of collecting information.


Based on the findings of this study, the Arabic version of the KDQOL-SFTM version 1.3 is reliable and valid. This questionnaire could be administered by the health workers to assess HRQOL among pre-dialysis CKD patients.


The study was approved by the University of Jordan Academic and Research Committee. All participants were interviewed by trained research assistants using a questionnaire containing the Arabic version of the EQ-5D and the short form health survey (RAND SF-36-Arabic version).5 Demographic data were also collected using a standard questionnaire. A random sample was then chosen, given a copy of the EQ-5D and re-interviewed over the phone using the EQ-5D after 2 to 4 weeks to assess test-retest reliability.


Patients or individuals are asked to fill out the questionnaire (tick boxes) by themselves and then it is scored by a clinician or researcher. There are variations of the SF-36; it is both licensed (Optum) and available freely online (Rand). Both sources are from different original authors and contain the same 36 questions and answers only differing slightly in the bodily pain and general health domains[4]. Users should document which version they are using and use the corresponding scoring system.


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Lee, J., Lee, D., Suh, K., Kim, J., Lim, J., & Goh, T. (2011). Validation of the Korean version of the Scoliosis Research Society-22 questionnaire. European Spine Journal, 20(10), 1751-1756. Find it on PubMed


Lonjon. G., Ilharreborde, B., Odent, T., Moreau., S., Glorion, C., Mazda K. (2014). Reliability and validity of the French-Canadian version of the scoliosis research society 22 questionnaire in France. Spine, 39(1), E26-E34. Find it on PubMed


Kyrölä, K., Järvenpää, S., Ylinen, J., Mecklin, J., Repo, J., & Häkkinen, A. (2017). Reliability and validity study of the Finnish adaptation of Scoliosis Research Society questionnaire version SRS-30. Spine, 42(12), 943-949. Find it on PubMed


Mousavi, S. J., Mobini, B., Mehdian, H., Akbarnia, B., Bouzari, B., Askary-Ashtiani, A., & ... Parnianpour, M. (2010). Reliability and validity of the Persian version of the Scoliosis Research Society-22r questionnaire. Spine, 35(7), 784-789. Find it on PubMed


Niemeyer, T., Schubert, C., Halm, H. F., Herberts, T., Leichtle, C., & Gesicki, M. (2009). Validity and reliability of an adapted German version of Scoliosis Research Society-22 questionnaire. Spine, 34(8), 818-821. Find it on PubMed


Potoupnis, M., Papavasiliou, K., Kenanidis, E., Pellios, S., Kapetanou, A., . . . Kapetanos, G. (2012). Reliability and concurrent validity of the adapted Greek version of the Scoliosis Research Society-22r questionnaire: A cross-sectional study performed on conservatively treated patients. Hippokratia, 16(3), 225-229. Find it on PubMed


Schlösser, T. P., Stadhouder, A., Schimmel, J. J., Lehr, A. M., van der Heijden, G. J., & Castelein, R. M. (2014). Reliability and validity of the adapted Dutch version of the revised Scoliosis Research Society 22-item questionnaire. Spine Journal, 14(8), 1663-1672. Find it on PubMed


The SF-36 comprises 36 items encompassing 9 domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health and reported health transition allowing for the generation of physical and mental health summary scores. The scale has been translated into several languages and takes approximately 10 min to complete. Scores on the SF-36 can be used in economic analyses by deriving utility weights [11]. The original SF-36 [28] was modified to improve the range and precision of some of the scales, improve the wording and format of the questionnaire, resulting in the SF-36 v2 [41], however the reviews largely failed to distinguish between the two versions. As a result, this review refers only to the SF-36 and does not specify whether the findings relate to Version 1 or Version 2. The reviews reported good to acceptable internal consistency and construct validity [13, 20]. People with HIV reported lower HRQoL on all dimensions compared to general population controls [13, 20]. Scale scores have been associated with treatment duration, less comorbidity and better social support [13]. The SF-36 has been found to be responsive to the initiation of ART, change in CD4 count, viral load and symptoms [4, 12, 20] however it may not be sensitive to change in ART medication in patients who are stable on ART [12]. Problems with floor and/or ceiling effects have been reported on some subscales [20]. The SF-36 was recommended for use in people with HIV in two of the reviews [4, 18], however a criticism of this and other MOS measures was that they were developed in US and translated into other languages without the input of patients to ensure conceptual and semantic equivalence, and therefore may not be relevant for use in cross-sectional research [20].


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