Translation, inter-rater reliability, agreement, and internal consistency of the Spanish version of the cumulated ambulation score in patients after hip fracture

T ansla ion, in e - a e eliabili y, ag eemen , and in e nal consis ency o he Spanish e sion o he cumula ed ambula ion sco e in pa ien s a e hip ac u e “This is an o iginal manusc ip o an a icle published by Taylo & F ancis in Disabili y and Rehabili a ion on Ma ch 2019, a ailable a : doi: 10.1080/09638288.2019.1577499.” 1 T ansla ion, in e - a e eliabili y, ag eemen , and in e nal consis ency o he Spanish 1 e sion o he cumula ed ambula ion sco e in pa ien s a e hip ac u e 2 Au ho s 3 Pa ocinio A iza-Vega.1,2, PhD, Ma a Mo a-T a e so.3, MSc, Ma iana O iz-Piña.4, MSc, 4 Mau en Celes e Ashe.5,6, PhD, Mo en Tange K is ensen.7,8, PhD. 5 6 1Rehabili a ion and T auma ology Se ice, Uni e si y Hospi al o G anada, G anada, Spain 7 2Depa men o Physio he apy, Uni e si y o G anada, G anada, Spain. 8 3Depa men o P e en i e Medicine and Public Heal h, Uni e si y o G anada, G anada, Spain. 9 4Vis a Ne ada Nu sing Home o olde adul s, G anada, Spain. 10 5The Uni e si y o B i ish Columbia, Vancou e , Canada. 11 6Cen e o Hip Heal h and Mobili y, Vancou e , Canada. 12 7Physical Medicine and Rehabili a ion Resea ch – Copenhagen (PMR-C),Copenhagen, 13 Denma k. 14 8Depa men s o Physio he apy and O hopaedic Su ge y, Copenhagen Uni e si y Hospi al, 15 H ido e, Copenhagen, Denma k. 16 17 18 19 Co esponding Au ho : Pa ocinio A iza Vega, PhD. Depa men o Physio he apy. Uni e si y 20 o G anada. Rehabili a ion and T auma ology Se ice, Uni e si y Hospi al o G anada. A enida 21 de la In es igación, s/n . CP 18016. G anada. Spain. Telephone: 0034 958021596, E-mail: 22 [email p o ec ed] 23 24 Abs ac 25 26 Pu pose: To ansla e he Cumula ed Ambula ion Sco e (CAS) in o Spanish (CAS-E) and o 27 examine he in e a e eliabili y and ag eemen o he CAS-E. 28 2 Ma e ials and Me hods: Two occupa ional he apis s, independen ly e iewed 60 pa ien s 29 consecu i ely admi ed o a auma ology se ice o a public hospi al wi h a hip ac u e, and 30 a ed he h ee CAS ac i i ies om 0 o 2, wi hin he i s pos -su ge y week. We de e mined he 31 in e nal consis ency o CAS-E using C onbach’s α coe icien . To es eliabili y, we used 32 weigh ed kappa s a is ics, he s anda d e o o measu emen (SEM) and he smalles eal 33 di e ence (SRD). We de e mined he sys ema ic be ween- a e bias using he McNema –Bowke 34 es . 35 Resul s: No be ween- a e bias was seen, and he C onbach’s α o he CAS-E was 0.89. The 36 weigh ed kappa was ≥ 0.83 o he h ee indi idual ac i i ies and he o al CAS-E, while he 37 obse ed ag eemen was ≥ 0.87. The SEM and he SRD o he o al CAS-E (0-6 poin s) we e 38 0.18 and 0.83 poin s, espec i ely. 39 Conclusions: We p esen he CAS o use in Spanish speaking coun ies and p o ide e idence 40 o excellen ela i e and absolu e eliabili y o he CAS-E o assess basic mobili y o pa ien s 41 wi h hip ac u e in an acu e ca e hospi al. 42 43 Key wo ds: hip ac u e, basic mobili y, eliabili y, olde adul s, psychome ic p ope ies 44 45 In oduc ion 46 The loss o unc ional independence a e hip ac u e is widely epo ed in he li e a u e [1–3], 47 and ea ly mobiliza ion is ecommended [4] o educe he isk o p olonged hospi al s ay, 48 mo bidi y [5], and mo ali y [5,6]. To op imize eco e y pos -hip ac u e, ehabili a ion should 49 begin soon a e su ge y [4,5], and clinicians need alid and eliable measu emen ins umen s 50 (e.g., ou come measu es, such as scales o sco es) o desc ibe and e alua e changes in pa ien s' 51 3 unc ion o guide ehabili a ion. Fo eal-wo ld up ake, ou come measu es mus also be simple o 52 use and quick o adminis e wi hin he demands o daily clinical p ac ice. 53 54 Ou come measu es equen ly used o objec i ely desc ibe olde adul s’ unc ion a e hip 55 ac u e include he Func ional Independence Measu e (FIM) [7], Ba hel Index [8], Timed Up 56 and Go Tes (TUG) [9] o he Tine i Pe o mance O ien ed Mobili y Assessmen (POMA) [10]. 57 Howe e , hese scales a e mos use ul o he assessmen o all pa ien s in he la e phases o 58 ehabili a ion (some loo e ec is seen in he acu e ca e se ing) [9,10]. The FIM is ime 59 consuming [7], he POMA canno be used in pa ien s wi h cogni i e impai men [10], while he 60 TUG p e equisi e he abili y o ise om a chai and walk, independen o suppo om ano he 61 pe son [9]. Thus, he e is a need o an e icien , easily applicable and s able ou come measu e o 62 moni o all olde adul s’ basic unc ion, ac oss he mobili y spec um and con inui y o ca e. 63 64 The Cumula ed Ambula ion Sco e (CAS ) [11] is a alid and eliable ou come measu e o 65 quan i y pa ien s’ abili y o pe o m h ee basic mobili y ac i i ies: (i) ge ing in and ou o bed; 66 (ii) si ing and ising om a chai (wi h a m es s); and (iii) indoo walking (wi h/wi hou walking 67 aid) [11]. Each subcomponen o he CAS is g aded ou o 2 poin s and he o al CAS sco e can 68 ange om 0 (dependen ) o 6 (independen ). The simplici y o he CAS makes i an ideal 69 ou come o use in a busy clinical se ing. P e ious esea ch ecognized he CAS as alid o use 70 wi h pa ien s wi h hip ac u e (including hose wi h cogni i e impai men ) (5), o al knee 71 eplacemen [12,13] and olde adul s wi h an acu e medical hospi al admission [14,15]. O he 72 li e a u e obse ed i s p edic i e abili y o hospi al leng h o s ay and sho - e m (one mon h) 73 pos -ope a i e mo ali y in pa ien s hip wi h ac u e [5]. In addi ion, he CAS can de ec 74 4 di e ences be ween g oups o pa ien s in ela ion o anemia [16], pain [17], ype o ac u e [18], 75 age [16] and he p e- ac u e unc ional le el [16,18]. O e all, he CAS is an impo an clinical 76 ins umen ha o e comes limi a ions o o he ou come measu es and is easy o in eg a e wi hin 77 daily p ac ice [19]. 78 79 The popula i y o he CAS is gaining momen um and is adop ed o use in many coun ies [20– 80 23]. In Denma k, he CAS is a manda o y componen o he na ionwide Danish Mul idisciplina y 81 Hip F ac u e Da abase [24]. In his way, he CAS can p o ide popula ion le el da a o u u e 82 e alua ion o change sco es ac oss se ings (acu e hospi al o communi y). Such a e sa ile 83 measu e is impo an o clinical p ac ice and popula ion heal h. Fo sou he n Eu ope, he c oss- 84 cul u al alidi y and eliabili y o he CAS is es ablished in I alian [20]. Spanish is he second 85 mos common language spoken globally, bu he CAS is no a ailable in Spain, whe e he annual 86 age-adjus ed incidence o hip ac u e in olde adul s (65 yea s and olde ) is 766 and 325 87 cases/100,000 o women and men espec i ely [25]. Gi en he high a e o hip ac u e in Spain, 88 i is impo an o maximize eco e y, and eliable and alid ou come measu es a e essen ial o 89 e idence-based p ac ice. The e o e, he aim o his s udy was o ansla e he English e sion o 90 he Cumula ed Ambula ion Sco e in o Spanish (CAS-E), and examine he in e a e eliabili y 91 and ag eemen o he CAS-E. 92 93 Me hods 94 P ocedu e 95 We en olled 60 consecu i e pa ien s wi h hip ac u e, admi ed o he auma se ice o he 96 Hospi al o (blinded o pee - e iew), be ween Janua y 2017 and Ma ch 2017. We included all 97 5 olde adul s aged 65 yea s and olde . Fo pa ien s wi h cogni i e impai men , he in o med 98 consen was signed by hei ela i es. The s udy was app o ed by he e hics commi ee o he 99 (blinded o pee - e iew), and all pa ien s, o hei p oxy, signed a consen o m be o e s a ing 100 he s udy. 101 102 We ex ac ed desc ip i e in o ma ion om he medical cha , such as, weigh and heigh , ype o 103 ac u e and su ge y. Du ing an in-pe son in e iew (conduc ed be ween day 2 and 6 pos - 104 su ge y) we collec ed he ollowing sociodemog aphic and clinical in o ma ion: age, gende , 105 highes le el o educa ion, esidence (p e- ac u e and discha ge), cogni i e s a us [Sho 106 Po able Men al S a e Ques ionnai e (SPMSQ)] [26], sel -pe cei ed heal h (5 i em Like scale), 107 p e- ac u e unc ional le el [Func ional Independence Measu e (FIM)] [7], and pain ( isual 108 analogue scale (VAS)] [27]. 109 110 The Cumula ed Ambula ion Sco e (CAS) 111 The CAS desc ibes h ee basic mobili y ac i i ies: (i) ge ing in and ou o bed ( he sequence o 112 e en s is as ollows: pa ien is supine on he bed, hen mo es o si ing, s anding o ans e ing 113 o a chai nex o he bed, hen e u ns o si ing, hen supine posi ion on he bed); (ii) si o s and 114 o si om a chai wi h a m es s (wi h o wi hou aids), and (iii) walking indoo s (wi h o wi hou 115 walking aids) [11]. All h ee CAS ac i i ies a e g aded ou o wo poin s and hey a e summed o 116 gene a e a o al 1-day sco e om 0 (dependen [bed bound]) o 6 (independen ). Each ac i i y is 117 sco ed wi h wo poin s when e bal o physical assis ance is no equi ed (independen ), e en 118 o sa e y easons; 1 poin is assigned when human assis ance ( e bal o physical assis ance) is 119 equi ed om one o mo e pe sons; and no poin s a e gi en when he pa ien is no able o do he 120 6 ac i i y despi e human assis ance (dependen ) [11]. O e all, i akes 5-10 minu es (depending on 121 pa ien s’ mobili y le el) o he clinician o obse e he pa ien comple e he h ee ac i i ies o 122 he CAS in he clinical se ing. 123 124 T ansla ion o he CAS 125 We ollowed he ecommenda ions p o ided by Ramada-Rodilla and colleagues [28] o ansla e 126 he comp ehensi e English e sion o he CAS manual [29]. Two people (un amilia wi h he 127 CAS) independen ly ansla ed i om English o Spanish using he exp essions o he Spanish 128 cul u e and language ( o p ese e he o iginal in en o he es ). A hi d pe son syn hesized he 129 new CAS om he wo e sions desc ibed abo e. This pe son had no ead he o iginal English 130 e sion o he es . 131 132 The back ansla ion was conduc ed by a ou h pe son who was a na i e English speake . This 133 English e sion was o wa ded o and app o ed by (au ho , blinded o pee - e iew), one o he 134 o iginal CAS de elope s [11]. The objec i e in his phase was o iden i y possible di e ences, 135 di icul ies, o e o s o he Spanish ansla ion in ela ion o he o icial English e sion. The 136 inal e sion o he Spanish ansla ion o he CAS (CAS-E) is loca ed in supplemen a y da a 137 (Appendix). 138 139 In e - a e Reliabili y 140 We ollowed he guide p o ided by Ko ne and colleagues [30] o exam he in e - a e 141 eliabili y. One senio dual-educa ed occupa ional and physio he apis (blinded o pee - e iew) 142 and one no ice CAS use (a g adua e s uden and occupa ional he apis ; blinded o pee - 143 7 e iew) es ed in e a e eliabili y o he CAS-E. Fo ou p elimina y wo k, he a e s i s me o 144 con i m he p ocedu es o he CAS-E. Following his he senio he apis (blinded o pee - 145 e iew) comple ed he CAS-E wi h 15 in-pa ien s wi h hip ac u e, while he no ice CAS 146 (blinded o pee - e iew) obse ed he p ocedu e. The ollowing day, he wo a e s concu en ly 147 e alua ed six pa ien s wi h he CAS-E (no included in he esul s o his s udy) and discussed he 148 sco es. The senio he apis was p e iously ained by one o he c ea o s o he CAS. 149 In b ie , o assess he in e - a e eliabili y o he CAS-E, he a e s used se e al p ocedu es o 150 add s eng h o he p ocedu e. Fi s , hey used a andom numbe gene a o o decide he o de o 151 who ga e he CAS-E ins uc ions o he pa ien s. In his way, a a he p o ided he ins uc ion o 152 30 pa ien s and he o he a he did he same o he o he 30 pa ien s. Second, a e s assessed 153 pa ien s in he same session (concu en ly), bu hey did no discuss he a ings and eco ded hei 154 sco es independen ly (a hi d pe son collec ed a ing sco es a he end o each day). Thi d, all 155 es ing was comple ed be o e pa ien s’ usual daily ehabili a ion. 156 157 Sample size 158 We based he sample size o he eliabili y es ing ollowing ecommenda ions o Hopkins WG 159 [31], who sugges p ecision o eliabili y es ima es equi e a minimum o 50 s udy pa ien s. We 160 included 10 addi ional pa ien s ( o al n=60) o consis ency wi h he eliabili y s udy o he 161 o iginal CAS [11]. 162 163 S a is ical analysis 164 We p esen con inuous da a as means (s anda d de ia ion), medians (q25, q75) o numbe and 165 pe cen ages depending on he da a and i s dis ibu ion. We used he Shapi o-Wilk Tes o 166 8 examina ion o no mal dis ibu ion o con inuous da a, and Chi-squa e o Fishe 's Exac es o 167 explo e di e ences o ca ego ical da a. We used C onbach’s α coe icien [32] o es o 168 in e nal consis ency be ween a e s. To calcula e he in e - a e eliabili y ( o indi idual 169 ac i i ies and he o al CAS-E) we used a linea weigh ed kappa and 95% con idence in e al 170 [33] o o dinal scales. We calcula ed he obse ed (exac ) ag eemen be ween a e s and he 171 p e alence o sco es 0–2 o he h ee ac i i ies and assessed sys ema ic be ween- a e bias using 172 he McNema -Bowke es . We p o ide a Bland-Al man plo o illus a e di e ences be ween 173 a e s’ sco es. We use he S anda d E o o Measu emen (SEM) o epo he absolu e 174 eliabili y a g oup le el based on he s anda d de ia ion (SD) o pa ien sco es o bo h a e s 175 and he In aclass Co ela ion Coe icien (ICC2.1), and calcula ed as SEM = SD x √(1-ICC) (34). 176 To calcula e he smalles eal di e ence (SRD; smalles measu emen change ha can be 177 in e p e ed as a eal change o an indi idual pe son) we used he ollowing equa ion; SRD = 178 SEM x √2 x 1.96 [35]. We used IBM SPSS S a is ics Ve sion 20.0 (IBM Co p., A monk, New 179 Yo k) and se he le el o signi icance a P<0.05. 180 181 Resul s 182 We p o ide sociodemog aphic and clinical da a o all pa ien s in Table 1. I ook 48 days o he 183 wo a e s o comple e he CAS-E on he 60 consecu i e in-pa ien s wi h hip ac u e, who we e 184 e alua ed be ween day 2 and 6 pos -su ge y. 185 186 [Table 1 nea he e] 187 188 15 ac u e su ge y. Age Ageing. 2008;37(2):173–8. 319 [17]. Foss NB, K is ensen MT, Palm H, Kehle H. 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Spanish e sion o he Cumula ed Ambula ion Sco e (CAS-E). 403 404 Escala de Mo ilidad Acumulada (CAS-E) Ac i idad Capaz de hace lo independien emen e (Sin guía e bal ni ayuda ísica), 2 pun os Capaz de hace lo con guía e bal o ayuda ísica de una o a ias pe sonas, 1 pun os Incapaz de hace lo incluso con ayuda de o as pe sonas, 0 pun os Le an a se de la cama y acos a se Le an a se y sen a se en una silla Camina den o de casa con o sin ayuda écnica Pun uación To al: 405 406 Le an a se de la cama y acos a se; (De supino en cama a sen a se en el bo de de la cama, 407 pe manece sen ado o sen a se en una silla jun o a la cama, y ol e a la posición de supino en 408 cama). 409 20 Se asignan 2 pun os cuando la ac i idad se desa olla independien emen e. Independien emen e 410 signi ica que no es necesa ia guía e bal ni ayuda ísica de una pe sona, incluso po azones de 411 segu idad. Los pacien es pueden usa ayudas écnicas. 412 Se asigna 1 pun o cuando se equie e ayuda de una pe sona. La ayuda de o a pe sona puede se 413 desde cualquie indicación e bal has a la ayuda ísica po pa e de una o a ias pe sonas. Los 414 pacien es pueden usa ayudas écnicas. 415 Se asignan 0 pun os si los pacien es no son capaces de le an a se de la cama. Es o signi ica que 416 los pacien es no pueden le an a se de la cama y sen a se en una silla incluso con la ayuda de una 417 o a ias pe sonas. Los pacien es pueden usa ayudas écnicas. 418 419 Le an a se y sen a se en una silla con eposab azos; (Le an a se, pe manece de pie y 420 sen a se). 421 Se asignan 2 pun os cuando la ac i idad se desa olla independien emen e. Independien emen e 422 signi ica que no es necesa ia guía e bal ni ayuda ísica de una pe sona, incluso po azones de 423 segu idad. Los pacien es pueden usa ayudas écnicas. 424 Se asigna 1 pun o cuando se equie e ayuda de una pe sona. La ayuda de o a pe sona puede se 425 desde cualquie indicación e bal has a la ayuda ísica po pa e de una o a ias pe sonas. Los 426 pacien es pueden usa ayudas écnicas. 427 Se asignan 0 pun os si los pacien es no son capaces de le an a se de la silla. Es o signi ica que 428 los pacien es no pueden le an a se y sen a se en una silla incluso con la ayuda de una o a ias 429 pe sonas. Los pacien es pueden usa ayudas écnicas. 430 431 Camina den o de casa 432 21 Se asignan 2 pun os cuando se consigue camina independien emen e usando una ayuda écnica. 433 Independien emen e signi ica que no es necesa ia guía e bal ni ayuda ísica de una pe sona, 434 incluso po azones de segu idad. Los pacien es pueden usa ayudas écnicas. 435 Se asigna 1 pun o cuando se equie e ayuda de una pe sona. La ayuda de o a pe sona puede se 436 desde cualquie indicación e bal has a la ayuda ísica po pa e de una o a ias pe sonas. Los 437 pacien es pueden usa ayudas écnicas. 438 Se asignan 0 pun os a aquellos pacien es que no son capaces de camina . Es o hace e e encia a 439 aquellos pacien es que no son capaces de camina incluso siendo ayudados po una o a ias 440 pe sonas al mismo iempo que usan una ayuda écnica pa a camina . 441 442 La pun uación o al es de 0 a 6 pun os. Cada una de las es ac i idades iene una pun uación 443 en e 0 y 2 pun os. 444 445 446 22 Tables 447 448 Table 1. Cha ac e is ics o pa ien s (N=60). Values a e p esen ed as median (q25-q75); numbe o pa ien s (%) and mean (s anda d de ia ion) [minimum-maximum] depending on he a iable. Age, y mean (SD); min-max 81.6 (6.8); 64-96 Gende Women 46 (77) Men 14 (23) Body Mass Index, (BMI) kg/m2 Unde weigh , BMI < 18.5 1 (2) No mal, BMI =18.5-24.9 18 (30) O e weigh , BMI > 25 41 (68) Highes le el o Educa ion, n (%) Canno ead and w i e 16 (27) Can ead and w i e 25 (42) P ima y school 13 (22) High School 3 (5) College (Uni e si y) 3 (5) Type o ac u e In acapsula 40 (67) Ex acapsula 20 (33) Type o Su ge y 23 Dynamic Hip Sc ew / In a Medulla Hip Sc ew 32 (53) Hemia h oplas y 28 (47) Cogni i e S a us No cogni i e impai men 27 (45) Mild cogni i e impai men 14 (23) Mode a e cogni i e impai men 10 (17) Se e e cogni i e impai men 9 (15) Sel -pe cei ed heal h Ve y good 1 (2) Good 21(35) A e age 23 (38) Bad 12 (20) Ve y bad 3 (5) P e- ac u e Func ional Le el (measu ed by FIM) Median (q25-q75) 102 (79-124) Pain du ing ac i i y (measu ed by VAS), mean (SD) 5.15 (2.41) P e- ac u e esidence Home, li es alone 17 (28) Home, li es wi h someone 28 (47) Rela i e´s home 9 (15) Nu sing home 6 (10) Discha ge des ina ion Home, li es alone 4 (7) 24 Home, li es wi h someone 30 (50) Rela i e´s home 18 (30) Nu sing home 8 (13) To al CAS-E, mean (SD); min-max no ice he apis 3.32 (1.86); 0-6 senio he apis 3.30 (1.91); 0-6 CAS-E. Cumula ed Ambula ion Sco e-Spanish e sion; FIM. Func ional Independence Scale; VAS. Visual Analogue Scale 449