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. 2023 Aug 21;49(4):e20220372.
doi: 10.36416/1806-3756/e20220372. eCollection 2023.

Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD

[Article in English, Portuguese]
André Vinicius Santana  1 , Andrea Daiane Fontana  1 , Rafaela Cristina de Almeida  1 , Leandro Cruz Mantoani  1 , Carlos Augusto Camillo  1   2 , Karina Couto Furlanetto  1   2 , Fátima Rodrigues  3   4 , Joana Cruz  5 , Alda Marques  6 , Cristina Jácome  7   8 , Heleen Demeyer  9 , Fabienne Dobbels  10 , Judith Garcia-Aymerich  11   12   13 , Thierry Troosters  9 , Nidia Aparecida Hernandes  1 , Fabio Pitta  1
Affiliations

Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD

[Article in English, Portuguese]
André Vinicius Santana et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version.

Methods: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity.

Results: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: "amount" domain = 0.87 (95% CI, 0.73-0.94) and "difficulty" domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = -0.63).

Conclusions: The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

Objetivo:: Adaptar o instrumento PROactive Physical Activity in COPD - clinical visit (C-PPAC) ao contexto cultural brasileiro e determinar a validade de critério, concordância da confiabilidade teste-reteste e consistência interna dessa versão.

Métodos:: Um protocolo de adaptação cultural e validação foi fornecido pelos autores do instrumento original e, juntamente com outra diretriz, foi aplicado em uma versão em português desenvolvida por um grupo de pesquisa parceiro de Portugal. A versão brasileira adaptada foi então aplicada transversalmente duas vezes, com intervalo de sete dias, em 30 indivíduos com DPOC (57% de homens; média de idade de 69 ± 6 anos; e média do VEF1 de 53 ± 18% do previsto) para avaliação da consistência interna e da confiabilidade teste-reteste. Os participantes também responderam ao International Physical Activity Questionnaire (IPAQ), à escala modificada do Medical Research Council, ao COPD Assessment Test e ao Saint George’s Respiratory Questionnaire para avaliação da validade de critério.

Resultados:: O instrumento C-PPAC apresentou boa consistência interna e excelente confiabilidade teste-reteste: domínio “quantidade” = 0,87 (IC95%: 0,73-0,94) e domínio “dificuldade” = 0,90 (IC95%: 0,76-0,96). As disposições gráficas de Bland-Altman, juntamente com os altos coeficientes de correlação de concordância de Lin, reforçaram essa concordância. A validade de critério mostrou correlações moderadas a fortes do instrumento C-PPAC com todos os outros instrumentos avaliados, principalmente com o IPAQ (rho = −0,63).

Conclusões:: A versão brasileira do instrumento C-PPAC é uma ferramenta confiável e válida para avaliar a experiência de indivíduos brasileiros com DPOC em relação à sua atividade física na vida diária.

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Conflict of interest statement

CONFLICTS OF INTEREST: None declared.

Figures

Figure 1
Figure 1. Bland & Altman plots comparing the first and second administration of the PROactive Physical Activity in COPD-clinical visit for the “Amount” domain (in A) and the “Difficulty” domain (in B). ULN: upper limit of normal; mean: mean difference; and LLN: lower limit of normal.
Figure 2
Figure 2. Plots of Lin’s concordance correlation coefficient graphic dispositions between the first and second administration of the PROactive Physical Activity in COPD-clinical visit for the “Amount” domain (in A) and the “Difficulty” domain (in B).
Figure 3
Figure 3. Correlations of the PROactive Physical Activity in COPD-clinical visit (C-PPAC) total score (i.e., including physical activity monitor data) with: A, the International Physical Activity Questionnaire (IPAQ); B, the COPD Assessment Test (CAT); C, the modified Medical Research Council (mMRC) scale; and D, the modified version of the Saint George’s Respiratory Questionnaire (SGRQm).
Figure 4
Figure 4. Correlations of the PROactive Physical Activity in COPD-clinical visit (C-PPAC) “Amount” domain (second visit) with: A, the International Physical Activity Questionnaire (IPAQ); B, the COPD Assessment Test (CAT); C, with the modified Medical Research Council (mMRC) scale; and D, the modified version of the Saint George’s Respiratory Questionnaire (SGRQm).
Figure 5
Figure 5. Correlations of the PROactive Physical Activity in COPD-clinical visit (C-PPAC) “Difficulty” domain (second visit) with: A, the International Physical Activity Questionnaire (IPAQ); B, the COPD Assessment Test (CAT); C, with the modified Medical Research Council (mMRC) scale; and D, the modified version of the Saint George’s Respiratory Questionnaire (mSGRQ).
See this image and copyright information in PMC

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