Adaptation of the City of Hope-Quality of Life-Ostomy Questionnaire From English to Brazilian Portuguese: A Validation Study.

PURPOSE: To culturally adapt the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) from English to Brazilian Portuguese and evaluate psychometric properties of the adapted instrument (internal consistency and construct validity). DESIGN: Methodological study to establish reliability and validity. SUBJECTS AND SETTING: The sample comprised 215 persons with stomas of any etiology who attended 1 of 3 specialized outpatient care center and 2 associations for persons with ostomies. Participants were residents of the state of Rio Grande do Sul, located in southeastern Brazil. METHODS: Techniques for cultural adaptation were carried out based on recommendations from the literature. We then evaluated the instrument's psychometric properties. Specifically, we evaluated construct (convergent and discriminant) validity and concurrent criterion validity via comparison of the adapted version of COH-QOL-OQ versus the WHOQOL-Bref (World Health Organization Quality of Life instrument). We also evaluated the internal consistency of the adapted COH-QOL-OQ, a measure of reliability. RESULTS: The internal consistency of the items was high with a Cronbach α of 0.92 for the total score and values ranging from 0.79 to 0.86 for the various domains of the COH-QOL-OQ. Confirmatory factorial analysis identified adjustment indexes to the acceptable model of adjustment for the COH-QOL-OQ model. Strong correlations between the COH-QOL-OQ and WHOQOL-Bref instrument domains confirmed the validity of the convergent construct. For the analysis of the concurrent criterion validity, the correlation coefficients between the score of item 16 and the other domains of COH-QOL-OQ ranged from 0.26 to 0.66. Analysis of the discriminate validity indicated that it was possible to isolate groups based on the temporal character of the stoma and time since ostomy surgery. CONCLUSIONS: The adapted version of COH-QOL-OQ demonstrates construct (convergent and discriminant) validity, concurrent criterion validity, and internal consistency (a measure of reliability) for evaluating health-related quality of life of persons with ostomies living in Brazil.

Health-Related Quality of Life in Persons With Ostomies Managed in an Outpatient Care Setting.

PURPOSE: We examined health-related quality of life (HRQOL) in persons with ostomies receiving outpatient care. We also analyzed relationships among HRQOL, demographic, and pertinent clinical factors. DESIGN: We used a descriptive, exploratory, cross-sectional study design to collect and analyze data. Data in this article are a secondary analysis of data collected from a primary study, developed by Santos and Gomboski, on the adaptation and validation of the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) to the Portuguese language in Brazil. SUBJECTS AND SETTING: A convenience sample of 215 adults living with an ostomy was evaluated. Slightly more than half (51.6%) were men, 67.5% underwent colostomy surgery, and 59.1% underwent cancer-related ostomy surgery. Subjects received care in specialized health care units in 3 cities in the Brazilian state of Rio Grande do Sul. METHODS: After approval by the Research Ethics Committee and permission from health care units, data were collected using 2 instruments: the World Health Organization Quality of Life-Short Version (WHOQOL-Bref) (generic HRQOL instrument) and the COH-QOL-OQ (disease specific HRQOL instrument). Data were analyzed using χ test and logistic regression (via a stepwise forward method). Patients were classified into 3 groups according to the means and standard deviations of the scores: low, moderate, and high quality of life (QOL). RESULTS: Ostomy patients had total scores of 69.6 ± 20.2 and 6.1 ± 1.4 for the WHOQOL-Bref and COH-QOL-OQ instruments, respectively. Patients with shorter times since their ostomy creation had worse scores on both the specific QOL (P = .006) and generic QOL (P = .019) instruments. Patients who did not practice religion (P = .027; odds ratio [OR] = 3.39) and those without a partner/spouse (P = .007; OR = 4.90) had increased probability of having worse scores on the WHOQOL-Bref (generic instrument). CONCLUSION: Persons living with ostomies were found to have scores indicating moderate HRQOL on a disease-specific and generic instrument. Shorter time since ostomy creation, lack of religious practice, and lack of a partner negatively influenced the HRQOL of these patients.

Adaptação cultural e validação do City of Hope - Quality of Life - Ostomy Questionnaire para a língua portuguesa no Brasil / Cultural adaptation and validadtion of City of Hope - Quality of Life - Ostomy Questionnaire in Portuguese spoken in Brazil

Considerando-se a falta de um instrumento de avaliação de qualidade de vida específico para pessoas estomizadas no Brasil, verificado após revisão bibliográfica de estudos sobre o tema em nosso meio, o objetivo desse estudo foi realizar a adaptação cultural e validar o instrumento City of Hope - Quality of Life - Ostomy Questionnaire (COH-QOL-OQ), para a língua portuguesa no Brasil. Após contato com a autora do instrumento original e obtenção de sua autorização para o desenvolvimento do processo de adaptação cultural e validação, o projeto recebeu também autorização do Comitê de Ética em Pesquisa da Secretaria Municipal de Saúde de Porto Alegre/RS. É um estudo do tipo metodológico, cujas etapas para adaptação cultural foram baseadas em Beaton et al (DATA), modificado conforme preconizado e utilizado no Instituto Municipal d'Investigación Médica de Barcelona (IMIN). Assim o processo de adaptação cultural, que caracterizaou a primeira parte deste estudo, seguiu os seguintes passos: tradução, avaliação por comitê de juízes, grupo focal com pessoas estomizadas e retrotradução. A versão retrotraduzida foi aprovada pela autora do instrumento original, Dra. Márcia Grant, e essa versão foi aplicada a 215 pessoas estomizadas, em três municípios do Estado do Rio Grande do Sul, para avaliação de algumas de suas propriedades psicométricas. A consistência interna do instrumento, analisada por meio do coeficiente alfa de Cronbach (>OU=0,70), resultou nos escores 0,92 para QV Total e 0,82, 0,86, 0,83, 0,79 para os domínios BES, BEP, BEF, BEE, respectivamente. A validade de conteúdo foi avaliada por meio do nível de concordância entre os juízes, obtendo-se 70%. A validade de critério concorrente, avaliada por meio da correlação (Pearson e Spearman) entre o item 16 do domínio BEP e os domínios do COH-QOL-OQ, verificando-se correlações entre 0,26 e 0,66. Quanto à validade de construto convergente -por meio da correlação entre os domínios do COH-QOL-OQ e do WHOQOL-Abreviado (coeficientes de correlação de Pearson e Spearman >OU=30) - os resultados variaram de 0,41 a 0,77. Finalmente, a validade de construto discriminante, em que se utilizaram os testes de Mann-Whitney, Kruskal-Wallis, t-Student e ANOVA, obteve-se discriminância na comparação para o tempo de estomizado, o caráter da estomia, a situação conjugal, a prática da religião. Os resultados permitiram concluir que o COH-QOL-OQ teve desempenho satisfatório, atestando sua confiabilidade e mostrando-se válido para medir a QV de pessoas ostomizadas.

One considering the lack of an evaluation tool of specific quality of life for ostomized people in Brazil, verified after a bibliographical review of studies about the theme in our field, the goal of this study was to carry out the cultural adaptation and to valid the instrument City of Hope Quality of Life Ostomy Questionnaire (COH-QOL-OQ). After contacting the author of the original instrument and obtaining her permission, though it was an instrument of free use and developing of the cultural adaptation process, as shown in the site of the City of Hope National Medical Center (COHNMC), the project has also received authorization from the Committee of ethics in researches of the Municipal Health Secretary of Porto Alegre/RS. It is a study of methodological kind that was carried out based on the steps for cultural adaptation of Guillemin, Bombardier and Beaton adapted for Beaton et al and yet adjusted by the steps followed by the Municipal Institute of Medical Investigation of Barcelona (IMIM). Therefore, the process of cultural adaptation, that has described the first phase of this study, followed the following steps: translations, evaluation by a committee of judges, focal group with ostomized people and retro translation. The retro translated version was approved by the author of the original instrument, Dra. Marcia Grant and such version was clinically applied to 215 ostomized people in three towns of the State of Rio Grande do Sul for evaluation of the psychometric properties of measure. Reliability was analyzed through intern consistency given by coefficient alfa of Cronbach ( > 70%), that resulted in scores 0,92 for QV Total and 0,82, 0,86, 0,83, 0,79 for dominions BES, BEP, BEF, BEE, respectively. One has also evaluated the validity of the content with acceptance of the level of agreement among the judges around 70%. The validity of the opponent criteria was evaluated by the correlationamong the item 16 of BEP dominion and the dominions of the COH-QOL-OQ and the validity of the convergent construct through the correlation among the dominions of the COH-QOL-OQ and of WHOQOL- Abbreviated (coefficients of correlation of Pearson and Spearman > 30). The results obtained were correlations between 0,26 to 0,66 for the opponent validity and 0,41 to 0,77 for the convergent validity. The validity of the discriminatory construct was evaluated by tests of Mann- Whitney, Kruskal-Wallis, t-student and ANOVA and there was discrimination when the dominions scores were compared with time of ostomized, sort of ostomy, marital status, religion practice. Concerning the type of ostonomy, income, education, work, religion and age there were no discrimination. One is able to conclude that the COH-QOL-OQ had a good performance, certifying its reliability and showing itself valid to measure the QV construct of ostomized people.

Predictive validity of Waterlow Scale for pressure ulcer development risk in hospitalized patients.

AIM: We sought to evaluate the predictive validity of the Waterlow Scale in hospitalized patients. SUBJECTS AND SETTING: The study was conducted at a general private hospital with 220 beds and a mean time of hospitalization of 7.4 days and a mean occupation rate of approximately 80%. Adult patients with a Braden Scale score of 18 or less and a Waterlow Scale score of 16 or more were studied. The sample consisted of 98 patients with a mean age of 71.1 + or - 15.5 years. METHODS: Skin assessment and scoring by using the Waterlow and Braden scales were completed on alternate days. Patients were examined at least 3 times to be considered for analysis. The data were submitted to sensitivity and specificity analysis by using receiver operating characteristic (ROC) curves and positive (+LR) and negative (-LR) likelihood ratios. RESULTS: The cutoff scores were 17, 20, and 20 in the first, second, and third assessment, respectively. Sensitivity was 71.4%, 85.7%, and 85.7% and specificity was 67.0%, 40.7%, and 32.9%, respectively. Analysis of the area under the ROC curve revealed good accuracy (0.64, 95% confidence interval [CI]: 0.35-0.93) only for the cutoff score 17 in the first assessment. The results also showed probabilities of 14%, 10%, and 9% for the development of pressure ulcer when the test results were positive (+LR) and of 3% (-LR) when the test results were negative for the cutoff scores in the first, second, and third assessment, respectively. CONCLUSION: The Waterlow Scale achieved good predictive validity in predicting pressure ulcer in hospitalized patients when a cutoff score of 17 was used in the first assessment.