Ronaldo Alves da Cunha

Translation, Cross-cultural Adaptation, and Clinimetric Testing of Instruments Used to Assess Patients With Patellofemoral Pain Syndrome in the Brazilian Population

STUDY DESIGN Clinical measurement study. OBJECTIVES To cross-culturally adapt the Anterior Knee Pain Scale (AKPS), the Functional Index Questionnaire (FIQ), and the Pain Severity Scale (PSS) for patellofemoral pain syndrome (PFPS) into Brazilian Portuguese. This study also aimed to test the measurement properties of the AKPS, the FIQ, and the PSS, and the existing Brazilian Portuguese versions of the numeric pain rating scale (NPRS) and the Global Perceived Effect scale in a group with PFPS. BACKGROUND PFPS is a common condition. Therefore, translated, culturally adapted, and clinimetrically tested instruments for measuring PFPS are needed. METHODS The AKPS, FIQ, and PSS instruments were cross-culturally adapted into Brazilian Portuguese. The measurement properties of the AKPS, FIQ, PSS, NPRS, and Global Perceived Effect scale (internal consistency, ceiling and floor effects, and construct validity) were tested in 83 patients with PFPS. The reproducibility and responsiveness were tested in 52 patients with PFPS in a test-retest design, with follow-up testing at 48 to 72 hours and at 4 weeks after baseline. RESULTS The AKPS, the FIQ, and the PSS yielded adequate internal consistency (Cronbach alpha ranging from .75 to .87) and excellent reliability (intraclass correlation coefficients [model 2,1] ranging from 0.90 to 0.97). The AKPS and the PSS yielded very good agreement (standard error of measurement, 2.9% and 3.5%, respectively). The highest correlations were observed among the AKPS, the FIQ, and the PSS (Pearson r>0.60, P<.05). No floor or ceiling effects were observed for any of the instruments. Effect sizes used for measuring internal responsiveness ranged from moderate to high for all measures. The NPRS and the AKPS were the measures with the highest external responsiveness. CONCLUSION The Brazilian Portuguese versions of the AKPS, FIQ, PSS, NPRS, and Global Perceived Effect scale have acceptable measurement properties.

Cross-cultural Adaptation and Measurement Properties of the Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Patella (VISA-P) Scale

STUDY DESIGN Clinical measurement. OBJECTIVES To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. BACKGROUND It is important to objectively measure symptoms and functional limitations related to patellar tendinopathy using outcome measures that have been validated in the language of the target population. Cross-cultural adaptations are also useful to enhance the understanding of the measurement properties of an assessment tool, regardless of the target language. METHODS The VISA-P questionnaire was translated into Brazilian Portuguese, culturally adapted, and titled VISA-P Brazil. It was then administered on 2 occasions with a 24- to 48-hour interval between them, and a third time after a month of physical therapy treatment. The following measurement properties were analyzed: internal consistency, test-retest reliability, agreement, construct validity, floor and ceiling effects, and responsiveness. RESULTS The VISA-P Brazil had high internal consistency (Cronbach α = .76; if item deleted, Cronbach α = .69-.78), excellent reliability and agreement (intraclass correlation coefficient = 0.91; 95% confidence interval: 0.85, 0.95; standard error of measurement, 5.2 points; minimal detectable change at the 90% confidence level, 12.2 points), and good construct validity (Pearson r = 0.60 compared to Lysholm). No ceiling and floor effects were detected for the VISA-P Brazil, and the responsiveness, based on 32 patients receiving physical therapy intervention for 1 month, demonstrated a large effect size of 0.97 (95% confidence interval: 0.68, 1.25). CONCLUSION The VISA-P Brazil is a reproducible and responsive tool and can be used in clinical practice and research to assess the severity of pain and disability of patients with patellar tendinopathy.

Functional Screening Tests: Interrelationships and Ability to Predict Vertical Jump Performance

There are several methods used in sports science to identify asymmetries in athletes, given their purported relevance to injury prevention and performance optimization. We aimed to verify whether asymmetries provided by isokinetic assessments, jump tests, and tensiomyography (TMG) are associated with each other, and whether their respective functional indices are related to jumping ability. TMG parameters, unilateral and bilateral squat-jump (SJ) and countermovement-jump (CMJ) performances, and peak torque in knee-extension and flexion with angular velocities of 60o/s and 300o/s for twenty-four soccer players were retained for analyses. Asymmetry was detected by examining the percentage difference between dominant and non-dominant legs. The median-split technique was used to identify the best and worst performers in SJ and CMJ tests. Results revealed that the asymmetries detected in the three different methods were not interrelated. Curiously, better performances in SJ and CMJ tests were associated with higher asymmetry levels. Furthermore, only the knee-extension peak torque at both angular velocities was correlated moderately to largely (r=0.48-0.66) with jump performance. Despite their recognized ability to predict the risk of injury, the absence of interrelationships between TMG, isokinetic tests, and unilateral jumps precludes their single use as a unique functional screening diagnostic. Finally, and very importantly, lower-limb asymmetry is not necessarily related to impaired vertical jump performance in soccer players.