Arabic translation, adaptation and modification of the Dialysis Symptom Index for chronic kidney disease stages four and five.

Hayfa Almutary,Ann Bonner,Clint Douglas

doi:10.1186/s12882-015-0036-2

Abstract

BackgroundSymptom burden in chronic kidney disease (CKD) is poorly understood. To date, the majority of research focuses on single symptoms and there is a lack of suitable multidimensional symptom measures. The purpose of this study was to modify, translate, cross-culturally adapt and psychometrically analyse the Dialysis Symptom Index (DSI).MethodsThe study methods involved four phases: modification, translation, pilot-testing with a bilingual non-CKD sample and then psychometric testing with the target population. Content validity was assessed using an expert panel. Inter-rater agreement, test-retest reliability and Cronbach’s alpha coefficient were calculated to demonstrate reliability of the modified DSI. Discriminative and convergent validity were assessed to demonstrate construct validity.ResultsContent validity index during translation was 0.98. In the pilot study with 25 bilingual students a moderate to perfect agreement (Kappa statistic = 0.60-1.00) was found between English and Arabic versions of the modified DSI. The main study recruited 433 patients CKD with stages 4 and 5. The modified DSI was able to discriminate between non-dialysis and dialysis groups (p < 0.001) and demonstrated convergent validity with domains of the Kidney Disease Quality of Life short form. Excellent test-retest and internal consistency (Cronbach’s α = 0.91) reliability were also demonstrated.ConclusionThe Arabic version of the modified DSI demonstrated good psychometric properties, measures the multidimensional nature of symptoms and can be used to assess symptom burden at different stages of CKD. The modified instrument, renamed the CKD Symptom Burden Index (CKD-SBI), should encourage greater clinical and research attention to symptom burden in CKD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0036-2) contains supplementary material, which is available to authorized users.

Highlights

Symptom burden in chronic kidney disease (CKD) is poorly understood
Developed by Weisbord et al [8], the Dialysis Symptom Index (DSI) was designed to examine the prevalence and distress of 30 self-reported physical and emotional symptoms. This contrasts with the purposes of other available instruments, such as the Modified Edmonton Symptom Assessment System [9], the Patient Outcome Scale Symptom Module (POS-S) [10] and the Pittsburgh Symptom Score [11] that have been used to assess symptom burden in CKD patients
The ICC score indicated an excellent agreement between the E and A versions of the CKD Symptom Burden Index (CKD-SBI) (ICC = 0.99, p < 0.001)

Summary

Introduction

Symptom burden in chronic kidney disease (CKD) is poorly understood. Chronic kidney disease (CKD) is associated with a wide range of physical and psychological symptoms which have a negative impact on health-related quality of life [1]. Developed by Weisbord et al [8], the DSI was designed to examine the prevalence and distress of 30 self-reported physical and emotional symptoms. This contrasts with the purposes of other available instruments, such as the Modified Edmonton Symptom Assessment System [9], the Patient Outcome Scale Symptom Module (POS-S) [10] and the Pittsburgh Symptom Score [11] that have been used to assess symptom burden in CKD patients. None of the currently available instruments measure the multidimensional nature of symptoms [12,13]

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