Abstract
BackgroundPatients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4–5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool. The purpose of this study is to carry out a cross-cultural adaptation of the POS-S Renal for Spanish-speaking patients, and to perform an analysis of the psychometric properties of this questionnaire.MethodsThe English version of the POS-S Renal was culturally adapted and translated into Spanish using a double forward and backward method. An expert panel evaluated the content validity. The questionnaire was pilot-tested in 30 patients. A total of 200 patients with CKD stage 4–5 filled in a modified Spanish version of the POS-S Renal and the MSAS-SF. Statistical analysis to evaluate the psychometric properties of the questionnaire was carried out.ResultsThe content validity index (CVI) was 0.97, which indicated that the content of the instrument is an adequate reflection of the symptoms in advanced CKD (ACKD). The factor analysis indicated a two-factor solution explaining 35.05% of total variance. The confirmatory factor analysis (CFA) demonstrated that the two factor model was well supported (comparative fit index = 0.98, root mean square error of approximation = 0.068). This assessment tool demonstrated a satisfactory test–retest reliability (r = 0.909 to factor 1, r = 0.695 to factor 2, r = 0.887 to total score), good internal consistency to factor 1 (α = 0.78) and moderate internal consistency to factor 2 (α = 0.56). Concurrent criterion-related validity with MSAS-SF was also demonstrated, with r = 0.860, which indicated a high degree of correlation with a validated instrument that has been used in patients with ACKD.ConclusionsThe Spanish modified version of the POS-S Renal is a reliable and valid instrument that can be used to assess symptoms in Spanish patients with CKD stage 4–5.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0402-8) contains supplementary material, which is available to authorized users.
Highlights
Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care
Among the tools most used for the study of symptoms in kidney patients are questionnaires that are not specific to renal patients, such as the Memorial Symptom Assessment Scale-Short Form(MSAS-SF) [10], questionnaires modified for use with patients on dialysis, such as the Edmonton Symptom Assessment System (ESAS) [11], and other specific questionnaires that have been developed to measure symptoms in Advanced Chronic Kidney Disease (ACKD), such as the Dialysis Symptom Index (DSI) [12] and the Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) [13]
The aims of this study were to carry out a crosscultural adaptation of the POS-S Renal into Spanish and to perform an analysis of test-retest reliability, internal consistency, internal structure, and concurrent criterionrelated validity with the MSAS-SF, a previously validated Patient reported outcome (PRO) measure which has been used in patients with ACKD [18,19,20]
Summary
Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4–5. A patient with Advanced Chronic Kidney Disease (ACKD)(defined, according to the international guidelines, as chronic kidney disease at stage 4 or 5 with a glomerular filtration rate < 30 ml/min) has an increased burden of physical and psychological symptoms that are associated with a poor health-related quality of life (HRQoL) [1,2,3]. Patient reported outcome (PRO) instruments are generally used to assess patients’ functional status, quality of life and symptoms [7] This is especially important in patients with chronic diseases such as chronic kidney disease (CKD), in which PRO measures can be used to evaluate, monitor, and facilitate the introduction of interventions [8]. Among the tools most used for the study of symptoms in kidney patients are questionnaires that are not specific to renal patients, such as the Memorial Symptom Assessment Scale-Short Form(MSAS-SF) [10], questionnaires modified for use with patients on dialysis, such as the Edmonton Symptom Assessment System (ESAS) [11], and other specific questionnaires that have been developed to measure symptoms in ACKD, such as the Dialysis Symptom Index (DSI) [12] and the Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) [13]
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