03689nas a2200277 4500000000100000008004100001260001300042653003100055653003000086653002600116653001100142653003700153653001800190653003100208653002500239653003100264653001600295100002000311700001800331245008600349300001200435490000700447050001800454520292500472022001403397 2013 d c2013 Jul10aActivities of Daily Living10aCross-Cultural Comparison10aDisability Evaluation10aHumans10aOutcome Assessment (Health Care)10aPsychometrics10aReproducibility of Results10aSocial Participation10aSurveys and Questionnaires10aTranslating1 aStevelink S A M1 avan Brakel WH00aThe cross-cultural equivalence of participation instruments: a systematic review. a1256-680 v35 aSTEVELINK20133 a

PURPOSE: Concepts such as health-related quality of life, disability and participation may differ across cultures. Consequently, when assessing such a concept using a measure developed elsewhere, it is important to test its cultural equivalence. Previous research suggested a lack of cultural equivalence testing in several areas of measurement. This paper reviews the process of cross-cultural equivalence testing of instruments to measure participation in society.

METHODS: An existing cultural equivalence framework was adapted and used to assess participation instruments on five categories of equivalence: conceptual, item, semantic, measurement and operational equivalence. For each category, several aspects were rated, resulting in an overall category rating of 'minimal/none', 'partial' or 'extensive'. The best possible overall study rating was five 'extensive' ratings. Articles were included if the instruments focussed explicitly on measuring 'participation' and were theoretically grounded in the ICIDH(-2) or ICF. Cross-validation articles were only included if it concerned an adaptation of an instrument developed in a high or middle-income country to a low-income country or vice versa.

RESULTS: Eight cross-cultural validation studies were included in which five participation instruments were tested (Impact on Participation and Autonomy, London Handicap Scale, Perceived Impact and Problem Profile, Craig Handicap Assessment Reporting Technique, Participation Scale). Of these eight studies, only three received at least two 'extensive' ratings for the different categories of equivalence. The majority of the cultural equivalence ratings given were 'partial' and 'minimal/none'. The majority of the 'none/minimal' ratings were given for item and measurement equivalence.

CONCLUSION: The cross-cultural equivalence testing of the participation instruments included leaves much to be desired. A detailed checklist is proposed for designing a cross-validation study. Once a study has been conducted, the checklist can be used to ensure comprehensive reporting of the validation (equivalence) testing process and its results.

IMPLICATIONS FOR REHABILITATION: • Participation instruments are often used in a different cultural setting than initial developed for. • The conceptualization of participation may vary across cultures. Therefore, cultural equivalence – the extent to which an instrument is equally suitable for use in two or more cultures – is an important concept to address. • This review showed that the process of cultural equivalence testing of the included participation instruments was often addressed insufficiently. • Clinicians should be aware that application of participations instruments in a different culture than initially developed for needs prior testing of cultural validity in the next context.

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