Cross-cultural adaptation to Brazilian Portuguese of the Michigan Neuropathy Screening Instrument: MNSI-Brazil

Abstract

Diabetic sensorimotor polyneuropathy (DSPN) affects approximately 10% of the subjects newly diagnosed 1,2,3 as type 2 diabetes and this percentage can increase by duration, lack of glycemic and cardiovascular complications 3,4,5 . When appropriately treated by restoration of glycemic control 3 , the progression of the DSPN can be delayed and the diabetic ulcers and amputations reduced 3,6 . However, the neuropathy is still the major cause of diabetic foot presenting damaged nerve fibers and this secondary complication affects more than 50% among the subjects diagnosed ABSTRACTSince 1994, the University of Michigan Diabetes Research and Training Center proposed an instrument to measure neuropathies not yet adapted to use in Brazil. Then, this study aimed to adapt cross-culturally the Michigan Neuropathy Screening Instrument (MNSI) into Brazilian Portuguese, verifying its reliability. Thirty diabetic patients were initially evaluated with the adapted version after completed the essential steps to accomplish the cross-cultural adaptation. Twenty-two of them completed the procedures to repeat the measured scores after day 1 (trial 0). The repeated measurements were tested at days 2 or 3 (trial 1) by another rater (inter-rater reliability) and retested at day 20 (trial 2) by one of the attended raters (inter-test reliability). There were not great semantics, linguistics or cultural differences between two versions and excellent reliability was confirmed by intra-class correlation coefficient above 0.840. It was concluded that MNSI in the Brazilian version is reliable and it is ready to use.Keywords: diagnosis; monitoring; diabetic neuropathies. RESUMODesde 1994, o Centro de Treinamento e Pesquisa em Diabetes da Universidade de Michigan propôs um instrumento não ainda adaptado para uso no Brasil para mensurar neuropatias. O objetivo deste estudo foi adaptar transculturalmente o Michigan Neuropathy Screening Instrument (MNSI) para o Português brasileiro, verificando sua confiabilidade. Trinta pacientes diabéticos foram inicialmente avaliados pela versão adaptada depois de completados os passos essenciais para finalizar a adaptação transcultural. Vinte e dois deles completaram os procedimentos para repetir os escores medidos depois do dia 1 (ensaio 0). As medidas repetidas foram testadas nos dias 2 ou 3 (ensaio 1) por outro examinador (confiabilidade interexaminador) e retestadas no dia 20 (ensaio 2) por um dos examinadores participantes (confiabilidade interteste). Não existiam diferenças semânticas, linguísticas ou culturais entre as duas versões e excelente confiabilidade foi confirmada pelo coeficiente de correlação intra-classe acima de 0,840. Conclui-se que o MNSI na versão brasileira é confiável e está pronto para uso.Palavras-chave: diagnóstico; monitoramento; neuropatias diabéticas.

Validity and reliability of the Turkish version of the Michigan Neuropathy Screening Instrument

“…In this method, when the instrument is applied to the same individual at different times, there should be no difference between the measurements and the correlation should be >0.70 for instrument stability [27]. The test-retest ICC values of the Portuguese and Brazilian Portuguese versions of the MNSI were 0.91 and 0.864, respectively [18,19]. In the present study, the test-retest analysis showed no difference between the measurements and the correlation between the two measurements was 0.97.…”

“…The MNSI has been adapted into many languages such as Portuguese and Brazilian Portuguese [18,19]. A valid and reliable Turkish version of the MNSI will help standardize the assessment of neuropathic patients in Turkey.…”

Fatores associados ao risco de pé diabético em pessoas com diabetes mellitus na Atenção Primária

“…Na segunda etapa foi realizado o exame clínico dos pés por meio do Instrumento de Classificação de Neuropatia de Michigan (Michigan Neuropathy Screening Instrument -MNSI), considerando neuropatia presente em escore igual ou superior a 2,5, com pelo menos um sinal ou sintoma (12) . A classificação do risco de desenvolver o pé diabético foi realizada a partir do instrumento para exame do pé diabético em 3 minutos (13) .…”

Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument

“…There are currently two Portuguese versions of the MNSI: one was carried out by Barbosa et al, 4 who translated and validated the questionnaire for European Portuguese, and the other by Oliveira et al, 5 who translated and cross-culturally adapted it to Brazilian Portuguese without properly testing the all instrument measurement properties, as it is highly recommended in science. Besides, their back translation was not performed by two persons with the source language as their mother tongue, as it is recommended in Beaton.…”

“…21 However, since the translation in the former study was carried out in Portugal, it exhibits semantic, idiomatic, cultural, and conceptual differences from Brazilian Portuguese and, therefore, cannot be used in Brazil. 5 The second study 5 failed to test the Brazilian Portuguese version of the questionnaire, making it impossible to determine whether the translation displays the same measurement properties as the original. In addition, in their cultural adaptation there is no mention to ''agulhadas'', which is a very common and important symptom related to diabetic neuropathy and this is included in the English version, among some other differences to the present cross-cultural adaptation.…”