Validation of Spanish versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ): a multicenter validation randomized study

Abstract

Introduction and Hypothesis The purpose of this study is to validate Spanish versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). Methods Spanish versions were developed using back translation. Validation was performed by randomizing bilingual women to complete the Spanish or English versions of the questionnaires first. Weighted kappa statistics assessed agreement for individual questions; interclass correlation coefficients (ICC) compared primary and subscale scores. Cronbach’s alpha assessed internal consistency of Spanish versions. To detect a 2.7 point difference in scores with 80% power and alpha of 0.05, 44 bilingual subjects were required. Results Individual questions showed good to excellent agreement (kappa ≥ .6) for all but 8 questions on the PFIQ. ICC’s of primary and subscale scores for both questionnaires showed excellent agreement. (All ICC ≥ 0.79). All Cronbach’s alpha’s values were excellent (≥ 0.84) for the primary scales of both questionnaires. Conclusions Valid and reliable Spanish versions of the PFIQ and PFDI have been developed.

The relationship between uterine leiomyomata and pelvic floor symptoms

“…Participants completed the validated short forms of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7). These questionnaires have been validated in English and in Spanish [17,18]. A response of 0 (no symptoms) or 1 (no bother) were grouped for data analysis into the category of "no bother."…”

Spanish translation and validation of four short pelvic floor disorders questionnaires

“…Spanish translations of the PFDI and PFIQ long forms have been previously developed [11,12]. However, we believe translation and validation of the more frequently used short versions was warranted for several reasons.…”

“…For example, question #6 of the PFIQ-7 is a condensed version of questions #26 and #30 of the PFIQ and the order of the questions in PFDI-20 is different from that of the PFDI. Only one of the prior studies addressed the short form questionnaires by performing a subgroup post hoc analysis of their long form data [11], rather than developing and testing the actual PFDI-20 and PFIQ-7. The previous studies also used the less-recommended translation/back-translation method described above.…”

“…Another caveat is that the subjects in this study were Latin American immigrants to the USA themselves or first-generation Americans (daughters of immigrants) and there may be differences when compared with nonimmigrant Latin American women. The use of bilingual patients for validation of a translation has been mentioned as a limitation in prior translation studies [11,19] because there could be differences between bilingual and monolingual Spanish speakers for whom these translations are intended. However, we believe that these putative differences, if any, are at least in part due to differences in educational status, which was quite evenly distributed in our study.…”

“…Finally, a back-translation of these versions into English by two independent native English-speaking translators was performed as a complementary last check before the validation phase, and comparability with the original English versions was evaluated by the English-speaking members of the Adjudication Committee. While prior work translating pelvic floor questionnaires used the translation/back-translation approach (with minor modifications) [11,12], this method has fallen out of favor in cross-cultural research because it focuses on a "word by word" translation rather than a conceptual and potentially more culturally sensitive one [8,9]. Translation/ back-translation allows investigators who do not know the target language to have a sense of control over the translated construct, but back-translations can mask syntactic, grammatical, and cultural errors.…”