Neurol Sci (2014) 35:1293–1298 DOI 10.1007/s10072-014-1855-9

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The Italian version of the functional behavior profile: reliability in a population of persons with multiple sclerosis Edoardo Balli • Tiziano Giovannelli Matteo Paci



Received: 14 February 2014 / Accepted: 7 June 2014 / Published online: 25 June 2014 Ó Springer-Verlag Italia 2014

Abstract The aims of this study were to translate and investigate the interrater, test–retest reliability and internal consistency of the functional behavior profile (FBP) in an Italian population with multiple sclerosis. The Italian version of the FBP (FBP-I) was developed and the reliability of the final questionnaire was measured. A sample of 22 persons with clinically diagnosed multiple sclerosis was independently assessed by two raters. Interrater and test– retest reliability of the subscores and of the total score of the FBP-I were good to excellent. The internal consistency of the FBP-I was high. The FBP-I showed good psychometric properties and it can be used to assess functional status in Italian-speaking patients with multiple sclerosis. Keywords Multiple sclerosis  Activities of daily living  Measurement  Outcome measures

Introduction The functional behavior profile (FBP), proposed by Baum et al. [1], was designed to measure the impaired person’s capabilities in performing tasks, interacting with others, and solving problems. The FBP, in its English version, was tested in dementia [1], stroke [2] and multiple sclerosis (MS) populations [3]. E. Balli School of Physiotherapy, University of Florence, Florence, Italy T. Giovannelli Unit of Functional Rehabilitation, Azienda USL 3, Pistoia, Italy M. Paci (&) Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy e-mail: [email protected]

The aims of this study were to translate and investigate the interrater, test–retest reliability and internal consistency of the FBP in an Italian population with multiple sclerosis.

Methods A sample of 22 persons (16 females) with MS was enrolled. They were between the ages of 31 and 65 years (mean age 48.2 ± 9.5), and had a diagnosis of MS for 12.6 ± 2.8 years and an Expanded Disability Status Scale (EDSS) of 5.07 ± 0.93. All of them were free from any history of other neurologic illnesses, had no history of alcohol, drug abuse and/or psychiatric illnesses, and used Italian as their primary language. All participants had a mini mental state examination score \18. Two raters independently examined all patients. To explore the test–retest reliability, both raters assessed again all patients 5 days later. The FBP is a 27-item questionnaire designed to measure the overall capacity of the impaired person to engage in the following areas: activities of daily living; cognition; executive function; functional mobility; life participation; patient satisfaction; reasoning and problem solving; social relationship tasks, social interactions, and problem solving. All of the questions relate to how the person with impaired cognitive function performs in his/her daily activities during the past week. Participants rate their symptoms on a 5-point Likert-type scale and scores range from 0 (have many troubles related to functional behavior) to 108 (no troubles related to functional behavior). Items are grouped in three areas: task performance (TP) (items 1–11), problem solving (PS) (items 9, 10, 21–27) and social interaction (SI) (items 11–21). The guidelines for the process of cross-cultural adaptation of self-report measures were followed [4].

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Table 1 Functional behavior profile (FBP) total and subsections reliability

ICC intra-class correlation coefficients, CI confidence interval, a Cronbach’s alpha

Interrater reliability (ICC; 95 % CI)

SEM

Test–retest reliability (ICC; 95 % CI)

SEM

Internal consistency (alpha; p value)

FBP total

0.734; 0.648–0.807

5.56

0.960; 0.928–0.978

2.16

0.89; \0.001

Task performance

0.941; 0.894–0.967

1.3

0.947; 0.906–0.971

1.23

0.90; \0.001

Social interaction

0.772; 0.681–0.851

2.05

0.909; 0.839–0.949

1.29

0.84; \0.001

Problem solving

0.872; 0.778–0.928

1.35

0.890; 0.808–0.939

1.25

0.86; \0.001

Forward translation. FBP was forward translated from English into Italian by a professional native-speaking Italian translator. When a concept had no equivalent in the Italian culture or language, it was modified to suit the cultural context. Backward translation. One bilingual native Englishspeaking translator backward translated the first version to verify that the Italian version adhered to the sense of the original version as much as possible. Test of the final version. Both the forward and the backward translations were submitted to an expert in physical therapy with extensive knowledge in English language. The final version was administered to 13 outpatients to verify if all the items and responses were understood correctly. Then, this stage ended with an Italian version, the FBP-I. For reliability analysis, a paired t test was preliminarily used to exclude the presence of significant differences (P \ 0.05) between the scores of each pair of examiners. For each subscore and for the total score of the scale, the interrater and test–retest reliability were then estimated by calculation of the single measure intraclass correlation coefficient (ICC), interpreted according to Fleiss [6] and the standard error of measurement (SEM). To evaluate internal consistency of the scale and correlations among the subscores and the total score, we calculated Cronbach’s alpha coefficient. Internal consistency was also measured on the whole set of FBP-I items and on the total score of each section.

Results The questionnaire was completed in 14.2 ± 3.0 min, and there were no missed answers, multiple responses and no

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problems of comprehension for items. The FBP-I is shown in Appendix 1. Interrater reliability of the subscores and of the total score of the FBP-I was demonstrated by the good to excellent levels of the ICC values (Table 1). We also found an excellent test–retest of the total score and of the subscores. The internal consistency of the FBP-I was high (Table 1). The internal consistency of the FBP-I was also found to be high among the subscores and the total score (Cronbach’s alpha = 0.892).

Discussion The Italian version of the FBP showed moderate to good levels of reliability. For interrater reliability, the ICCs were higher than 0.70, which is the minimum level acceptable for measures to be used in populations, while only subsection TP has an acceptable level to be used in individuals [6]. Otherwise, the ICCs for test–retest reliability are higher than 0.90, with the exception of PS subscores. We can argue that the lower levels of interrater reliability may be due to the less restricted definition of the domains construct [7]. The FBP-I showed excellent internal consistency. These results are consistent with those found by Baum et al. [2] and lower than those reported in patients with dementia [1]. The present study has methodologic limitations, i.e., the sample of patients was not large and only one translator was used for both forward and backward translations. In conclusion, this study shows that the FBP-I has good psychometric properties and it can be used to assess functional status in patients with MS. Further investigations in larger and different populations are needed, to confirm the reliability and to assess the validity of the FBP-I.

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References 1. Baum C, Edwards DF, Morrow-Howell N (1993) Identification and measurement of productive behaviors in senile dementia of the Alzheimer type. Gerontologist 33:403–408. doi:10.1093/geront/33. 3.403 2. Baum MC, Edwards DF (2000) Documenting productive behaviors. Using the functional behavior profile to plan discharge following stroke. J Gerontol Nurs 26:34–40 3. Goverover Y, Kalmar J, Gaudino-Goering E, Shawaryn M, Moore NB, Halper J, DeLuca J (2005) The relation between subjective and objective measures of everyday life activities in persons with multiple sclerosis. Arch Phys Med Rehabil 86:2303–2308. doi:10. 1016/j.apmr.2005.05.016

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Neurol Sci (2014) 35:1293–1298 4. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of selfreport measures. Spine 25:3186–3191 5. Fleiss J (1986) The Design and analysis of clinical experiments. Wiley, New York 6. Fitzpatrick R, Davey C, Buxton MJ, Jones DR (1998) Evaluating patient based outcome measures for use in clinical trials. Health Technol Assess 2:1–74 7. D’zurilla TJ, Maydeu-olivares A (1995) Conceptual and methodological issues in social problem-solving assessment. Behav Ther 26:409–432. doi:10.1016/S0005-7894(05)80091-7

The Italian version of the Functional Behavior Profile: reliability in a population of persons with multiple sclerosis.

The aims of this study were to translate and investigate the interrater, test-retest reliability and internal consistency of the functional behavior p...
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