title: Translation and cross-cultural adaptation of the lower extremity functional scale into a Brazilian Portuguese version and validation on patients with knee injuries.
abstract: METHODS
  Clinical measurement.
  
  
  OBJECTIVE
  To translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into a Brazilian Portuguese version, and to test the construct and content validity and reliability of this version in patients with knee injuries.
  
  
  BACKGROUND
  There is no Brazilian Portuguese version of an instrument to assess the function of the lower extremity after orthopaedic injury.
  
  
  METHODS
  The translation of the original English version of the LEFS into a Brazilian Portuguese version was accomplished using standard guidelines and tested in 31 patients with knee injuries. Subsequently, 87 patients with a variety of knee disorders completed the Brazilian Portuguese LEFS, the Medical Outcomes Study 36-Item Short-Form Health Survey, the Western Ontario and McMaster Universities Osteoarthritis Index, and the International Knee Documentation Committee Subjective Knee Evaluation Form and a visual analog scale for pain. All patients were retested within 2 days to determine reliability of these measures. Validation was assessed by determining the level of association between the Brazilian Portuguese LEFS and the other outcome measures. Reliability was documented by calculating internal consistency, test-retest reliability, and standard error of measurement.
  
  
  RESULTS
  The Brazilian Portuguese LEFS had a high level of association with the physical component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.82), the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.87), the International Knee Documentation Committee Subjective Knee Evaluation Form (r = 0.82), and the pain visual analog scale (r = -0.60) (all, P<.05). The Brazilian Portuguese LEFS had a low level of association with the mental component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.38, P<.05). The internal consistency (Cronbach α = .952) and test-retest reliability (intraclass correlation coefficient = 0.957) of the Brazilian Portuguese version of the LEFS were high. The standard error of measurement was low (3.6) and the agreement was considered high, demonstrated by the small differences between test and retest and the narrow limit of agreement, as observed in Bland-Altman and survival-agreement plots.
  
  
  CONCLUSIONS
  The translation of the LEFS into a Brazilian Portuguese version was successful in preserving the semantic and measurement properties of the original version and was shown to be valid and reliable in a Brazilian population with knee injuries.
authors.affiliation: Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, Brazil. leo@brasilsaude.org
authors.forename: Leonardo
authors.initials: L
authors.lastname: Metsavaht
authors.forename: Gustavo
authors.initials: G
authors.lastname: Leporace
authors.forename: Marcelo
authors.initials: M
authors.lastname: Riberto
authors.forename: Maria Matilde M
authors.initials: MM
authors.lastname: Sposito
authors.forename: Letícia N C
authors.initials: LN
authors.lastname: Del Castillo
authors.forename: Liszt P
authors.initials: LP
authors.lastname: Oliveira
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Batista
mesh_terms: D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000523:psychology / Q000534:rehabilitation*; D001938:Brazil; D016001:Confidence Intervals; D018864:Cultural Diversity; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007718:Knee Injuries / Q000523:psychology / Q000534:rehabilitation*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011594:Psychometrics; D015203:Reproducibility of Results; D013223:Statistics as Topic; D014175:Translating; D055815:Young Adult