title: Arabic translation, adaptation and modification of the Dialysis Symptom Index for chronic kidney disease stages four and five.
abstract: BACKGROUND
  Symptom burden in chronic kidney disease (CKD) is poorly understood. To date, the majority of research focuses on single symptoms and there is a lack of suitable multidimensional symptom measures. The purpose of this study was to modify, translate, cross-culturally adapt and psychometrically analyse the Dialysis Symptom Index (DSI).
  
  
  METHODS
  The study methods involved four phases: modification, translation, pilot-testing with a bilingual non-CKD sample and then psychometric testing with the target population. Content validity was assessed using an expert panel. Inter-rater agreement, test-retest reliability and Cronbach's alpha coefficient were calculated to demonstrate reliability of the modified DSI. Discriminative and convergent validity were assessed to demonstrate construct validity.
  
  
  RESULTS
  Content validity index during translation was 0.98. In the pilot study with 25 bilingual students a moderate to perfect agreement (Kappa statistic = 0.60-1.00) was found between English and Arabic versions of the modified DSI. The main study recruited 433 patients CKD with stages 4 and 5. The modified DSI was able to discriminate between non-dialysis and dialysis groups (p < 0.001) and demonstrated convergent validity with domains of the Kidney Disease Quality of Life short form. Excellent test-retest and internal consistency (Cronbach's α = 0.91) reliability were also demonstrated.
  
  
  CONCLUSIONS
  The Arabic version of the modified DSI demonstrated good psychometric properties, measures the multidimensional nature of symptoms and can be used to assess symptom burden at different stages of CKD. The modified instrument, renamed the CKD Symptom Burden Index (CKD-SBI), should encourage greater clinical and research attention to symptom burden in CKD.
authors.affiliation: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia. hayfa.almutary@connect.qut.edu.au.|School of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia. hayfa.almutary@connect.qut.edu.au.
authors.forename: Hayfa
authors.initials: H
authors.lastname: Almutary
authors.affiliation: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia. ann.bonner@qut.edu.au.|Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia. ann.bonner@qut.edu.au.|Visiting Research Fellow, Renal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. ann.bonner@qut.edu.au.
authors.forename: Ann
authors.initials: A
authors.lastname: Bonner
authors.affiliation: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD, 4059, Australia. c2.douglas@qut.edu.au.
authors.forename: Clint
authors.initials: C
authors.lastname: Douglas
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001083:Arabia; D003431:Cross-Cultural Comparison; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D018434:Sickness Impact Profile; D014177:Translations