The Journal of Bone and Joint Surgery (American). 2005;87:788-794.
doi:10.2106/JBJS.D.02080
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of the Short Musculoskeletal Function Assessment Questionnaire: The SMFA-BR

Marcus K. Taylor, MS1, Ricardo Pietrobon, MD, PhD1, Andreia Menezes, RN2, Steven A. Olson, MD1, Deng Pan, MS1, Neeti Bathia, BS3, Robert F. DeVellis, PhD4, Paulo Kume, PhD5 and Laurence D. Higgins, MD1

1 Departments of Psychiatry and Behavioral Sciences (M.K.T.) and Orthopedic Surgery (R.P., S.A.O., D.P., and L.D.H.), Duke University Medical Center, Box 3119 (M.K.T.), Box 3094 (R.P.), Box 3389 (S.A.O.), Box 3615 (D.P. and L.D.H.), Durham, NC 27710. E-mail address for M.K. Taylor: mktaylor{at}duke.edu
2 Rua Jucelino K. De Oliveira, 19, 83430 Campina Grande do Sul, PR, Brazil
3 20 East 70th Street, Apartment 5K, New York, NY 10021
4 Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, 3310c Thurstone Building, Chapel Hill, NC 27705
5 Rua Vicente Machado, n° 47, Apto 122, CEP:84020-010 Curitiba - PR, Brazil

Investigation performed at Duke University Medical Center, Durham, North Carolina, and Hospital Angelina Caron Campina Grande do Sul, Brazil

NOTE: The authors thank Karen C. Nielsen, MD, Erika L. Nielsen, Kent Loenhoff, and Marcos A.M. Ribeiro for their contributions to this research.

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Orthopaedic Trauma Association. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: This study was designed to translate, culturally adapt, and validate a Brazilian Portuguese version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-BR).

Methods: The SMFA was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and then submitted to a committee of clinical, psychometric, and language experts. The questionnaire was then administered to 220 trauma patients at a midsize hospital in southern Brazil. Test-retest reliability was examined at one and seven days. Scale reliability and validity were assessed, and factor structure was analyzed.

Results: Patients with only one region of dysfunction reported less dysfunction than did patients with two or three regions of dysfunction. Both the SMFA-BR dysfunction and the SMFA-BR bother scores had significant correlations with all Brazilian Short Form-36 (SF-36) subscales except for bodily pain. Test-retest reliabilities, as determined by intraclass correlation analyses, were 0.99 (95% confidence interval, 0.97, 1.00) at one day (n = 10) and 0.99 (95% confidence interval, 0.96, 1.00) at seven days (n = 17) for the dysfunction index and 0.99 (95% confidence interval, 0.98, 1.00) at one day (n = 10) and 0.97 (95% confidence interval, 0.97, 1.00) at seven days (n = 17) for the bother index. Cronbach alpha reliabilities were 0.95 (95% confidence interval, 0.93, 0.97) and 0.91 (95% confidence interval, 0.89, 0.94) for the dysfunction and bother indices, respectively. Minimal ceiling and floor effects were observed for the bother subscale only. Exploratory factor analysis yielded a three-factor structure: upper-extremity dysfunction, lower-extremity dysfunction, and bother.

Conclusions: A reliable and valid Brazilian Portuguese version of the SMFA was developed. It will facilitate the examination of functional performance within a large patient population as well as allow cross-cultural comparisons.


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