Adaptação transcultural do High Activity Arthroplasty Score (HAAS) da língua inglesa britânica para a língua portuguesa do Brasil e avaliação das evidências de validade da versão brasileira (HAAS-Brasil) em pacientes submetidos à artroplastia de quadril

Abstract

In the evaluation of the functional condition of hip arthroplasties, various instruments in the literature emphasize pain as the primary symptom and limiting factor for performing daily activities. While useful for assessing patients with significant comorbidities, these instruments have low sensitivity in differentiating individuals who experience little or no pain and can perform higher-demand activities, such as intense sports or recreational activities. In response to this limitation, the High Activity Arthroplasty Score (HAAS) was developed, specifically designed to assess the function of patients post knee and/or hip arthroplasty by evaluating their physical activity level without the usual emphasis on pain symptoms. This self-report instrument was originally developed in British English and has not yet been adapted for use in Brazil. The objective of this study was to perform a cross-cultural adaptation of the HAAS into Brazilian Portuguese and to assess its validity evidences in post hip arthroplasty patients. This cross-sectional study included both qualitative and quantitative methodology and was divided into two phases. The first phase of the study involves the cross-cultural adaptation of the HAAS from British English to Brazilian Portuguese, resulting in the HAAS-Brazil. The adaptation process comprises six steps: translation, synthesis of the translations, expert committee review, pre-testing, back-translation, and submission to the original developers. The pre-test was administered to 46 volunteers using criterion saturation sampling. Modifications were made to the original instrument to adapt it to the target language. At the end of phase I, the adapted version, HAAS-Brazil, was produced. The second phase of the study was the process of evaluating the validity evidence gathered from the HAAS-Brazil scores according to the psychometric parameters recommended by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) associated with Item Response Theory (IRT) techniques. The validity and reliability domains of the instrument based on the analysis of its internal and external structure were tested. In this phase, 120 patients, 50.9% female, who had undergone hip arthroplasty at least 6 months prior, were administered the HAAS-Brazil, Hip Outcome Score, and 12-Item Short-Form Health Survey. The HAAS-Brazil retest was administered to 81 patients. The scores produced by the patients demonstrated adequate content validity (CVC > 0.9), satisfactory structural validity, construct validity in line with the formulated hypotheses regarding the instrument, good internal consistency (ρ Mokken = 0.707; α Cronbach = 0.663), and adequate test-retest reliability ([ICC(3,K) = 0.840; p < 0.05]; [Z = -1.209; p = 0.230]). The IRT analysis showed good instrument precision (F = 0.78) The scores generated by the HAAS-Brazil gathered satisfactory validity evidence for its use in clinical and research contexts for patients undergoing hip arthroplasty in Brazil.