Cross-cultural adaptation and psychometric properties of a Spanish-language version of the Vestibular Disorders Activities of Daily Living Scale (VADL-ES)

Abstract

Background

Vestibular disorders affect mobility, independence, and quality of life. Culturally adapted assessment tools are essential for accurate evaluation and effective treatment in diverse populations.

Objectives

To translate, culturally adapt, and evaluate the psychometric properties of the Vestibular Disorders Activities of Daily Living Scale (VADL) into European Spanish (VADL-ES).

Methods

The VADL was adapted following international cross-cultural guidelines. Psychometric testing included internal consistency (Cronbach’s α), test–retest reliability (ICC), content validity (CVI), convergent validity with the Dizziness Handicap Inventory (DHI), and discriminant validity (ROC analysis, Youden index). Floor/ceiling effects, standard error of measurement (SEM), minimal detectable change (MDC₉₅), and structural validity (exploratory and confirmatory factor analysis) were also assessed.

Results

The VADL-ES showed excellent internal consistency (α = 0.978), test–retest reliability (ICC = 0.988), strong correlation with the DHI (ρ = 0.768), and high content validity (S-CVI = 0.93). ROC analysis yielded an AUC = 0.988 with 100% specificity. Factor analysis confirmed a three-factor structure explaining 72% of variance. No floor or ceiling effects were observed; MDC95 was 0.91.

Conclusions

The VADL-ES is a valid and reliable instrument for assessing functional limitations in Spanish-speaking patients with vestibular disorders, enabling standardized evaluation and longitudinal monitoring in clinical and research settings.

Keywords

activities of daily living scale cross-cultural validation disability evaluation psychometrics vestibular diseases

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References

Neuhauser

von Brevern

Radtke

, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005; 65(6): 898–904.

Smith

Pyke

Fowler

, et al. Impact and experiences of vestibular disorders and psychological distress: qualitative findings from patients, family members and healthcare professionals. Health Expect 2024; 27(1): e13906.

Neuhauser

Radtke

von Brevern

, et al. Burden of dizziness and vertigo in the community. Arch Intern Med 2008; 168(19):2118–2124. Erratum in: Arch Intern Med. 2009; 12;169(1):89.

Neuhauser

. The epidemiology of dizziness and vertigo. Handb Clin Neurol 2016; 137: 67–82.

Agrawal

Carey

Della Santina

, et al. Disorders of balance and vestibular function in US adults: data from the national health and nutrition examination survey, 2001-2004. Arch Intern Med 2009; 169(10): 938–944.

Mueller

Strobl

Jahn

, et al. Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: results from the KORA-age study. Qual Life Res 2014; 23(8): 2301–2308.

Jacobson

Newman

. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg 1990; 116(4): 424–427. https://doi.org/10.1001/archotol.1990.01870040046011

Powell

Myers

. The Activities-specific Balance Confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 1995; 50A(1): M28–M34. https://doi.org/10.1093/gerona/50a.1.m28

Fong

Aslakson

, et al. Systematic review of patient-reported outcome measures in clinical vestibular research. Arch Phys Med Rehabil 2015; 96(2): 357–365.

10.

Cohen

Kimball

. Development of the vestibular disorders activities of daily living scale. Arch Otolaryngol Head Neck Surg 2000; 126: 881–887.

11.

Aratani

Ricci

Caovilla

, et al. Brazilian version of the vestibular disorders activities of daily living Scale (VADL). Braz J Otorhinolaryngol 2013; 79(2): 203–211.

12.

Luo

Jie

, et al. Chinese version of the vestibular disorders activities of daily living Scale. Laryngoscope 2022; 132(7): 1446–1451.

13.

Rao

Tedla

Sangadala

, et al. Development and cross-cultural adaptation of the vestibular disorders activities of daily living scale in the Kannada language and testing its psychometric properties. Niger J Clin Pract 2022; 25(5): 605–611.

14.

Mehrkian

Erfanimanesh

Bakhshi

. Validity and reliability of the Persian version of the vestibular disorders activities of daily living scale. Aud Vestib Res 2018; 27(1): 25–30.

15.

Lopez-Escamez

Carey

Chung

, et al. Diagnostic criteria for Menière’s disease. J Vestib Res 2015; 25(1): 1–7.

16.

Lempert

Olesen

Furman

, et al. Vestibular migraine: diagnostic criteria. J Vestib Res 2012; 22(4): 167–172.

17.

von Brevern

Bertholon

Brandt

, et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 2015; 25(3–4): 105–117.

18.

Argimon

Jiménez

. Métodos de investigación clínica y epidemiológica. 5th ed. Elsevier, 2019.

19.

Mundfrom

Shaw

. Minimum sample size recommendations for conducting factor analyses. Int J Test 2005; 5: 159–168.

20.

Comrey

Lee

. A first course in factor analysis. 2nd ed. Lawrence Erlbaum Associates, 1992.

21.

Anthoine

Moret

Regnault

, et al. Sample size used to validate a scale: a review of publications on newly-developed patient-reported outcomes measures. Health Qual Life Outcomes 2014; 12: 176.

22.

Beaton

Bombardier

Guillemin

, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 2000; 25: 3186–3191.

23.

Wild

Grove

Martin

, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health 2005; 8: 94–104.

24.

Pérez

Garmendia

Martín

, et al. Adaptación cultural de dos cuestionarios de medida de la salud en pacientes con vértigo. Acta Otorrinolaringol Esp 2000; 51(7): 572–580.

25.

Sousa

Rojjanasrirat

. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research. J Eval Clin Pract 2011; 17: 268–274.

26.

Epstein

Osborne

Elsworth

, et al. Cross-cultural adaptation of the health education impact questionnaire: experimental study showed expert committee, not back-translation, added value. J Clin Epidemiol 2015; 68: 360–369.

27.

Guillemin

Bombardier

Beaton

. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993; 46: 1417–1422.

28.

Terwee

Bot

de Boer

, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34–42.

29.

Bonett

. Sample size requirements for testing and estimating coefficient alpha. J Educ Behav Stat 2002; 27: 335–340.

30.

Shrout

Fleiss

. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420–428.

31.

Costello

Osborne

. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval 2005; 10: 1–7.

32.

Kline

. Exploratory and confirmatory factor analysis. In: Tinsley

HEA

Brown

(eds) Handbook of applied multivariate statistics and mathematical modeling. Academic Press, 2000, pp. 265–299.

33.

Hair

Black

Babin

, et al. Multivariate data analysis. 8th ed. Cengage Learning, 2019.

34.

Bentler

. Cutoff criteria for fit indexes in covariance structure analysis. Struct Equ Modeling 1999; 6: 1–55.

35.

Swets

. Measuring the accuracy of diagnostic systems. Science 1988; 240: 1285–1293.

36.

Greiner

Pfeiffer

Smith

. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 2000; 45: 23–41.

37.

Youden

. Index for rating diagnostic tests. Cancer 1950; 3(1): 32–35.

38.

Stratford

Binkley

Riddle

. Health-status measures: strategies and analytic methods for assessing change scores. Phys Ther 1996; 76: 1109–1123.

39.

Gorsuch

. Factor analysis. 2nd ed. Lawrence Erlbaum Associates, 1983.

40.

Epstein

Santo

Guillemin

. A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. J Clin Epidemiol 2015; 68(4): 435–441. https://doi.org/10.1016/j.jclinepi.2014.11.021

41.

Cruchinho

López-Franco

Capelas

, et al. Handovers4SafeCare. Translation, cross-cultural adaptation, and validation of measurement instruments: a practical guideline for novice researchers. J Multidiscip Healthc 2024; 17: 2701–2728. https://doi.org/10.2147/JMDH.S419714

42.

McKown

Acquadro

Anfray

, et al. Good practices for the translation, cultural adaptation, and linguistic validation of clinician-reported outcome, observer-reported outcome, and performance outcome measures. J Patient-Rep Outcomes 2020; 4(1): 89. https://doi.org/10.1186/s41687-020-00248-z

43.

Worthington

Whittaker

. Scale development research: a content analysis and recommendations. Couns Psychol 2006; 34: 806–828.

44.

Vereeck

Truijen

Wuyts

, et al. Test-retest reliability of the Dutch version of the dizziness handicap inventory. B-ENT 2006; 2: 75–80.

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