Ferrans and Powers Quality of Life Index for Spinal Cord Injury: to adapt in local language

Objective To translate and culturally adapt Telugu version of Quality of Life tool among Spinal Cord Injury patients. Method It’s a prospective cross sectional study conducted at tertiary neuro centre care hospital. The English version was translated into Telugu by two expert medical professionals and cross checked by three experts in Telugu vocabulary. Nursing students who had good prociency in reading and writing in English and Telugu languages were chosen for checking tool reliability. Initially English language was administered on satisfaction domain followed by importance domain with one month apart. After two months Telugu version was administered in same way as English version. The reliability analysis was done. Results The tool was administered on 50 nursing students. The Cronbach’s alpha for satisfaction domain was 0.97 and importance domain was 0.91, indicating excellent reliability. Conclusion The Telugu version of QOL tool had excellent reliability. Therefore it can be administered in Telugu language for evaluating the quality of life of people with spinal cord injury.


Introduction
Spinal cord injury (SCI) is a major public health issue. In India, due to rapid advancement in motorization and industrialization the SCI are increasing every year. SCI results in motor and sensory impairment which may be temporary for short time or permanent throughout lifetime depending on the severity of injury and individual factors. 1, 2 Majority of SCI survivors will have permanent nonrepairabledamage to spinal cord thus they will suffer from secondary complications which will have major effect on their daily activities. Quality of life (QOL) is an important parament of disabled patient, especially among SCIs. The parameter in QOL includes subjective and objective aspects of injured patient. 3 Therefore; evaluating QOL among SCI patients is a challenging issue. The tool has been widely adapted and translated in major languages across the world. As per the census of 2001, the Telugu is a rst language of over 74 million people in India. At present, Telugu is a third major language that is spoken in the country. Hence it is very important to have QLI in Telugu language. Thus, there is lack of reliable studies addressing QLI tool in Telugu language. The objective of the present study is to translate and culturally adapt the Ferrans and Powers Quality of Life (QLI), Spinal Cord Injury-III in Telugu language.

Methods
It's a prospective cross-sectional study conducted at the department of Neurosurgery, Narayana Medical College, Nellore. Permission through email was sought from Farren to translate and validate this tool in Telugu language. The study was approved by Institute Ethical Committee. The tool was translated by two medical professionals who were pro cient in reading, writing, and speaking of Telugu and English languages. All 37 items of both parts of health quality; satisfaction and importance were translated. 4,5 The translated items were read by three independent professionals. Independent readers have ensured that the translation in Telugu is accurate and awless by giving their suggestions. The nal draft of Telugu version was nalized after incorporation of suggestions and corrections of readers (attachment I).
Fifty nursing students, well pro cient in English and Telugu languages were chosen for the study. The informed written consent was obtained from all the participant. Participants did not receive any incentives for their participation in the study. Two interviewers (not know to each other) administered the tool in English language on all the participants. All standard procedures for administering the tool were followed. The questions of satisfaction and importance domains were administered with one month apart. The Telugu translated questionnaire was administered after 2 months of administering English language. A gap of one month was maintained between administration of satisfaction and importance domain.

Statistical analysis
The data was analyzed with the help of Statistical Package for the Social Science, version 18. The Cronbach's alpha and correlation were calculated for difference between interviewee responses on English and Telugu questionnaire.
The Cronbach's alpha coe cient was calculated for QLI in Telugu language among Telugu speaking population. The domains of satisfaction and importance had a Cronbach's alpha coe cient of ≥0.9, indicating excellent reliability. Table 1 revels result of the reliability analysis.

Discussion
There are many tools available but none are without limitations. The most accepted and commonly used tools are from developed countries and have been adapted in developing countries in their native languages. Among such tools the Ferrans and Powers Quality of Life (QLI) is very reliable and a valid tool that has been found very comprehensive and applicable in assessing the quality of life in SCI patients. 3,6 The QLI Spinal Cord Injury -Version III, is a speci c version which was speci cally designed for spinal cord injury. 7 The study result reports that satisfaction and importance domains of QLI in Telugu language had excellent internal consistency as re ected by Cronbach's alpha value (α ≥ 0.9). The intercorrelation between satisfaction and importance domains of QLI in English and translated Telugu language is very high. The result of all the Telugu translated items of tool are all most same as English language, because intercorrelation between the translation and English language is excellent. Hence both the satisfaction and importance domains of QLI in Telugu language have excellent reliability.
A study from Brazil translated QLI for SCI into Portuguese cultural vocabulary and reported that the kappa coe cient was statistically stable of all the items of the tool. 8