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Cross-cultural adaptation of the connective tissue disease screening questionnaire and development of a Chinese version in a multi-ethnic Asian population

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Abstract

Objectives

To cross-culturally adapt the Connective Tissue Disease (CTD) Screening Questionnaire (CSQ) in a multi-ethnic Asian population in Singapore.

Methods

An expert panel of accredited rheumatologists evaluated the content validity of the original CSQ. Consenting participants newly referred from primary care to a rheumatology specialist outpatient clinic for evaluation of possible CTDs were studied. Cognitive debriefing interviews (CDIs) using the original CSQ were conducted with English-speaking participants, with modifications made based on their inputs and in discussion with a second expert panel (rheumatologists and the CSQ developers). Forward and back translations of the adapted English version were reviewed by the second expert panel. The common translation produced was tested in CDIs with Chinese-speaking participants. Adapted English and Chinese versions were pilot tested in a separate group of newly referred patients.

Results

Content validity of the original CSQ was confirmed by the expert panel. A total of 30 and 15 participants were recruited for English and Chinese CDIs, respectively. Alternative terms and explanatory notes were added to difficult medical terms in the adapted English CSQ. A further explanatory note was added to one difficult item, and English medical terms were retained in the Chinese version. Pilot testing of the adapted CSQ was performed on 116 participants, which exhibited an overall sensitivity and specificity of 71% and 58%, respectively, in identifying CTDs.

Conclusions

The adapted CSQ demonstrated satisfactory sensitivity in the pilot testing and appears to be a promising tool for facilitating early identification of CTDs in the multi-ethnic Asian population.

Key Points

• Early identification and management of patients with CTDs is crucial given their high disease burden and short “windows of opportunity.”

• High reliability and validity of original CSQ and its cross-culturally adapted versions have been reported; however, the CSQ has not been validated in Southeast Asia where CTDs are associated with higher morbidity and mortality compared to other countries.

• Our cross-culturally adapted CSQ demonstrated satisfactory sensitivity in identifying CTDs in the multi-ethnic Asian population.

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Acknowledgements

We would like to thank Ms. Si Yu Ong for the participant recruitment, data collection, and forward translation. Dr. Tze Chin Tan for forward translation. Ms. Li Chang Ang and Ms. Kay Yuan Chong for back translation. Ms. Shuqin Xiong and Ms. Jie Kie Phang for participant recruitment, and all the patients who participated in this study.

Funding

This study was funded by a Health Services Research Grant (HSRG) from the Singapore Ministry of Health National Medical Research Council (NMRC Grant Number: NMRC/HSRG/0075/2017). The study funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing of this manuscript.

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Authors and Affiliations

  1. Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Singapore

    Ling Xiang, Andrea Hsiu Ling Low, Ying Ying Leung, Warren Fong, Elenore J. B. Uy & Julian Thumboo

  2. Health Services Research Unit, Singapore General Hospital, Singapore, Singapore

    Edmund Pek Siang Teo

  3. Duke-NUS Medical School, Singapore, Singapore

    Andrea Hsiu Ling Low, Ying Ying Leung, Warren Fong, Yu Heng Kwan & Julian Thumboo

  4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Andrea Hsiu Ling Low, Ying Ying Leung, Warren Fong & Julian Thumboo

  5. Academic Clinical Program for Medicine, Singapore General Hospital, Singapore, Singapore

    Xiaohui Xin

  6. Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore

    Mihir Gandhi

  7. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore

    Mihir Gandhi

  8. Brigham and Women’s Hospital, Boston, MA, USA

    Jeffrey Andrew Sparks & Elizabeth W. Karlson

  9. Harvard Medical School, Boston, MA, USA

    Jeffrey Andrew Sparks & Elizabeth W. Karlson

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  1. Ling Xiang
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Xiang, L., Teo, E.P.S., Low, A.H.L. et al. Cross-cultural adaptation of the connective tissue disease screening questionnaire and development of a Chinese version in a multi-ethnic Asian population. Clin Rheumatol 38, 2383–2397 (2019). https://doi.org/10.1007/s10067-019-04567-5

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