SEEK: Salford Environment for Expertise and Knowledge

June 2015

Linguistic validation and cultural adaptation of the Valued Life Activities Scale in Turkey in people with rheumatoid arthritis.

Tonga, E & Hammond, A & Prior, Y 2015, 'Linguistic validation and cultural adaptation of the Valued Life Activities Scale in Turkey in people with rheumatoid arthritis.', Annals of Rheumatic Disease, 74:2.


Background: The Valued Life Activities Scale (VLAs) was specifically developed for people with rheumatoid arthritis (RA)1 to measure daily activities and participatory roles. The original VLAs items (75) were derived from content analysis of diaries completed by patients with RA or osteoarthritis. Revisions have been made to the scoring, items grouped into domains using factor analysis and the items were revised (and reduced to 33) based on participants' responses as to which items are most important to them2-5.
Objectives: To conduct the linguistic and cultural adaptation of the VLAs to Turkish prior to psychometric testing to validate the use of this questionnaire in Turkish people with RA.
Methods: The linguistic and cultural adaptation of the VLAs was conducted following guidelines for the process of cross-cultural adaptation of self-reported measures4. This involved the (i) initial forward translation of the British-English version of VLAs by two (informed and uninformed) native Turkish speakers; (ii) synthesis through consensus; (iii) back translation by two native English speakers who were blinded to the content of the questionnaire, and did not have medical backgrounds; and (iv) a final review conducted by an expert panel which consolidated all the versions and developed a pre-final Turkish VLAs (TUR-VLAs). Following this, to ensure the TUR-VLAs content is understandable and relevant to Turkish people with RA, face-to-face cognitive de-briefing interviews were conducted. Participants were recruited from rheumatology clinics ensuring a broad range of demographics such as participants' age, employment status and functional abilities.
Results: At the end of a four staged translation and cross-cultural adaptation process only minimal changes (e.g. “going to café” were used instead of going to the pub) were made to the questionnaire. Following this, cognitive de-briefing interviews were conducted with six participants (age: 45.16 (SD11.30) years; female:5 (83%); disease duration:13.83 (SD6.46) years; HAQ:9 (SD 2.76). Of these three people were employed, two were home-makers and one was retired. Participants found the TUR-VLAs content easily understandable, and relevant to Turkish people. As a result, no items were removed and no new items were added to TUR-VLAs.
Conclusions: The linguistic and cross-cultural adaptation of the VLAs to Turkish provides a basis for the first rheumatology occupational therapy assessment in Turkey. Following the psychometric testing of TUR-VLAs this instrument will be freely accessible for Turkish health professionals working in rheumatology for both clinical assessment and research purposes.
Katz P, Yelin E (1994) Arthritis Care and Research 7(2):69-77.
Katz P, Yelin E (1995) Arthritis and Rheumatism 38(1):49-56
Katz P (1995) Arthritis Care and Research 8(4):272-278.
Katz P et al. (2006) Annals of the Rheumatic Diseases 65:763-769.
Katz P (2008) Arthritis Rheum (Arthritis Care Res) 59:1416–1423.
Beaton (2000) Spine (Phila Pa 1976). 15;25(24):3186-91.
Acknowledgements: We would like to extend our thanks to participating patients and the administrative staff from the Marmara University Hospital. Also many thanks to the EULAR Health Professionals Grant for funding this study.


SEEK Members

External Authors

Eda Tonga

Publication Details

Annals of Rheumatic Disease, 74:2.