Psychometric properties of Arabic-translated-related quality of life scales for people with parkinson disease: a scoping review.


Journal

BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562

Informations de publication

Date de publication:
14 Sep 2024
Historique:
received: 16 08 2023
accepted: 05 09 2024
medline: 15 9 2024
pubmed: 15 9 2024
entrez: 14 9 2024
Statut: epublish

Résumé

Parkinson's disease (PD) substantially contributes to poor functional outcomes, loss in productivity, and poor health-related quality of life (HRQoL). Despite the existence of various scales, there is a notable gap in existing HRQoL reviews with regard to the availability of Arabic validated scales. As a response to this gap, the aim of our scoping review is to identify validated scales, focusing on their psychometric validation procedures, to contribute valuable insights to the understanding of HRQoL among the Arabic-speaking people with PD. A scoping review was conducted at the end of December 2022, using the Medline and Embase databases. The focus of this review was on examining the psychometric properties and validation procedures of included scales. Articles were included in the full-text screening process if they focused on people with PD of any age, included a scale measuring HRQoL in Arabic, and were written in English, French, or Arabic. After applying inclusion/exclusion criteria, 10 studies were selected to analyze HRQoL scales validated in people with PD. However, the PDQ-39 is the only HRQol PD specific scales validated in the Arabic language. Five studies validated in people with PD were identified in the context of instrument validation (3 generic, 1 specific validated in 2 studies). There are several HRQoL measurement scales for people with PD. However, only one specific HRQoL instrument has been validated in Arabic for people with PD. For the remaining instruments identified they were just used in people with PD without being validated in this population.

Sections du résumé

BACKGROUND BACKGROUND
Parkinson's disease (PD) substantially contributes to poor functional outcomes, loss in productivity, and poor health-related quality of life (HRQoL). Despite the existence of various scales, there is a notable gap in existing HRQoL reviews with regard to the availability of Arabic validated scales. As a response to this gap, the aim of our scoping review is to identify validated scales, focusing on their psychometric validation procedures, to contribute valuable insights to the understanding of HRQoL among the Arabic-speaking people with PD.
METHODS METHODS
A scoping review was conducted at the end of December 2022, using the Medline and Embase databases. The focus of this review was on examining the psychometric properties and validation procedures of included scales. Articles were included in the full-text screening process if they focused on people with PD of any age, included a scale measuring HRQoL in Arabic, and were written in English, French, or Arabic.
RESULTS RESULTS
After applying inclusion/exclusion criteria, 10 studies were selected to analyze HRQoL scales validated in people with PD. However, the PDQ-39 is the only HRQol PD specific scales validated in the Arabic language. Five studies validated in people with PD were identified in the context of instrument validation (3 generic, 1 specific validated in 2 studies).
CONCLUSION CONCLUSIONS
There are several HRQoL measurement scales for people with PD. However, only one specific HRQoL instrument has been validated in Arabic for people with PD. For the remaining instruments identified they were just used in people with PD without being validated in this population.

Identifiants

pubmed: 39277745
doi: 10.1186/s12889-024-20002-0
pii: 10.1186/s12889-024-20002-0
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

2505

Informations de copyright

© 2024. The Author(s).

Références

Tysnes OB, Storstein A. Epidemiology of Parkinson’s disease. J Neural Transm (Vienna). 2017;124(8):901–5.
pubmed: 28150045 doi: 10.1007/s00702-017-1686-y
Samii A, Nutt JG, Ransom BR. Parkinson’s Disease Lancet. 2004;363(9423):1783–93.
pubmed: 15172778
Marras C, et al. Prevalence of Parkinson’s disease across North America. NPJ Parkinsons Dis. 2018;4:21.
pubmed: 30003140 pmcid: 6039505 doi: 10.1038/s41531-018-0058-0
al Rajeh S, et al. A community survey of neurological disorders in Saudi Arabia: the Thugbah study. Neuroepidemiology. 1993;12(3):164–78.
pubmed: 8272177 doi: 10.1159/000110316
Ashok PP, et al. Epidemiology of Parkinson’s disease in Benghazi, North-East Libya. Clin Neurol Neurosurg. 1986;88(2):109–13.
pubmed: 3757381 doi: 10.1016/S0303-8467(86)80005-1
Attia Romdhane N, et al. Prevalence study of neurologic disorders in Kelibia (Tunisia). Neuroepidemiology. 1993;12(5):285–99.
pubmed: 8309504 doi: 10.1159/000110330
Benamer HT, et al. Parkinson’s disease in arabs: a systematic review. Mov Disord. 2008;23(9):1205–10.
pubmed: 18442138 doi: 10.1002/mds.22041
Safiri S, et al. The burden of Parkinson’s disease in the Middle East and North Africa region, 1990–2019: results from the global burden of disease study 2019. BMC Public Health. 2023;23(1):107.
pubmed: 36642724 pmcid: 9841703 doi: 10.1186/s12889-023-15018-x
Garcia Ruiz PJ, Catalán MJ, Fernández JM, Carril. Initial motor symptoms of Parkinson disease. Neurologist. 2011;17(6 Suppl 1):S18–20.
pubmed: 22045320 doi: 10.1097/NRL.0b013e31823966b4
Wolters E. Non-motor extranigral signs and symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(Suppl 3):S6–12.
pubmed: 20083010 doi: 10.1016/S1353-8020(09)70770-9
Seppi K, et al. The Movement Disorder Society Evidence-Based Medicine Review Update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26(0 3):S42–80.
pubmed: 22021174 pmcid: 4020145
Seppi K, et al. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review. Mov Disord. 2019;34(2):180–98.
pubmed: 30653247 pmcid: 6916382 doi: 10.1002/mds.27602
Kumaresan M, Khan S. Spectrum of non-motor symptoms in Parkinson’s Disease. Cureus. 2021;13(2):e13275.
pubmed: 33728210 pmcid: 7949722
Perlmutter JS. Assessment of Parkinson disease manifestations. Curr Protoc Neurosci 2009 Chapter 10: p. Unit10.1.
Váradi C. Clinical Features of Parkinson’s Disease: The Evolution of Critical Symptoms. Biology (Basel), 2020. 9(5).
Rizek P, Kumar N, Jog MS. An update on the diagnosis and treatment of Parkinson disease. CMAJ. 2016;188(16):1157–65.
pubmed: 27221269 pmcid: 5088077 doi: 10.1503/cmaj.151179
Karceski S. Parkinson disease and mortality. Neurology. 2018;91(22):e2106–8.
pubmed: 30478081 doi: 10.1212/WNL.0000000000006565
Gonzalez MC, et al. Parkinson’s disease clinical milestones and mortality. Npj Parkinson’s Disease. 2022;8(1):58.
pubmed: 35550520 pmcid: 9098431 doi: 10.1038/s41531-022-00320-z
Poortvliet PC, et al. The Queensland Parkinson’s project: an overview of 20 years of mortality from Parkinson’s disease. J Mov Disorders. 2021;14(1):34.
doi: 10.14802/jmd.20034
Macleod AD, Taylor KS, Counsell CE. Mortality in Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 2014;29(13):1615–22.
pubmed: 24821648 doi: 10.1002/mds.25898
Marinus J, et al. Evaluation of the Dutch version of the Parkinson’s Disease Questionnaire 39. Parkinsonism Relat Disord. 2008;14(1):24–7.
pubmed: 17702633 doi: 10.1016/j.parkreldis.2007.05.005
Kline EM, et al. Genetic and Environmental Factors in Parkinson’s Disease Converge on Immune function and inflammation. Mov Disord. 2021;36(1):25–36.
pubmed: 33314312 doi: 10.1002/mds.28411
Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson Disease: a review. JAMA. 2020;323(6):548–60.
pubmed: 32044947 doi: 10.1001/jama.2019.22360
Cuenca L, et al. Parkinson’s disease: a short story of 200 years. Histol Histopathol. 2019;34(6):573–91.
pubmed: 30540129
Parmar M, Grealish S, Henchcliffe C. The future of stem cell therapies for Parkinson disease. Nat Rev Neurosci. 2020;21(2):103–15.
pubmed: 31907406 doi: 10.1038/s41583-019-0257-7
Weintraub D, Mamikonyan E. The Neuropsychiatry of Parkinson Disease: a perfect storm. Am J Geriatr Psychiatry. 2019;27(9):998–1018.
pubmed: 31006550 pmcid: 7015280 doi: 10.1016/j.jagp.2019.03.002
Hoseinipalangi Z et al. A global systematic review and meta-analysis of the quality of life of patients with Parkinson’s disease. East Mediterr Health J, 2023. 29.
European Medicines. Agency. Committee for Medicinal Products for Human use (CHMP): „Reflection paper on the regulatory guidance for the use of health-related quality of life (HRQL) measures in the evaluation of medicinal products. 27 July 2005 [Last accessed 29 January 2013]. Available from: https://www.ispor.org/workpaper/research_practices/proconcepts_definitions.pdf .
U.S Department of Health and Human Services Food and Drug Administration Guidance for Industry: „Patient-Reported Outcome Measures. Use in Medical Product Development to Support Labeling Claims.December 2009 [Last accessed 29 January 2013]. Available from: http://www.fda.gov/downloads/Drugs/Guidances/UCM193282.pdf .
Sawicki-Wrzask D, Thomsen M, Bjerrum OJ. An analysis of the fixed-dose combinations authorized by the European Union, 2009–2014: a Focus on Benefit-Risk and Clinical Development conditions. Ther Innov Regul Sci. 2015;49(4):553–9.
pubmed: 30222435 doi: 10.1177/2168479014567322
Schipper H. Clinch, JJ, Olweny CLM (1996) Quality of life studies: definitions and conceptual issues, In Spilker B, editor Quality of Life and Pharmacoeconomics in Clinical Trials. Lippincott-Raven Publishers:Philadelphia. PP 11–23.
International Society for Quality of Life Research (ISOQOL).health related of quality of life research. Available in: http://www.isoqol.org/about-isoqol/what-is-health-related-quality-of-life-research
Schipper H, Olweny CJ. Quality of life studies: definitions and conceptual issues. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott-Raven; 1996. pp. 11–23.
Sanchez-Luengos I, et al. Predictors of health-related quality of life in Parkinson’s disease: the impact of overlap between health-related quality of life and clinical measures. Qual Life Res. 2022;31(11):3241–52.
pubmed: 35842497 pmcid: 9546987 doi: 10.1007/s11136-022-03187-y
Portillo MC, Haahr A, Navarta-Sánchez MV. Management, levels of support, quality of life, and social inclusion in Parkinson’s Disease: interventions, innovation, and practice development. Parkinson’s Disease. 2021;2021:1–4.
doi: 10.1155/2021/4681251
Bottomley A, et al. Current state of quality of life and patient-reported outcomes research. Eur J Cancer. 2019;121:55–63.
pubmed: 31561134 doi: 10.1016/j.ejca.2019.08.016
van den Heuvel L, et al. Personalizing decision-making for persons with Parkinson’s disease: where do we stand and what to improve? J Neurol. 2022;269(7):3569–78.
pubmed: 35084559 pmcid: 9217860 doi: 10.1007/s00415-022-10969-4
Dawoud DM, et al. Translation, cultural adaptation and psychometric validation of the SF-6D measure of health-related quality of life for use in arabic-speaking countries. Res Social Adm Pharm. 2020;16(12):1754–9.
pubmed: 32057690 doi: 10.1016/j.sapharm.2020.01.018
Nair L, Adetayo OA. Cultural competence and Ethnic Diversity in Healthcare. Plast Reconstr Surg Glob Open. 2019;7(5):e2219.
pubmed: 31333951 pmcid: 6571328 doi: 10.1097/GOX.0000000000002219
Pelzang R, Hutchinson AM. Establishing Cultural Integrity in qualitative research: reflections from a cross-cultural study. Int J Qualitative Methods. 2018;17(1):1609406917749702.
doi: 10.1177/1609406917749702
Al Sayah F, et al. Health related quality of life measures in Arabic speaking populations: a systematic review on cross-cultural adaptation and measurement properties. Qual Life Res. 2013;22(1):213–29.
pubmed: 22350531 doi: 10.1007/s11136-012-0129-3
Martinez-Martin P, et al. Health-related quality-of-life scales in Parkinson’s disease: critique and recommendations. Mov Disord. 2011;26(13):2371–80.
pubmed: 21735480 doi: 10.1002/mds.23834
Berardi A, et al. Tools to assess the quality of life in patients with Parkinson’s disease: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2021;21(1):55–68.
pubmed: 33090885 doi: 10.1080/14737167.2021.1841638
Tricco AC, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73.
pubmed: 30178033 doi: 10.7326/M18-0850
Gazzard G et al. A scoping review of quality of life questionnaires in Glaucoma patients. J Glaucoma, 2021. 30(8).
Aburuz S, et al. The validity and reliability of the arabic version of the EQ-5D: a study from Jordan. Ann Saudi Med. 2009;29(4):304–8.
pubmed: 19584581 pmcid: 2841459 doi: 10.4103/0256-4947.55313
El Osta N, et al. Validation of the arabic version of the SF-36, generic questionnaire of quality of life related to health among the elderly in Lebanon. East Mediterr Health J. 2019;25(10):706–14.
pubmed: 31774136
Guermazi M, et al. Translation in Arabic, adaptation and validation of the SF-36 Health Survey for use in Tunisia. Ann Phys Rehabil Med. 2012;55(6):388–403.
pubmed: 22795246 doi: 10.1016/j.rehab.2012.05.003
Kharroubi SA et al. Examining the feasibility and acceptability of valuing the Arabic Version of SF-6D in a Lebanese Population. Int J Environ Res Public Health, 2020. 17(3).
Khoshhal S, et al. Assessment of quality of life among parents of children with congenital heart disease using WHOQOL-BREF: a cross-sectional study from Northwest Saudi Arabia. Health Qual Life Outcomes. 2019;17(1):183.
pubmed: 31842888 pmcid: 6915919 doi: 10.1186/s12955-019-1249-z
Shalash AS, et al. Non-motor symptoms as predictors of quality of life in Egyptian patients with Parkinson’s Disease: a cross-sectional study using a culturally adapted 39-Item Parkinson’s Disease Questionnaire. Front Neurol. 2018;9:357.
pubmed: 29881368 pmcid: 5976737 doi: 10.3389/fneur.2018.00357
Ahmadou TM, et al. Assessment of the quality of life in Moroccan Parkinson’s patients. Acta Neuropsychologica. 2020;18:67–76.
doi: 10.5604/01.3001.0013.9739
Coons SJ, et al. Reliability of an arabic version of the RAND-36 Health Survey and its equivalence to the US-English version. Med Care. 1998;36(3):428–32.
pubmed: 9520966 doi: 10.1097/00005650-199803000-00018
Ohaeri JU, Awadalla AW. The reliability and validity of the short version of the WHO Quality of Life Instrument in an arab general population. Ann Saudi Med. 2009;29(2):98–104.
pubmed: 19318760 pmcid: 2813624 doi: 10.4103/0256-4947.51790
AboAbat A, et al. Psychometric validation of a Saudi Arabian version of the sf-36v2 health survey and norm data for Saudi Arabia. J Patient-Reported Outcomes. 2020;4(1):67.
doi: 10.1186/s41687-020-00233-6
Emrani L, Senhaji M, Bendriss A. Measuring health-related quality of life in the population of Tetouan, Morocco, by the SF-36: normative data and the influence of gender and age. East Mediterranean Health J = La Revue De santé De La Méditerranée Orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ. 2016;22:133–41.
Shalash AS, et al. Clinical Profile of Non-motor symptoms in patients with essential tremor: impact on quality of life and age-related differences. Tremor Other Hyperkinet Mov (N Y); 2019. p. 9.
Elagib MAA, Hamid OEA. The Health-related Quality of Life of Sudanese Patients with Idiopathic Parkinson’s Disease. 2020.
Bekairy AM, et al. Validity and reliability of the arabic version of the the EuroQOL (EQ-5D). A study from Saudi Arabia. Int J Health Sci (Qassim). 2018;12(2):16–20.
pubmed: 29599689
Khedr EM, et al. Depression and anxiety among patients with Parkinson’s disease: frequency, risk factors, and impact on quality of life. Egypt J Neurol Psychiatry Neurosurg. 2020;56(1):116.
doi: 10.1186/s41983-020-00253-5
Marinus J, et al. Health related quality of life in Parkinson’s disease: a systematic review of disease specific instruments. J Neurol Neurosurg Psychiatry. 2002;72(2):241–8.
pubmed: 11796776 pmcid: 1737742 doi: 10.1136/jnnp.72.2.241
Peto V, et al. The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Qual Life Res. 1995;4(3):241–8.
pubmed: 7613534 doi: 10.1007/BF02260863
Jenkinson C, et al. The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age Ageing. 1997;26(5):353–7.
pubmed: 9351479 doi: 10.1093/ageing/26.5.353
Auquier P, et al. [Validation of the French language version of the Parkinson’s Disease Questionnaire - PDQ-39]. Rev Neurol (Paris). 2002;158(1):41–50.
pubmed: 11938321
Hagell P, et al. Health status measurement in Parkinson’s disease: validity of the PDQ-39 and Nottingham Health Profile. Mov Disord. 2003;18(7):773–83.
pubmed: 12815656 doi: 10.1002/mds.10438
Murthy V. Cadi-Soussi N. Patient reported Outcomes instruments in Schizophrenia: a review of Psychometric Properties. Open J Med Psychol. 2014;3(2):141–56. Toumi M.
doi: 10.4236/ojmp.2014.32017
Storf M. The impact of FDA and EMA guidances regarding patient reported outcomes (PRO) on the drug development and approval process. Scientific examination work to obtain the title Master. of Drug Regulatory Affairs; 2013.
Xin Y, McIntosh E. Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review. Qual Life Res. 2017;26(1):1–23.
pubmed: 27778141 doi: 10.1007/s11136-016-1428-x
Jenkinson C, et al. Cross-cultural evaluation of the Parkinson’s Disease Questionnaire: tests of data quality, score reliability, response rate, and scaling assumptions in the United States, Canada, Japan, Italy, and Spain. J Clin Epidemiol. 2003;56(9):843–7.
pubmed: 14505768 doi: 10.1016/S0895-4356(03)00148-3
Bushnell DM, Martin ML. Quality of life and Parkinson’s disease: translation and validation of the US Parkinson’s Disease Questionnaire (PDQ-39). Qual Life Res. 1999;8(4):345–50.
pubmed: 10472167 doi: 10.1023/A:1008979705027
Martínez Martín P, et al. The PDQ-39 Spanish version: reliability and correlation with the short-form health survey (SF-36). Neurologia. 1999;14(4):159–63.
pubmed: 10363490
Carod-Artal FJ, Martinez-Martin P, Vargas AP. Independent validation of SCOPA-psychosocial and metric properties of the PDQ-39 Brazilian version. Mov Disord. 2007;22(1):91–8.
pubmed: 17094102 doi: 10.1002/mds.21216
McKown S, 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.
pubmed: 33146755 pmcid: 7642163 doi: 10.1186/s41687-020-00248-z
Haro JM, et al. Understanding the impact of persistent symptoms in schizophrenia: cross-sectional findings from the Pattern study. Schizophr Res. 2015;169(1–3):234–40.
pubmed: 26431792 doi: 10.1016/j.schres.2015.09.001
Blanchard JJ, et al. Toward the next generation of negative symptom assessments: the collaboration to advance negative symptom assessment in schizophrenia. Schizophr Bull. 2011;37(2):291–9.
pubmed: 20861151 doi: 10.1093/schbul/sbq104

Auteurs

Chiraz Azaiez (C)

Sociological Research Group on Contemporary Societies (GRESCO), University of Limoges, BP 23204, Limoges, 87032, France.
Institute of Sport and Physical Education of Gafsa, University of Gafsa, Gafsa, 2100, Tunisia.
Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3047, Tunisia.

Naser Chalghaf (N)

Institute of Sport and Physical Education of Gafsa, University of Gafsa, Gafsa, 2100, Tunisia.
Ostgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16126, Italy.

Amayra Tannoubi (A)

Ostgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16126, Italy.
Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Kef, 7100, Tunisia.

Noomen Guelmami (N)

Ostgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16126, Italy.
Department of Mathematics and Statistics, York University, Toronto, ON, 4700, Canada.

Medina Srem-Sai (M)

Department of Health, Physical Education, Recreation and Sports, University of Education, P.O. Box 25, Winneba, Ghana.

Frank Quansah (F)

Department of Educational Foundations, University of Education, P.O. Box 25, Winneba, Winneba, Ghana.

John Elvis Hagan (JE)

Department of Health, Physical Education and Recreation, University of Cape Coast, PMB TF0494, Cape Coast, Ghana. elvis.hagan@ucc.edu.gh.
Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501, Bielefeld, Germany. elvis.hagan@ucc.edu.gh.

Heifa Sneni (H)

Institute of Sport and Physical Education of Gafsa, University of Gafsa, Gafsa, 2100, Tunisia.
Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3047, Tunisia.

Ghada Boussayala (G)

Institute of Sport and Physical Education of Gafsa, University of Gafsa, Gafsa, 2100, Tunisia.
Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3047, Tunisia.

Imane Ghalmi (I)

Université de Mohamed Cherif Messadia, Souk Ahras, 41000, Algeria.

Mazin Inhaier Lami (MI)

College of Physical Education and Sports Sciences, University of Wasit, 52001, Wasit, Iraq.

Nicola Luigi Bragazzi (NL)

Ostgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16126, Italy.
Department of Mathematics and Statistics, York University, Toronto, ON, 4700, Canada.

Stephane Mandigout (S)

University of Limoges, HAVAE, Limoges, 20217, F-87000, UR, France.

Choukri Ben Ayed (CB)

Sociological Research Group on Contemporary Societies (GRESCO), University of Limoges, BP 23204, Limoges, 87032, France.

Fairouz Azaiez (F)

Institute of Sport and Physical Education of Gafsa, University of Gafsa, Gafsa, 2100, Tunisia.
Ostgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16126, Italy.

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