Translation and psychometric properties of the Gujarati version post-COVID functional status scale

Introduction

The beginning of the year 2020, has marked an outbreak of Severe Acute Respiratory Syndrome from a novel coronavirus (SARS-CoV 2). COVID-19 has been labeled a global pandemic by the World Health Organization (WHO) for two years, as of January 2022.1, 2

Previous studies suggest that symptoms such as fatigue, dyspnea, cough, and headache were present even after testing negative for the virus. 3, 4 This phenomenon where symptoms persisted even months after the infection is termed ‘Post COVID Syndrome’. 5 Due to this reason, there is a limitation in the functional capacity of the infected population. 6, 7 A recent patient coined term ‘long COVID’ is in use which refers to a condition in which the people recovered from COVID-19 still report lasting effects from the disease or have suffered from the usual symptoms for longer than the average population. 8, 9, 10

An ordinal scale with functional limitations, the ‘Post COVID Functional Status scale’, is a scale to capture the heterogeneity of the post-COVID-19 outcomes and measure the consequence of the disease apart from binary outcomes such as mortality. It is an easy and reproducible instrument to identify and check the prognosis of COVID-19 survivors suffering from slow or incomplete recovery. The Post-COVID-19 Functional Status (PCFS) Scale can be assessed upon discharge from the hospital, at another 4- and 8-weeks post-discharge to monitor direct recovery, and at 6 months to assess functional sequelae.11, 12 The increasing number of long COVID cases or post COVID-19 syndrome among COVID-19 survivors necessitates the use of this scale among the wide population to keep a check on the prognosis of the patient post-infection. 

Gujarati is the native language of the state of Gujarat in India. It is the sixth most common language spoken in India and the 26th most common language spoken in the world and is spoken by more than 55 million people across the globe. 13 It is also the fastest-growing Indian language in various continents such as North America and Europe. 14

As of 10th January 2022, India has reported 34.5 million recovered cases, out of which the state of Gujarat has reported 8.2 million recovered cases. 15 The adapted version of the PCFS Scale will be useful in the tracking of the post COVID-19 functional status in the individuals who can comprehend the scale better in the Gujarati language.

Materials and Methods

Prior to the commencement of the study, along with the Institutional Ethics committee approval, valid permissions were sought from the authors of the original scale. The authors were communicated about each step of the translation via electronic mail medium.

According to the guidelines given by the American Society of Orthopaedic surgeons, the study commenced in three phases (16). The first phase included lingual forward and backward translation of the Post-COVID-19 Functional Status (PCFS) scale to Gujarati. The second phase comprised an expert committee that reviewed the language and accuracy of the Gujarati version of the PCFS scale. Finally, in the third phase, the scale was given to a population of post-COVID-19 patients to test the psychometric properties like test-retest reliability and internal consistency.

Phase III- psychometric property evaluation

The pre-final version of the scale was given to a sample population of 30 post-COVID-19 patients. This pre-final version also included the demographic questions, which asked name, age, sex, and a brief history of symptoms. A google form of the questionnaire was sent to these 30 individuals, twice with an interval of 48 hours so that clinical changes in the health status could be avoided.

The entire procedure is explained in Figure 1.

Figure 1

Procedure of translation of the English version of the Gujarati Post-COVID Functional Status Scale. 16

Results

Face and content validity

The expert committee comprised a total of seven members, and the pre-final scale was presented to them, wherein they approved of the initial translation, and suggested minor grammatical changes in the few items, as stated in Figure 2. No changes in the cross-cultural adaptation were suggested by the committee.

Figure 2

Changes in the construct of the scale after expert committee review

Table 1

Test-Rest Results

		Test	Retest
Can you live alone without any assistance from another person? (independently able to eat, walk, use toilet, etc)	Yes	29	30
	No	1	0
Are there any duties at home or at work which you are no longer able to perform yourself?	Yes	2	3
	No	27	27
Do you suffer from symptoms, pain, depression or anxiety?	Yes	2	2
	No	25	26
Do you need to avoid or reduce duties/activities or spread them over time?	Yes	0	0
	No	2	2
Mean Grade in P1		0.466	0.433
Mean Grade in P2		0.34	0.30

Table 2

Internal Consistency results

	Test 1	Test 2
Items	2	2
Sum of variances	1.89	4.16
Variance of total scores	3.18	7.34
Cronbach's Alpha (ɑ)	0.81	0.86

Discussion

India is a country of diverse cultures and this leads to the existence of several languages across the country. India currently has more than 250 scheduled and unscheduled mother tongues out of which only 22 are the official languages of India. Since a major population of India is from rural areas, they tend to understand their native languages only. Gujarati has been spoken by more than 4.58% population of the country. Since the Post-COVID Functional Status Scale is a quick self-administered tool for the assessment of the limitation of the functional capacity of patients, it is important to employ a validated translated version of a local language to be able to cover a wide range of the population. This scale has already been translated to various Indian languages such as Farsi, Hindi (which covers 57.1% of the Indian population) Kannada (covers 4.9% of the Indian population), Urdu (covers 5.2% of the Indian population), Telugu (covers 7.8% of Indian population), Marathi (covers 8.2% of Indian population) and Bengali (covers 8.9% of Indian population) versions are still in process. 17 

This study shows that the translation and adaptation of the ‘Post COVID Functional Status scale’ to the Gujarati language is successful. The Face and Content Validity, Internal Consistency, and Test-Retest reliability of the translated version of the Post COVID Functional Status Scale were good and comparable with the properties of the original version. The guidelines of the American Association of Orthopaedic Surgeons were used to preserve the essence of the original scale to the translated version. Since no cultural adaptations were required for Indian society, the scale has only been linguistically adapted. 

In this study, the authors found that the Gujarati Version of PCFS provided reliable results of the Functional Status in post COVID patients. The Cronbach alpha values of 0.821 and 0.866 for internal consistency suggest good to excellent reliability. The ICC value of 0.99 suggests a very high correlation and stability of the scale. 

Conclusions 

In conclusion, the Gujarati Version of the PCFS Scale provides a valid and reliable tool to assess functional status among post COVID-19 patients. The translated version will help improve health care and the quality of life of patients who live in the native lands of Gujarat.

Acknowledgements

We would like to express our special thanks of gratitude to the Dean of our institution who allowed us to carry out this research project on the premises of our institution. And finally, we would like to thank our patients who were kind enough to be a part of our study.

Conflict of Interest

The authors declare that there is no conflict of interest.

Source of Funding

None.