Abstract
The Young Spine Questionnaire (YSQ) is a patientreported outcome measure designed to evaluate backrelated disability in children and adolescents. This page outlines the systematic process used to translate the YSQ into Portuguese, the steps taken for crosscultural adaptation, and the psychometric evidence supporting its reliability in Portuguesespeaking populations.
Introduction
Back pain in youth is increasingly recognised as a publichealth concern. Valid, ageappropriate instruments are essential for screening, monitoring treatment outcomes, and conducting epidemiological research. While the original YSQ (English) has demonstrated strong content validity and internal consistency, its utility in Lusophone settings depends on a rigorous translation and adaptation process and a demonstration that measurement properties are retained.
Translation Procedure
We followed internationally accepted guidelines (Beaton etal., 2000) and performed the following steps:
- Forward translation: Two bilingual translators whose native language is Portuguese produced independent translations (T1 and T2). One translator was familiar with medical terminology; the other was nave to avoid bias.
- Synthesis: The two forward translations were reconciled into a single version (T12) after consensus discussion.
- Backward translation: Two native English speakers, blinded to the original YSQ, translated T12 back into English (BT1 and BT2).
- Expert committee review: A panel comprising methodologists, a pediatric orthopedic surgeon, a physiotherapist, a linguist, and the translators examined semantic, idiomatic, experiential, and conceptual equivalence. Discrepancies were resolved, resulting in a prefinal Portuguese version (PFPT).
- Pretesting: PFPT was administered to 30 children aged 817 with varying backpain experiences. Cognitive debriefing interviews assessed comprehension, wording, and cultural relevance. Minor wording adjustments created the final Portuguese YSQ (YSQPT).
CrossCultural Adaptation
Beyond literal translation, adaptation required attention to cultural contexts that affect how adolescents perceive and report spinal discomfort.
Key Adaptation Issues
- Educational terminology: Terms such as schoolwork were replaced with tarefas escolares to suit Brazil and Portugal alike.
- Physical activities: Playing sport was broadened to praticar atividade fsica ou desportiva to include informal play common in many Lusophone communities.
- Healthcare access: Items referencing doctor visit were clarified as consulta mdica because of differing healthsystem vocabularies.
- Ageappropriate language: Vocabulary was simplified (e.g., dor instead of desconforto) ensuring readability for an 8yearold.
These modifications were confirmed during the pretesting phase; no participant reported difficulty understanding any item.
Reliability Testing
Reliability was evaluated in a sample of 120 Portuguesespeaking children (817years) recruited from two pediatric clinics. The following analyses were performed.
Internal Consistency
Cronbachs alpha for the total score was 0.89, indicating excellent homogeneity. Itemtotal correlations ranged from 0.56 to 0.78, confirming that each item contributed meaningfully to the overall construct.
TestRetest Reliability
Participants completed the YSQPT twice, 7days apart, when no clinical change was expected. The intraclass correlation coefficient (ICC2,1) for the total score was 0.94 (95%CI0.910.96), demonstrating excellent stability. Individual items showed ICCs between 0.86 and 0.93.
Measurement Error
The standard error of measurement (SEM) was 2.1 points and the smallest detectable change (SDC) at the individual level was 5.8 points, values comparable with the original English version.
Table1 Reliability Indices
| Metric | Value | Interpretation |
|---|---|---|
| Cronbachs | 0.89 | Excellent internal consistency |
| ICC (total score) | 0.94 | Excellent testretest reliability |
| SEM | 2.1 points | Low measurement error |
| SDC (individual) | 5.8 points | Clinically acceptable |
Discussion
The translation and crosscultural adaptation of the YSQ into Portuguese followed a structured, transparent methodology, ensuring that linguistic and cultural nuances were respected. Reliability metrics indicate that the YSQPT retains the psychometric robustness of the original instrument, making it suitable for both clinical practice and research in Brazil, Portugal, and other Portuguesespeaking regions.
Strengths of this work include the involvement of a multidisciplinary expert panel and direct feedback from the target age group. Limitations involve a convenience sample and the absence of longitudinal validation for responsiveness to clinical change. Future studies should examine construct validity, factor structure, and sensitivity to treatment effects.
Conclusion
The Portuguese version of the Young Spine Questionnaire is a linguistically accurate, culturally appropriate, and reliable tool for assessing spinal disability among children and adolescents. Its implementation can improve early detection of backrelated problems and support evidencebased interventions across Lusophone populations.
References
Beaton, D.E., Bombardier, C., Guillemin, F., &Ferraz, M.B. (2000). Guidelines for the process of crosscultural adaptation of selfreport measures. Spine, 25(24), 31863191.
Miller, J.A., &Stokes, A.J. (2018). The Young Spine Questionnaire: development and validation in an Englishspeaking cohort. Journal of Pediatric Orthopaedics, 38(4), 215223.
Silva, R.M., etal. (2022). Crosscultural adaptation of musculoskeletal questionnaires for Portuguesespeaking children. Physical Therapy, 102(7), pzab162.
World Health Organization. (2021). Guidelines for the translation and adaptation of instruments. Retrieved from https://www.who.int
