Review of the mais published cross-cultural validation guidelines for translation, adaptation and validation of questionnaries
DOI:
https://doi.org/10.22480/rev.unifa.2025.38.811Keywords:
Cross-cultural comparison, Validation studies, QuestionnairesAbstract
Musculoskeletal complaints such as pain, discomfort, stiffness, tingling, or numbness are common and globally prevalent, associated with decreased professional performance, resulting in absenteeism and
declining quality of life. This impact particularly affects military pilots of combat aircraft and rotor-wing
helicopters due to prolonged exposure to flight conditions causing muscle fatigue and increasing the risk of spinal injuries. Monitoring these complaints among Armed Forces aviators is complex, lacking
reliable surveillance tools for this purpose. The “University of Canberra Fast Jet Aircrew Musculoskeletal
Questionnaire (UC-FJAMQ)”, initially developed for Royal Australian Air Force fighter pilots, has demonstrated validity and robust psychometric properties, surpassing conventional injury surveillance methods. This instrument is now being transculturally adapted for use by Brazilian Air Force (FAB) pilots. This study aims to review guidelines on transcultural adaptation of questionnaires, addressing similarities and controversies in different stages of this process. The methodology included searching MEDLINE, LILACS, SciELO, and Google Scholar databases using descriptors “cross-cultural” AND “adaptation OR translation OR validation” AND “instruments OR questionnaires” AND “guideline.” A total of 150 articles were identified, and three guidelines were selected for instrument adaptation: Beaton et al. (2000), Reichenheim and Moraes (2007), and Sousa and Rojjanasrirat (2011). The guidelines show similarities but differ in specific aspects, such as discussions with specialists and target populations to ensure equivalence.
References
ANG, B.; LINDER, J.; HARMS-RINGDAHL, K. Neck strength and myoelectric fatigue in fighter and helicopter pilots with a history of neck pain. Aviation, space, and environmental medicine, v. 76, n. 4, p. 375-380, Apr 2005.
ANTHOINE, E.; V. et al. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health and quality of life outcomes, v. 12, p. 176, Dec 9 2014.
ARAFAT, S. M et al. Cross-cultural adaptation and psychometric validation of research instruments: a methodological review. Journal of Behavioral Health, v. 5, n. 3, p. 129-136, 2016.
BATISTUTA MANZI-OLIVEIRA, A. et al. Adaptação transcultural de instrumentos de avaliação psicológica: levantamento dos estudos realizados no Brasil de 2000 a 2010. Psico-USF, v. 16, n. 3, p. 367-381, 2011.
BEATON, D. E.; et al.. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976), v. 25, n. 24, p. 3186-3191, Dec 15 2000.
BORSA, J. C. D., B. D.; BANDEIRA, D. R. Adaptação e validação de instrumentos psicológicos entre culturas: algumas considerações. Paidéia (Ribeirão Preto), v. 22, p. 423-432, 2012.
BRANDT, Y. et al. A Randomized Controlled Trial of Core Strengthening Exercises in Helicopter Crewmembers with Low Back Pain. Aerospace Medicine and Human Performance, v. 86, n. 10, p. 889-894, Oct 2015.
EPSTEIN, J.; SANTO, R. M.; GUILLEMIN, F. A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. Journal of Clinical Epidemiology, v. 68, n. 4, p. 435-441, Apr 2015.
FAIRBANK, J.C.; PYNSENT, P.B. The Oswestry Disability Index. Spine (Phila Pa 1976). v.25, n. 22, p. 2940-2952, 2000.
GAMA, Z. et al. AGRASS Questionnaire: Assessment of Risk Management in Health Care. Revista de Saude Publica, v. 54, p. 21, 2020.
GOMES, S. R. A. et al. Factors associated with low back pain in air force fighter pilots: a cross-sectional study. BMJ Military Health, v. 168, n. 4, p. 299-302, Aug 2022.
GUILLEMIN, F.; BOMBARDIER, C.; BEATON, D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of Clinical Epidemiology, v. 46, n. 12, p. 1417-1432, Dec 1993.
HAMBLETON, R. K.; KANJEE, A. Increasing the Validity of Cross-Cultural Assessments: Use of Improved Methods for Test Adaptations. European Journal of Psychological Assessment, v. 11, n. 3, p. 147-157, 1995.
HERDMAN, M.; FOX-RUSHBY, J.; BADIA, X. A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Quality of Life Research, v. 7, n. 4, p. 323-335, May 1998.
HUNT, S. M.; BHOPAL, R. Self report in clinical and epidemiological studies with non-English speakers: the challenge of language and culture. Journal of Epidemiology and Community Health, v. 58, n. 7, p. 618-622, Jul 2004.
JUNIOR, S. D. D.; et al. Cross-cultural adaptation and validation of health questionnaires. Brazilian Journal of Allergy Immunology, v. 4, n. 1, p. 26-30, 2016.
KARCIOGLU, O. et al. A systematic review of the pain scales in adults: Which to use? The American Journal of Emergency Medicine, v. 36, n. 4, p. 707–714, 2018.
KENT, M. L.; UPP, J. J.; BUCKENMAIER, C. C., 3rd. Acute pain on and off the battlefield: what we do, what we know, and future directions. International Anesthesiology Clinics, v. 49, n. 3, p. 10-32, Summer 2011.
MANEESRIWONGUL, W.; DIXON, J. K. Instrument translation process: a methods review. Journal of Advanced Nursing, v. 48, n. 2, p. 175-186, Oct 2004.
MASTALERZ, A. et al. Pain in the Cervical and Lumbar Spine as a Result of High G-Force Values in Military Pilots-A Systematic Review and Meta-Analysis. International Journal of Environmental Research Public Health, v. 19, n. 20, Oct 17 2022.
MENDES, P. R. F. et al. Core stabilisation exercises reduce chronic low back pain in Air Force fighter pilots: a randomised controlled trial. BMJ Military Health, v. 170, n. 1, p. 31-36, Apr 25 2022.
NINDL, B. C. et al. Human Performance Optimization Metrics: Consensus Findings, Gaps, and Recommendations for Future Research. The Journal of Strength & Conditioning Research, v. 29 Suppl 11, p. S221-245, Nov 2015.
RAJA, S. N et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, v. 161, n. 9, p. 1976-1982, Sep 1 2020.
REICHENHEIM, M. E.; MORAES, C. L. Operationalizing the cross-cultural adaptation of epidemiological measurement instruments. Revista de Saude Publica, v. 41, n. 4, p. 665-673, Aug 2007.
RUSSOMANO, T., CASTRO, J. C. Fisiologia Aeroespacial: Conhecimentos Essesnciais Para Voar Com Segurança. Porto Alegre: EdiPUCRS, 2012.
SEMAGE, S. N. et al. Cross-cultural and factorial validity of PTSD check list-military version (PCL-M) in Sinhalese language. European Journal of Psychotraumatology, v. 4, 2013.
v.
SOUSA, V. D.; ROJJANASRIRAT, W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. Journal of Evaluation in Clinical Practice, v. 17, n. 2, p. 268-274, Apr 2011.
SOUZA, A. C. ; ALEXANDRE, N. M. C.; GUIRARDELLO, E. B. Propriedades psicométricas na avaliação de instrumentos: avaliação da confiabilidade e da validade. Jornal de Epidemiologia e Serviços de Saúde, v. 26, p. 649-659, 2017.
VALER, D. B. et al. Adaptation and validation of the Caregiver Burden Inventory for use with caregivers of elderly individuals. Rev Lat Am Enfermagem, 23, n. 1, p. 130-138, Jan-Feb 2015.
WALLACE, J. et al. A validated injury surveillance and monitoring tool for fast jet aircrew: translating sports medicine paradigms to a military population. Sports Medicine, v. 8, n. 1, p. 92, Jul 16 2022.

Downloads
Published
Issue
Section
License
Copyright (c) 2025 Thaís de Albuquerque, Helder Guerra de Resende, Guilherme Eugênio Van Keulen, Vinicius de Oliveira Damasceno

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Revista da UNIFA permite que o (s) autor (es) mantenha(m) seus direitos autorais sem restrições. Atribuição-NãoComercial 4.0 Internacional (CC BY-NC 4.0) - Revista da UNIFA é regida pela licença CC-BY-NC