Abstract
BACKGROUND: Language barriers during clinical care are a cause for particular concern for individuals from diverse linguistic backgrounds, especially the Hispanic and Latino US population, who comprise >19% of the American population and speak Spanish, the second most spoken language globally. Ensuring the inclusion of these patients in pediatric sports medicine and rehabilitation research is critical in minimizing bias and necessitates the development of patient-reported outcome measures available for use in Spanish. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) quantifies activity levels, developed for children and adolescents. PURPOSE: To validate a Spanish-translated and cross-culturally adapted version of the HSS Pedi-FABS questionnaire (Spanish HSS Pedi-FABS). STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Phase I consisted of the development and pretesting of the Spanish HSS Pedi-FABS for content validity. Phase II consisted of administering the English and Spanish versions to bilingual children and adolescents aged 10 to 18 years for construct validity and reliability. Participant demographic data and questionnaire responses were recorded. Internal consistency reliability was tested using Cronbach α. Construct validity was assessed by calculating a 2-way random-effects model of intraclass correlation coefficient (ICC) between the total scores and each item of the English and Spanish questionnaires. Floor and ceiling effect testing was performed by calculating the proportion of minimum and maximum overall scores in the cohort, respectively, to ensure they did not exceed a 15% threshold. RESULTS: The study included 50 patients with a mean age of 14.1 ± 2.0 years, of whom 52% were female. Internal consistency reliability of the Spanish HSS Pedi-FABS was excellent (Cronbach α = 0.92). Construct validity testing demonstrated excellent agreement between the English and Spanish questionnaires (ICC = 0.91). No floor or ceiling effects were demonstrated by either scale, as the minimum score was observed only twice (4%) in each scale and the maximum score was not observed. CONCLUSION: This study demonstrated that the Spanish HSS Pedi-FABS questionnaire is a valid and reliable tool that physicians can use to quantify physical activity levels in Spanish-speaking pediatric and adolescent populations. The validation of the Spanish HSS Pedi-FABS questionnaire is an important step in ensuring the inclusion of Spanish-speaking patients in pediatric sports medicine and rehabilitation research.