Background: Hand injuries can significantly impair individuals' ability to engage in essential daily and social activities, necessitating valid and culturally relevant tools to assess participation limitations. The Participation Behaviour Questionnaire (PBQ), originally developed in Persian and grounded in the International Classification of Functioning, Disability and Health (ICF), was designed to evaluate the extent of participation restrictions following hand and upper limb injuries.
Purpose: This study aimed to translate and cross-culturally adapt the PBQ for use among Canadian English-speaking individuals with hand injuries and assess its content validity within a Canadian clinical context.
Methods: The PBQ was adapted according to Beaton's five-step guideline for the cross-cultural translation of self-report measures. Cognitive interviews were conducted with 15 patients and 22 healthcare professionals, including physiotherapists, hand therapists, surgeons, and rehabilitation researchers, using think-aloud and semi-structured methods to examine item clarity, consistency of interpretation, and cultural appropriateness.
Findings: Cognitive interviews with 15 patients and 22 experts revealed 25 items requiring revision, with 88% of concerns related to clarity and comprehension. Overall, clarity issues were identified in 22 of the 37 items, resulting in 18 substantive revisions. For example, the item "I feel I have lost my autonomy" was revised to "I feel I have lost my independence in daily tasks" to improve clarity. Commonly misunderstood terms included "public transport" and "voluntary job," which were refined using culturally contextual examples. Cultural and contextual factors also influenced how participants interpreted items such as "My use of public transport" (12%) and "Engagement in voluntary work" (20%).
Implications: The English-adapted PBQ demonstrated evidence of content validity based on participant feedback regarding clarity, relevance, and comprehensibility. The 18 substantive revisions enhanced cultural and linguistic appropriateness by addressing clarity in 22 of 37 items, refining ambiguous terminology, and incorporating Canadian-contextual examples where necessary. These findings represent an initial step in the overall validation process; in this pre-psychometric, single-center Canadian-English study, additional research is required to assess the instrument's psychometric properties, including construct validity, reliability, and responsiveness.