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Spanish validation of the Dyspnea Index (DI): translation, cultural adaptation, and psychometric evaluation
Clara Espina González1, Araceli Caballero Rabasco2, Diego Rodríguez Chiaradía3
1Otorhinolaryngology Department, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain.
Antecedents And Objective:
Laryngeal disorders are an important but often underrecognized cause of dyspnea in otorhinolaryngology practice. The assessment of symptom severity is challenging due to the episodic nature of symptoms and the limited availability of objective tests during symptomatic episodes. The Dyspnea Index (DI) is a validated patient-reported outcome measure specifically designed to assess laryngeal dyspnea; however, a Spanish version has not previously been validated. The objective of the present study is to translate, culturally adapt and validate the Spanish version of the Dyspnea Index (DI).
Methods:
A single-center, cross-sectional validation study was conducted, including patients aged ≥12 years who complained of laryngeal dyspnea, excluding comorbid conditions causing dyspnea of other origin. Healthy adult controls without otorhinolaryngologic or pulmonary disorders were recruited among medical students and hospital staff. The DI was translated by three independent otolaryngologists, synthesized into a consensus version, and back-translated by a professional translator. Psychometric evaluation included internal consistency (Cronbach's α), known-group validity (Welch's t, Mann-Whitney U, Cohen's d), floor/ceiling effects, and exploratory factor analysis (PCA).
Results:
Forty-three patients and forty-three healthy controls were analyzed. Mean DI scores were 21.44 ± 10.08 in patients and 1.23 ± 1.96 in controls (p < 0.0001; Cohen's d = 2.78). Internal consistency was excellent overall (α = 0.955) and good-to-excellent in patients (α = 0.879). A floor effect was present in 33.7% and a ceiling effect in 1.2%. PCA supported a predominantly unidimensional structure (PC1 eigenvalue = 4.99, explained variance = 48.7%).
Conclusion:
The Spanish DI demonstrates excellent reliability and validity, with psychometric properties comparable to validated versions in other languages. It is a robust tool for the assessment of laryngeal dyspnea in Spanish-speaking settings.
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