Cross-cultural translation, adaptation and validation of the Burnt Hand Outcome Tool (BHOT) from English to French Canadian
Introduction
Hand burn injuries can occur either as part of a larger burn injury or as an isolated injury [1]. In either case, burns to the hand are a leading cause of impairment after a burn injury as the hand is an important functional system [2]. Indeed, a person’s level of hand function has a large impact on their capacity to carry out activities of daily living (ADLs) and on their quality of life [1], [3], [4]. Additionally, the manual capabilities regained following a burn injury influences the patient’s ability to fully reintegrate into their pre-injury life [5]. As a result, it is important to measure the functional impact of hand burns, which has been traditionally accomplished using multiple complementary generic functional assessments such as the disabilities of the arm, shoulder and hand (DASH), the Michigan Hand Questionnaire (MHQ), and the Test d’Évaluation des Membres Supérieurs des Personne Agées (TEMPA) [3], [4], [6]. However, these assessments were not developed for burn survivors and therefore, do not fully address the burn patient’s reality [3], [6]. Nor have their psychometric properties been evaluated with this population as no hand function assessment tool has been thoroughly validated with hand burn injuries [6].
For instance, generic evaluations neglect to address important aspects such as scarring, itching, and psychological impacts of burns [4], [7], [8]. Hand burns differ from other hand pathologies as they can include substantial skin loss and scarring, which can cause important aesthetic and sensory changes impacting well-being [6], [9], [10]. Therefore, clinicians must use several assessments for a holistic evaluation, which include the Patient and Observer Scar Assessment Scale (POSAS) [11] and the Burn Specific Health Scale (BSHS) or its shorter version: the BSHS-B [12], [13], [14].
The lack of a comprehensive outcome tool specific to hand burns has an impact on the evaluation process, and thus the treatment, making it more time-consuming and resource intensive. Bache et al. emphasize the importance of having an assessment tool designed for hand burn injuries with good clinical properties to provide evidence-based care that would promote optimal recovery, ideally full recovery [3]. Since there is no consensus on the outcome measure, or the multiple outcome measures, that should be used to monitor the recovery of hand burn survivors, research on the efficacy of treatments and best practices for hand burn injuries are compromised [3], [6], [15], [16]. Therefore, the Burnt Hand Outcome Tool (BHOT) was developed by Bache et al. [3] to respond to the unique needs of hand burn injuries while being comprehensive and quick to use. Patient-reported outcome measures entail several benefits including being time-efficient and client-centered while promoting patient engagement in their care [3], [6].
The BHOT was developed by combining four assessments frequently used with hand burns: the DASH, the MHQ, the POSAS, and the BSHS-B [3]. The questions from these tools were collected and randomized with the scores removed, and a committee of experts in burns then determined the most relevant questions to incorporate into the BHOT. They selected five questions for each of the following four predetermined sub-categories: 1. Task specific; 2. General ability to carry out activities; 3. Appearance, scars, pain and sensation; and 4. Emotional, social and work impact. The authors demonstrated that the BHOT has excellent reliability, criterion validity when compared to the DASH, construct validity, and responsiveness. The assessment has not yet been translated in any other language nor has its clinimetric properties been further assessed since its development by Bache et al. [3]. However, the DASH, MHQ, the Patient Scar Assessment Scale (PSAS) and the BSHS-B have been translated into French [17], [18], [19], [20].
The BHOT is currently employed where English is the language of choice, but the language barrier prevents its use with the francophone population. Therefore, clinicians and researchers working with francophone patients who had sustained hand burns require a validated French version of the BHOT. To ensure the quality of the translation and cultural adaptation, and to be able to compare the results with the original English version, the method followed was the “Principles of good practice for the Translation and Cultural Adaptation Process for patient-reported outcome (PRO) measures” outlined by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force for Translation and Cultural Adaptation [21]. Feedback from the participants must be analyzed to improve the adaptation and ensure that the translation is understandable from a language and cultural point of view by the target population.
Thus, this study aimed to develop a French-Canadian version of the BHOT (BHOT-F) for clinical use and research, to assess its content validity, and to confirm its construct convergent validity.
Section snippets
Participants
Study participants were patients treated at the Montreal Burn Centre, which includes the Villa Medica Rehabilitation Hospital, Entraide Grands Brûlés and the Centre Hospitalier de l’Université de Montréal (CHUM). Inclusion criteria included being: 16 years of age or older, a French speaker, and sustaining a burn injury requiring hospitalization affecting: (1) any body part except hands for the field-testing group or, (2) one or both hands for the construct convergent validation process (CCVP)
Participants’ characteristics
Forty participants took part in the study — one participant was excluded as the individual did not meet the inclusion criteria (the burn was proximal to the wrist and did not involve the hand). Table 1 reports the participants’ demographic information.
Two participants replied to 19 of the 20 items as they did not provide an answer for item B-5; the other 37 participants completed all 20 items from the BHOT-F. The scores vary from 20 to 81. Fourteen participants were unable to provide a means of
Discussion
Hand burns have a profound impact on patients, affecting multiple dimensions such as functionality, aesthetics and emotional state. To monitor the patient’s recovery and provide the best possible treatment, healthcare professionals require culturally adapted outcome measures and, ideally, a tool that is quick, accessible and comprehensive. The BHOT was created to meet these needs for English speaking burn survivors who have sustained hand burns.
The purpose of the study was to develop a
Conflict of interest
There were no conflict of interest.
Acknowledgements
The authors are grateful for the generous contribution of the Montreal Burn Centre’s clinicians, research staff and patients for their time and resources invested in the project. In addition, we are grateful to Dr. Bache et al. for developing the BHOT and agreeing to allow us to translate and culturally adapt it to French-Canadian.
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