Cross cultural adaptation of the Water Orientation Test Alyn (WOTA) 1 and 2 – Portuguese version

Abstract

Introduction: Aquatic Physical therapy plays an important role in the treatment of several clinical conditions. A therapy programme associated with water properties enhances the progress and recovery of body functions and structures, activities and participation, and quality of life [1,2]. Outcomes assessment is fundamental for the construction of an evidence-based practice. WOTA 1 and 2 are two important aquatic instruments that were developed to assess the mental adaptation of the swimmer and his function in the water based on the principles of the Halliwick method. WOTA 1 was developed to evaluate children with difficulties in following or understanding instructions. WOTA 2 was developed to assess children with higher functional abilities or that are able to follow instructions [3]. The purpose of this study was to adapt and cultural validate WOTA 1 and 2 to portuguese language and to assess its psychometric properties.

Materials and methods: This is a methodological study of adaptation and cultural validation of an instrument in a foreign language. The different steps recommended in the literature were carried out. The cross cultural equivalence was done through Delphi technique by the expert committee, composed by five aquatic physical therapists experts. One round was enough because agreement between experts was 80% or more on the items. The pretest was done by a small sample of physical therapists (PT) in order to assess if the translated instrument was understandable and the language was clear. No problems were pointed by the pretest PT to the Portuguese version so the process of cross validation continued with the assessment of psychometric properties of the instrument. A convenience sample of forty children divided into two groups participated on the study. In WOTA 1 twenty participants (80% male and 20% female; mean ± SD age, 8.3 ± 2.8 years) and in WOTA 2 twenty participants (70% male and 30% female; mean ± SD age, 13.6 ± 2.8 years). Two physical therapists evaluated the children in the beginning and one month later. All subjects’ guardians signed informed consent.

Results: WOTA 1 and WOTA 2 both showed good psychometrics values. WOTA 1 showed very good values of internal consistency (Cronbach α= 0.91) and test-retest reliability (ICC= 0.94; 95%CI). The WOTA 2 also showed high internal consistency (Cronbach α= 0.89) and good test-retest reliability (ICC= 0.99 (95%CI)). The instrument is divided into two sub-scales (mental adaptation (MA) and functional performance (FP)). Both sub-scales scored with good values of consistency and test-retest reliability (MA Cronbach α= 0.68; ICC= 0.95 (95%CI); FP Cronbach α= 0.90; ICC= 0.99 (95%CI)).

Discussion and conclusion: WOTA-P 1 and WOTA-P 2 are a valid and reliable instrument to portuguese language and its results are comparable with the english version.

Acknowledgements

The authors acknowledge the aquatic physiotherapists experts for their work on the validation of the instrument and the children that participated in the study.