Cultural and semantic equivalence of the activity measure post-acute care (AM-PAC) after its translation into Mandarin Chinese

Abstract

Purpose: The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese.

Method: This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis.

Results: Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI adjusted conversion table was generated to transform the raw scores of the measure for comparisons between the two countries.

Conclusions: This study provides evidence to support the conceptual equivalence of the AM-PAC when used in rehabilitation patients between American and Taiwanese cultural contexts. Some DFI items between the two groups were found, suggesting that some differences in semantic understanding of these items between cultures require cross-cultural adjustments.

Implications for Rehabilitation

• Cultural equivalence needs to be tested before applying a clinical measure to another context.

• The findings of this study supported the three activity domains that the Activity Measure Post-Acute Care measures: Basic Mobility, Daily Activity, and Applied Cognition, which are all important rehabilitation outcomes that need to be assessed and monitored across rehabilitation settings.

• Differential item functioning was observed between the English and Chinese versions of the Activity Measure Post-Acute Care, indicating that linguistic and cultural differences across countries need to be adjusted for before using the translated measure in clinical practice.

Keywords:

• Cross-cultural comparison
• rehabilitation
• psychometrics
• patient outcome assessment
• subacute care
• outpatients

Acknowledgements

Project team members included Yi-Cian Lai and Yi-An Lien (Taipei Medical University). We thank the collaborating hospitals: Shuang Ho Hospital, Wan Fang Hospital, and Taipei Medical University Hospital.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Ministry of Health and Welfare, Taiwan [Grant Nos. MOHW104-TDU-B-212-113001 and MOHW105-TDU-B-212-133018] and in part by the Ministry of Science and Technology, Taiwan [Grant Nos. MOST104-2314-B-038-003 and MOST105-2628-B-038–003-MY3].