Cross-cultural validation of the French version of the Lymphedema Functioning, Disability and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL)

Abstract

Purpose

Upper limb lymphedema is a vexing morbidity that can occur after the treatment for breast cancer. The Lymphedema Functioning, Disability and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL) is a valid and reliable tool assessing problems in functioning in patients with breast cancer-related lymphedema. Until now, a French-language version was lacking. The aim of this study was to perform a cross-cultural validation of the French version of the Lymph-ICF-UL questionnaire.

Methods

A forward–backward translation process between the original language (Dutch) and the target language (French) was performed. Psychometric properties of this final French version were examined in 50 participants.

Results

Intraclass correlation coefficients for test–retest reliability ranged from 0.66 to 0.95. Cronbach’s alpha coefficients for internal consistency were higher than 0.77. Face and content validity were very good because the scoring system was clear for all participants (100%), questions were understandable (100%), and all complaints due to BCRL were mentioned by 78% of the participants. Construct validity was moderate. Convergent validity was established since 3 out of 5 expected domains of the Lymph-ICF-UL showed a moderate correlation with expected domains of the 36-item Short-Form Health Survey. There was satisfactory divergent validity as 6 out of 9 hypotheses assessing divergent validity were accepted.

Conclusion

The French version of the Lymph-ICF-UL is a reliable and valid questionnaire and ready for use in clinical as well as in scientific practice.

Implications for rehabilitation

• Since the introduction of more effective treatment modalities increasing the number of breast cancer survivors, the amount of patients dealing with lymphedema is rising likewise up to a pooled incidence rate of more than 16% of the women treated for breast cancer.

• The French version of the Lymph-ICF-UL is a reliable and valid questionnaire for assessing problems in functioning of patients with breast cancer-related lymphedema of the arm and/or hand.

• As the questionnaire provides patient information in the different domains of the International Classification of Functioning, Disability and Health, it facilitates evaluating the impact of breast cancer-related lymphedema on daily functioning.

• Based on the outcomes of the Lymph-ICF-UL treatment goals can be set, where after the questionnaire can be used to monitor long-term results of this treatment and self-care.

Keywords:

• Breast neoplasms
• rehabilitation
• lymphedema
• surveys and questionnaires
• reliability and validity

Acknowledgements

The authors are very grateful to the hospitals collaborating in this study. The authors also extend very grateful thanks to the study participants, and to Kevin Dusart and Lore Vos for measuring and handing over the questionnaires to the study participants. All authors critically revised the manuscript for important intellectual content and approved the final manuscript.

Disclosure statement

The authors have no conflicts of interest to declare.

Clinical trial registration number

The cross-cultural validation study makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in clinicaltrials.gov (NCT02609724). CME reference S58689, EudraCT Number 2015-004822-33.

Additional information

Funding

This study is financed by the Agency for Innovation by Science and Technology, applied Biomedical Research (IWT 150178). In order to arrange such financing, a separate collaboration agreement has been signed by the KU Leuven and the beneficiaries.