Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care

doi:10.1016/j.jpsychores.2006.10.018

Journal of Psychosomatic Research

Volume 62, Issue 3, March 2007, Pages 301-304

https://doi.org/10.1016/j.jpsychores.2006.10.018 Get rights and content

Abstract

Objective

The Chalder Fatigue Questionnaire (CFQ) is an instrument used to measure physical and mental fatigue. We translated and adapted the questionnaire and tested its reliability and validity in a Brazilian primary care setting.

Method

A pilot study with 204 consecutive primary care attenders in Sao Paulo, Brazil, verified the internal consistency and factor structure of the questionnaire. After some modifications through a rigorous translation, back-translation, and cross-cultural adaptation procedure, a validation study was conducted with 304 attenders, who also completed the fatigue section of the Revised Clinical Interview Schedule (CIS-R).

Results

The internal consistency of the Brazilian CFQ slightly improved from the pilot to the validation study: Cronbach's alpha from .86 to .88. The two-factor structure (physical and mental fatigue) also improved. According to the receiver operating curve analysis with the fatigue section of the CIS-R as the standard criterion, 3/4 was chosen as the cutoff for Brazilian primary care (sensitivity 69.1% and specificity 79.4%).

Conclusion

The Brazilian CFQ had good reliability and validity. The cutoff was determined as 3/4 and the factor structure of the English CFQ was closely reproduced.

Introduction

Chronic fatigue syndrome (CFS) is characterized by severe physical and mental fatigue, physical and mental fatigability occurring after minimal activity, and other accompanying symptoms, which cannot be explained by any other medical condition and have persisted for at least 6 months [1]. The Chalder Fatigue Questionnaire (CFQ) has been developed and widely used either to measure the severity of fatigue or as an aid for assessing patients with CFS [2]. The original validation work reported the scale to be both reliable and valid with a high degree of internal consistency and a two-factor structure (physical and mental fatigue) [2]. The CFQ has been used in Brazil but had not been validated in that setting [3], [4]. As preliminary steps for a cross-cultural study of CFS in Brazil and the United Kingdom (UK) [5], a pilot study was conducted in 2001 to verify the feasibility of the main study and provide data on the internal consistency and factor structure of the Brazilian version of the CFQ. A formal validation study for the Brazilian CFQ was conducted in July and August 2003. We report here the results of the pilot and the validation studies.

Section snippets

Translation, back-translation, and cross-cultural adaptation

Previous versions of the CFQ used in Brazil have not been formally validated. Hence, a properly designed validation study was conducted in 2003, following a published guideline on cross-cultural adaptation of health-related measures [6]. Two sets of translations and back-translations of the CFQ were prepared. One translator was a Brazilian psychiatrist (H.J.C.), who had translated the original English version into Portuguese for the pilot study in 2001 and improved the 2001 version according to

Internal consistency

Data from the pilot study showed a high degree of internal consistency with a Cronbach's alpha of .86 (Table 1). The same was true for the validation study (α=.88).

Principal component analyses

The principal component analysis of the pilot study data suggested a two-dimensional solution with two factors presenting an eigenvalue of 1 or more (4.59 and 1.36), but three items loading into both factors (Table 2). The first two principal components accounted for 54.2% of the variance. The validation data suggested the same

Discussion

An appropriate validation of a psychometric instrument is an essential step before carrying out any research study. It is even more so when the study is cross-cultural in nature. Hence, we went through a rigorous process of an initial pilot study, translation, back-translation, cross-cultural adaptation, and, finally, a validation study. As a result, the internal consistency and factor structure of the Brazilian CFQ closely matched the original English version. Internal consistency measured by

Acknowledgments

Dr. Cho received a scholarship from the Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazilian Ministry of Education. Drs. Albina Torres, Carlos Lima, and William Lee are gratefully acknowledged for their collaboration.

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There are more references available in the full text version of this article.

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Short communicationCross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care

Abstract

Objective

Method

Results

Conclusion

Introduction

Section snippets

Translation, back-translation, and cross-cultural adaptation

Internal consistency

Principal component analyses

Discussion

Acknowledgments

J Psychosom Res

J Clin Epidemiol

Chronic fatigue syndrome

BMJ

Multiple sclerosis: descriptive study of its clinical forms in 302 cases

Arq Neuropsiquiatr

Chronic fatigue among bank workers in Brazil

Occup Med (Lond)

Short communication
Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care