Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD

Objective: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, testretest reliability agreement, and internal consistency of this version. Methods: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese- language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD ( 57% were men; mean age was 69 +/- 6 years; and mean FEV 1 was 53 +/- 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity. Results: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: amount domain = 0.87 (95% CI, 0.73- 0.94) and difficulty domain = 0.90 (95% CI, 0.76- 0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C- PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = - 0.63). Conclusions: The Brazilian Portuguese version of the C- PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

Automated summary

The objective of this study was to adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and determine its validity, reliability, and internal consistency. The results showed that the C-PPAC instrument had good internal consistency and excellent test-retest reliability. The criterion validity of the instrument was demonstrated through moderate to strong correlations with other evaluation tools, particularly the International Physical Activity Questionnaire (IPAQ). In conclusion, the Brazilian Portuguese version of the C-PPAC is a reliable and valid tool for assessing physical activity in individuals with COPD in Brazil.