TCI mobile: validação de constructo, tradução e adaptação transcultural e análise da usabilidade do aplicativo de saúde para ser utilizado por pessoas com AVC crônico

Abstract

This doctoral thesis comprises two studies related to the use of mobile health applications aimed at individuals with chronic Cerebral Vascular Accident (stroke). Study I aimed to investigate the construct validity of the TCI Mobile application for the evaluation of mobility in a real environment of people after chronic stroke. We expected to find a positive moderate to strong correlation with the Life Space Assessment (LSA) scale, with the 6-Minute Walk Test (6MWT), with the self-selected speed in the 10-meter Walk Test (10MWT), and with the Lower Extremity Motor Activity Log (LEMAL). In addition, we expected to find a moderate to strong negative correlation with Timed Up and Go (TUG). This was a cross-sectional study, carried out with 30 individuals diagnosed with stroke for more than six months who were able to walk. Data collection took place over five days. On the first day, held in the physiotherapy department, sociodemographic data were collected and instruments to assess mobility and gait were applied: TUG, LSA, 6MWT, 10MWT, and LEMAL. On the second day, during a previously authorized home visit, an accelerometer was installed in the less affected limb and a smartphone containing the TCI Mobile application was made available, which remained in use for three consecutive days. After this period, the equipment was collected by the researchers. The results confirmed the hypothesis of the study, demonstrating a positive and high correlation between the TCI Mobile measurements and the activity monitors (r = 0.63; p < 0.01), as well as with the MWT10 (r = 0.54; p < 0.01) and the LSA (r = 0.54; p < 0.01). There was a negative and high correlation with the TUG (r = −0.50; p < 0.01) and a moderate positive correlation with the 6MWT (r = 0.42; p = 0.02) and LEMAL (r = 0.45; p = 0.01), indicating consistency of the measurements obtained by the app in the assessment of mobility in the real environment. Study II aimed to perform the translation and cross-cultural adaptation of the TCI Mobile application from Brazilian Portuguese to United States English, as well as to evaluate the content validity and usability of the adapted version. The translation and cross-cultural adaptation process was conducted in five sequential stages: (1) initial translation from Portuguese to English by independent translators; (2) synthesis of the translated versions in a single consensual document; (3) back-translation into Portuguese by translators whose mother tongue was Portuguese and who did not have access to the original version; (4) analysis by a ommittee of experts to verify semantic, idiomatic and conceptual equivalences; and (5) conducting pre-testing with end users. After completing these steps, the English version was evaluated by individuals with chronic stroke (injury time greater than six months), with score higher than 24 points in the Mini-Mental State Examination and access to the internet, as well as by therapists with experience in the application of Induced Restraint Therapy. The evaluation of content validity and usability of the English version had the participation of 24 evaluators, 12 therapists and 12 individuals with chronic stroke living in North America. The analysis of the relevance, comprehensiveness and comprehensibility of the tasks and notifications of the application was carried out through the calculation of the Content Validity Ratio (CVR), adopting as an acceptability criterion the minimum value of 0.59. Task list items and push notifications that did not reach this value were deleted or reworded as suggested by the participants. The usability of the application was evaluated using the User Version of the Mobile Application Rating Scale (uMARS), with the results presented using means and standard deviations. In the initial stages of the adaptation process (I to III), no relevant divergences were identified between the versions produced by translators and back-translators. In stage IV, the expert committee made adjustments to ensure conceptual equivalence and clarity in the drafting of terms and instructions. During the pre-test (step V), the content validity analysis indicated the exclusion of 24 of the 68 tasks originally available in the application, in addition to the removal of a push notification. It was also observed the need to reformulate 14 tasks to ensure better cultural and contextual adequacy to the target audience. The usability assessment using the uMARS scale demonstrated satisfactory levels of usability both among therapists and among individuals with stroke, indicating good acceptability and ease of use of the adapted version of the application. The findings obtained in this thesis contribute to the advancement of the use of mobile technologies in the rehabilitation of people after stroke, evidencing the validity, usability and cultural adequacy of a digital tool aimed at the assessment and monitoring of mobility in real life contexts. These results expand the possibilities of clinical application and provide subsidies for future research and for the improvement of digital strategies aimed at neurofunctional rehabilitation and the promotion of autonomy in this population.