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      Personal and Social Performance (PSP) scale for patients with schizophrenia: translation to Portuguese, cross-cultural adaptation and interrater reliability Translated title: A escala de Performance Social e Pessoal (PSP) para pacientes com esquizofrenia: tradução para o português, adaptação transcultural e confiabilidade entre avaliadores

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          Abstract

          INTRODUCTION: Schizophrenia is a chronic mental disorder associated with impairment in social functioning. The most widely used scale to measure social functioning is the GAF (Global Assessment of Functioning), but it has the disadvantage of measuring at the same time symptoms and functioning, as described in its anchors. OBJECTIVES:Translation and cultural adaptation of the PSP, proposing a final version in Portuguese for use in Brazil. METHODS: We performed five steps: 1) translation; 2) back translation; 3) formal assessment of semantic equivalence; 4) debriefing; 5) analysis by experts. Interrater reliability (Intraclass correlation, ICC) between two raters was also measured. RESULTS: The final version was applied by two independent investigators in 18 adults with schizophrenia (DSM-IV-TR). The interrater reliability (ICC) was 0.812 (p < 0.001). CONCLUSION: The translation and adaptation of the PSP had an adequate level of semantic equivalence between the Portuguese version and the original English version. There were no difficulties related to understanding the content expressed in the translated texts and terms. Its application was easy and it showed a good interrater reliability. The PSP is a valid instrument for the measurement of personal and social functioning in schizophrenia.

          Translated abstract

          INTRODUÇÃO: A esquizofrenia é um transtorno mental crônico associado a prejuízos no funcionamento social. A escala mais utilizada para medir o funcionamento social é a GAF (Global Assessment of Functioning), mas ela tem a desvantagem de medir ao mesmo tempo sintomas e funcionamento, conforme descrito em suas âncoras de pontuação. OBJETIVOS: Tradução e adaptação cultural da escala de Performance Social e Pessoal (PSP) para o português e avaliação da confiabilidade entre avaliadores. MÉTODOS: Foram seguidas cinco etapas: 1) tradução; 2) retrotradução; 3) avaliação formal da equivalência semântica; 4) debriefing; 5) análise por especialistas. A confiabilidade entre avaliadores (Correlação Intraclasse, ICC) também foi medida. RESULTADOS: A versão final da PSP foi aplicada por dois investigadores independentes em 17 adultos com esquizofrenia (DSM-IV-TR). A confiabilidade entre avaliadores (ICC) foi de 0.812 (p < 0.001). CONCLUSÃO: A tradução e a adaptação da PSP mostraram um nível adequado de equivalência semântica entre a versão em português e a versão original em inglês. Não houve dificuldade na compreensão do conteúdo expresso nos textos e termos traduzidos. Sua aplicação foi simples e mostrou boa confiabilidade entre avaliadores. A PSP é um instrumento válido para a mensuração do funcionamento pessoal e social na esquizofrenia.

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          A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach

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            Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia.

            In trying to more broadly define outcome in the efficient long-term treatment of patients with schizophrenia it is necessary to consider not only a reduction in psychopathological symptoms but also a successful psychosocial reintegration. Thus, a more exact assessment of psychosocial functioning is needed. Since the GAF (Global Assessment of Functioning) scale and the SOFAS (Social and Occupational Functioning Assessment Scale) are less operationalized and confuse psychosocial facts with psychopathological symptoms, the Personal and Social Performance (PSP) scale was developed [Morosini, P.L., Magliano, L., Brambilla, L., Ugolini, S., Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 1001, 323-329.] containing the four main areas "socially useful activities, personal and social relationships, self-care, as well as disturbing and aggressive behaviour". Validation of the PSP scale was conducted in a sample of 62 patients with acute schizophrenia. Rating instruments were PSP, GAF, SOFAS, PANSS, CGI, and Mini-ICF-P (Mini-ICF-Rating for Mental Disorders). The results showed good reliability with alpha=.64-.84, high test-retest reliability as well as good inter-rater reliability for the PSP scale. Furthermore, PSP proved good validity with high correlations to GAF (r=.91), SOFAS (r=.91), and Mini-ICF-P (r=-.69). The hypothesis that more critically ill patients would show lower scores on PSP than lesser ill patients was only confirmed for PANSS negative symptoms. Thus, the findings prove the PSP scale to be a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in the acute state.
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              Personal and social functioning in schizophrenia: defining a clinically meaningful measure of maintenance in relapse prevention.

              Relapse prevention and maintenance of social functioning are important treatment objectives in the long-term management of schizophrenia. However, relatively little is known about measuring maintenance of social functioning to assess treatment benefit in relapse prevention clinical trials or as a tool to predict relapse in clinical practice. This study aims (1) to define a clinically meaningful decrease in the Personal and Social Performance scale (PSP) to assess antipsychotic treatment benefit in terms of maintenance of functioning and (2) to explore the threshold value of PSP decline as a useful tool to predict relapse in clinical practice. This post hoc analysis of two similar placebo-controlled relapse prevention clinical trials consisted of an exploration of change in PSP that would represent a clinically important decrement to measure treatment benefit in terms of time to PSP decrement (ITT analysis set; Study 1: n = 205) and an assessment of predictive value of PSP decrement and relapse status (ITT analysis set; Study 2: n = 408). A 10-point decrement in PSP score was the threshold value for a clinically meaningful decline in personal and social functioning in a relapse prevention trial (Study 1). A strong association was found with relapse status: 61% of subjects with at least a 10-point decrease in PSP experienced the decrement prior to (between start of double-blind phase and before day of relapse) or on the day of relapse (Study 2). Kaplan-Meier survival analysis of time to at least a 10-point decrement in PSP showed that the proportion of subjects who did not experience at least a 10-point PSP decrease was statistically significantly greater in the paliperidone palmitate group than in the placebo group (p = 0.0014) (Study 2). Findings suggest a 10-point PSP decrement is a clinically relevant measure of maintenance of functioning in patients stabilized with antipsychotic therapy. Paliperidone palmitate demonstrated a statistically significant treatment benefit in terms of maintenance of functioning versus placebo. Furthermore, measuring a clinically relevant PSP decrement may be useful as an early functional indicator of relapse in clinical practice. The exploration and validation of the threshold value of change in the PSP was designed and conducted post hoc. Predictive value is limited by the frequency in which PSP assessments were carried out in these trials, underscoring the importance of regular assessment.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jbpsiq
                Jornal Brasileiro de Psiquiatria
                J. bras. psiquiatr.
                Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (Rio de Janeiro )
                1982-0208
                2012
                : 61
                : 3
                : 176-180
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                [2 ] Universidade Federal do Rio de Janeiro Brazil
                [3 ] Universidade de Würzburg Alemanha
                Article
                S0047-20852012000300009
                10.1590/S0047-20852012000300009
                fd9abbe5-d59b-4a88-acf3-ee2e877c0fce

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0047-2085&lng=en
                Categories
                PSYCHIATRY

                Clinical Psychology & Psychiatry
                Schizophrenia,PSP,social functioning,Personal and Social Performance scale,Esquizofrenia,funcionamento social,escala de Performance Social e Pessoal

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