# SWEDISH TRANSLATION, CULTURAL ADAPTATION AND TESTING OF THE PROSTHETIC UPPER EXTREMITY FUNCTIONAL INDEX-2

## TL;DR

This paper describes the translation and adaptation of a questionnaire for measuring prosthesis use in children to a Swedish context, ensuring it is easy to understand and relevant.

## Contribution

The paper provides a culturally adapted and validated Swedish version of the Prosthetic Upper Extremity Functional Index-2 questionnaire for children.

## Key findings

- The translated PUFI-2 was found to be relevant and easy to understand for Swedish children and parents.
- The questionnaire is accessible on computers and mobile devices and supports children's participation in treatment planning.

## Abstract

We aimed to translate, culturally adapt and test the Prosthetic Upper Extremity Functional Index-2 for a Swedish context.

Ten children with congenital upper limb deficiency with an upper limb prosthesis and their parents.

The translation and cultural adaptation of the Prosthetic Upper Extremity Functional Index-2 was conducted according to the International Society for Pharmacoeconomics and Outcomes Research Principles of Good Practice for cross-cultural adaptation of patient-reported outcome measures; this comprises 10 steps, including Preparation, Forward Translation, Reconciliation, Back Translation, Back Translation Review, Harmonization, Cognitive Debriefing, Review of Cognitive Debriefing Results and Finalization, Proofreading and Final Report.

The new translated version, tested on 10 children, 4 boys and 6 girls, 3–14 years showed good relevance for the Swedish context, the questions were easy to understand, and response options were easy to interpret. It was also easily accessible on computers and mobile devices.

The Swedish version of the Prosthetic Upper Extremity Functional Index-2 is user-friendly and provide information of the child’s self-reported prosthesis use in a Swedish context. Children’s right to express their opinions, is crucial, and using the questionnaire prior to their clinic visits gives children the opportunity to participate in goal setting and treatment planning.

The Prosthetic Upper Extremity Functional Index (PUFI) is a Canadian self-report questionnaire for children (3–18 years) with an upper limb prosthesis. The questionnaire asks about performance of various 2-handed activities. Children under 10 years answer with a parent. The answers provide a comprehensive picture of the child’s real-world prosthesis use. Children’s daily activities change with time, and therefore an updated Canadian version, PUFI-2, has been developed. We aimed to translate and culturally adapt PUFI-2 for use in a Swedish context. The Swedish version was tested on Swedish children and parents who stated that the questions were relevant, and easy to understand and respond. The PUFI-2 gives children the opportunity to participate in goal setting and treatment planning.