# Translation and cross-cultural adaptation of the Brazilian version of the Boston Residue and Clearance Scale (BR-BRACS)

## TL;DR

This study translated and adapted the Boston Residue and Clearance Scale into Brazilian Portuguese and validated its image content for evaluating swallowing.

## Contribution

The paper provides a validated Brazilian Portuguese version of the BR-BRACS scale with culturally adapted images for pharyngeal residue assessment.

## Key findings

- The translation and cross-cultural adaptation of BR-BRACS was successfully completed with content validity evidence.
- Images for the scale showed near-perfect agreement among judges in visual-perceptual evaluation.
- Discrepancies in translation were resolved through consensus, ensuring equivalence with the original version.

## Abstract

This study aimed to translate and cross-culturally adapt The Boston Residue and Clearance Scale (BR-BRACS) into Brazilian Portuguese and validate the image selection content for the scale.

The project was approved by the Institution’s Ethics Committee under number 67715717.6.0000.5406. The process involved translating the scale into the target language, synthesizing the translations, and back-translating it into the original language. A literature review was conducted to define the concept of pharyngeal residue and ensure the content validity of the images representing the scale. Then, 50 fiberoptic endoscopic evaluations of swallowing were analyzed and submitted to three judges for visual-perceptual evaluation. Agreement among the judges was analyzed using Fleiss' Kappa test with a 95% confidence interval.

Discrepancies in lexical and syntactic contexts were identified during translation and resolved through a consensus among translators and authors. The back-translated versions were equivalent to the original. The images proposed for the scale showed near-perfect agreement among the judges.

The translation, cross-cultural adaptation, and selection of images for visual-perceptual evaluation of pharyngeal residue in the BR-BRACS were completed with evidence of content validity.

Este estudo teve por objetivo traduzir e adaptar transculturalmente para a Língua Portuguesa do Brasil a The Boston Residue and Clearance Scale (BR-BRACS) e validar o conteúdo da seleção de imagens para compor a escala.

Projeto aprovado pelo Comitê de Ética da Instituição sob o número 67715717.6.0000.5406. Foi realizada a tradução para o idioma alvo, síntese das traduções e retrotradução para o idioma original. Para a validade de conteúdo das imagens representativas da escala foi realizada busca na literatura para definir o conceito de resíduos faríngeos, análise de 50 exames de videoendoscopia da deglutição e análise perceptivo visual das imagens por três juízes. A concordância entre juízes foi analisada por meio do teste Kappa Fleiss com intervalo de confiança de 95%.

Na tradução houve discrepâncias no contexto lexical e sintático que foram ajustadas em formato de consenso entre tradutores e autores, e na retrotradução as versões apresentaram equivalência. As imagens propostas para compor a escala apresentaram concordância quase perfeita entre os juízes.

O processo de tradução e adaptação transcultural, bem como a seleção das imagens para análise perceptivo-visual de resíduos faríngeos da BR-BRACS foi concluído com evidência de validade de conteúdo.