Translation, cross-cultural and construct validity of the Dutch-Flemish PROMIS (R) upper extremity item bank v2.0

Erik Jan A. Haan, Caroline B. Terwee, Marieke F. Van Wier, Nienke W. Willigenburg, Derek F.P. Van Deurzen, Martijn F. Pisters, Aaron J. Kaat, Leo D. Roorda*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: To develop a Dutch–Flemish translation of the PROMIS® upper extremity (PROMIS-UE) item bank v2.0, and to investigate its cross-cultural and construct validity as well as its floor and ceiling effects in patients with musculoskeletal UE disorders. Methods: State of the art translation methodology was used to develop the Dutch–Flemish PROMIS-UE item bank v2.0. The item bank and four legacy instruments were administered to 205 Dutch patients with musculoskeletal UE disorders visiting an orthopedic outpatient clinic. The validity of cross-cultural comparisons between English and Dutch patients was evaluated by studying differential item functioning (DIF) for language (Dutch vs. English) with ordinal logistic regression models and McFadden’s pseudo R2-change of ≥ 2% as critical value. Construct validity was assessed by formulating a priori hypotheses and calculating correlations with legacy instruments. Floor/ceiling effects were evaluated by determining the proportion of patients who achieved the lowest/highest possible raw score. Results: Eight items showed DIF for language, but their impact on the test score was negligible. The item bank correlated, as hypothesized, moderately with the Dutch–Flemish PROMIS pain intensity item (Pearson’s r = − 0.43) and strongly with the Disabilities of the Arm, Shoulder and Hand questionnaire, Subscale Disability/Symptoms (Spearman’s ρ = − 0.87), the Functional Index for Hand Osteoarthritis (ρ = − 0.86), and the Michigan Hand Outcomes Questionnaire, Subscale Activities of Daily Living (ρ = 0.87). No patients achieved the lowest or highest possible raw score. Conclusions: A Dutch–Flemish PROMIS-UE item bank v2.0 has been developed that showed sufficient cross-cultural and construct validity as well as absence of floor and ceiling effects.

Original languageEnglish
Pages (from-to)1123-1135
Number of pages13
JournalQuality of Life Research
Issue number4
Publication statusPublished - 1 Apr 2020


  • Construct validity
  • Cross-cultural validity
  • Floor and ceiling effects
  • Patient-Reported Outcomes Measurement Information System (PROMIS)
  • Upper extremity


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