Transcultural adaptation, validity, and reliability of the SINBAD System Classification for Brazilian Portuguese.
Julliany Lopes Dias, Eline Lima Borges, Danubia Mendes E Torres and 7 others
PMID 41221918WHAT IT FOUND
The Brazilian Portuguese SINBAD foot-ulcer scoring tool was adapted and judged relevant by experts, but its six items did not consistently act as one measure.
Use each item clinically; do not rely on the total score alone.
Key findings
01The Brazilian Portuguese SINBAD version reached acceptable content validity after two rounds of expert review, and all items were adequate in the second round.
02In 113 patients with 120 diabetes-related foot ulcers, the adapted version's internal consistency was 0.635, and the authors say this means the items are not consistently measuring the same construct.
03Eight of 23 SINBAD terms were changed during adaptation, and the tool scores six items from 0 or 1 to a maximum of six points.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The reliability analysis used a convenience sample of 113 patients from selected referral outpatient services and primary care centres, so the result may not represent all people with diabetes-related foot ulcers. The adapted version's total score showed low internal consistency (0.635), below the 0.70 threshold the researchers set, so the six items may not measure one single severity construct. The content validation response rate was low: 23 of 121 invitations returned, and the second round used 12 experts. The study tested translation, expert relevance and internal consistency; it did not test whether using the tool improves ulcer healing, amputation or other patient outcomes. The authors note the original SINBAD system is a scoring tool, not a classification, and the adapted version was not tested as a classification.
Declared interests
The paper states that it was extracted from a doctoral dissertation at Universidade Federal de Goiás and supported by CNPq, Grant #312093/2013-6. No other conflict declaration is given.
The easy way to misread this
Do not read the adapted SINBAD total score as a proven severity classification. The study showed language and content validity, but the total score did not hang together as one measure (0.635), so the six-point total should not be treated as one reliable measure of ulcer severity.