Translation and Cross-Cultural Adaptation of the International Duke Activity Status Index in the Urdu Version

Background: Cardiovascular diseases are a leading cause of morbidity worldwide, necessitating effective tools for functional capacity assessment. The Duke Activity Status Index is widely used for this purpose; its adaptation and validation for Urdu speakers ensures accessibility and accuracy in clinical evaluations for native patients. Objective: To translate, cross-culturally adapt, and determine the validity & reliability of the Duke Activity Status Index Questionnaire in the Urdu version through psychometric properties. Methodology: It was a descriptive cross-sectional study conducted within 6 months at Allama Iqbal Hospital, Sialkot. A sample of 18 participants older than 22 years, having diagnosed coronary artery disease, valvular heart disease, arrhythmia, and who were able to recite and comprehend both Urdu and English, were included in the study. Two independent translators, both of whom had command of both English and Urdu and who were native speakers, worked on the forward translation from English to Urdu and formulated. A thorough review was done by the expert panel, which consisted of 10 experts having more than 10 years of clinical experience in cardiopulmonary physical therapy. The final Urdu version was forwarded to two expert translators, who were both native English speakers, for backwards translation, while maintaining the blinding. A small pilot study was done on 10 cardiovascular disease patients. The translated version was again re-evaluated by the bilingual experts for any inconsistencies that might have existed.  The final phase II focused on cross-cultural adaptation and the establishment of the reliability and validity of this version. The participants were requested to fill Urdu version, and the test was repeated after 20 hours. Intra-class correlation coefficient was applied to analyse test-retest reliability. Results: The Duke Activity Status Index had good face and content validity. The test-retest reliability showed a strong relationship between the two measures (r=0.01) and an excellent correlation (intra-class correlation=0.89). Conclusion: The Duke Activity Status Index-Urdu version showed a very good agreement of the translated Urdu version with the original English version. The psychometric properties of this version were good, with strong reliability and validity.