DOI: 10.

1590/0100-6991e-20223377-en Original Article

Translation into portuguese of a set of questionnaires designed to

evaluate the impact of using a telepresence robot during
postoperative ward rounds
Tradução para a língua portuguesa de um conjunto de questionários destinados
à avaliação do impacto da utilização de um robô de telepresença em visitas
hospitalares pós-cirúrgicas

Leonardo Kristem1 ; Cacio Ricardo Wietzycoski2 ; Guilherme da Silva Mazzini1 .

A B S T R A C T

Introduction: the use of telepresence grows with the advancement of technology integration into medical practice. Regarding surgery,
effective distance communication can translate into better perioperative care. Though, the patients’ perception about this modality
needs to be critically evaluated. Structured questionnaires using objective scales are the instruments of choice for measuring subjective
aspects. However, there are no such questionnaires available in Portuguese. Our objective was, thus, translate and adapt into Portuguese
a specific questionnaire evaluating the use of telepresence robots during post-operatory ward rounds. Methods: search on PubMed
and selection of a set of validated questionnaires in English, translation into Portuguese according to the principles of good practice
for the translation and cultural adaptation process for patient-reported outcomes measures. The original author approved the final
version. Results: three questionnaires that assess ward rounds assisted by a telepresence robot were translated. Questionnaires are
directed to the patient who receives the visit via telepresence or face-to-face visit and to the medical team accompanying the visit. The
questionnaires use the Likert scale and contain thirteen questions that address 5 spheres: Communication; Dignity and Confidentiality;
Contents; Time; General Impressions. Conclusions: this is the first instrument in Portuguese designed to assess the impression of
patients and professionals involved in ward rounds using a telepresence robot. It has the potential to be used in clinical studies involving
the use of this technology in care.

Keywords: Telemedicine. Questionnaires. Translating. Post-Operative Care.

INTRODUCTION institutions, and patients using telemedicine3,4. Even in

eminently traditional activities such as surgery, studies

T elemedicine is the use of technology employed

via communication networks for the delivery of
health services, assistance, and medical education from
have been conducted in recent decades investigating
the role of telemedicine and its potential to generate
benefits without interfering with patient safety. In a
one geographic location to another1. Its use and its study conducted with 23 high-risk patients undergoing
modalities, such as telepresence, have increased on a bariatric surgery who received preoperative evaluation
large scale with the advancement of the incorporation and follow-up via teleconference, the authors found
of technologies into medical practice, associated with equivalent surgical outcomes when compared with
the need to optimize costs and resources. Since 2020, matched patients who had traditional care5. Despite
the use of telemedicine has grown exponentially due to its dissemination, however, the subjective perception
the SARS-CoV-2 pandemic and the need to integrate of the parties about this type of interaction still lacks
policies such as social distancing and better use of scientific evaluation6.
human resources2. Similarly, several previous experiences Questionnaires structured through scales
have demonstrated positive outcomes for medical staff, or scores are the instruments of choice for measuring

1 - Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia do Aparelho Digestivo - Porto Alegre - RS - Brasil 2 - Hospital da Unimed do Vale do CaÍ,
CEMTrOM - Centro Especializado por Excelência para o Tratamento da Obesidade e Metabolismo - Montenegro - RS - Brasil

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 Kristem
2 Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds

subjective aspects7, allowing their use in scientific studies set of questionnaires in English, designed,
in a reproducible and comparable manner. So far, there validated, and published by Croghan,
are no structured questionnaires available in Portuguese Carroll, Reade, Gillis, and Ridgway, 20188;
aiming to assess the impact of using telepresence 2. Preparation: we requested authorization by
technology in hospitalized patients that could be applied the author of the original tool, granting her a
in clinical studies. license to use the translated questionnaires;
The objective of the present study was to select 3. Translation: translation of the questionnaires
and translate into Portuguese a group of questionnaires, into Portuguese by two Brazilian researchers
already available and validated in English, which perform fluent in English, adapting the language
an objective and reproducible assessment of the impact level to high school education. Each
of telepresence robots in postoperative hospital visits, translated the questionnaire independently,
so that these tools can be applied in studies with seeking a conceptual translation rather
Portuguese-speaking patients. than a literal one;
4. Consensus: After the translation phase,
METHODS the work team, composed of three
Brazilian researchers, met and selected
Questionnaire selection the most appropriate version of the set of
questionnaires. This was called “Version 1”;
We carried out a search on PubMed and selected 5. Back-translation: A native English speaker,
an original work by Croghan, Carroll, Reade, Gillis, and fluent in Portuguese, and experienced in
Ridgway, 20188. In it, the authors developed and validated translating medical papers, performed the
a group of questionnaires that assess the perception of translation of Portuguese ‘Version 1’ into
patients and medical staff in relation to postoperative English, the original language of the set of
medical visits during hospitalization. In this work, patients questionnaires. This professional did not
in postoperative recovery were divided into two groups: have access to the original English version
one group receiving medical visits from the traditional of the questionnaires and was instructed to
care team (surgeon accompanied by non-medical staff perform a literal translation. This was called
physically present) and one group receiving visits where the “Back-translated Version”;
the surgeon used a telepresence robot, accompanied by 6. Review and approval by the original author:
physically present non-medical staff. To assess the subjective The Back-Translated Version was submitted
perceptions of patients in both groups and the care team, for evaluation by the author of the original
three multidimensional questionnaires were developed, questionnaires in English, who considered
addressing the spheres of Communication, Dignity and it equivalent to the original version,
Confidentiality, Content, Time, and General Impressions. approving it without objections or requests
for modifications;
Portuguese language translation 7. Final report: We wrote a report on the
process of translating and adapting the set
Based on a previously used and known of questionnaires. This article originates
translation methodology protocol into Portuguese9,10, from the report.
and in accordance with good practices for the process Face validity, aiming at an assessment of the
of translation and cultural adaptation11, the process of perception of the patient undergoing a hospital visit by
translation into Portuguese of the questionnaires used in telepresence, was weighted at each stage in a consensual
the original work involved the following steps: way among the researchers. As it is not a questionnaire
1. Selection: Initially, we performed a search of patient-reported outcomes and because there was
on PubMed and selected the pioneering rigor in all stages of translation, the researchers judged

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Kristem
Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds 3

that there was no need for a validation stage of cognitive 1), aimed at control patients who receive a face-to-face
unfolding with patients, in accordance with good visit; Questionnaire B (Table 2) for the patients who
practices described by Wild, Grove, Martin, Eremenco, receives the telepresence visit; and Questionnaire C
McElroy, Verjee-Lorenz, et al., 200510. (Table 3) for the medical team accompanying the visit.
The questionnaires use a 5-point Likert scale (strongly
RESULTS agree, agree, neutral, disagree, strongly disagree) and
contain 13 questions that address the following spheres:
At the end of the review phase, the authors Communication, Dignity and Confidentiality, Content,
defined the final version of three translated and Time, and General Impressions. Questionnaire B also
previously validated questionnaires to be used as clinical has two additional questions in the General Impressions
research tools evaluating the postoperative hospital visit domain, which assesses patients’ satisfaction and
assisted by a telepresence robot: Questionnaire A (Table comfort regarding the hospital visit via telepresence.

Table 1 - Questionnaire A.

Questionário ao paciente
Nós estamos ansiosos para receber sua opinião sobre a visita à enfermaria. Ficaríamos gratos se você pudesse com-
pletar com honestidade o questionário abaixo relacionado aos diferentes aspectos da sua experiência. Por favor, para
cada questão circule a resposta que mais reflita sua opinião. Todas as respostas são anônimas.
Comunicação
1. Você pôde ver seu médico?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
2. Você pôde se comunicar com seu médico?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
3. Você foi cumprimentado(a) pelo seu médico e perguntado(a) sobre o seu bem-estar?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
4. Você entendeu o que o médico disse para você?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
5. Você sentiu que podia discutir quaisquer sintomas ou problemas que o incomodavam?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Dignidade e confidencialidade
6. Você sentiu que o(s) médico(s) mantiveram a sua confidencialidade durante a visita à enfermaria?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
7. A sua dignidade foi preservada durante a visita à enfermaria?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
8. A equipe comunicou efetivamente seus sinais vitais e resultados de exames ao seu médico assistente/sênior?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Conteúdo
9. A equipe examinou você de maneira apropriada e comunicou os achados ao meu médico assistente/sênior?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente

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4 Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds

10. O médico informou você sobre as suas condições?

Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
11. Você ficou satisfeito(a) com o plano de manejo?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
12. Os médicos responderam às minhas questões?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Tempo
13. Eu senti que os médicos ficaram uma quantidade de tempo apropriada comigo?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente

Table 2 - Questionnaire B.

Questionário ao paciente
Você foi visitado na enfermaria pelo seu médico assistente/sênior que não estava presente fisicamente, mas que se
comunicou com você e com a equipe através de um computador (referido abaixo como “visita à enfermaria por
telecomunicação”). Nós estamos ansiosos para receber sua opinião sobre este conceito. Ficaríamos gratos se você
pudesse completar com honestidade o questionário abaixo relacionado aos diferentes aspectos da sua experiência.
Por favor, para cada questão circule a resposta que mais reflita sua opinião. Todas as respostas são anônimas.
Comunicação
1. Você pôde ver seu médico?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
2. Você pôde se comunicar com seu médico?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
3. Você foi cumprimentado(a) pelo seu médico e perguntado(a) sobre o seu bem-estar?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
4. Você entendeu o que o médico disse para você?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
5. Você sentiu que podia discutir quaisquer sintomas ou problemas que o incomodavam?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Dignidade e confidencialidade
6. Você sentiu que o(s) médico(s) mantiveram a sua confidencialidade durante a visita à enfermaria?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
7. A sua dignidade foi preservada durante a visita à enfermaria?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
8. A equipe comunicou efetivamente seus sinais vitais e resultados de exames ao seu médico assistente/sênior?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente

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Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds 5

Conteúdo
9. A equipe examinou você de maneira apropriada e comunicou os achados ao meu médico assistente/sênior?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
10. O médico informou você sobre as suas condições?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
11. Você ficou satisfeito(a) com o plano de manejo?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
12. Os médicos responderam às minhas questões?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Tempo
13. Eu senti que os médicos ficaram uma quantidade de tempo apropriada comigo?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Impressões Gerais
14. Você acha que a visita à enfermaria por telecomunicação é uma solução satisfatória caso seu médico assistente
não possa estar presente fisicamente no hospital?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
15. Se você for internado em um hospital no futuro, você se sentiria confortável com visitas regulares à enfermaria
por telecomunicação?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
16. Por favor liste quaisquer comentários que você tenha, incluindo preocupações ou possíveis áreas para melhoria:

Table 3 - Questionnaire C.

Questionário para o médico/enfermeiro da equipe

Nós estamos muito interessados em receber sua opinião sobre a visita à enfermaria assistida por robô. Tendo par-
ticipado de duas ou mais dessas visitas, você poderia por favor completar o questionário abaixo a respeito das suas
impressões da interação com o médico comunicando-se via robô?
Comunicação
1. Você e o(a) paciente puderam ver o médico?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
2. Você e o(a) paciente puderam se comunicar com o médico?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
3. Você sentiu que o(a) paciente pôde discutir quaisquer sintomas ou problemas que o incomodavam?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
4. A equipe comunicou efetivamente os sinais vitais/exame ao seu médico assistente/sênior?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
5. Você pôde fazer as perguntas que tinha em relação ao cuidado com paciente, via robô?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente

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6 Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds

Dignidade e confidencialidade
6. Você sentiu que a confidencialidade do paciente foi mantida na visita à enfermaria?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
7. A dignidade do paciente foi preservada durante a visita à enfermaria?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Conteúdo
8. Você e o(a) paciente foram apropriadamente informados do plano de manejo?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
9. Você ficou satisfeito(a) com o diagnóstico e plano de manejo?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Tempo
10. Você sentiu que foi dispendida uma quantidade de tempo apropriada com o(a) paciente?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Impressões gerais
11. Você acha que a visita à enfermaria por telecomunicação é uma solução satisfatória caso seu médico assistente
não possa estar presente fisicamente no hospital?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
12. Você se sentiria confortável com visitas regulares à enfermaria por telecomunicação?
Concordo plenamente Concordo Neutro Discordo Discordo Totalmente
Impressões Gerais
13. Por favor liste quaisquer preocupações que você possa ter em relação às visitas à enfermaria por telecomunicação:

All questionnaires have an explanatory à enfermaria” was translated back as “ward round”.
header, customized for each target group, in simple In the translation phase, in a consensual way among
and objective language, allowing the self-application the researchers, we decided to use “plenamente”
of the instrument. Questionnaires B and C have an (“completely”, “fully”) as a translation for “strongly”,
open question with a free answer to allow spontaneous despite the literal translation “fortemente”, due to the
comments about the telepresence modality. consecrated use in Portuguese of this adverb associated
The term “ward round” was translated and with the verb “concordar” (“agree”), being more
adapted to “visita à enfermaria” (“ward visit”), for accurate to represent the intent of completeness. Still
better understanding by the patients. The term “round”, during this phase, the researchers chose to use gender
despite being part of the medical jargon in Brazilian morphemes with their proper inflections in parentheses
Portuguese, could not be understood by most of the in terms with gender marks, according to the standard
target population of the questionnaire and, because of norm of the Portuguese language.
that, it was not chosen for the translation. This choice The original author of the questionnaires fully
was corroborated in the back-translation when “visita approved the final translation without objections.

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Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds 7

DISCUSSION Croghan, Carroll, Reade, Gillis, and Ridgway, 20188,

into a language other than English.
The present study sought to translate and The translation of questionnaires has intrinsic
adapt a set of questionnaires about the subjective limitations and known biases, such as cultural differences,
perception of patients in hospital visits assisted by the use of technical jargon, and the formatting of the
telepresence, adopting a protocol previously used in questionnaire itself12. We tried to minimize these biases
this type of translation12. Instead of creating a tool for by avoiding the use of medical or ambiguous terms or
this purpose, we decided to adapt an already used and double questions, always adapting to the educational
validated one, for efficiency and because there is already level of the target population. We kept the original
an existing one in English, allowing its comparative use formatting of the questionnaire with the spacing and
internationally. Questionnaires like these are essential horizontal alignment of the answers to avoid horizontal
for investigations using telepresence technology. bias, as well as the original scale, to avoid inconsistency.
The use of structured tools such as this one allows a Moreover, the number of pages, words, and characters
better understanding of subjective aspects, such as of each questionnaire remained similar. Because it is not a
the patient’s experience in a hospital or the perception questionnaire dedicated to clinical outcomes reported by
of their care, transferring different domains of health patients, considering the face validity, comprehensibility,
to an objective form, through a numerical scale, the and clarity analyzed at each stage of the translation,
Likert one. In addition, it also allows comparison and because the target audience is extremely broad and
between individuals and groups, with others or with diverse (patients in a hospital), we deemed necessary to
each other in a given period7. For this, it is necessary carry out a cognitive unfolding for the elaboration of the
to ensure adequate understanding of the parts, final version of this tool.
simplicity, and speed in execution. The structuring of Notably, the daily practice of medicine values
the three questionnaires in this work according to the the reduction of costs and time, without reducing the
Likert scale and their synthetic format, in common quality of care. In this sense, telemedicine presents
language, guarantee these characteristics. In addition, itself as an exciting alternative, but like any new
the reference selected for this work, originally in medical technology and, in accordance with current
English and applied to a British cohort of individuals in health regulations, caution and extensive investigation
postoperative hospital admission, is unprecedented and of its impact are required prior to its adoption. Thus,
recent, addressing universal health domains, facilitating the present tool adds to the current literature as it has
its application in different regions. The translation and broad applicability potential in the development of
adaptation of this tool into Portuguese, according telemedicine in Brazil.
to the aforementioned aspects for all questions, was
prepared in multiple meetings by the authors, with CONCLUSION
back-translation by a professional native speaker of
English and fluent in Portuguese, with experience in This is the first instrument in Portuguese
translating documents and scientific medical works, in designed to measure the subjective assessment of
addition to the contribution and endorsement of the patients and professionals involved in postoperative
original author. hospital visits using a telepresence robot. Critical
During the execution of this work, we followed evaluation of the use of this new technology is essential
the principles and parameters established in the guidelines for it to be incorporated, considering not only its impact
for the translation and adaptation of questionnaires. on outcomes, but also the perception of patients and
Following these procedures, we guarantee contextual, hospital staff of the quality of care provided.
conceptual, and semantic equivalence, generating a set We hope that this tool will be widely used in
of questionnaires corresponding to the original. This clinical studies involving the use of this technology in
was the first translation and adaptation of the tool by healthcare.

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8 Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds

R E S U M O

Introdução: O uso da telepresença cresce com o avanço da integração de tecnologias à prática médica. No que tange a cirurgia, a
comunicação à distância efetiva pode traduzir-se em um melhor cuidado perioperatório. No entanto, a percepção das partes acerca
desta modalidade carece de avaliação científica. Questionários estruturados através de escalas são os instrumentos de escolha na
mensuração de aspectos subjetivos. Entretanto, não há uma ferramenta validada neste molde em língua portuguesa. Nosso objetivo
foi traduzir e adaptar para língua portuguesa um questionário específico de percepção sobre o uso de robôs de telepresença em visita
hospitalar pós-cirúrgica. Métodos: foi realizada busca no PubMed e selecionado um conjunto de questionários validados em língua
inglesa. Após, realizada a tradução para a língua portuguesa conforme as boas práticas para o processo de tradução e adaptação
cultural. A autora original avaliou e aprovou a versão traduzida. Resultados: foram traduzidos três questionários autoaplicáveis e
direcionados para os pacientes que recebem a visita por telepresença ou presencial e à equipe médica que acompanha as visitas
com o objetivo de avaliar a visita hospitalar assistida por robô de telepresença. O conjunto utiliza a escala de Likert e contêm treze
perguntas que abordam as esferas Comunicação; Dignidade e Confidencialidade; Conteúdo; Tempo; Impressões Gerais. Conclusões:
este é o primeiro instrumento em língua portuguesa desenhado para avaliar a impressão de pacientes e profissionais envolvidos em
rounds utilizando um robô de telepresença, tendo potencial para ser utilizado em estudos clínicos que envolvam a utilização desta
tecnologia na assistência.

Palavras-chave: Telemedicina. Questionários. Tradução. Cuidado Pós-Operatório.

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Received in: 23/05/2022 Mailing address:

Accepted for publication: 06/06/2022 Guilherme da Silva Mazzini
Conflict of interest: no. E-mai: guimazzini@gmail.com
Funding source: none.

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