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Background <p>Death rattles are a frequent clinical sign in patients in an end-of-life situation, despite the lack of consensus on how to address them. The Victoria Respiratory Congestion Scale (VRCS) is an internationally utilized scale, but it has yet to be translated to Spanish. The aim of the present study was to translate and cross-culturally adapt the VRCS into Spanish and to assess selected psychometric properties, namely criterion validity and inter-rater reliability, in patients at the end-of-life.</p> Methods <p>A systematic translation and cross‑cultural adaptation methodology was applied to ensure semantic, conceptual, and cultural equivalence of the instrument for Spanish‑speaking patients at the end-of-life. A cross-sectional study was conducted between May and September 2024 in home-care patients and patients in the palliative care unit at Hestia Balaguer Hospital and Hospital de la Ribera, to assess the criterion validity and inter-rater reliability of the Spanish version of the VRCS. Criterion validity was evaluated by calculating the correlation between the sound level measurements obtained using a smartphone sound level meter app and the VRCS scores using Spearman’s correlation coefficient. Inter-rater reliability was calculated using weighted Cohen’s kappa by comparing the VRCS scores independently assigned by two observers.</p> Results <p>The first outcome of the study was the translation and cross-cultural adaptation of the Spanish VRCS (Sp-VRCS). The validity and reliability were assessed in a sample of 47 patients aged between 54 and 98 years old, with 82.98% being men. In addition, 76.60% of them had a primary diagnosis of cancer. Spearman’s correlation coefficients were ρ = 0.758 (maximum dB), ρ = 0.649 (mean dB), and ρ = 0.569 (minimum dB), indicating moderate to acceptable correlations. All correlations were statistically significant (<i>p</i> &lt; 0.01, two-tailed). The inter-rater reliability analysis revealed that the weighted Cohen’s kappa coefficient was 1.00, indicating a perfect inter-rater agreement in this sample.</p> Conclusions <p>The Sp‑VRCS demonstrated good criterion validity and high inter-rater reliability agreement. The present study provides preliminary psychometric evidence for the Spanish version of the VRCS. The results support its use as a feasible and clinically useful scale for assessing respiratory congestion in palliative care patients at the end-of-life. Further multicentre validation studies addressing additional psychometric properties are recommended before broader implementation.</p>

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Translation, cross-cultural adaptation and preliminary psychometric evaluation of the Victoria Respiratory Congestion Scale into Spanish

  • 期刊论文

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  • 发表日期：

    2026年7月9日

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  • Jaume Canal-Sotelo,
  • Antonio Martin-Marco,
  • David Bottaro-Parra,
  • Rosa Blasi-Martínez,
  • Lina Nitola-Mendoza,
  • Adrià Oller-Bonache,
  • Carla Camí,
  • Eva Barallat-Gimeno

摘要

Background

Death rattles are a frequent clinical sign in patients in an end-of-life situation, despite the lack of consensus on how to address them. The Victoria Respiratory Congestion Scale (VRCS) is an internationally utilized scale, but it has yet to be translated to Spanish. The aim of the present study was to translate and cross-culturally adapt the VRCS into Spanish and to assess selected psychometric properties, namely criterion validity and inter-rater reliability, in patients at the end-of-life.

Methods

A systematic translation and cross‑cultural adaptation methodology was applied to ensure semantic, conceptual, and cultural equivalence of the instrument for Spanish‑speaking patients at the end-of-life. A cross-sectional study was conducted between May and September 2024 in home-care patients and patients in the palliative care unit at Hestia Balaguer Hospital and Hospital de la Ribera, to assess the criterion validity and inter-rater reliability of the Spanish version of the VRCS. Criterion validity was evaluated by calculating the correlation between the sound level measurements obtained using a smartphone sound level meter app and the VRCS scores using Spearman’s correlation coefficient. Inter-rater reliability was calculated using weighted Cohen’s kappa by comparing the VRCS scores independently assigned by two observers.

Results

The first outcome of the study was the translation and cross-cultural adaptation of the Spanish VRCS (Sp-VRCS). The validity and reliability were assessed in a sample of 47 patients aged between 54 and 98 years old, with 82.98% being men. In addition, 76.60% of them had a primary diagnosis of cancer. Spearman’s correlation coefficients were ρ = 0.758 (maximum dB), ρ = 0.649 (mean dB), and ρ = 0.569 (minimum dB), indicating moderate to acceptable correlations. All correlations were statistically significant (p < 0.01, two-tailed). The inter-rater reliability analysis revealed that the weighted Cohen’s kappa coefficient was 1.00, indicating a perfect inter-rater agreement in this sample.

Conclusions

The Sp‑VRCS demonstrated good criterion validity and high inter-rater reliability agreement. The present study provides preliminary psychometric evidence for the Spanish version of the VRCS. The results support its use as a feasible and clinically useful scale for assessing respiratory congestion in palliative care patients at the end-of-life. Further multicentre validation studies addressing additional psychometric properties are recommended before broader implementation.