Cross-cultural adaptation, validity, and reliability study of the Chinese version of the vestibular activities avoidance Instrument-9.

Abstract

BackgroundPatients with vestibular disorders frequently avoid specific environments and activities due to the fear of dizziness episodes. However, this fear avoidance belief and behavior may inhibit the compensatory mechanisms of the vestibular system, thereby impacting the rehabilitation process. The Vestibular Activities Avoidance Instrument-9 (VAAI-9) is a 9-item tool specifically designed to identify and measure the fear avoidance beliefs and behaviors associated with vestibular disorders.ObjectiveTo translate and culturally adapt the VAAI-9 into Chinese and to investigate its reliability and validity of the Chinese Version.MethodsThe Brislin translation model was strictly followed to conduct cross-cultural adaptation of the VAAI-9, which included translation, back translation, expert consultation, and preliminary investigation, ultimately resulting in the Chinese version of the VAAI-9 (VAAI-9-C). A total of 330 Chinese-speaking patients with dizziness or vestibular disorders were recruited through convenience sampling, and they were asked to complete the baseline questionnaire and the VAAI-9-C. The reliability of the instrument was evaluated through item analysis, internal consistency was measured by Cronbach's alpha, and test-retest reliability was assessed by the intraclass correlation coefficient (ICC) and the minimal detectable change (MDC₉₅). Content validity was determined by expert evaluation results, including the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Structural validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).ResultsDuring the cross-cultural adaptation process, minor revisions were made to the content expression to ensure semantic equivalence. The correlation coefficients between each item and the total score of VAAI-9-C ranged from 0.745 to 0.794. Cronbach's alpha was 0.911 and ICC was 0.886 for the VAAI-9-C total scale. The MDC₉₅ was 8.78 points. The I-CVI for each item of the VAAI-9-C ranged from 0.9 to 1.0, and the S-CVI was 0.98. Exploratory factor analysis revealed three common factors and explained 88% of the total variance. Confirmatory factor analysis indicated that χ²/df = 1.317, incremental fit index (IFI) = 0.995, Tucker-Lewis index (TLI) = 0.992, comparative fit index (CFI) = 0.995, root mean square error of approximation (RMSEA) = 0.038, and standardized root mean square residual (SRMR) = 0.024, demonstrating a good model fit.ConclusionsThe VAAI-9-C demonstrates strong reliability and validity, making it an effective tool for evaluating fear avoidance beliefs and behaviors in the Chinese-speaking population with dizziness.