Translation into Spanish and validation of the Tinnitus Functional Index (TFI)

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(A) Sp-TFI score test-retest. (B) THI score test-retest. This Bland and Altman plot modified for non-continuous variables showed that the median differences of test-retest paired scores remained within two standard deviations." ] ] ] "textoCompleto" => "<elsevierMultimedia ident="tb0005"></elsevierMultimedia>IntroductionTinnitus is a sensation of noise perceived by an individual without an external sound stimulus. It can negatively affect people’s quality of life, impairing their ability to do intellectual work and reducing their psychological well-being.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The measurement of tinnitus is still controversial and there is no standardized measure used in routine audiological assessment, which makes it difficult to assess the global prevalence of this condition. A recent study reported tinnitus prevalence rates in Europe ranging from 8.7% to 28.3%; with an overall prevalence of 14.7%.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> It has been suggested that there is a relation between the severity of tinnitus and hearing loss. Only about 10% of tinnitus sufferers have normal hearing, making hearing impairment the most common comorbidity of tinnitus.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Despite the lack of a gold standard, some subjective assessment tools have been described that may help to determine the impact of tinnitus. These include the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI) and visual analogue scales (VAS).<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a> Notably, using the TFI, Mahafza et al. showed that patients suffering from sensorineural hearing loss had more persistent tinnitus, a lower sense of control over their tinnitus, sleep disturbance, auditory difficulties attributed to tinnitus, difficulty relaxing and a poorer quality of life than tinnitus patients without hearing loss.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Given responsiveness to treatment-related changes, its comprehensive coverage of the domains of tinnitus impact, and its psychometric properties, the TFI could be used as a standard instrument in both clinical and research settings.Since first published in 2012, the TFI has been translated into a range of languages and validated in several countries (e.g., Germany, United Kingdom, and Sweden).<a class="elsevierStyleCrossRefs" href="#bib0040">8–10</a> To our knowledge, however, there is no validated Spanish version of the TFI. Therefore, the objectives of this study were to translate into Spanish, cross-culturally adapt and validate the TFI for use in Spain.Materials and methodsThis study was a prospective, non-interventional, observational trial in patients experiencing tinnitus. The study was approved by the ethics committee of (Name of the hospital blinded for review) Hospital and all participants gave written informed consent. The study was performed in accordance with the ethical principles laid down in the Declaration of Helsinki of 1975, as revised in 2008. We followed the recommendations of the World Health Organization for the translation and adaptation of instruments and those of Guillemin et al. for the cross-cultural adaptation of health-related quality of life measures.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> Moreover, we followed the STROBE statement for cross-sectional studies.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>The Spanish version of the TFI (Sp-TFI) was obtained in the following way. Stage I: the original TFI was translated by two independent otolaryngologists - head & neck surgeons who were both Proficiency level in English and Spanish. Stage II: The Spanish versions obtained were combined in a single document and sent to a panel of six experts in otology at our Otorhinolaryngology Department for comments. It was agreed that there were only very minor (non-meaningful) differences between the two translations and a general consensus was reached on a single version. Stage III: This agreed Spanish version was sent to a third otorhinolaryngology - head & neck surgeon with Proficiency in English and Spanish for back-translation to English and no meaningful differences were found with respect to the original version. Stage IV: the translated questionnaire was piloted in a group of patients to test its comprehensibility, ensuring that the patients understood the items as intended. Stage V: The panel of experts reviewed the patients’ responses, and as there was a consensus that the patients had understood the questions well, agreed that the questionnaire piloted could be definitive version (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The TFI was developed to provide a rating of tinnitus severity and the impact of its severity, and also a responsive measure of change in severity. It is composed of 25 items divided into eight subscales: intrusiveness (I), sense of control (SC), cognition (C), sleep (SL), auditory (A), relaxation (R), quality of life (Q), and emotional distress (E).<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The THI is a 25-item self-reported questionnaire that has been widely used in tinnitus clinical practice and research to assess distress and disability associated with tinnitus. In this instrument, the 25 items are grouped into three subscales: functional (disability affecting daily life); emotional (anxiety and mental stress); and catastrophic (hopelessness, loss of control, and inability to cope with the problem). Three response options are provided for each item: yes, sometimes or no, awarded scores of 4, 2, and 0, respectively. Consequently, the THI total score ranges from zero to 100, higher total scores indicating more severe handicap related to tinnitus. The validity and reliability of the Spanish version have been confirmed.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Additionally, the loudness and annoyance related to tinnitus can be evaluated using VAS.<a class="elsevierStyleCrossRefs" href="#bib0030">6,15</a>To assess the reliability of the Sp-TFI, patients with tinnitus symptoms who came to an otology consultation, between May 2019 and March 2020, were asked to complete this new questionnaire, and also the THI and two VAS.<a class="elsevierStyleCrossRefs" href="#bib0030">6,14</a> Specifically, using the VAS, patients were asked to rate their self-perceived tinnitus loudness and their annoyance on an 11-point Likert scale from 0 to 10. Lastly, they were asked to indicate which ear was affected by the tinnitus. The same patients were asked to complete the same questionnaires at 3 weeks and again at 6 months after the first consultation.At baseline, patients were screened for cognitive impairment through an interview and by reviewing their medical records. Data on clinical and demographic characteristics were also obtained from the medical records of each participant. To explore convergent validity, we assessed correlations between scores on Sp-TFI, THI and VAS.We prospectively included all patients who were Spanish native speakers, older than 18 years old, and had at least a 1-month history of tinnitus. Exclusion criteria were previous otology surgery on the same side as the tinnitus and/or a diagnosis of malignancy of the ear, as well as refusal to participate or insufficient cognitive skills to complete the questionnaires.Statistical analysis was conducted using R 4.1.2 statistical language software (R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL (<a href="https://www.R-project.org/">https://www.R-project.org/</a>) with standard CRAN libraries. The internal consistency of the Sp-TFI was assessed with standard Cronbach’s α, considering the THI score the gold standard, and the temporal stability of the test with the intraclass correlation coefficient (ICC) type 2,1 in the nomenclature of Shrout and Fleiss.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> Specifically, ICC (2,1) was calculated in R using the psych package version 2.1.9 (Revelle, W. (2021) psych: Procedures for Personality and Psychological Research, Northwestern University, Evanston, Illinois, USA.<a href="https://CRAN.R-project.org/package=psych">https://CRAN.R-project.org/package=psych</a>).<a class="elsevierStyleCrossRef" href="#bib0090">18</a>A linear model was used to identify statistically significant influences and interactions between the variables studied, considering THI score the predicted (dependent) variable. The model equation was developed using a stepwise backward/forward (independent) variable selection method based on the Bayesian information criterion.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Statistical significance of the interactions detected in the model was evaluated using analysis of variance (ANOVA) Wald Type II tests.A p value under 0.05 was considered statistically significant for this study. For both Cronbach’s α and ICC (2,1), values of 0.8 or above were considered target values to validate temporal stability (test-retest) and internal consistency of the Sp-TFI.<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a>ResultsA total of 18 participants were included, with a mean age of 45.77 (SD: 11.87) years; 12 were female (66.67 %) and 6 were male (33.33%). Half of the participants experienced tinnitus in their left ear and half in their right. The mean pure-tone average (PTA), considering values measured at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz, was 29.34 (SD: 8.08) dB-HL in the affected ear. The main scores obtained on each questionnaire (THI and Sp-TFI) are plotted in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Assessing the internal consistency of the Sp-TFI, we obtained a standard Cronbach’s α for the overall score of 0.83 (taking the THI score as the gold standard). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> details the other standard Cronbach’s α values calculated in this study, namely, those for the Sp-TFI subscales and VAS. Analyzing the temporal stability of the Sp-TFI, we found an ICC(2,1) for the overall score of 1 (CI: 0.99–1). ICC(2,1) values for THI, Sp-TFI subscales and VAS scores also calculated are detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Bland and Altman plots (graphical concordance analysis) are shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> for paired test-retest scores of the Sp-TFI and THI. A positive correlation was found between the THI and Sp-TFI, r = 0.71 (CI: 0.36−0.88, p < 0.01).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>Among the demographic and audiological characteristics and test scores studied, the stepwise backward/forward variable selection method with a Bayesian information criterion step value of 38.59 indicated that the variables that should be included in the linear model were: age, sex, laterality, history of contralateral ear surgery, PTA, VAS R subscale score, overall Sp-TFI score and SL, R, I, C, and A subscale scores. Exploring the predictive value of variables included in the linear model, the ANOVA Wald test showed a statistically significant predictive effect of the following variables on THI score: sex (p < 0.01), PTA (p = 0.03), overall Sp-TFI score (p = 0.02), and Sp-TFI SL, R, and A subscale scores (p = 0.03, p = 0.03 and p < 0.01, respectively). <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> is an effect plot of the variables found to be statistically significant predictors of THI score with the ANOVA Wald test.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionIn this study, the TFI has been translated into Spanish and validated for clinical practice. To the best of our knowledge, this is the first study designed to perform a translation from English to Spanish, cross-cultural adaptation and validation of the TFI for use in Spain.Given the psychological impact of tinnitus and the extent to which it may impair patients’ quality of life, validated disease-specific questionnaires are essential for the comprehensive assessment of this population. As we have mentioned previously, the TFI, developed by Meikle et al. in 2012, provides a reliable and valid measurement of the multiple domains of tinnitus severity and intervention outcomes.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> The scientific literature describes other questionnaires such as the THI and VAS that may be used to assess the emotional and functional impact or loudness of tinnitus.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Nonetheless, the TFI has some major advantages such as its comprehensive coverage of many important tinnitus-related complaints, as well as the sum of its subscale scores providing a reliable categorization of tinnitus severity and allowing assessment of responsiveness to treatment.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> To date, TFI has been translated, adapted and validated versions in numerous languages, including German, English, Swedish, Italian, and Mandarin Chinese.<a class="elsevierStyleCrossRefs" href="#bib0040">8–10,23,24</a>The present study found the Sp-TFI had a high overall internal consistency (Cronbach’s α = 0.83), lower than that of the original version (α = 0.97), and the afore mentioned Chinese (α = 0.969), Swedish (α = 0.93) and Italian (α between 0.92 and 0.96) versions, but higher than that found in the UK (α = 0.80). Analyzing subscales separately, we found a relatively low internal consistency in the Intrusiveness and Auditory subscales (0.68 and 0.65, respectively). Given that both values are near the threshold considered to indicate acceptable internal consistency (0.7) and the moderate sample size. Also, VAS loudness and annoyance had low values, 0.52 and 0.58, respectively, so we might attribute these lower values to the mood of patients on the day the questionnaire was completed. Indeed, low internal consistency was not observed in the Swedish version,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> but the UK analysis of the English version found an even lower value for Intrusiveness (α of 0.58).<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Hence, we consider that further research should be carried out to explore the properties of the Intrusiveness subscale.The temporal stability of the measurements was assessed using the ICC(2,1). Considering the 95% confidence interval of the ICC estimate, values greater than 0.90 are indicative of excellent reliability. Notably, we found an ICC(2,1) of 1 (CI: 0.99–1), indicating great test-retest reliability, even higher than values found for the original version (ICC = 0.78), for the German version (ICC = 0.91), for the Swedish version (ICC = 0.93).<a class="elsevierStyleCrossRefs" href="#bib0025">5,8,10</a> and in the UK analysis of the original version (ICC = 0.91).<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The reason for this could be that we allowed only 2 weeks between the test and retest, while Meikle et al. waited 3 months, though similarly short intervals were used to assess the other translations (between 1 and 3 weeks). Analyzing the subscales of the Sp-TFI, all the scores also had excellent reliability.The Sp-TFI’s convergent validity with the THI was high (r = 0.71, p < 0.01) and comparable to that found for the Chinese, Swedish, and Italian versions and UK analysis of the English version (r = 0.86, 0.8, 0.77 and 0.75, respectively).The evaluation of each predictive variable showed direct correlations of the THI with sex, PTA, Sp-TFI overall score, and Sp-TFI SL and R subscale scores. Meanwhile, an indirect correlation was found between the THI and Sp-TFI A subscale scores. Notably, the Sp-TFI A subscale obtained a low Cronbach’s α (α = 0.65), while in analysis of the Swedish and Italian versions, the authors also observed a weaker correlation for this Auditory subscale than the other seven subscales (r = 0.52 and α = 0.35, respectively).The main strength of this study is that the translation, cross-cultural adaptation, and validation of the Sp-TFI was carried out following the highest standards for translation of self-assessment questionnaires.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Strong validity was achieved with internal consistency higher than 0.8, comparable to results obtained for the original English and translated versions.The main limitation of the study is that most of the authors and translators involved in this work were Spanish. For this reason, we believe that further research is necessary to assess whether linguistic and/or cultural modifications are required to adapt it for use in other Spanish-speaking countries. Moreover, despite the good results, the small sample size could lead to bias and may limit the reliability and validity of the results. Therefore, a larger sample should be recruited and used for further validation. Finally, our study suggests that the Sp-TFI is a suitable instrument for measuring the impact of tinnitus among Spanish speakers in Spain. The reliability and validity of this version seem to be very good and comparable to the original version of the TFI and indicate it can be used to assess tinnitus in clinical practice.ConclusionA Spanish cross-culturally adapted version of the TFI (Sp-TFI) has been produced and validated. It can be considered reliable for use in clinics to assess the severity of tinnitus and its impact on patients’ daily lives. The use of this version of the TFI by Spanish-speaking scientists will allow comparisons between data from different countries and thereby contribute to advancing our understanding of this disabling condition.Declaration of interestsThe authors have no conflicts of interest to report. They are solely responsible for the content and writing of the paper.Funding statementThe authors report no external funding.AuthorshipMMSR were responsible for this study design, data analysis and drafting of the manuscript. JJN, MSG and XA collected the data for this study. JRM performed the statistical analysis and collaborated in the drafting of the manuscript. XA led the research group." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2031169" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Level of evidence" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1737987" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2031170" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1737986" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Declaration of interests" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding statement" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Authorship" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-09" "fechaAceptado" => "2022-11-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1737987" "palabras" => array:5 [ 0 => "Questionnaire" 1 => "Adaptation" 2 => "Validation" 3 => "Tinnitus" 4 => "TFI" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1737986" "palabras" => array:5 [ 0 => "Cuestionario" 1 => "Adaptación" 2 => "Validación" 3 => "Tinnitus" 4 => "IFT" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe objectives of this study were to translate into Spanish, cross-culturally adapt and validate the TFI. Materials and MethodsThe TFI questionnaire translated into Spanish (Sp-TFI) and cross-culturally adapted following the published guidelines on cross-cultural adaptation of health questionnaires was evaluated using two indicators. Its internal consistency was assessed with Cronbach’s α considering the Tinnitus Handicap Inventory (THI) as the gold standard. Further, its test-retest reliability was assessed with intraclass correlation coefficients (ICCs). ICCs were also calculated for the THI and visual analogue scales (VAS) for tinnitus tested and retested in all participants. ResultsThe mean age of the 18 participants was 45.77 (SD: 11.87) years; 12 were female (66.67 %) and 6 were male (33.33%). Half of the participants experienced tinnitus in their left ear and half in their right. The mean pure-tone average (PTA) in the affected ear was 29.34 (SD: 8.08) dB-HL. Regarding internal consistency and reliability of the Sp-TFI respectively, Cronbach’s α was 0.83 and the ICC type (2,1) was 1 (CI: 0.99–1). Among the variables studied, we found the following independent predictors had statistically significant effects on THI score: sex (p < 0.01), PTA (p = 0.03), overall Sp-TFI score (p = 0.02) and Sp-TFI SL, R and A subscale scores (p = 0.03, p = 0.03, and p < 0.01, respectively). ConclusionBased on the internal consistency and reliability results obtained in this study, the cross-culturally adapted Spanish version of the TFI (Sp-TFI) has been validated for use in Spain. Level of evidence2B: Individual cohort study/low-quality randomized control studies" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Level of evidence" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosLos objetivos del estudio fueron traducir al español, adaptar culturalmente y validar el IFT. Materiales y métodosEl cuestionario del IFT traducido al castellano (C-IFT) y la adaptación cultural, se realizó mediante las guías publicadas para la adaptación cultural en los cuestionarios para la salud. La consistencia interna fue evaluada mediante el alfa de Cronbach’s considerando el cuestionario de incapacidad provocada por el tinnitus (THI) cómo el cuestionario de referencia. Además, la fiabilidad test-retest se evaluó mediante los coeficientes de correlación intraclase (ICC). También se calcularon los ICC para el THI y las escalas analógicas visuales (VAS) para el tinnitus probado y reevaluado en todos los participantes. ResultadosLa edad media de los 18 participantes fue de 45,77 (DE: 11,87) años; 12 eran mujeres (66,67 %) y 6 eran hombres (33,33 %). La mitad de los participantes experimentaron tinnitus en el oído izquierdo y la otra mitad en el derecho. El promedio de tonos puros (PTA) en el oído afectado fue de 29,34 (DE: 8,08) dB-HL. En cuanto a la consistencia interna y la fiabilidad del C-IFT, respectivamente, el α de Cronbach fue de 0,83 y el ICC (2,1) fue de 1 (IC: 0,99-1). Entre las variables estudiadas, encontramos que los siguientes predictores independientes tuvieron efectos estadísticamente significativos en la puntuación de THI: sexo (p < 0,01), PTA (p = 0,03), puntuación general de C-IFT (p = 0,02) y C-IFT SL, R y las puntuaciones de la subescala A (p = 0,03, p = 0,03 y p < 0,01, respectivamente). ConclusiónEn base a los resultados de la consistencia interna y fiabilidad obtenidos en este estudio, la versión española adaptada transculturalmente del IFT (C-IFT) ha sido validada para su uso en España." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:3 [ 0 => array:1 [ "imagen" => "gr1a.jpeg" ] 1 => array:1 [ "imagen" => "gr1b.jpeg" ] 2 => array:1 [ "imagen" => "gr1c.jpeg" ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Final Spanish translation of the TFI." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1258 "Ancho" => 3333 "Tamanyo" => 177454 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Box plot showing main scores and corresponding descriptive statistics obtained with the Spanish versions of the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (Sp-TFI) by sex and laterality. Men had higher Sp-TFI and THI scores than women (24.6 ± 30.42 vs. 6.41 ± 10.35, respectively)." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1269 "Ancho" => 3333 "Tamanyo" => 168628 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Bland and Altman graphical concordance analysis plots for test-retest paired Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (Sp-TFI) scores. (A) Sp-TFI score test-retest. (B) THI score test-retest. This Bland and Altman plot modified for non-continuous variables showed that the median differences of test-retest paired scores remained within two standard deviations." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2238 "Ancho" => 3333 "Tamanyo" => 351756 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Predictor effect plot for Tinnitus Handicap Inventory (THI) score obtained from the linear model and analysis of variance Wald test. The following predictive variables for THI were statistically significant: sex (p < 0.01), pure-tone average (PTA; p = 0.03), overall Spanish Tinnitus Functional Inventory (Sp-TFI) score (p = 0.02), and Sp-TFI Sleep (SL), Relaxation (R) and Auditory (A) subscale scores (p = 0.03, p = 0.03 and p < 0.01 respectively). The blue lines are the regression lines between the variables, and the areas shaded blue indicate the confidence band (95% confidence intervals)." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "The overall Sp-TFI score has a 0.83 internal consistency. The internal consistency was also measured for Sp-TFI subscales, the highest values being found for the R, E and SC scores. Moreover, VAS scores were also measured.*Sp-TFI subscales: I (Intrusiveness), SC (sense of control), C (cognition), SL (sleep), A (auditory), R (relaxation), Q (quality of life), and E (emotional distress). Visual analogue scale (VAS): loudness (L) and annoyance (A)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Test \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Std. Cronbach α (vs THI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Test \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Std. Cronbach α (vs THI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI global score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI R score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI I score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI Q score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI SC score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI E score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI C score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS L score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI SL score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS D score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI A score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3371215.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Internal consistency of the new Spanish version of the Tinnitus Functional Inventory (Sp-TFI) and Visual Analogue Scale (VAS) vs the validated Tinnitus Handicap Inventory (THI) measured by standard Cronbach’s α." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Sp-TFI overall score and subscales had an ICC (2,1) of 1 (CI: 0.99−1) or 0.99 (CI: 0.99−1). VAS subscales obtained values slightly lower than those for the Sp-TFI (0.95−0.96) and THI had an ICC (2,1) of 0.99 (CI: 0.99−1).*Sp-TFI subscales: I (Intrusiveness), SC (sense of control), C (cognition), SL (sleep), A (auditory), R (relaxation), Q (quality of life), and E (emotional distress). Visual analogue scale (VAS): loudness (L) and annoyance (A)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Test-retest \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC (2,1) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Test-retest \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC (2,1) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI global score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (CI: 0.99−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI R score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (CI: 0.99−1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI I score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (CI: 0.99−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI Q score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (CI: 1−1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI SC score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (CI: 1−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI E score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (CI: 0.99−1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI C score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (CI: 0.99−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS L score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 (CI: 0.89−0.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI SL score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (CI: 1−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS D score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.96 (CI: 0.92−0.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TFI A score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (CI: 1−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">THI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (CI: 0.99−1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3371216.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Temporal stability of the Spanish version of the Tinnitus Functional Inventory (Sp-TFI) subscales, Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores measured by intraclass correlation coefficients (type (2,1))." ] ] 6 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "Keypoints<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1There is not a gold standard questionnaire to assess the tinnitus accepted.</li><li class="elsevierStyleListItem" id="lsti0010">2TFI is a subjective questionnaire to know how the tinnitus affects the quality of life of our patients.</li><li class="elsevierStyleListItem" id="lsti0015">3TFI assess the sleep disturbance, auditory difficulties and difficulty relaxing attributed to tinnitus.</li><li class="elsevierStyleListItem" id="lsti0020">4The Spanish version of the TFI has a great internal consistency, is reliable and easy to apply clinically.</li><li class="elsevierStyleListItem" id="lsti0025">5The Spanish version of the TFI is valid for use in Spain.</li></ul>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Textbook of Tinnitus Introduction. 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Original article

Translation into Spanish and validation of the Tinnitus Functional Index (TFI)

Traducción y validación al español del índice funcional para el tinnitus (IFT)

Maria Montserrat Soriano-Reixacha,b,

Corresponding author

mariamontserrat.sorianoreixach@osakidetza.eus

Corresponding author.

, Juan José Navarro Sampedroa, Miren Sonsoles Goiburu Mingueza, Jorge Rey-Martíneza,b, Xabier Altunaa,b

a Otology Unit, Department of Otorhinolaryngology Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Basque Country, Spain

b Biodonostia Health Research Institute, Otorhinolaryngology Area, Osakidetza Basque Health Service, Donostia-San Sebastian, Basque Country, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0040" class="elsevierStylePara elsevierViewall">Tinnitus is a sensation of noise perceived by an individual without an external sound stimulus&#46; It can negatively affect people&#8217;s quality of life&#44; impairing their ability to do intellectual work and reducing their psychological well-being&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The measurement of tinnitus is still controversial and there is no standardized measure used in routine audiological assessment&#44; which makes it difficult to assess the global prevalence of this condition&#46; A recent study reported tinnitus prevalence rates in Europe ranging from 8&#46;7&#37; to 28&#46;3&#37;&#59; with an overall prevalence of 14&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It has been suggested that there is a relation between the severity of tinnitus and hearing loss&#46; Only about 10&#37; of tinnitus sufferers have normal hearing&#44; making hearing impairment the most common comorbidity of tinnitus&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the lack of a gold standard&#44; some subjective assessment tools have been described that may help to determine the impact of tinnitus&#46; These include the Tinnitus Handicap Inventory &#40;THI&#41;&#44; Tinnitus Functional Index &#40;TFI&#41; and visual analogue scales &#40;VAS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> Notably&#44; using the TFI&#44; Mahafza et al&#46; showed that patients suffering from sensorineural hearing loss had more persistent tinnitus&#44; a lower sense of control over their tinnitus&#44; sleep disturbance&#44; auditory difficulties attributed to tinnitus&#44; difficulty relaxing and a poorer quality of life than tinnitus patients without hearing loss&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Given responsiveness to treatment-related changes&#44; its comprehensive coverage of the domains of tinnitus impact&#44; and its psychometric properties&#44; the TFI could be used as a standard instrument in both clinical and research settings&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since first published in 2012&#44; the TFI has been translated into a range of languages and validated in several countries &#40;e&#46;g&#46;&#44; Germany&#44; United Kingdom&#44; and Sweden&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> To our knowledge&#44; however&#44; there is no validated Spanish version of the TFI&#46; Therefore&#44; the objectives of this study were to translate into Spanish&#44; cross-culturally adapt and validate the TFI for use in Spain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><p id="par0055" class="elsevierStylePara elsevierViewall">This study was a prospective&#44; non-interventional&#44; observational trial in patients experiencing tinnitus&#46; The study was approved by the ethics committee of <span class="elsevierStyleItalic">&#40;Name of the hospital blinded for review&#41;</span> Hospital and all participants gave written informed consent&#46; The study was performed in accordance with the ethical principles laid down in the Declaration of Helsinki of 1975&#44; as revised in 2008&#46; We followed the recommendations of the World Health Organization for the translation and adaptation of instruments and those of Guillemin et al&#46; for the cross-cultural adaptation of health-related quality of life measures&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Moreover&#44; we followed the STROBE statement for cross-sectional studies&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The Spanish version of the TFI &#40;Sp-TFI&#41; was obtained in the following way&#46; Stage I&#58; the original TFI was translated by two independent otolaryngologists - head &#38; neck surgeons who were both Proficiency level in English and Spanish&#46; Stage II&#58; The Spanish versions obtained were combined in a single document and sent to a panel of six experts in otology at our Otorhinolaryngology Department for comments&#46; It was agreed that there were only very minor &#40;non-meaningful&#41; differences between the two translations and a general consensus was reached on a single version&#46; Stage III&#58; This agreed Spanish version was sent to a third otorhinolaryngology - head &#38; neck surgeon with Proficiency in English and Spanish for back-translation to English and no meaningful differences were found with respect to the original version&#46; Stage IV&#58; the translated questionnaire was piloted in a group of patients to test its comprehensibility&#44; ensuring that the patients understood the items as intended&#46; Stage V&#58; The panel of experts reviewed the patients&#8217; responses&#44; and as there was a consensus that the patients had understood the questions well&#44; agreed that the questionnaire piloted could be definitive version &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The TFI was developed to provide a rating of tinnitus severity and the impact of its severity&#44; and also a responsive measure of change in severity&#46; It is composed of 25 items divided into eight subscales&#58; intrusiveness &#40;I&#41;&#44; sense of control &#40;SC&#41;&#44; cognition &#40;C&#41;&#44; sleep &#40;SL&#41;&#44; auditory &#40;A&#41;&#44; relaxation &#40;R&#41;&#44; quality of life &#40;Q&#41;&#44; and emotional distress &#40;E&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The THI is a 25-item self-reported questionnaire that has been widely used in tinnitus clinical practice and research to assess distress and disability associated with tinnitus&#46; In this instrument&#44; the 25 items are grouped into three subscales&#58; functional &#40;disability affecting daily life&#41;&#59; emotional &#40;anxiety and mental stress&#41;&#59; and catastrophic &#40;hopelessness&#44; loss of control&#44; and inability to cope with the problem&#41;&#46; Three response options are provided for each item&#58; yes&#44; sometimes or no&#44; awarded scores of 4&#44; 2&#44; and 0&#44; respectively&#46; Consequently&#44; the THI total score ranges from zero to 100&#44; higher total scores indicating more severe handicap related to tinnitus&#46; The validity and reliability of the Spanish version have been confirmed&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Additionally&#44; the loudness and annoyance related to tinnitus can be evaluated using VAS&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">To assess the reliability of the Sp-TFI&#44; patients with tinnitus symptoms who came to an otology consultation&#44; between May 2019 and March 2020&#44; were asked to complete this new questionnaire&#44; and also the THI and two VAS&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;14</span></a> Specifically&#44; using the VAS&#44; patients were asked to rate their self-perceived tinnitus loudness and their annoyance on an 11-point Likert scale from 0 to 10&#46; Lastly&#44; they were asked to indicate which ear was affected by the tinnitus&#46; The same patients were asked to complete the same questionnaires at 3 weeks and again at 6 months after the first consultation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">At baseline&#44; patients were screened for cognitive impairment through an interview and by reviewing their medical records&#46; Data on clinical and demographic characteristics were also obtained from the medical records of each participant&#46; To explore convergent validity&#44; we assessed correlations between scores on Sp-TFI&#44; THI and VAS&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We prospectively included all patients who were Spanish native speakers&#44; older than 18 years old&#44; and had at least a 1-month history of tinnitus&#46; Exclusion criteria were previous otology surgery on the same side as the tinnitus and&#47;or a diagnosis of malignancy of the ear&#44; as well as refusal to participate or insufficient cognitive skills to complete the questionnaires&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Statistical analysis was conducted using R 4&#46;1&#46;2 statistical language software &#40;R Core Team &#40;2021&#41;&#46; R&#58; A language and environment for statistical computing&#46; R Foundation for Statistical Computing&#44; Vienna&#44; Austria&#46; URL &#40;<a href="https://www.R-project.org/">https&#58;&#47;&#47;www&#46;R-project&#46;org&#47;</a>&#41; with standard CRAN libraries&#46; The internal consistency of the Sp-TFI was assessed with standard Cronbach&#8217;s &#945;&#44; considering the THI score the gold standard&#44; and the temporal stability of the test with the intraclass correlation coefficient &#40;ICC&#41; type 2&#44;1 in the nomenclature of Shrout and Fleiss&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> Specifically&#44; ICC &#40;2&#44;1&#41; was calculated in R using the psych package version 2&#46;1&#46;9 <span class="elsevierStyleItalic">&#40;Revelle&#44; W&#46; &#40;2021&#41; psych&#58; Procedures for Personality and Psychological Research&#44; Northwestern University&#44; Evanston&#44; Illinois&#44; USA&#46;</span><a href="https://CRAN.R-project.org/package=psych">https&#58;&#47;&#47;CRAN&#46;R-project&#46;org&#47;package&#61;psych</a><span class="elsevierStyleItalic">&#41;&#46;</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A linear model was used to identify statistically significant influences and interactions between the variables studied&#44; considering THI score the predicted &#40;dependent&#41; variable&#46; The model equation was developed using a stepwise backward&#47;forward &#40;independent&#41; variable selection method based on the Bayesian information criterion&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Statistical significance of the interactions detected in the model was evaluated using analysis of variance &#40;ANOVA&#41; Wald Type II tests&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A p value under 0&#46;05 was considered statistically significant for this study&#46; For both Cronbach&#8217;s &#945; and ICC &#40;2&#44;1&#41;&#44; values of 0&#46;8 or above were considered target values to validate temporal stability &#40;test-retest&#41; and internal consistency of the Sp-TFI&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">A total of 18 participants were included&#44; with a mean age of 45&#46;77 &#40;SD&#58; 11&#46;87&#41; years&#59; 12 were female &#40;66&#46;67 &#37;&#41; and 6 were male &#40;33&#46;33&#37;&#41;&#46; Half of the participants experienced tinnitus in their left ear and half in their right&#46; The mean pure-tone average &#40;PTA&#41;&#44; considering values measured at 500&#8239;Hz&#44; 1000&#8239;Hz&#44; 2000&#8239;Hz and 4000&#8239;Hz&#44; was 29&#46;34 &#40;SD&#58; 8&#46;08&#41; dB-HL in the affected ear&#46; The main scores obtained on each questionnaire &#40;THI and Sp-TFI&#41; are plotted in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Assessing the internal consistency of the Sp-TFI&#44; we obtained a standard Cronbach&#8217;s &#945; for the overall score of 0&#46;83 &#40;taking the THI score as the gold standard&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> details the other standard Cronbach&#8217;s &#945; values calculated in this study&#44; namely&#44; those for the Sp-TFI subscales and VAS&#46; Analyzing the temporal stability of the Sp-TFI&#44; we found an ICC&#40;2&#44;1&#41; for the overall score of 1 &#40;CI&#58; 0&#46;99&#8211;1&#41;&#46; ICC&#40;2&#44;1&#41; values for THI&#44; Sp-TFI subscales and VAS scores also calculated are detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Bland and Altman plots &#40;graphical concordance analysis&#41; are shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> for paired test-retest scores of the Sp-TFI and THI&#46; A positive correlation was found between the THI and Sp-TFI&#44; r&#8239;&#61;&#8239;0&#46;71 &#40;CI&#58; 0&#46;36&#8722;0&#46;88&#44; p&#8239;&#60;&#8239;0&#46;01&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Among the demographic and audiological characteristics and test scores studied&#44; the stepwise backward&#47;forward variable selection method with a Bayesian information criterion step value of 38&#46;59 indicated that the variables that should be included in the linear model were&#58; age&#44; sex&#44; laterality&#44; history of contralateral ear surgery&#44; PTA&#44; VAS R subscale score&#44; overall Sp-TFI score and SL&#44; R&#44; I&#44; C&#44; and A subscale scores&#46; Exploring the predictive value of variables included in the linear model&#44; the ANOVA Wald test showed a statistically significant predictive effect of the following variables on THI score&#58; sex &#40;p&#8239;&#60;&#8239;0&#46;01&#41;&#44; PTA &#40;p&#8239;&#61;&#8239;0&#46;03&#41;&#44; overall Sp-TFI score &#40;p&#8239;&#61;&#8239;0&#46;02&#41;&#44; and Sp-TFI SL&#44; R&#44; and A subscale scores &#40;p&#8239;&#61;&#8239;0&#46;03&#44; p&#8239;&#61;&#8239;0&#46;03 and p&#8239;&#60;&#8239;0&#46;01&#44; respectively&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> is an effect plot of the variables found to be statistically significant predictors of THI score with the ANOVA Wald test&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; the TFI has been translated into Spanish and validated for clinical practice&#46; To the best of our knowledge&#44; this is the first study designed to perform a translation from English to Spanish&#44; cross-cultural adaptation and validation of the TFI for use in Spain&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Given the psychological impact of tinnitus and the extent to which it may impair patients&#8217; quality of life&#44; validated disease-specific questionnaires are essential for the comprehensive assessment of this population&#46; As we have mentioned previously&#44; the TFI&#44; developed by Meikle et al&#46; in 2012&#44; provides a reliable and valid measurement of the multiple domains of tinnitus severity and intervention outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The scientific literature describes other questionnaires such as the THI and VAS that may be used to assess the emotional and functional impact or loudness of tinnitus&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Nonetheless&#44; the TFI has some major advantages such as its comprehensive coverage of many important tinnitus-related complaints&#44; as well as the sum of its subscale scores providing a reliable categorization of tinnitus severity and allowing assessment of responsiveness to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> To date&#44; TFI has been translated&#44; adapted and validated versions in numerous languages&#44; including German&#44; English&#44; Swedish&#44; Italian&#44; and Mandarin Chinese&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10&#44;23&#44;24</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The present study found the Sp-TFI had a high overall internal consistency &#40;Cronbach&#8217;s &#945;&#8239;&#61;&#8239;0&#46;83&#41;&#44; lower than that of the original version &#40;&#945;&#8239;&#61;&#8239;0&#46;97&#41;&#44; and the afore mentioned Chinese &#40;&#945;&#8239;&#61;&#8239;0&#46;969&#41;&#44; Swedish &#40;&#945;&#8239;&#61;&#8239;0&#46;93&#41; and Italian &#40;&#945; between 0&#46;92 and 0&#46;96&#41; versions&#44; but higher than that found in the UK &#40;&#945;&#8239;&#61;&#8239;0&#46;80&#41;&#46; Analyzing subscales separately&#44; we found a relatively low internal consistency in the Intrusiveness and Auditory subscales &#40;0&#46;68 and 0&#46;65&#44; respectively&#41;&#46; Given that both values are near the threshold considered to indicate acceptable internal consistency &#40;0&#46;7&#41; and the moderate sample size&#46; Also&#44; VAS loudness and annoyance had low values&#44; 0&#46;52 and 0&#46;58&#44; respectively&#44; so we might attribute these lower values to the mood of patients on the day the questionnaire was completed&#46; Indeed&#44; low internal consistency was not observed in the Swedish version&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but the UK analysis of the English version found an even lower value for Intrusiveness &#40;&#945; of 0&#46;58&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Hence&#44; we consider that further research should be carried out to explore the properties of the Intrusiveness subscale&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The temporal stability of the measurements was assessed using the ICC&#40;2&#44;1&#41;&#46; Considering the 95&#37; confidence interval of the ICC estimate&#44; values greater than 0&#46;90 are indicative of excellent reliability&#46; Notably&#44; we found an ICC&#40;2&#44;1&#41; of 1 &#40;CI&#58; 0&#46;99&#8211;1&#41;&#44; indicating great test-retest reliability&#44; even higher than values found for the original version &#40;ICC&#8239;&#61;&#8239;0&#46;78&#41;&#44; for the German version &#40;ICC&#8239;&#61;&#8239;0&#46;91&#41;&#44; for the Swedish version &#40;ICC&#8239;&#61;&#8239;0&#46;93&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;10</span></a> and in the UK analysis of the original version &#40;ICC&#8239;&#61;&#8239;0&#46;91&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The reason for this could be that we allowed only 2 weeks between the test and retest&#44; while Meikle et al&#46; waited 3 months&#44; though similarly short intervals were used to assess the other translations &#40;between 1 and 3 weeks&#41;&#46; Analyzing the subscales of the Sp-TFI&#44; all the scores also had excellent reliability&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The Sp-TFI&#8217;s convergent validity with the THI was high &#40;r&#8239;&#61;&#8239;0&#46;71&#44; p&#8239;&#60;&#8239;0&#46;01&#41; and comparable to that found for the Chinese&#44; Swedish&#44; and Italian versions and UK analysis of the English version &#40;r&#8239;&#61;&#8239;0&#46;86&#44; 0&#46;8&#44; 0&#46;77 and 0&#46;75&#44; respectively&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The evaluation of each predictive variable showed direct correlations of the THI with sex&#44; PTA&#44; Sp-TFI overall score&#44; and Sp-TFI SL and R subscale scores&#46; Meanwhile&#44; an indirect correlation was found between the THI and Sp-TFI A subscale scores&#46; Notably&#44; the Sp-TFI A subscale obtained a low Cronbach&#8217;s &#945; &#40;&#945;&#8239;&#61;&#8239;0&#46;65&#41;&#44; while in analysis of the Swedish and Italian versions&#44; the authors also observed a weaker correlation for this Auditory subscale than the other seven subscales &#40;r&#8239;&#61;&#8239;0&#46;52 and &#945;&#8239;&#61;&#8239;0&#46;35&#44; respectively&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The main strength of this study is that the translation&#44; cross-cultural adaptation&#44; and validation of the Sp-TFI was carried out following the highest standards for translation of self-assessment questionnaires&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Strong validity was achieved with internal consistency higher than 0&#46;8&#44; comparable to results obtained for the original English and translated versions&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The main limitation of the study is that most of the authors and translators involved in this work were Spanish&#46; For this reason&#44; we believe that further research is necessary to assess whether linguistic and&#47;or cultural modifications are required to adapt it for use in other Spanish-speaking countries&#46; Moreover&#44; despite the good results&#44; the small sample size could lead to bias and may limit the reliability and validity of the results&#46; Therefore&#44; a larger sample should be recruited and used for further validation&#46; Finally&#44; our study suggests that the Sp-TFI is a suitable instrument for measuring the impact of tinnitus among Spanish speakers in Spain&#46; The reliability and validity of this version seem to be very good and comparable to the original version of the TFI and indicate it can be used to assess tinnitus in clinical practice&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0160" class="elsevierStylePara elsevierViewall">A Spanish cross-culturally adapted version of the TFI &#40;Sp-TFI&#41; has been produced and validated&#46; It can be considered reliable for use in clinics to assess the severity of tinnitus and its impact on patients&#8217; daily lives&#46; The use of this version of the TFI by Spanish-speaking scientists will allow comparisons between data from different countries and thereby contribute to advancing our understanding of this disabling condition&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Declaration of interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to report&#46; They are solely responsible for the content and writing of the paper&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding statement</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors report no external funding&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0175" class="elsevierStylePara elsevierViewall">MMSR were responsible for this study design&#44; data analysis and drafting of the manuscript&#46; JJN&#44; MSG and XA collected the data for this study&#46; JRM performed the statistical analysis and collaborated in the drafting of the manuscript&#46; XA led the research group&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The objectives of this study were to translate into Spanish&#44; cross-culturally adapt and validate the TFI&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and Methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The TFI questionnaire translated into Spanish &#40;Sp-TFI&#41; and cross-culturally adapted following the published guidelines on cross-cultural adaptation of health questionnaires was evaluated using two indicators&#46; Its internal consistency was assessed with Cronbach&#8217;s &#945; considering the Tinnitus Handicap Inventory &#40;THI&#41; as the gold standard&#46; Further&#44; its test-retest reliability was assessed with intraclass correlation coefficients &#40;ICCs&#41;&#46; ICCs were also calculated for the THI and visual analogue scales &#40;VAS&#41; for tinnitus tested and retested in all participants&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The mean age of the 18 participants was 45&#46;77 &#40;SD&#58; 11&#46;87&#41; years&#59; 12 were female &#40;66&#46;67 &#37;&#41; and 6 were male &#40;33&#46;33&#37;&#41;&#46; Half of the participants experienced tinnitus in their left ear and half in their right&#46; The mean pure-tone average &#40;PTA&#41; in the affected ear was 29&#46;34 &#40;SD&#58; 8&#46;08&#41; dB-HL&#46; Regarding internal consistency and reliability of the Sp-TFI respectively&#44; Cronbach&#8217;s &#945; was 0&#46;83 and the ICC type &#40;2&#44;1&#41; was 1 &#40;CI&#58; 0&#46;99&#8211;1&#41;&#46; Among the variables studied&#44; we found the following independent predictors had statistically significant effects on THI score&#58; sex &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;01&#41;&#44; PTA &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;03&#41;&#44; overall Sp-TFI score &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;02&#41; and Sp-TFI SL&#44; R and A subscale scores &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;03&#44; <span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;03&#44; and <span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;01&#44; respectively&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Based on the internal consistency and reliability results obtained in this study&#44; the cross-culturally adapted Spanish version of the TFI &#40;Sp-TFI&#41; has been validated for use in Spain&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Level of evidence</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">2B&#58; Individual cohort study&#47;low-quality randomized control studies</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Level of evidence"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Los objetivos del estudio fueron traducir al espa&#241;ol&#44; adaptar culturalmente y validar el IFT&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Materiales y m&#233;todos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">El cuestionario del IFT traducido al castellano &#40;C-IFT&#41; y la adaptaci&#243;n cultural&#44; se realiz&#243; mediante las gu&#237;as publicadas para la adaptaci&#243;n cultural en los cuestionarios para la salud&#46; La consistencia interna fue evaluada mediante el alfa de Cronbach&#8217;s considerando el cuestionario de incapacidad provocada por el tinnitus &#40;THI&#41; c&#243;mo el cuestionario de referencia&#46; Adem&#225;s&#44; la fiabilidad test-retest se evalu&#243; mediante los coeficientes de correlaci&#243;n intraclase &#40;ICC&#41;&#46; Tambi&#233;n se calcularon los ICC para el THI y las escalas anal&#243;gicas visuales &#40;VAS&#41; para el tinnitus probado y reevaluado en todos los participantes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">La edad media de los 18 participantes fue de 45&#44;77 &#40;DE&#58; 11&#44;87&#41; a&#241;os&#59; 12 eran mujeres &#40;66&#44;67 &#37;&#41; y 6 eran hombres &#40;33&#44;33 &#37;&#41;&#46; La mitad de los participantes experimentaron tinnitus en el o&#237;do izquierdo y la otra mitad en el derecho&#46; El promedio de tonos puros &#40;PTA&#41; en el o&#237;do afectado fue de 29&#44;34 &#40;DE&#58; 8&#44;08&#41; dB-HL&#46; En cuanto a la consistencia interna y la fiabilidad del C-IFT&#44; respectivamente&#44; el &#945; de Cronbach fue de 0&#44;83 y el ICC &#40;2&#44;1&#41; fue de 1 &#40;IC&#58; 0&#44;99-1&#41;&#46; Entre las variables estudiadas&#44; encontramos que los siguientes predictores independientes tuvieron efectos estad&#237;sticamente significativos en la puntuaci&#243;n de THI&#58; sexo &#40;p&#8239;&#60;&#8239;0&#44;01&#41;&#44; PTA &#40;p&#8239;&#61;&#8239;0&#44;03&#41;&#44; puntuaci&#243;n general de C-IFT &#40;p&#8239;&#61;&#8239;0&#44;02&#41; y C-IFT SL&#44; R y las puntuaciones de la subescala A &#40;p&#8239;&#61;&#8239;0&#44;03&#44; p&#8239;&#61;&#8239;0&#44;03 y p&#8239;&#60;&#8239;0&#44;01&#44; respectivamente&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusi&#243;n</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">En base a los resultados de la consistencia interna y fiabilidad obtenidos en este estudio&#44; la versi&#243;n espa&#241;ola adaptada transculturalmente del IFT &#40;C-IFT&#41; ha sido validada para su uso en Espa&#241;a&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Objetivos"
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          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "multimedia" => array:7 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:3 [
          0 => array:1 [
            "imagen" => "gr1a.jpeg"
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            "imagen" => "gr1b.jpeg"
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          2 => array:1 [
            "imagen" => "gr1c.jpeg"
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        "detalles" => array:1 [
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            "identificador" => "at0005"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Final Spanish translation of the TFI&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1258
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            "Tamanyo" => 177454
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Box plot showing main scores and corresponding descriptive statistics obtained with the Spanish versions of the Tinnitus Handicap Inventory &#40;THI&#41; and Tinnitus Functional Index &#40;Sp-TFI&#41; by sex and laterality&#46; Men had higher Sp-TFI and THI scores than women &#40;24&#46;6&#8239;&#177;&#8239;30&#46;42 vs&#46; 6&#46;41&#8239;&#177;&#8239;10&#46;35&#44; respectively&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bland and Altman graphical concordance analysis plots for test-retest paired Tinnitus Handicap Inventory &#40;THI&#41; and Tinnitus Functional Index &#40;Sp-TFI&#41; scores&#46; &#40;A&#41; Sp-TFI score test-retest&#46; &#40;B&#41; THI score test-retest&#46; This Bland and Altman plot modified for non-continuous variables showed that the median differences of test-retest paired scores remained within two standard deviations&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 2238
            "Ancho" => 3333
            "Tamanyo" => 351756
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Predictor effect plot for Tinnitus Handicap Inventory &#40;THI&#41; score obtained from the linear model and analysis of variance Wald test&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The following predictive variables for THI were statistically significant&#58; sex &#40;p&#8239;&#60;&#8239;0&#46;01&#41;&#44; pure-tone average &#40;PTA&#59; p&#8239;&#61;&#8239;0&#46;03&#41;&#44; overall Spanish Tinnitus Functional Inventory &#40;Sp-TFI&#41; score &#40;p&#8239;&#61;&#8239;0&#46;02&#41;&#44; and Sp-TFI Sleep &#40;SL&#41;&#44; Relaxation &#40;R&#41; and Auditory &#40;A&#41; subscale scores &#40;p&#8239;&#61;&#8239;0&#46;03&#44; p&#8239;&#61;&#8239;0&#46;03 and p&#8239;&#60;&#8239;0&#46;01 respectively&#41;&#46; The blue lines are the regression lines between the variables&#44; and the areas shaded blue indicate the confidence band &#40;95&#37; confidence intervals&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The overall Sp-TFI score has a 0&#46;83 internal consistency&#46; The internal consistency was also measured for Sp-TFI subscales&#44; the highest values being found for the R&#44; E and SC scores&#46; Moreover&#44; VAS scores were also measured&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#42;Sp-TFI subscales&#58; I &#40;Intrusiveness&#41;&#44; SC &#40;sense of control&#41;&#44; C &#40;cognition&#41;&#44; SL &#40;sleep&#41;&#44; A &#40;auditory&#41;&#44; R &#40;relaxation&#41;&#44; Q &#40;quality of life&#41;&#44; and E &#40;emotional distress&#41;&#46; Visual analogue scale &#40;VAS&#41;&#58; loudness &#40;L&#41; and annoyance &#40;A&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Std&#46; Cronbach &#945; &#40;vs THI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Std&#46; Cronbach &#945; &#40;vs THI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">TFI global score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI R score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI I score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI Q score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI SC score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI E score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI C score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAS L score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI SL score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAS D score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI A score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Internal consistency of the new Spanish version of the Tinnitus Functional Inventory &#40;Sp-TFI&#41; and Visual Analogue Scale &#40;VAS&#41; vs the validated Tinnitus Handicap Inventory &#40;THI&#41; measured by standard Cronbach&#8217;s &#945;&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sp-TFI overall score and subscales had an ICC &#40;2&#44;1&#41; of 1 &#40;CI&#58; 0&#46;99&#8722;1&#41; or 0&#46;99 &#40;CI&#58; 0&#46;99&#8722;1&#41;&#46; VAS subscales obtained values slightly lower than those for the Sp-TFI &#40;0&#46;95&#8722;0&#46;96&#41; and THI had an ICC &#40;2&#44;1&#41; of 0&#46;99 &#40;CI&#58; 0&#46;99&#8722;1&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#42;Sp-TFI subscales&#58; I &#40;Intrusiveness&#41;&#44; SC &#40;sense of control&#41;&#44; C &#40;cognition&#41;&#44; SL &#40;sleep&#41;&#44; A &#40;auditory&#41;&#44; R &#40;relaxation&#41;&#44; Q &#40;quality of life&#41;&#44; and E &#40;emotional distress&#41;&#46; Visual analogue scale &#40;VAS&#41;&#58; loudness &#40;L&#41; and annoyance &#40;A&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">TFI global score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;CI&#58; 0&#46;99&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TFI R score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;99 &#40;CI&#58; 0&#46;99&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI I score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;99 &#40;CI&#58; 0&#46;99&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TFI Q score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;CI&#58; 1&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TFI SC score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;CI&#58; 1&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI E score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;99 &#40;CI&#58; 0&#46;99&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TFI C score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;CI&#58; 0&#46;99&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">VAS L score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;95 &#40;CI&#58; 0&#46;89&#8722;0&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFI SL score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;CI&#58; 1&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">VAS D score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96 &#40;CI&#58; 0&#46;92&#8722;0&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TFI A score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;CI&#58; 1&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">THI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;99 &#40;CI&#58; 0&#46;99&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Temporal stability of the Spanish version of the Tinnitus Functional Inventory &#40;Sp-TFI&#41; subscales&#44; Tinnitus Handicap Inventory &#40;THI&#41; and Visual Analogue Scale &#40;VAS&#41; scores measured by intraclass correlation coefficients &#40;type &#40;2&#44;1&#41;&#41;&#46;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0010" class="elsevierStylePara elsevierViewall">Keypoints<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0015" class="elsevierStylePara elsevierViewall">There is not a gold standard questionnaire to assess the tinnitus accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0020" class="elsevierStylePara elsevierViewall">TFI is a subjective questionnaire to know how the tinnitus affects the quality of life of our patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0025" class="elsevierStylePara elsevierViewall">TFI assess the sleep disturbance&#44; auditory difficulties and difficulty relaxing attributed to tinnitus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0030" class="elsevierStylePara elsevierViewall">The Spanish version of the TFI has a great internal consistency&#44; is reliable and easy to apply clinically&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0035" class="elsevierStylePara elsevierViewall">The Spanish version of the TFI is valid for use in Spain&#46;</p></li></ul></p></span>"
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                          "etal" => false
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                            0 => "A&#46;R&#46; Moller"
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            1 => array:3 [
              "identificador" => "bib0010"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                            1 => "A&#46; Lugo"
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                          ]
                        ]
                      ]
                    ]
                  ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tinnitus in normally hearing patients&#58; clinical aspects and repercussions"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "T&#46; Ganz"
                            1 => "&#205;&#46;R&#46; Torres"
                            2 => "C&#46;P&#46; Dias"
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                        ]
                      ]
                    ]
                  ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of the tinnitus handicap inventory"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;W&#46; Newman"
                            1 => "G&#46;P&#46; Jacobson"
                            2 => "J&#46;B&#46; Spitzer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archotol.1996.01890140029007"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8630207"
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                  "contribucion" => array:1 [
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                        0 => array:2 [
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                            0 => "M&#46;B&#46; Meikle"
                            1 => "J&#46;A&#46; Henry"
                            2 => "S&#46;E&#46; Griest"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/AUD.0b013e31822f67c0"
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                      "titulo" => "Measurement of feelings using visual analogue scales"
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                          "etal" => false
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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              "etiqueta" => "7"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
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                        0 => array:2 [
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                            0 => "N&#46; Mahafza"
                            1 => "F&#46; Zhao"
                            2 => "A&#46; El Refaie"
                            3 => "F&#46; Chen"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/14992027.2020.1804081"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Audiol&#46;"
                        "fecha" => "2021"
                        "volumen" => "60"
                        "numero" => "3"
                        "paginaInicial" => "220"
                        "paginaFinal" => "226"
                        "link" => array:1 [
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              "identificador" => "bib0040"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tinnitus functional index&#58; validation of the German version for Switzerland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Peter"
                            1 => "T&#46; Kleinjung"
                            2 => "R&#46; Jeker"
                            3 => "M&#46; Meyer"
                            4 => "R&#46; Klaghofer"
                            5 => "S&#46; Weidt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Health Qual Life Outcomes&#46;"
                        "fecha" => "2017"
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            8 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychometric properties of the Tinnitus Functional Index &#40;TFI&#41;&#58; assessment in a UK research volunteer population"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Fackrell"
                            1 => "D&#46;A&#46; Hall"
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Article information

ISSN: 00016519
Original language: English

DOI:10.1016/j.otorri.2022.11.002

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