Letter to the Editor
Regarding the process of adaptation and validation into Spanish of the specific questionnaire on quality of life in patients with tracheostomy (TQOL)
Respecto al proceso de adaptación y validación al español del cuestionario específico de calidad de vida en pacientes con traqueostomía (TQOL)
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Given that the instrument has 21 items, a sample size of at least 105 subjects would be expected.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Tabernero et al., supports the sample size from the article on the original instrument,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> but this study corresponds to a pilot study where a sample size greater than 30 is sufficient for piloting, but not for statistical validation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0015" class="elsevierStylePara elsevierViewall">Unidimensionality: The instrument was considered unidimensional,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> which is incorrect since at least 8 dimensions can be identified such as: Pain, Physical appearance, Difficulty swallowing, Smell, Taste, Communication, Restlessness/anxiety, Satisfaction with tracheostomy, which are covered with a single question. Notwithstanding, even if the instrument was effectively a single dimension, the Alpha coefficient is more reliable when applied to 20 or fewer items; a larger number can give a false impression of high internal consistency, as in this case.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0020" class="elsevierStylePara elsevierViewall">Response to items: When Cronbach's Alpha is used, a number between 4 and 7 responses per item is recommended. However, when these are categorical, between 5 and 7 is recommended, as is the case with some questions of this instrument. When there are items with responses of 4 categories/levels and others of 5, the variability of the scale may be affected, and correlated errors may be generated that may overestimate the reliability of the instrument in a range that may even be between .38 and .4.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition to the three aspects mentioned above, it is important to emphasize the clinical characteristics of the population where the study is applied. In the original study<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> it was applied to 37 patients, one of whom had a cannula with a cuff and 36 without a cuff. In the pilot study, information was omitted regarding the baseline condition of the tracheostomised patients and the characteristics of the tracheostomy: of those who had a cannula without a cuff, whether or not they had a speaking valve, or whether it was occluded for periods of time; and of those who had a cannula with a cuff, whether or not they had ventilatory support. Furthermore, in the study by Tabernero et al. 45 patients participated, the underlying condition of whom was mainly oncological (42 patients), with a high presence of laryngectomies and pharyngolaryngectomies, that may have been a source of bias.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the above, we believe that it is advisable to reassess the validation process carried out, taking into account all the requirements that the use of Cronbach's Alpha has, or use another statistic such as Mc Donald's Omega.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This work has not received any type of funding</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adaptación y validacion al español de un cuestionario específico de calidad de vida en pacientes con traqueostomía (TQOL)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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