Brief Report
Linguistic and conceptual adaptation of the “Coercion Experience Scale” to Spanish
Adaptación lingüística y conceptual al español de la Escala de experiencia de coerción
Esperanza L. Gómez-Durána,b,c,
, Carles Martin-Fumadóc,d, Rebeca Santonjae, Maite Campilloe, Josep Arimany Mansob, Jan Bergkf, Tilman Steinertg
Corresponding author
a Fundació Sociosanitària de Barcelona, Barcelona, Spain
b Servei de Responsabilitat Professional, Col·legi de Metges de Barcelona, Consell de Col·legis de Metges de Catalunya, Barcelona, Spain
c Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
d Institut de Medicina Legal de Catalunya, Barcelona, Spain
e Centres Assistencials Emili Mira i López, Santa Coloma de Gramenet, Spain
f Krankenhaus für Psychosomatische Medizin und Psychotherapie, Bad Krozingen, Germany
g Centre for Psychiatry Suedwuerttemberg, Ulm University, Ulm, Germany
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In spite of the ethical and safety issues regarding coercive measures, their use is still seen as inevitable for handling acute patients to prevent them from harming themselves or others.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Moreover, the coercive measure that is selected and its effects vary greatly, reflecting the existence of powerful local effects.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Non-coercive measures and de-escalation techniques are the intervention of choice when it comes to handling acute agitation and threatening behaviours.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Coercive measures such as isolation or mechanical restraint must be used with caution and only as a last resort once other methods for handling the situation have failed.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> The least restrictive alternative is always recommended.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> The fact is coercive interventions are associated with an increased incidence of physical and psychological injury, both in patients and in healthcare professionals, and they have harmful short- and long-term effects on the patient/professional relationship.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In our field there are studies that describe some of the harmful effects of coercive interventions,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> and legislation has been passed in this regard in recent years.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> Yet the lack of well-designed publications and random studies analysing the effects of isolation and mechanical restraint on a national and international level is, according to Sailas, “surprising and alarming”.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> The ethical and methodological difficulties have only been addressed quite recently.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> Patient complaints regarding coercive measures generally focus on subjective feelings of humiliation, punishment and traumatisation,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> but there are few instruments for evaluating these aspects. Many of them focus on non-psychiatric issues or only deal with mechanical restraint<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> or the hospital admissions process<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> or their use in the penitentiary system.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Bergk, Flammer and Steinert published the <span class="elsevierStyleItalic">Coercion Experience Scale</span> (CES) in 2010.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> The CES is an instrument for measuring the subjective experience of patients in coercive interventions, such as isolation or mechanical restraint. It can be used with patients who need support after coercive interventions or to compare the subjective experiences of various coercive interventions.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The degree of restriction is evaluated for each human right (none/a little/moderate/severe/extreme), and except for “human dignity”, how it was experienced (acceptable/uncomfortable/unpleasant/very unpleasant/extremely unpleasant). The degree of restriction was proposed to reflect the objective conditions and the experience was proposed to reflect the subjective impact. The stressors were assessed on a Likert-scale (not stressful/mildly/moderate/severely/extreme).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The validity was evaluated by calculating correlation coefficients between the subscales and a visual analogue scale (VAS) that measured the total effect of the coercive measure, an instrument for measuring post-traumatic stress disorder (PTSD), patient satisfaction and the Impact of Event Scale (IES-R). Staff members assessed another VAS on the overall effect of the measure on the patient, which was used as an external point of reference. To estimate the risk of traumatisation induced by the coercive intervention, a regression of the total score on the PTSD screening score was carried out. After the analysis explaining the factors, 11 items with factor loadings under 0.50 were eliminated. Another item was eliminated after the analysis of each item separately. The psychometric properties of the 33 final items of the CES showed satisfactory validity and reliability. The cut-off point for detecting PTSD was defined as 70 points on the CES scale.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The CES scale pioneered the evaluation of the subjective experience of coercive measures in psychiatry. It is the first instrument that measures psychological impact in a coercive psychiatric intervention, and it may become the landmark test in this field.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The process of adapting instruments from their original language into others is crucial for evaluating the reality of various geographical locations and for being able to unify and contrast results obtained throughout the world. Moreover, creating a scale is a very costly process. The CES was originally developed in German. We believe that translating it and adapting it in Spanish – one of the most widely spoken languages in the world – is a valuable task that would help provide better evidence on the different types of coercive interventions. A brief overview of the process of adapting the language and concepts of the CES to Spanish is discussed below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0045" class="elsevierStylePara elsevierViewall">The translation/back-translation method was used for the linguistic and conceptual adaptation of the CES following the test guides for translation and adaptation of the international testing commission.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> This technique, which has been used successfully in previous adaptations,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> corroborates the semantic and structural equivalence between the original items and those translated into Spanish. Two of the authors of the CES were contacted in order to obtain the original version of the CES in German. A German native and one of the authors (ELGD), a psychiatrist and forensic physician, translated the scale directly into Spanish. In accordance with the recommendations of the international test commission,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> the translators were sufficiently qualified in the language and understood the target culture, thus ensuring that the subtleties and tones of the original scale were maintained.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To double-check the first Spanish translation, three external proofreaders evaluated the original translation independently. These proofreaders indicated the items that could be improved semantically or grammatically or both, and they worked with one of the original translators (ELGD) to reach a consensus on the version. Once they agreed on a version, a bilingual German translator re-translated the CES back into German. This translator was not familiar with the German original. This ensured the reliability of the back translation.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Once this translation was complete, the document was sent to one of the original authors of the CES (TS). This author compared the new German version with the original and classified the items based on how they matched the original items. This classification was done using a ranking that measured two basic characteristics: semantic and conceptual matching. This way, the re-translated items that matched the original items both semantically and structurally were classified as “Type A”. Those which had a satisfactory conceptual match but which differed in one or more words from the original version were tagged as “Type B”. Items that retained the original meaning but did not have a satisfactory conceptual match were classified as “Type C”. “Type D” items were those where there was no semantic or structural match between the original and the back translation.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Items that did not have a good equivalence with the original version (Type C or D) were re-analysed by the research group to find a satisfactory version accepted by consensus. The items that were modified were back-translated again by an independent translator.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Lastly, TS once again compared the original scale and the back-translated scale to confirm that their equivalence had increased due to the adjustments made in the items brought into question.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">The first evaluation of the equivalence between the original items and the back-translation to the Spanish revealed a high degree of “Type A” equivalence in 8 of the 33 back-translated items (24.2%), “Type B” in 17 items (51.5%), “Type C” in 4 items (12.1%), and “Type D” in the other 4 (12.1%).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Alternative Spanish translations were done for the items classified as C and D equivalences. The new versions of these items were then put through the back-translation process and obtained “A” or “B” equivalences. In the final Spanish version of the CES shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, 14 of the items had a “Type A” equivalence (42.4%), and 19 items had a “Type B” equivalence (57.5%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion/conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Spanish version of the CES is the result of the process of translating/back-translating the original German scale, with an appropriate linguistic and conceptual adaptation. Maintaining a conceptual and semantic equivalence ensures the original degree is maintained of the validity and functionality of the instrument.</p><p id="par0085" class="elsevierStylePara elsevierViewall">This adaptation of the scale for the Spanish-speaking population means there is no longer an instrument lacking with these characteristics, and its psychometric validation in the future will make it possible to have reference values in the Spanish population in the future. Thus Spanish speaking populations will have a resource for estimating the subjective experience of patient coercion, which may eventually be compared with other patients around the world.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">There are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres739342" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion/conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec743342" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres739343" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión/conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec743343" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion/conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-08" "fechaAceptado" => "2015-06-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec743342" "palabras" => array:4 [ 0 => "Coercion" 1 => "Mechanical restraint" 2 => "Scale adaptation" 3 => "Restraint" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec743343" "palabras" => array:4 [ 0 => "Coerción" 1 => "Contención física" 2 => "Adaptación de escalas" 3 => "Contención" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Issues surrounding coercive measures are an area of concern among mental health clinicians. Their use tends to be seen as unavoidable in the acute patient management in order to prevent harm to the patient or others. They should be used with caution, and only as a last resort. The lack of scientific literature about the effects of coercive interventions is limited, especially regarding patient perceptions. The “Coercion Experience Scale” (CES) is pioneer in the evaluation of the subjective experience of coercive measures.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Linguistic and conceptual adaptation process into Spanish of the CES, using translation-back-translation methodology, with semantic and conceptual equivalence rating.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All items of the final version received a type A (perfect) or B (satisfactory) equivalence assessment.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion/conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The adapted version has good parity with the original version, guaranteeing proper measurement in samples of Spanish-speaking populations.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion/conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las medidas coercitivas son un área de discusión entre profesionales de la salud mental. Su uso se entiende como inevitable en el manejo del paciente agudo con la finalidad de evitar daños a sí mismo o a otros. Sin embargo, deben usarse con precaución y únicamente como último recurso. La literatura sobre sus efectos perjudiciales es limitada, aún más respecto a las percepciones de los pacientes, siendo la <span class="elsevierStyleItalic">Coercion Experience Scale</span> (CES) pionera en la evaluación de la experiencia subjetiva de las medidas coercitivas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Proceso de adaptación lingüística y conceptual-traducción al español de la CES, mediante traducción-retrotraducción con escalas de equivalencia semántica y conceptual.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La versión final en español presenta una equivalencia tipo A (perfecta) o tipo B (satisfactoria) para todos sus ítems.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusión/conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La versión adaptada presenta una buena paridad con la original, permitiendo la medición adecuada en muestras de habla española.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión/conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Durán EL, Martin-Fumadó C, Santonja R, Campillo M, Arimany Manso J, Bergk J, et al. Adaptación lingüística y conceptual al español de la Escala de experiencia de coerción. Rev Esp Med Legal. 2016;42:24–29.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr1a.jpeg" ] 1 => array:1 [ "imagen" => "gr1b.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Adaptation of the CES to Spanish.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use and avoidance of seclusion and restraint: Consensus statement of the American association for emergency psychiatry project Beta seclusion and restraint workgroup" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.K. 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| 2020 August | 43 | 10 | 53 |
| 2020 July | 19 | 11 | 30 |
| 2020 June | 14 | 15 | 29 |
| 2020 May | 38 | 12 | 50 |
| 2020 April | 24 | 5 | 29 |
| 2020 March | 37 | 10 | 47 |
| 2020 February | 27 | 9 | 36 |
| 2020 January | 26 | 8 | 34 |
| 2019 December | 46 | 18 | 64 |
| 2019 November | 29 | 10 | 39 |
| 2019 October | 30 | 9 | 39 |
| 2019 September | 31 | 9 | 40 |
| 2019 August | 22 | 10 | 32 |
| 2019 July | 21 | 17 | 38 |
| 2019 June | 89 | 26 | 115 |
| 2019 May | 193 | 16 | 209 |
| 2019 April | 98 | 9 | 107 |
| 2019 March | 24 | 8 | 32 |
| 2019 February | 35 | 12 | 47 |
| 2019 January | 12 | 6 | 18 |
| 2018 December | 14 | 2 | 16 |
| 2018 November | 32 | 4 | 36 |
| 2018 October | 49 | 3 | 52 |
| 2018 September | 39 | 9 | 48 |
| 2018 August | 16 | 0 | 16 |
| 2018 July | 27 | 1 | 28 |
| 2018 June | 18 | 1 | 19 |
| 2018 May | 15 | 2 | 17 |
| 2018 April | 16 | 1 | 17 |
| 2018 March | 103 | 0 | 103 |
| 2018 February | 20 | 0 | 20 |
| 2018 January | 18 | 0 | 18 |
| 2017 December | 20 | 0 | 20 |
| 2017 November | 13 | 1 | 14 |
| 2017 October | 19 | 4 | 23 |
| 2017 September | 14 | 2 | 16 |
| 2017 August | 11 | 0 | 11 |
| 2017 July | 8 | 3 | 11 |
| 2017 June | 38 | 9 | 47 |
| 2017 May | 27 | 1 | 28 |
| 2017 April | 6 | 1 | 7 |
| 2017 March | 6 | 44 | 50 |
| 2017 February | 3 | 2 | 5 |
| 2017 January | 11 | 0 | 11 |
| 2016 December | 14 | 5 | 19 |
| 2016 November | 12 | 6 | 18 |
| 2016 October | 27 | 5 | 32 |
Show all