Translation, cross-cultural adaptation, and validation of the Munro Scale in Italian

Background: The Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients - Adult (Munro scale) is a pressure ulcer/injury risk assessment scale for adult surgical patients. It consists of 3 sections relating to the preoperative, intraoperative, and postoperative periods. It is not available in Italian. Purpose: The aim of this study was to translate the Munro scale into Italian and assess its cross-cultural content and face validity. Methods: The translation and cross-cultural adaptation process adhered to World Health Organization guidelines including forward translation, expert review, and back translation. Health care professionals with a minimum of 5 years of experience working in the operating rooms of different hospitals in northern Italy were invited to participate in a content and face validation of the translated instrument. Content validity was evaluated by rating the relevance of each scale item using a 4-point Likert scale, ranging from 1 (not relevant) to 4 (very relevant). Face validity (comprehensibility and clarity) was also measured using a 4-point rating scale. Results: Expert agreement of the translated instrument reached a Fleiss' kappa of 0.95. The content validity index was 0.91, and all items had a score ≥ 3 for clarity and comprehensibility. Conclusion: The Italian version of the Munro scale can be used safely to assess patient risk of injuries during the perioperative period in Italy. The translation and validation study results confirmed that the Italian version was consistent with the original version. Further testing, including prospective validation, is needed.