| | Stages | Description |
| | Preparation (stage 1) | The study was approved by the original authors of the FMA and by the Institutional Review Board at the hosting university. |
| | Forward translation (stage 2) | The instrument was translated from its original language (English) into the target language (Brazilian Portuguese) by two independent translators (T1 and T2). T1 was an occupational therapist, and T2 was a social scientist, both fluent in English. |
| | Reconciliation (stage 3) | The translated versions were reconciled (T12) using a table that listed the discrepancies, which was sent to each translator via e-mail. |
| | Back translation (stage 4) | The synthesis that resulted from the reconciliation of the first two first versions was back translated (from Brazilian Portuguese into English) by two translators whose native language was English but who were proficient in Brazilian Portuguese. |
| | Harmonization and equivalence analysis (stage 5) | An expert committee composed of eleven experts, nine occupational therapists, and two physical therapists were contacted by e-mail. Ten had a master’s degree, and four had PhDs. They filled in a form addressing professional information and analysed a table where the translated version of the FMA was divided into independent sentences. Each sentence was assessed in terms of semantic equivalence (SE), that is, whether the meanings of words were equivalent; idiomatic equivalence (IE), whether idiomatic expressions and colloquialisms were equivalent; conceptual equivalence (COE), whether the concepts are maintained in the translated version; and cultural equivalence (CUE), the cultural context must be coherent with the context of the country where the translated instrument will be used [16]. Whenever they disagreed with a sentence, the experts provided a justification and presented a suggestion to change it. As part of this stage, a face-to-face meeting was also held with two authors of the instruments in Nashville, TN, United States, when all the previous stages of the cross-cultural adaptation process were presented.
The process in which sentences were analysed was repeated, but at this time, the table contained only the changes suggested by the expert committee. The Brazilian versions of FMA performed by two independent translators were reconciled and then back translated into English and compared to the original version. The Brazilian version was found to be equivalent to the original instrument, indicating that the instrument’s concepts were preserved. During stage 5 (expert committee), however, the instrument was further changed. All sentences for which agreement was below 85% were revised. |
| | Face validity (stage 6) | The face validity of the prefinal version of the FMA corresponded to stage 6 of cross-cultural adaptation, where 24 participants were divided into two groups: Group 1 (12 clients with disabilities who used any device that aided mobility) and Group 2 (12 undergraduate students from the occupational therapy program at the Federal University of São Carlos, São Carlos, Brazil). |
| | Stage 7 (final report) | Finally, the cross-cultural adaptation was concluded with the final report, sent by e-mail to the authors of the original instrument, who approved all the previous stages. |
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