Cross-cultural Adaptation, Validation, and Reliability of the Persian version of the Toronto Extremity Salvage Score (TESS) for Lower Extremity

Objectives: The Toronto Extremity Salvage Score for the lower extremity (LE-TESS) is a commonly used patient-reported outcome measure (PROM) designed to assess physical disability in patients following lower limb salvage surgery for bone or soft tissue tumors. Although the TESS has been widely translated and culturally adapted for clinical and research purposes in many countries, it has not yet been translated into Persian (Farsi) or validated for use in Iranian society. This study aims to provide a validated and reliable Persian version of the TESS questionnaire. Methods: The LE-TESS questionnaire was adapted for the Iranian (Persian) society in accordance with international translation and cultural adaptation guidelines. The reliability and validity of the Persian LE-TESS were assessed in patients referred to Shafa Yahyaeian Hospital who underwent lower limb salvage procedures for malignant tumors between ۲۰۱۶ and ۲۰۲۲. Cronbach's alpha was used to measure internal consistency, and test-retest reliability was assessed within two weeks to calculate the intraclass correlation coefficient (ICC). Construct validity was evaluated using Spearman's rank correlation with the Short Form-۳۶. Results: In this study, ۳۱ patients (۵۴.۸% male) were included, with a mean age of ۲۶.۱۶ ± ۹.۶۱ years. The internal consistency evaluated by Cronbach’s alpha was ۰.۸۸۷, and the intraclass correlation coefficient (ICC) assessed by the test-retest reliability was ۰.۸۷۲. This research’s SEM and MDC ۰.۹۵ values were as much as ۱۱.۶۳ and ۳۲.۲۳, respectively. The construct validity analysis revealed a strong correlation between the Persian LE-TESS and the SF-۳۶. Conclusion: The Persian version of the LE-TESS demonstrated reliability and validity in assessing the physical function of patients who underwent lower limb salvage surgery for bone and soft tissue tumors.         Level of evidence: IV

Keywords:

Cross-Cultural Adaptation , Persian language , Reliability , TESS , Toronto Extremity Salvage Score , Translation , Validity