Arabic Version of the Short Anterior Cruciate Ligament–Return to Sport After Injury Scale: Translation, Cross-cultural Adaptation, and Validation

Abstract

Background: The short version of the Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI) scale is a self-reported questionnaire developed to assess the psychological readiness of patients to return to sports after ACL reconstruction (ACLR). Purpose: To translate, cross-culturally adapt, and validate the short version of the ACL-RSI scale into the Arabic language (ACL-RSI-Ar). Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The original short version of the ACL-RSI scale was forward and backward translated, cross-culturally adapted, and validated following international standardized guidelines. Sixty patients who participated in sports activities and underwent ACLR completed the ACL-RSI-Ar, the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and Knee injury and Osteoarthritis Outcome Score (KOOS) scales. To assess test-retest reliability, 34 participants completed the ACL-RSI-Ar scale twice. Statistical tests were conducted to test the internal consistency, reliability, and construct and discriminant validity of the ACL-RSI-Ar scale. Results: The ACL-RSI-Ar showed adequate internal consistency (Cronbach alpha = 0.734) and excellent test-retest reliability (intraclass correlation coefficient, 0.871). The ACL-RSI-Ar was strongly correlated with the IKDC (Spearman ρ = 0.515, P < .001) and weakly to strongly correlated with all KOOS subscales (Spearman ρ = 0.247-0.590, P < .05). Patients who returned to sports had significantly higher scores on the ACL-RSI-Ar scale when compared with those who did not return to sports ( P = .001). Conclusion: The short ACL-RSI-Ar scale, as translated, was internally consistent, reliable, and valid for evaluating psychological readiness to return to sports after ACLR in Arabic-speaking patients.

A Systematic Review of Psychometric Properties of Knee-Related Outcome Measures Translated, Cross-Culturally Adapted, and Validated in Arabic Language

“…A total of 20 articles were selected for this review; out of which 12 articles were from Saudi Arabia [ 1 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], two each from Morocco [ 36 , 37 ], Egypt [ 38 , 39 ], and Jordan [ 40 , 41 ], and one each from Tunisia [ 14 ], and Kuwait [ 42 ]. A total of 10 knee-related outcome measures were cross-culturally adapted, and their psychometric measurement properties were evaluated in the Arabic language.…”

“…They were Western Ontario and McMaster universities osteoarthritis index (WOMAC) [ 1 , 14 , 37 ], knee injury and osteoarthritis outcome score (KOOS) [ 33 , 34 , 35 , 38 , 39 , 43 ] knee outcome survey- activities of daily living scale (KOS-ADLS) [ 30 , 42 ]. Oxford knee score [ 1 ], anterior knee pain scale [ 31 ], osteoarthritis of knee and hip health-related quality of life (OAKHQoL) scale [ 37 ], Kujala patellofemoral pain scoring system [ 40 , 41 ], intermittent and constant osteoarthritis pain questionnaire (ICOAP) [ 25 ], short version of anterior cruciate ligament-return to sport after injury scale (ACL-RSI) [ 26 ], and Tegner activity scale (TAS) [ 27 ]. WOMAC was validated in three different ways, i.e., reduced WOMAC [ 44 ], original WOMAC [ 37 ], and Sfax WOMAC [ 14 ], that were evaluated in three different nations, i.e., Saudi Arabia [ 1 ], Morocco [ 37 ], and Tunisia [ 14 ].…”

“…The function subscale was present in all PROMs, followed by pain and symptom subscales (three PROMs each). Most of these tools were evaluated on knee osteoarthritis patients [ 14 , 28 , 29 , 35 , 36 , 37 , 38 , 43 ], apart from three on patellofemoral pain syndrome [ 31 , 40 , 41 ], anterior cruciate ligament/ligamentous injury, and meniscal injury [ 26 , 27 , 38 , 39 ]. Two studies used the population of various knee-related conditions to evaluate their tools [ 30 , 42 ] ( Table 1 ).…”

“…Among the 20 included studies, three [ 25 , 28 , 40 ] have not formed an expert review (stage IV) to examine or discuss back translation; two studies did not mention stage II [ 30 , 32 ]; three studies did not mention stage IV [ 14 , 25 , 40 ], and two studies did not mention stage V [ 32 , 40 ], respectively. All except two [ 26 , 36 ] used at least 10 patients at stage V (pilot study). Recall may be a source of bias in one study’s test-retest reliability [ 14 ].…”

Awareness of asthma and its management in primary school teachers in Baghdad, Iraq

“…Al-Motlaq and Sellick's score was translated and cross-culturally adapted in accordance with the 'Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures'. 24 Two clinical pharmacists (Muhannad Salih and Arwa Abd) who are native Arabic speakers with outstanding English language skills translated the scale into Arabic. The original short form of the scale, as well as the two translations, were evaluated and discussed with a third clinical pharmacist (Hayder Fawzi) in order to fix any conceptual flaws or conflicts and create one Arabic version of the scale.…”