Cross-cultural adaption, translation and validation of the Toronto extremity salvage score (TESS) for patients in German-speaking countries

Abstract

Summary Objective The preferred treatment for malignant bone and soft tissue tumors is limb salvage surgery; the Toronto extremity salvage score (TESS) is commonly used to measure physical functioning of the affected extremity. The aims of this study were to translate and culturally adapt the German version of the TESS, as well as to explore its convergent reliability, validity and re-test reliability. Study design Patients (n = 50) 32 lower extremity (LE) and 18 upper extremity (UE) were asked to fill out the German TESS two times (t1: clinical visit, t2: regular email) and the SF-36 once. Methods The TESS questionnaires were translated from English into German, back translated into English, and culturally adapted. The reliability was assessed with Cronbach’s alpha (α). The validity was measured with the SF-36 physical component score and TESS using the Spearman rank correlation coefficient (r). Furthermore, the test-retest reliability was calculated with the intraclass correlation coefficient (ICC). Results Internal consistency for both questionnaires was excellent (LE t1: α = 0.924, t2: α = 0.952; UE t1: α = 0.957, t2: α = 0.898). A statistically significant correlation was found between the SF-36 physical component scale and the German TESS (LE r = 0.741, UE r = 0.713). The ICC between baseline (t1) and re-test (t2) was 0.952 and 0.871 for the lower and upper extremities, respectively. Conclusion Initial evidence demonstrated that the German TESS is a valid and reliable instrument for use with patients after surgical treatment of malignant bone or soft tissue sarcoma.

Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma

“…The functional outcome was determined using the Musculoskeletal Tumor Society Score (MSTS), the Toronto Extremity Salvage Score (TESS) and the Subjective Shoulder Value (SSV). MSTS and TESS are commonly used in tumour orthopaedics to assess the functional outcome following limb-sparing surgery, and there are specifically designed versions of each for upper and lower extremities, respectively [ 16 , 17 ] . The upper extremity version of the MSTS includes six questions on dexterity, pain, emotional acceptance, function, hand positioning and the ability to lift objects with the affected arm [ 17 ].…”

“…Each question is scored on a scale from 0 (very limited) to 5 (no restriction), with a maximum score of 30 points [ 17 ]. The upper extremity version of the TESS includes 29 questions, each scored on a scale from 1 (impossible to do) to 5 (not at all difficult), on everyday upper extremity tasks such as cutting vegetables or doing household chores [ 16 ]. The maximum score is 145 points, which is converted to a percentage to allow easier comparability [ 16 ].…”

“…The upper extremity version of the TESS includes 29 questions, each scored on a scale from 1 (impossible to do) to 5 (not at all difficult), on everyday upper extremity tasks such as cutting vegetables or doing household chores [ 16 ]. The maximum score is 145 points, which is converted to a percentage to allow easier comparability [ 16 ]. Furthermore, we obtained the SSV, where a patient rates the function of the operated shoulder (as a percentage) compared to the contralateral shoulder [ 18 ].…”

Cross-cultural adaptation and validation of a self-reporting tool to assess health-related quality of life for Egyptians with extremity bone sarcomas in childhood or adolescence.

“…The original TESS-leg revealed an Egyptian median score that was slightly higher than those reported in Italy and Greece [15,23], and comparable to Vienna [18], while being inferior to several other scores [14,17,[24][25][26][27].…”

“…On the contrary, it lacks a mental domain which is essential in evaluating the overall HRQOL of these patients [16,17]. Previously reported TESS scores were highly correlated with the physical and social domains of the 36-Item Short Form Survey (SF-36), but not linked to its mental component score [16][17][18]. PROMIS is a single computerized-adaptive testing (CAT) tool with several domains, including physical function and depression form, and it seems a proper choice that has been previously used following orthopedic surgeries [13,19].…”