The Arabic Version of the Tegner Activity Scale in Patients with Anterior Cruciate Ligament Reconstruction: Translation, Validation, and Cross-Cultural Adaptation

Abstract

Background: The Tegner activity scale is a patient-reported questionnaire that is frequently used to measure activity levels in patients with anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to translate, cross-culturally adapt, and validate the Tegner activity scale into Arabic. Methods: The Tegner activity scale–Arabic version (TAS-Ar) was forward and backward translated, cross-culturally adapted, and validated according to established guidelines. Seventy-five patients who underwent ACLR were instructed to complete the TAS-Ar, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale. The test-retest reliability of the TAS-Ar was assessed in 39 patients. Statistical tests were conducted to test the reliability and construct validity of the TAS-Ar. Results: The TAS-Ar showed excellent test-retest reliability, with intraclass correlation coefficients of 0.836 (p < 0.001). The TAS-Ar was significantly correlated with the IKDC (Spearman’s rho = 0.476, p < 0.001), all KOOS subscales (Spearman’s rho = 0.195–0.497, p < 0.05), and the KOOS total score (Spearman’s rho = 0.469, p < 0.001). Conclusions: The Arabic version of the Tegner activity scale is a reliable and valid measure that can be used to evaluate the activity level of Arabic-speaking patients following ACLR.

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 ).…”

“…OAKHQoL, Kujala PFPSS, LKS, and IKDC were not validated in the Saudi Arabian population ( Table 1 ). Four studies included only males [ 26 , 27 , 29 , 33 ], while one study included only females [ 35 ], and in another two studies, the majority (~90%) of the patients were females. Eight studies [ 14 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] were from countries other than Saudi Arabia, using local dialects in their PROM.…”

“…Internal consistency of individual subscales was not mentioned for KOS-ADLS [ 27 , 30 , 42 ] and anterior knee pain scale [ 31 ]. Evaluation of internal consistency was mentioned in the methodology, but values were not given in the results for reduced WOMAC [ 28 ].…”