Validation process of Toronto Exremity Salvage Score in Italian: A quality of life measure for patients with extremity bone and soft tissue tumors

Abstract

Background and Objectives Limb salvage surgery remains the standard treatment in bone and soft tissue tumors. Toronto Extremity Salvage Score (TESS) is the most used quality of life measure. Our objective was to perform cross‐cultural adaptation and validation in Italian, testing test‐retest reliability, construct validity, and responsiveness. Methods We interviewed patients already treated for content validity. A total of 124 patients completed TESS and other questionnaires presurgery, at 3 months, 3 months + 2 weeks, and 6 months follow‐up. We calculated intraclass correlation coefficients (ICCs) for reliability, associations with Pearson's r, and change over time with paired T tests. Results A new item regarding touch‐screen devices was added to the upper extremity (UE) questionnaire. ICC resulted of 0.99 for lower extremity (LE) and 0.98 for UE patients, Pearson's r between TESS and Musculoskeletal Tumor Society was .66 and .64, EuroQol‐5D‐5L r was .62 and .61, and r between TESS and short form‐36 physical function subscale was .76 and .71 for LE and UE groups, respectively. Paired T test results were statistically significant to detect change over time (0.03, 0.04, and 0.04 for LE groups and 0.03, 0.01, and 0.04 for UE groups). Conclusion The Italian version of TESS can be used for the bone and soft tissue sarcoma population in clinical trials in Italy and with Italian speaking patients abroad to ensure patients’ perspectives for efficacy and efficiency of treatments.

Cross-cultural adaptation and validation of the Musculoskeletal Tumor Society (MSTS) scoring system and Toronto Extremity Salvage Score (TESS) for musculoskeletal sarcoma patients in Greece

“…In the Greek version of TESS, question 29 was assessing the ability of the patient to socialize with his or her friends. This is the first crosscultural adaptation analysis of the TESS questionnaire identifying a relatively lower factor loading value for this specific question, and therefore, this finding could be attributed to inter-cultural differences related to the perception of having musculoskeletal cancer diagnosis between patients from different countries and its impact on the patients' social interactions [11,21,[23][24][25]. When attempting to validate the TESS in non-English language, researchers should pay attention to this specific question at the translation stage in order to achieve successful cross-cultural adaptation of the TESS.…”

“…No difference in the postoperative TESS scores of female and male patients was detected; however, the mean postoperative MSTS for lower extremity score was significantly higher in female patients. The English version of the TESS questionnaire had been translated, validated and culturally adapted by other countries including Korea, Japan, Italy, Brazil, and China in patients with sarcoma of the upper and/or lower extremity [11,21,[23][24][25]. It is important to appropriately validate one or more patient evaluation instruments in order to perform clinical outcome studies in orthopedic oncology.…”

“…Although the translation and cross-cultural adaptation process was complex, the Greek version of the TESS was found to have adequate reliability, internal consistency, and external validity for use in clinical practice. Previous studies have successfully performed cross-cultural adaptation of this scale in patients with bone and soft tissue tumors of the lower extremity [11,21,[23][24][25].…”

“…The lower extremity version of MSTS has been translated and validated into multiple languages including Danish, Chinese, Portuguese, and Japanese [12,[17][18][19][20]. Similarly, the upper and/or lower extremity versions of the TESS, have been translated and validated in Italian, Dutch, Japanese, Chinese, and Korean [11,[21][22][23][24][25].…”

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

“…The direct translations for two questions were too long and confusing for the pretest patients to answer without support from the interviewer [15][16][17]. Therefore, these questions (UE 25, 26 and LE 26, 27) were changed so the TESS can be completed by patients themselves without any assistance from or explanation of questions by healthcare providers (12)(13)(14). Furthermore, because distinct transcripts from two authors (CH and CT) were merged into one final version during the translation process, minor changes were made to most questions.…”