# Translation and cross-cultural adaptation of the Toronto extremity salvage score system into Arabic and its validity

## TL;DR

This study translated the Toronto Extremity Salvage Score into Arabic and confirmed it is clear, reliable, and valid for assessing patients with musculoskeletal tumors in Saudi Arabia.

## Contribution

The paper introduces a validated Arabic version of the TESS for evaluating extremity tumor patients in Arabic-speaking populations.

## Key findings

- TESS-AR showed excellent test-retest reliability with an interclass correlation coefficient of 0.965.
- Cronbach’s alpha for TESS-AR was 0.972 for lower extremity and 0.969 for upper extremity, indicating strong internal consistency.
- TESS-AR demonstrated strong and moderate correlations with SF-36 and EORTC QLQ C30, supporting its construct validity.

## Abstract

The treatment of musculoskeletal (MSK) tumors involving the extremities has evolved over the past decade with the introduction of prosthesis and new chemotherapy regimen. The Toronto Extremity Salvage Score system (TESS) is a patient-filled questionnaire that measures the functional status of patients with MSK tumors who underwent limb-salvaging procedure. The purpose of this study is to translate TESS into Arabic (TESS-AR) and to examine its reliability and validity.

Our study is a multi-center in Riyadh, Saudi Arabia. Arabic-speaking adults diagnosed with MSK tumors involving the extremities were included. TESS-AR was created following clear, user-friendly guidelines for translation. Moreover, reliability and validity were measured using the test-retest method and construct validity, respectively.

108 participants completed the TESS-AR, 56% had lower limb tumors. The participants reported that the TESS-AR was clear and all questions and answers were understood. The test-retest reliability showed excellent reliability, with an interclass correlation coefficient of 0.965 for both the lower and upper extremity TESS-AR. Cronbach’s alpha of lower extremity TESS-AR was 0.972, whereas that of upper extremity TESS-AR was 0.969, indicating strong internal consistency. The construct validity between TESS-AR and SF-36 showed a strong and moderated correlation between most of the components, with a Pearson correlation coefficient >0.40. Similar results were found between TESS-AR and EORTC QLQ C30.

The TESS-AR is a comprehensible, valid, and reliable score for assessing functional outcomes in patients with extremity tumors. We believe that TESS-AR can be used by clinicians, researchers, and patients alike.