# Linguistic Validation and Cross-Cultural Adaptation of the Shoulder Telehealth Assessment Tool for Filipino Patients with Musculoskeletal Shoulder Condition: Cross-Sectional Study

## TL;DR

This study created a culturally adapted Filipino version of a telehealth tool for assessing shoulder conditions, finding it valid and reliable but needing improvements in the strength section.

## Contribution

The paper introduces a linguistically validated and culturally adapted Filipino version of the Shoulder Telehealth Assessment Tool (STAT).

## Key findings

- The Filipino STAT showed excellent content validity and interrater reliability.
- Understandability was excellent for pain and activity but poor for strength.
- Some Tagalog words and unfamiliarity with the tool hindered comprehension for some participants.

## Abstract

Telerehabilitation has been widely adopted to meet the growing rehabilitation demand, but it is often limited by unstable internet connection, poor audiovisual resolution, and difficult virtual assessment. The Shoulder Telehealth Assessment Tool (STAT), a comprehensive, patient-led, preconsultation shoulder physical examination pictorial guide, was developed to address these limitations by easing the communication of instruction during the consultation and potentially removing the need for video calls.

This study aimed to develop a linguistically valid and culturally appropriate Filipino version of STAT and to evaluate its content validity, internal consistency, understandability, and ease of use.

A cross-sectional study on the Filipino STAT was conducted in three phases: (1) linguistic validation by experts, (2) cross-cultural adaptation through pretesting of 12 participants diagnosed with a musculoskeletal shoulder condition at the Philippine General Hospital, and (3) pilot study on 47 participants of the same population.

The Filipino STAT had an excellent content validity (scale validity index=0.80‐0.97), excellent interrater reliability (κ coefficient=0.82‐1.00), and good internal consistency (Cronbach α=0.87). Understandability was found to be excellent for pain and activity (98%), good for range of motion and special tests (85%), and poor for strength (37%). However, 24% (11/46) of participants perceived the tool difficult to understand with the use of some Tagalog words as the primary barrier, followed by non-familiarity with the tool and difficulty reading the text.

Development of the Filipino STAT through a rigorous linguistic validation and cultural adaptation has produced a culturally appropriate, valid, and reliable tool. Pain and activity, range of motions, and special test subdomains are suitable for clinical assessment, while strength subdomain needs further improvement in understandability.