# Cross-cultural adaptation and validation of the brain injury vision symptom survey: bridging the gap with an Arabic version

## TL;DR

This paper introduces a validated Arabic version of a questionnaire for assessing visual symptoms after brain injury, making it accessible to Arabic-speaking patients.

## Contribution

The study provides a cross-culturally adapted and validated Arabic version of the Brain Injury Vision Symptom Survey.

## Key findings

- The Arabic BIVSS showed excellent internal consistency (Cronbach’s α = 0.897) and test–retest reliability (ICC = 0.952).
- Score distributions were approximately normal, and minimal detectable change was calculated as 8.12 points.

## Abstract

Traumatic brain injury (TBI) often causes visual symptoms that hinder rehabilitation. The Brain Injury Vision Symptom Survey (BIVSS) is an established 28-item questionnaire for TBI-related visual symptoms, but it is only available in English. We aimed to create and validate an Arabic version to provide a culturally adapted tool for Arabic-speaking patients.

The BIVSS was translated into Arabic using Beaton’s cross-cultural adaptation model (forward–backward translation, expert committee review, cognitive debriefing). Twenty-nine TBI patients completed the Arabic BIVSS twice, one month apart. Internal consistency was measured with Cronbach’s alpha. Test–retest reliability was assessed with an intraclass correlation coefficient [ICC(3,1)]. Agreement between test and retest was examined via Bland–Altman analysis (mean bias and 95% limits of agreement [LOA]). We also calculated the standard error of measurement (SEM) and the 95% minimal detectable change (MDC₉₅). Shapiro–Wilk tests were used to assess normality.

The Arabic BIVSS showed excellent internal consistency (Cronbach’s α = 0.897) and test–retest reliability (ICC(3,1) = 0.952, 95% CI [0.750, 0.984]). Bland–Altman analysis indicated a slight mean bias of −3.59 (test minus retest), with 95% LOA from −11.71 to 4.54. No proportional bias was observed. The SEM was 2.93, and MDC₉₅ was 8.12 points. Score distributions were approximately normal (Shapiro–Wilk p = 0.024 at baseline, 0.083 at retest).

The Arabic BIVSS is a reliable and valid instrument for assessing TBI-related visual symptoms. This cross-culturally adapted version can facilitate clinical screening and research in Arabic-speaking populations. However, given the small sample size and lack of a control group, further research is required to establish population-specific cut-off values and assess construct validity and responsiveness.