# Cross-cultural adaptation and psychometric testing of the Turkish Version of the Workplace Activity Limitations Scale (WALS) in people with inflammatory arthritis

## TL;DR

This study adapts and validates the Turkish version of the Workplace Activity Limitations Scale for people with inflammatory arthritis, ensuring it is reliable and culturally appropriate.

## Contribution

The study provides a validated Turkish version of the WALS, enabling its use in Turkish-speaking populations with inflammatory arthritis.

## Key findings

- The Turkish WALS demonstrated high internal consistency (Cronbach’s alpha = 0.89) and excellent test–retest reliability (ICC = 0.91).
- The Turkish WALS met the Rasch model requirements for fit and showed moderate correlations with other validated work limitation measures.
- The Turkish WALS is a valid and reliable tool for assessing workplace activity limitations in individuals with inflammatory arthritis.

## Abstract

The Workplace Activity Limitations Scale (WALS) is a widely used measure to assess work-related functional limitations in individuals with rheumatologic diseases. However, no validated Turkish version of the WALS exists, limiting its applicability in Turkish-speaking populations. This study aims to conduct a cross-cultural adaptation and psychometric evaluation of the Turkish version of WALS in individuals with inflammatory arthritis (IA).

WALS was forward and backward translated, and cognitive debriefing interviews were conducted with 30 participants to assess comprehensibility and cultural relevance. Then, 200 participants completed the Turkish version of the WALS along with the Work Limitation Questionnaire-Short Form (WLQ-SF), the Rheumatoid Arthritis Work Instability Scale (RA-WIS), the Work Productivity Activity Impairment General Health V2.0 (WPAI-GH), the Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Impact of Disease (RAID). Of these, 79 participants also completed the WALS again 2 weeks later to assess test–retest reliability.

WALS showed high internal consistency (Cronbach’s alpha = 0.89) and excellent test–retest reliability (ICC (2.1): 0.91). WALS met the Rasch model requirements for fit. Concurrent validity showed that the WALS total score was moderately correlated with the WLQ total score (r = −0.57), some parameters of the WPAI (r2 = 0.42; r3 = 0.40; r4 = 0.43), HAQ (r = 0.54) and RAID (r = 0.57).

The Turkish version of the WALS is a valid and reliable instrument for assessing workplace activity limitations in individuals with IA. It can be used in clinical and research settings to assess work-related functional difficulties and guide occupational interventions for Turkish-speaking individuals with IA.