Translation, Validation, and Cross-Cultural Adaptation of the Patient and Observer Scar Assessment Scale (POSAS) into Persian

Document Type : RESEARCH PAPER

Authors

Joint Reconstruction Research Center, Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran

10.22038/abjs.2025.84746.3857

Abstract

Objectives: This study aimed to translate, culturally adapt, and validate the Patient and Observer Scar Assessment Scale (POSAS) for Persian-speaking populations, ensuring its applicability and reliability in both clinical and research settings in Iran.
Methods: The cross-cultural adaptation process involved forward and backward translations, expert panel reviews, and pre-testing. A total of 60 post-surgical patients participated in the study. Psychometric evaluations included content validity, internal consistency, and test-retest reliability. Content Validity Ratios (CVRs) and Content Validity Indices (CVIs) were calculated, with thresholds set at 0.51 and 0.79, respectively. Reliability was assessed using Cronbach’s alpha coefficients (≥0.7) and test-retest stability over a two-week interval.
Results: The Persian POSAS demonstrated robust psychometric properties. All items exceeded the CVI threshold, achieving strong expert consensus (CVR ≥0.51). Cronbach’s alpha coefficients were 0.88 and 0.81 for the Observer Scar Assessment Scale (OSAS) and Patient Scar Assessment Scale (PSAS), respectively, indicating high internal consistency. Test-retest reliability confirmed stability over time. These results were consistent with previous adaptations in other languages, including Arabic and Italian.
Conclusion: The Persian adaptation of POSAS is a valid and reliable tool for scar assessment, filling a critical gap in patient-centered care for Persian-speaking populations. This tool enables standardized evaluation of scars and supports clinical research. Future studies should explore its responsiveness to therapeutic interventions and its applicability across diverse patient demographics.
        Level of evidence: Ⅲ

Keywords

Main Subjects

References

  1. Weiser TG, Haynes AB, Molina G, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-209F. doi:10.2471/BLT.15.159293.
  2. Brockes JP, Kumar A, Velloso CP. Regeneration as an evolutionary variable. J Anat. 2001;199 (Pt 1-2):3-11. doi:10.1046/j.1469-7580.2001.19910003.x.
  3. Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ. Rating the burn scar. J Burn Care Rehabil. 1990;11(3):256-260. doi:10.1097/00004630-199005000-00014.
  4. Gallucci GL, Rosa YC, Cerrutti WG, Tanoira I, Rellan I. WALANT Technique versus Local Anesthesia with a Tourniquet in Carpal Tunnel Syndrome. Arch Bone Jt Surg..2023;11(5):321-325. doi:10.22038/abjs.2023.62995.3052
  5. Pieniak M, Höfer B, Knipping J, et al. Children and adolescents with primary headaches exhibit altered sensory profiles–a multi-modal investigation. J Headache Pain. 2024;25(1):111. Published 2024 Jul 9. doi:10.1186/s10194-024-01819-x.
  6. Gallucci GL, Rosa YC, Cerrutti WG, Tanoira I, Rellan I. WALANT Technique versus Local Anesthesia with a Tourniquet in Carpal Tunnel Syndrome. Arch Bone Jt Surg. 2023;11(5):321-325. doi:10.22038/abjs.2023.62995.3052
  7. 7. Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MW. A new quantitative scale for clinical scar assessment. Plast Reconstr Surg. 1998;102(6):1954-1961. doi:10.1097/00006534-199811000-00022.
  8. 8. Draaijers LJ, Tempelman FR, Botman YA, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960-1967. doi:10.1097/01.prs.0000122207.28773.56.
  9. 9. Nguyen TA, Feldstein SI, Shumaker PR, Krakowski AC. A review of scar assessment scales. Semin Cutan Med Surg. 2015;34(1):28-36. doi:10.12788/j.sder.2015.0125.
  10. 10. van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of         linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg. 2005;116(2):514-522. doi:10.1097/01.prs.0000172982.43599.d6.
  11. 11. Deslauriers V, Rouleau DM, Alami G, MacDermid JC. Translation of the Patient Scar Assessment Scale (PSAS) to French with cross-cultural adaptation, reliability evaluation and validation. Can J Surg. 2009;52(6):E259-E263.
  12. 12. Vercelli S, Ferriero G, Bravini E, et al. Cross-cultural adaptation, reproducibility and validation of the Italian version of the Patient and Observer Scar Assessment Scale (POSAS). Int Wound J. 2017;14(6):1262-1268. doi:10.1111/iwj.12795.
  13. 13. Al-Drees T, Albosaily A, Alanazi L, et al. Translation and cultural adaptation of an Arabic version of the patient scar assessment scale for thyroidectomy patients. Saudi Med J. 2019;40(6):590-594. doi:10.15537/smj.2019.6.24197.
  14. 14. Lawshe CH. A Quantitative Approach to Content Validity. Personnel psychology. Personnel psychology, 1975;28 (4): 563-575. doi:0.1111/j.1744-6570.1975.tb01393.x.
  15. 15. Waltz CF, Bausell BR. Nursing research: design statistics and computer analysis. Davis Fa; 1981.
  16. 16. Santos JR. Cronbach's alpha: A tool for assessing the reliability of scales. The Journal of Extension. 1999;37(2):15.
  17. 17. Restrepo S, Rojas S, Sanabria A. Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery. Int Wound J. 2020;17(1):21-31. doi:10.1111/iwj.13218.
  18. 18. Altman DG, eds. Practical statistics for medical research. 1st ed. Chapman and Hall/CRC; 1990.
  19. 19. Seyyah M, Yurdalan SU. Cultural adaptation and validation of Patient and Observer Scar Assessment Scale for Turkish use. Burns.2018;44(5):1352-1356. doi:10.1016/j.burns.2018.02.026.
  20. 20. Lenzi L, Santos J, Raduan Neto J, Fernandes CH, Faloppa F. The Patient and Observer Scar Assessment Scale: Translation for portuguese language, cultural adaptation, and validation. Int Wound J. 2019;16(6):1513-1520. doi:10.1111/iwj.13228.
  21. 21. Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. doi:10.1016/j.jclinepi.2006.03.012.
  22. 22. Al Naimi A, Mouzakiti N, Eißmann C, Louwen F, Bahlmann F. Does the appearance of the cutaneous scar after cesarean section reflect the residual myometrial thickness?. Arch Gynecol Obstet. 2021;303(3):847-851. doi:10.1007/s00404-020-05943-2.
  23. 23. Streiner DL, Norman GR, Cairney J, eds. Health measurement scales: a practical guide to their development and use. 5st ed. Oxford university press; 2024.
  24. 24. Mallery P, George D. SPSS for windows step by step. Available at:‏ https://dl.acm.org/doi/abs/10.5555/557542.2000.
  25. 25. McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32(1):40-66. doi:10.1097/00005650-199401000-00004.
  26. 26. Nicholas RS, Falvey H, Lemonas P, et al. Patient-related keloid scar assessment and outcome measures. Plast Reconstr Surg. 2012;129(5):1213. doi:10.1097/PRS.0b013e3182402c51.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 10
October 2025
Pages 649-655

Files

History

  • Receive Date: 24 December 2024
  • Revise Date: 07 March 2025
  • Accept Date: 05 April 2025

Share

How to cite

Statistics