The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Cross-cultural Adaptation, Validation, and Reliability of the Persian version of the Toronto Extremity Salvage Score (TESS) for Lower Extremity

Document Type : RESEARCH PAPER

Authors
Khodamorad Jamshidi 1
Keihan Mostafavi 1
Khalil Kargar Shooroki 1
Marzieh Latifi 2
Seyyed Mohammad Ata Sharifi Dalooei 1
Mohammad Mohammadi 3
1 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
2 Medical ethics and law research center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
3 School of Medicine, Iran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2025.80920.3691
Abstract
Objectives: The Toronto Extremity Salvage Score for the lower extremity (LE-TESS) is a commonly used patient-reported outcome measure (PROM) designed to assess physical disability in patients following lower limb salvage surgery for bone or soft tissue tumors. Although the TESS has been widely translated and culturally adapted for clinical and research purposes in many countries, it has not yet been translated into Persian (Farsi) or validated for use in Iranian society. This study aims to provide a validated and reliable Persian version of the TESS questionnaire.
Methods: The LE-TESS questionnaire was adapted for the Iranian (Persian) society in accordance with international translation and cultural adaptation guidelines. The reliability and validity of the Persian LE-TESS were assessed in patients referred to Shafa Yahyaeian Hospital who underwent lower limb salvage procedures for malignant tumors between 2016 and 2022. Cronbach's alpha was used to measure internal consistency, and test-retest reliability was assessed within two weeks to calculate the intraclass correlation coefficient (ICC). Construct validity was evaluated using Spearman's rank correlation with the Short Form-36.
Results: In this study, 31 patients (54.8% male) were included, with a mean age of 26.16 ± 9.61 years. The internal consistency evaluated by Cronbach’s alpha was 0.887, and the intraclass correlation coefficient (ICC) assessed by the test-retest reliability was 0.872. This research’s SEM and MDC 0.95 values were as much as 11.63 and 32.23, respectively. The construct validity analysis revealed a strong correlation between the Persian LE-TESS and the SF-36.
Conclusion: The Persian version of the LE-TESS demonstrated reliability and validity in assessing the physical function of patients who underwent lower limb salvage surgery for bone and soft tissue tumors.
        Level of evidence: IV                                         
Keywords
Cross-cultural adaptation
Persian language
Reliability
TESS
Toronto extremity salvage score
Translation
Validity
Subjects
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The Archives of Bone and Joint Surgery
Volume 13, Issue 8
August 2025
Pages 509-516

  • Receive Date 03 July 2024
  • Revise Date 18 February 2025
  • Accept Date 23 February 2025