The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Persian Version of the Patient-Rated Ulnar Nerve Evaluation (PRUNE)

Document Type : RESEARCH PAPER

Authors
Hamed Naghizadeh 1
Hamid Arabi 2
Omid Salkhori 1
Mohammad Ayati Firoozabadi 1
Seyyed Saeed Khabiri 3
Seyyed Hadi Kalantar 1
Elham Poorghasem 4
Aidin Arabzadeh 1
1 Joint Reconstruction Research Center, Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran- Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
2 Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
3 Joint Reconstruction Research Center, Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2025.89398.4054
Abstract
Objectives: The Patient-Rated Ulnar Nerve Evaluation (PRUNE) is a validated, condition-specific instrument designed to assess symptoms and functional limitations in individuals with ulnar nerve disorders. However, no Persian adaptation has been developed to date. The present study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the PRUNE among patients with Cubital Tunnel Syndrome (CuTS).
Methods: Following international guidelines, the PRUNE was translated and culturally adapted into Persian. A total of 106 patients with clinically diagnosed Cubital Tunnel Syndrome (CuTS) were enrolled in the study. Internal consistency was evaluated using Cronbach’s alpha, and test–retest reliability was determined with the Intraclass Correlation Coefficient (ICC) over a two-week interval. Construct validity was examined through an exploratory factor analysis (EFA) using principal component extraction and Varimax rotation. Convergent validity was examined by assessing the correlations between PRUNE scores and those of established instruments, including the QuickDASH, DASH, and Visual Analog Scale (VAS).
Results: The Persian version of the PRUNE demonstrated excellent internal consistency (Cronbach’s α = 0.889) and strong test–retest reliability (ICC = 0.886). Exploratory factor analysis confirmed a multidimensional factor structure consistent with that of the original instrument. Significant positive correlations were observed between the PRUNE and the QuickDASH (r = 0.768), DASH (r = 0.699), and VAS (r = 0.664), supporting its convergent validity.
Conclusion: The Persian version of the PRUNE proved to be a reliable and valid instrument for assessing symptoms and functional limitations in Persian-speaking patients with Cubital Tunnel Syndrome. It can be confidently applied in both clinical practice and research contexts.
        Level of evidence: II
Keywords
Cross-cultural adaptation
Cubital tunnel syndrome
Persian translation
PRUNE
Psychometric validation
Upper limb assessment
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 7
July 2026
Pages 448-456

  • Receive Date 08 July 2025
  • Revise Date 24 September 2025
  • Accept Date 02 November 2025