Cross-cultural adaptation and validation of a self-reporting tool to assess health-related quality of life for Egyptians with extremity bone sarcomas in childhood or adolescence.

Abstract

Purpose Our study pursued cross-cultural adaptation, and validation of the pediatric Toronto Extremity Salvage Score (pTESS) and Toronto Extremity Salvage Score (TESS) to assess the functional outcome for Egyptian children and adult survivors of childhood bone cancer. Mental domains were added to allow the evaluation of health-related quality of life (HRQOL) Methods The internal consistency and test-retest reliability of the studied forms were assessed. For convergent validity, correlations between scores of the generic Pediatric Quality of Life Inventory (PEDSQL 4.0) and pTESS /TESS scores were reported. Exploratory Factor Analysis (EFA) was feasible for pTESS-leg; due to the insufficient samples, only the average inter-item correlation coefficients were reported for the remaining versions. Results Out of 233 participants, 134 responded to pTESS leg, 53 to TESS-leg, 36 to pTESS-arm, and only 10 to TESS-arm. All versions showed excellent internal consistency (Cronbach’s alpha > 0.9), good test-retest reliability (Intra-class coefficients > 0.8), moderate to strong correlations with PEDSQL, and acceptable average inter-item correlation coefficients (≥ 0.3). In the EFA, all mental items were loaded on one separate factor with factor loadings exceeding 0.4. Chemotherapy, primary surgery within one year, or tibial tumors showed significantly inferior pTESS/TESS scores in lower extremities. Conclusion The Egyptian pTESS and TESS are valid and reliable self-reporting tools for assessing the functional outcome following surgeries of extremity bone sarcomas. The mental domains enabled the assessment of the overall health status in our population. Future studies should include larger sample size and evaluate the ability of pTESS/TESS to track progress over time.