Cross-cultural adaptation of the lumbar North American Spine Society questionnaire for Italian-speaking patients with lumbar spinal disease

STUDY DESIGN: A cross-cultural adaptation and cross-sectional study of a sample of lumbar spine patients, with a subsample followed prospectively for retest reliability. OBJECTIVES: To assess the Italian version instrument reliability and validity. SUMMARY OF BACKGROUND DATA: The orthopaedic outcome measurements have been usually focused on objective parameters as radiograph measures or other technical aspects. However, these parameters are weakly related with outcomes that are more relevant to patients as functional status and symptoms. In the last ten years, the patient-oriented measures have become an important aspect of spinal clinical outcome evaluation. The most common instruments to assess patient perspective are self-administered questionnaires that must be validated by a widely accepted process to evaluate reliability and validity, which are fundamental for every instrumental measure. METHODS: The North American Spine Society (NASS) questionnaire was culturally adapted for Italian-speaking people following the Guillemin criteria. The Italian version was tested on 74 consecutive patients who were referred to the authors' department and suffered from low back pain with leg irradiation. The results were compared with other validated patient-oriented measures. Forty-eight-hour retests were performed on a subsample of 45 patients. RESULTS: The questionnaire was favorably accepted by patients. The lumbar spine pain and disability and neurogenic symptoms subscales showed a high correlation with other patient-oriented measures, as hypothesized, and it also showed good values on test-retest. CONCLUSIONS: The questionnaire should be considered for patient health status monitoring and for clinical trials.     

Italian Version of University of California at Los Angeles (UCLA) Activity Score: Cross-Cultural Adaptation

Over the last 10 years, patient-oriented evaluations using questionnaires have become an important aspect of clinical outcome studies. Any questionnaire must be translated and culturally adapted in order to be used with different language groups, and the translated version must then be evaluated for reliability, validity and responsiveness which are fundamental attributes of any measurement tool. The aim of this study is the validation, translation and cross-cultural adaptation of the Italian version of UCLA activity Score, following the Guillemin criteria. The results show that our Italian version of the UCLA score has the following: reproducibility expressed as ICC = 0.994, an internal consistency calculated as Spearman–Brown coefficient = 0.754 and finally the construct validity has demonstrated a significant Pearson's correlation coefficient with other validated hip questionnaires.     

Italian version of the Disability of the Arm,Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation

An Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire has been devised and its reliability and validity have been assessed in a cross-sectional study of 108 consecutive patients with upper extremity pathologies. A sub-sample of 30 patients was used to assess re-test reliability. The principal DASH scale showed a high correlation with other patient-oriented measures and demonstrated good reproducibility, consistency and validity, which were similar to those for other languages' versions of DASH. These findings suggest that the evaluation capacities of the Italian DASH are equivalent to those of other language versions of the DASH.     

Lessons learned during the cross-cultural adaptation of the American Shoulder and Elbow Surgeons shoulder form into German

Cross-cultural adaptation and testing of reliability and validity were performed by use of a sample of 118 patients after shoulder arthroplasty. They completed a questionnaire booklet containing the American Shoulder and Elbow Surgeons (ASES) questionnaire, Shoulder Pain and Disability Index (SPADI), Short Form 36, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and 1 week later, they completed the ASES questionnaire again. The cross-cultural adaptation procedure revealed no major problems. The intraclass correlation coefficients (ICCs) for the subscales for pain and function and for the total score were very high (>0.84); the ICC for the subscale instability was unacceptably low. Function of the contralateral side was consistently better for all items (P < .01). Reliability for both function scales was similar (ICC >0). The ASES scores showed moderate correlation of 0.57 to 0.67 with the various scales of the SF-36 and higher correlation with the DASH (0.84) and SPADI (0.92). The German ASES showed good reliability and validity and can be used for shoulder-specific patient self-assessment in comparison to the contralateral (unaffected) side and provides additional information to objective parameters. The instability domain does not provide any additional clinical information.     

Cross-cultural adaptation and validation of the Italian version of the Western Ontario Osteoarthritis of the Shoulder index (WOOS)

Background

The Western Ontario Osteoarthritis of the Shoulder index (WOOS) has been introduced as a disease-specific quality of life measurement in patients with glenohumeral arthritis. The aim of the present study was to perform a cross-cultural adaptation of the English version of the WOOS to Italian and to assess its validity, reliability and responsiveness in patients with glenohumeral joint osteoarthritis treated conservatively.

Material and methods

The adaptation process was carried out following the simplified Guillemin criteria. The English version was translated into Italian by two bilingual orthopaedic surgeons and then translated back into English by two different bilingual orthopaedic surgeons. The original version was compared with the back-translation. The questionnaire was prospectively administered to 30 patients with glenohumeral osteoarthritis at baseline and again after 5 days for retest reliability. After 6 months of conservative treatment, the responsiveness of the questionnaire was assessed in a subsample of 20 patients. The level of statistical significance was set at 0.05.

Results

The interclass correlation coefficient between test and retest of the WOOS was 0.99 (P < 0.001). Pearson’s correlation coefficient between the WOOS and disability of the arm, shoulder and hand (DASH) preoperatively was 0.73 (P < 0.01) and the correlation between the changes of score for the WOOS and DASH was 0.75 (P < 0.01). There were no floor or ceiling effects. Responsiveness, calculated by standardized response mean, was 1.1 and effect size was 1.3.

Conclusions

The Italian version of the WOOS questionnaire has shown to be equivalent to its English version and demonstrated good validity, reliability and responsiveness to conservative treatment of glenohumeral osteoarthritis.

Level of evidence

Level II.

     

Italian version of the Roland Disability Questionnaire,specific for low back pain: cross-cultural adaptation and validation

Over the last 10 years, patient-oriented evaluations using questionnaires have become an important aspect of clinical spinal outcome studies. Any questionnaire must be translated and culturally adapted in order to be used with different language groups, and the translated version must then be evaluated for reliability and validity, which are fundamental attributes of any measurement tool. The Roland Disability Questionnaire, a low back pain disease-specific tool, was submitted to translation into Italian and to cross-cultural adaptation following the Guillemin criteria. It was then validated on 70 patients (37 male and 33 female; mean age 58, range: 28-67) suffering from low back pain as assessed by clinical examination, imaging and also electromyography in cases of suspected neurological impairment. The test-retest reliability, assessed with intraclass correlation, was 0.92 and the internal consistency reached a Cronbach's alpha of 0.82. The Italian version of the Roland Disability Questionnaire satisfied the validation criteria, showing characteristics of reliability and validity similar to previously published versions translated and adapted for other countries.     

Validation of the Korean Version of the Manchester-Oxford Foot Questionnaire in Patients With Hallux Valgus

The Manchester-Oxford Foot Questionnaire (MOXFQ) is a practical, reliable, and valid questionnaire for hallux valgus surgery and has been translated into several languages. However, the MOXFQ has not been translated into Korean. In the present study, we aimed to translate and evaluate the validity and reliability of the Korean version of the MOXFQ for patients affected by hallux valgus. In accordance with the guidelines of cross-cultural adaptation, we translated the English version of MOXFQ into Korean and then backward translated it into English. We sent out letters that included the Korean version of the MOXFQ, a visual analog scale measure of pain, and a validated Korean version of the short-form 36-item Health Survey to 135 patients with hallux valgus. A retest was administered after 2 weeks. Of the 135 patients, 104 responded to the first questionnaire, and 82 of the first-time responders returned their second questionnaires. We evaluated the test–retest reliability, internal consistency, concurrent validity, and construct validity of the Korean version of the MOXFQ. The intraclass correlation coefficient for test–retest reliability was 0.82 for the total MOXFQ and ranged from 0.81 to 0.82 for the 3 subscales. Cronbach's alpha for the total MOXFQ was 0.85 and ranged from 0.8 to 0.92 for the 3 subscales. Concurrent and construct validity was supported by significant correlation with the visual analog scale and short-form 36-item Health Survey subscale scores. The Korean version of the MOXFQ was tested, and it was found to be a valid and reliable instrument for patients with hallux valgus.     

Reliability by surgical status of self-reported outcomes in patients who have shoulder pathologies

STUDY DESIGN: A test-retest design was used to evaluate the reliability of the self-report sections of 4 shoulder pain and disability scales. OBJECTIVE: The objective of the study was to compare interitem consistency and test-retest reliability by surgical status (postoperative versus nonoperative) and to evaluate the effect of surgical status in the prediction of retest scores. BACKGROUND: Patients and healthcare providers evaluate shoulder status based on self-evaluations of pain and disability. Shoulder outcome measures have been developed that include self-reports, but the properties of these measures have not been assessed by surgical status. METHODS AND MEASURES: A questionnaire containing self-report sections of 4 shoulder scales was administered to study participants twice with 1 week between administrations. The outcome measures examined were the: (1) University of California at Los Angeles (UCLA) Shoulder Score; (2) Constant-Murley Scale (CMS); (3) American Shoulder and Elbow Society (ASES) Shoulder Index; and (4) Shoulder Pain and Disability Index (SPADI). Intraclass correlation coefficients (ICC) were calculated to estimate the test-retest reliability of each of the scales and subscales. The interitem consistencies of the multi-item subscales were assessed using Cronbach's alpha. The effect of surgical status on shoulder outcome scale reliability was evaluated using a general linear models approach. RESULTS: The interitem consistency estimates for the multi-item scales were high with both operative and nonoperative participants (0.88 to 0.96). With the exception of the satisfaction subscale of the UCLA Shoulder Score for the nonsurgical group, the estimated intraclass coefficients ranged from 0.51 to 0.91. The prediction of UCLA-satisfaction and ASES-disability, pain, and total retest scores was improved with the addition of surgical status into a regression model. CONCLUSIONS: The examined scales exhibited good internal consistency across surgical status. The postsurgical sample's reproducibility estimates tended to be higher than those of the nonsurgical sample. Reliability of shoulder outcome scales can be affected by patient surgical status.     

„Western Ontario Shoulder Instability Index“ (WOSI)

Background

Outcome assessment after orthopaedic interventions is becoming more and more important. However, there are no disease-specific instruments for patient self-assessment of shoulder instability. The goal of our study was to translate and test the Western Ontario Shoulder Instability Index (WOSI) using a standardised approach. The guidelines of the American Association of Orthopedic Surgeons were used for the translation and cross-cultural adaptation process.

Material and method

Understanding was tested in 20 healthy subjects, and reliability and validity were quantified in 30 patients with shoulder instability. The quality of the translated version was described using the criteria of homogeneity, reliability, and construct validity.

Results

The test–retest reliability of the total score [intraclass correlation coefficient (ICC), 0.87] and of the subscores with the ICC (sports, leisure, and work 0.73; sensitivity 0.81; physical symptoms 0.82; and behaviour 0.90) was high. The internal consistency of the total scale was also high (Cronbach‘s alpha 0.89).

Conclusions

The WOSI covers a broad range of symptoms and impaired functioning in patients with shoulder instability. The German translation shows good results regarding understanding, homogeneity, reliability, and validity. Therefore, it is a useful instrument for self-assessment in patients with shoulder instability.     

Validation and reliability of a Japanese version of the Shoulder Pain and Disability Index: A cross-sectional study

BackgroundThe Shoulder Pain and Disability Index (SPADI) is a simple disease specific questionnaire that is used to evaluate the impact of shoulder disorders. The purpose of this study was to translate the SPADI into Japanese (SPADI-Jp) and evaluate its reliability and validity in Japanese patients with shoulder disorders.MethodsCross-cultural adaptation of the SPADI was performed according to international guidelines. A total of 100 patients with shoulder disorders participated in this study. Each participant was asked to finish the SPADI-Jp, Disability of Arm, Shoulder and Hand (DASH), and the Short-Form 36 (SF-36) at the initial visit. Thirty-four patients repeated the SPADI-Jp to assess the test–retest reliability. The test–retest reliability was quantified using the interclass correlation coefficient (ICC), while Cronbach's alpha was calculated to assess the internal consistency. The construct validity was assessed using Spearman's rank correlation coefficients.ResultsInternal consistency in the SPADI-Jp was very high (0.969), as measured by the Cronbach's alpha. The ICC of the SPADI-Jp was 0.930. There was a strong, positive correlation between the DASH and the SPADI-Jp (r = 0.837, p < 0.001). The SPADI-Jp was significantly correlated with most of the SF-36 subscales. The correlations of the SPADI-Jp with physical subscales of the SF-36 were stronger than those with the other subscales.ConclusionsWe demonstrated that the SPADI-Jp is a reliable and valid self-assessment tool. Because cross-cultural adaptation, validation, and reliability of the disease-specific questionnaire for shoulder pain and disability have not been evaluated in Japan, the SPADI-Jp can be useful for evaluating such patients in the Japanese population.     

The Penn shoulder score: reliability and validity

STUDY DESIGN: Psychometric evaluation of a cross-sectional survey. OBJECTIVES: The purpose of this study was to examine the psychometric properties of reliability and validity of the Penn Shoulder Score (PSS). BACKGROUND: Shoulder outcome measures are used to assess patient self-report levels of pain, satisfaction, and function. The PSS is a 100-point shoulder-specific self-report questionnaire consisting of 3 subscales of pain, satisfaction, and function. This scale has been utilized in the literature. However, the measurement properties of reliability and validity, including responsiveness, of the PSS subscales and overall scale need to be established. METHODS AND MEASURES: Patients (n = 40) with shoulder disorders undergoing a course of outpatient physical therapy completed the PSS at initial visit and again within 72 hours to assess test-retest reliability. The Constant Shoulder Score (CSS) and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were also completed at the initial visit and compared to the PSS to assess convergent construct validity. A separate cohort of patients (n = 109) completed the PSS at initial visit and 4 weeks later. These scores were used to assess internal consistency and responsiveness. RESULTS: Reliability analysis revealed a test-retest ICC2,1 of 0.94 (95% CI, 0.89-0.97). Internal consistency analysis revealed a Cronbach alpha of 0.93. The standard error of measurement (SEM) was +/- 8.5 scale points (based on a 90% CI) and the minimal detectable change (MDC) was +/- 12.1 scale points (based on a 90% CI). The minimal clinically important difference (MCID) for improvement was 11.4 points. Pearson product moment correlation coefficients between the PSS and the CSS and ASES were 0.85 and 0.87, respectively. Responsiveness analysis revealed an effect size of 1.01 and a standardized response mean of 1.27. CONCLUSIONS: This study has demonstrated that the PSS is a reliable and valid measure for reporting outcome of patients with various shoulder disorders.     

The Italian version of the Oxford 12-item Knee Questionnaire—cross-cultural adaptation and validation

Questionnaires must be translated and adapted to suit the cultural characteristics of different countries with different languages; they then need to be validated using a standard process. This was done for the Italian version of the Oxford Knee Questionnaire (OKQ), and its reliability and validity were assessed in a cross-sectional study of 50 consecutive patients referred for gonarthrosis and whose knees were replaced. A "subsample" of 20 patients was assessed prospectively to confirm the reliability of the Italian version, and these results were then compared with other clinical studies. The Italian OKQ scale correlated well with other clinical studies and also showed good results with regard to reproducibility, consistency, and validity when compared to the other published versions of the OKQ.     

Cross-cultural adaptation and validation of the Italian version of the Kerlan–Jobe Orthopaedic Clinic Shoulder and Elbow score

Background

The Kerlan–Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a reliable and sensitive tool to measure the performance of overhead athletes. The purpose of this study was to carry out a cross-cultural adaptation and validation of the KJOC questionnaire in Italian and to assess its reliability, validity, and responsiveness.

Materials and methods

Ninety professional athletes with a painful shoulder were included in this study and were assigned to the “injury group” (n = 32) or the “overuse group” (n = 58); 65 were managed conservatively and 25 were treated by arthroscopic surgery. To assess the reliability of the KJOC score, patients were asked to fill in the questionnaire at baseline and after 2 weeks. To test the construct validity, KJOC scores were compared to those obtained with the Italian version of the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, and with the DASH sports/performing arts module. To test KJOC score responsiveness, the follow-up KJOC scores of the participants treated conservatively were compared to those of the patients treated by arthroscopic surgery.

Results

Statistical analysis demonstrated that the KJOC questionnaire is reliable in terms of the single items and the overall score (ICC 0.95–0.99); that it has high construct validity (r _s = ?0.697; p < 0.01); and that it is responsive to clinical differences in shoulder function (p < 0.0001).

Conclusions

The Italian version of the KJOC Shoulder and Elbow score performed in a similar way to the English version and demonstrated good validity, reliability, and responsiveness after conservative and surgical treatment.

Level of evidence

II.

     

American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form,patient self-report section: reliability,validity, and responsiveness

The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), patient self-report section. Patients with shoulder dysfunction (n = 63) completed the ASES, The University of Pennsylvania Shoulder Score, and the Short Form-36 during the initial evaluation, 24 to 72 hours after the initial visit, and after 3 to 4 weeks of physical therapy. The test-retest reliability (intraclass correlation coefficient[1-way random-effects], 0.84; 95% CI lower limit, 0.75) and internal consistency (Cronbach alpha, 0.86) values were acceptable. The standard error of the measure was 6.7 ASES points (90% CI, 11.0). Construct and discriminant validity was demonstrated. Responsiveness was demonstrated with a standardized response mean of 1.5 and an effect size of 1.4. The minimal detectable change was 9.7 ASES points (90% CI, 16), and the minimal clinically important difference was 6.4 ASES points. The results indicate that the ASES is a reliable, valid, and responsive outcome tool.     

Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH)

We developed a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH) by performing cross-cultural adaptation and evaluated the reliability and validity of the K-DASH. The K-DASH, SF-36, and Visual Analog Scale (VAS) for pain were administered to 161 patients with arm, shoulder, and hand problems. The internal consistency of the disability/symptom scores of the K-DASH was high (Cronbach's alpha 0.94). The retest assessed 131 of the 161 patients. The intraclass correlation coefficient was 0.91. The construct validity was evaluated using the correlations between the K-DASH and the SF-36 and VAS. The physical and mental component summary scales of the SF-36 and the VAS at rest and during activity were significantly correlated with the DASH disability/symptom scores. Despite the linguistic and cultural differences, the reliability and validity of the K-DASH were just as excellent as those of the original DASH.     

Reliability and validity of Turkish version of the Scoliosis Japanese Questionnaire- 27 in patients with adolescent idiopathic scoliosis

BackgroundThe aim of this study was to evaluate the reliability and validity of an adapted Turkish version of the Scoliosis Japanese Questionnaire- 27 (SJ- 27).MethodsTranslation and retranslation of the English version of the SJ- 27 was conducted, and all steps of the cross-cultural adaptation process were performed. The Turkish version of the SJ- 27, the Scoliosis Research Society-22 (SRS- 22) questionnaire and the Short Form-36 (SF- 36) were performed to 139 patients with AIS. Reliability was assessed using the test–retest method (Pearson's correlation coefficient); internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the SJ- 27 with the SRS- 22 questionnaire and SF- 36.ResultsThe mean Cobb angles were 23.2 ± 8.3° and 19 ± 5.9° for thoracic and lumbar regions, respectively. The SJ- 27 showed excellent test/retest reliability with an Intraclass correlation coefficient of 0.99. Internal consistency of the SJ- 27 was found to be very good (Cronbach's alpha = 0.991). The SJ- 27 demonstrated very good construct validity with the SRS- 22 total score (r = 0.61). The similar domains of the SJ- 27 and SF- 36 questionnaire was correlated also in the study.ConclusionsThe Turkish version of the SJ- 27 to measure health related quality of life in adolescent idiopathic scoliosis was found to have very good validity, excellent reliability, and high internal consistency.     

The cross-cultural adaptation of the DASH questionnaire in Canadian French.

The purpose of this study was to perform a cross-cultural adaptation of the original version of the Disability of Arm, Shoulder and Hand (DASH) questionnaire to Canadian French. The cross-cultural adaptation followed five steps: forward translations into Canadian French, a synthesis of the translations, back translations into English, revision by a committee of experts, and test of the prefinal version. The content validity and the internal consistency of the Canadian French version of the questionnaire were assessed by experts involved in the study and by subjects who participated in the pilot study. Results indicate that the scores were adequately distributed without floor or ceiling effect. Item completion was excellent and item responses had a good distribution. Internal consistency of the total score was high (Cronbach alpha = 0.94) and item-total correlations were substantial for most items (0.43-0.88). These results are similar to previous studies on the DASH questionnaire supporting linguistic and conceptual equivalence of the Canadian French version.     

The measurement of normative American Shoulder and Elbow Surgeons scores

We determined baseline scores on the American Shoulder and Elbow Surgeons (ASES) questionnaire in individuals who had no known shoulder condition and evaluated related factors that could influence the score. A modified version of the questionnaire was completed by 343 patients from an outpatient orthopaedic center being seen for conditions unrelated to the shoulder. A separate group completed the questionnaire at two different times to assess its reliability. The mean ASES score was 92.2 +/- 14.5 points. The instrument was found to be very reliable (intraclass correlation coefficient = 0.96). Only the variables of shoulder status and sports participation entered the regression model to explain the variance in scores. Subjects aged 60 years or older exhibited decreased ability to lift above shoulder level and reach behind the back when compared with younger cohorts. Previous investigators have made the assumption that a normal preinjury ASES score is 100 points. This study raises questions about this assumption. This information can serve as a basis to compare normative scores with those of patients with active shoulder disease.     

Validity and reliability of the loco-check questionnaire after cross-cultural adaptation for Indonesia

BackgroundA large number of the elderly in Indonesia are affected by an increasing number of disabilities, with reduced mobility being one of the causes. Locomotive syndrome may cause decreased mobility, and its progression can impair the activities of daily living. Early screening is essential to halt its progression. The loco-check, a screening tool for locomotive syndrome, is available in English. A cross-cultural adaptation of this tool for an Indonesian version is important to maintain the validity of the questionnaire for its implementation in Indonesia. The aim of this study was to obtain a valid Indonesian version of the loco-check questionnaire that has been adapted as per Indonesian language and cultural conventions (through a cross-cultural adaptation process).MethodsThe subjects in the study were community-dwelling geriatrics over 65 years of age who were recruited using consecutive non-probability judgment sampling according to the inclusion criteria. This study, conducted from February to October 2019, was divided into two stages consisting of: (1) language and cultural adaptation; (2) validity and reliability testing. The seven items on the loco-check were translated using forward-backward translation. The final questionnaire was generated through an expert panel discussion. The validity and reliability were evaluated using concurrent validity and Cronbach's alpha using SPSS Version 23.0.ResultsIn the first stage, the first and second trials showed a strong correlation between the English and Indonesian versions of the questionnaire with r = 0.997 (p < 0.001) and r = 0.825 (p = 0.003), respectively. The final Indonesian version of the loco-check had a good validity and reliability with r = 0.981 (p < 0.001) and Cronbach's alpha of 0.768, respectively.ConclusionThe Indonesian cross-cultural adaptation of the loco-check questionnaire is a valid and reliable general questionnaire that could enable screening for locomotive syndrome in Indonesia.     

The Patient-Rated Tennis Elbow Evaluation Questionnaire was successfully translated to Persian

IntroductionThe Patient-Rated Tennis Elbow Evaluation (PRTEE) is designed to evaluate pain and disability in subjects with lateral elbow tendinopathy. This questionnaire is available in Swedish, Italian, and some other languages. A Persian language version of the questionnaire is needed for both research and clinical purposes.Purpose of the StudyThe purpose of this study was to translate and cross-culturally adapt the PRTEE questionnaire into the Persian language and to determine its validity and reliability.MethodsThe PRTEE was translated and culturally adapted from English into Persian (PRTEE-P) according to the established guidelines. The PRTEE-P was completed by 68 Iranian subjects (44 women, 24 men) diagnosed with chronic lateral elbow tendinopathy. To assess test-retest reliability, all subjects filled out the PRTEE-P on a second admission within one week. The intraclass correlation coefficient (ICC) and Cronbach's alpha were measured to report reliability. The validity was determined by correlating the PRTEE-P questionnaire with the Persian version of the Disabilities of the Arm, Shoulder, and Hand questionnaire.ResultsThe Persian version of the PRTEE showed a high internal consistency with a Cronbach's alpha of 0.99, demonstrating good test-retest reliability (ICC = 0.99). It was well correlated with Disabilities of the Arm, Shoulder, and Hand (r = 0.80).ConclusionThe PRTEE-P is a reliable and valid tool designed for measuring pain and disability in subjects with lateral elbow tendinopathy.