(P 208) TRANSLATION, CROSS CULTURAL ADAPTATION AND VALIDATION OF TESS IN REGIONAL INDIAN LANGUAGES WITH ~500 MILLION GLOBAL DIASPORA

Objective: The Toronto-Extremity-Salvage-Score (TESS), a patient-reported-outcome-measure in patients with surgery for an extremity tumor, has not been validated in regional Indian languages Hindi (600 million worldwide-speakers) and Marathi (100 million worldwide-speakers) with a global diaspora. We translated, culturally adapted and validated TESS for Indian patients in English, Hindi and Marathi to allow international comparison of results. We evaluate 1. Test-retest reliability 2. Internal-consistency 3.Construct-validity 4. External-validity with Musculoskeletal-Tumour-Society-Score (MSTS); for the translated versions.

Methods: We developed Hindi and Marathi versions of TESS using standard process of translation, synthesis, back-translation, expert review and appraisal. 400 patients were administered TESS twice, at day 0 and at 2 weeks (for test-retest reliability). After data attrition, responses were analysed in 387 (80
English, 198 Hindi and 109 Marathi). Reliability was measured using Intraclass-correlation-coefficient (ICC), internal-consistency using Cronbach’s alpha (Ca), construct-validity using Kaiser’s-
criteria (Eigenvalue >1 rule), Scree-Plots for factor-analysis, external-validity against MSTS using Bland-Altman-plots and criterion-validity Spearman’s-Rho.

Results: The reliability and consistency were excellent both for Hindi and Marathi (ICC 0.91 Upper-Extremity, 0.92 Lower-Extremity, Cronbach’s-alpha 0.96 Upper-Extremity and 0.94 Lower-Extremity). Construct-validity was excellent with Kaiser-criteria of 0.8, Bartlett’s-test (p < 0.0001), Scree-plot elbow of 3 domains. External-validity against MSTS was excellent with Bland-Altman-plot showing less than 5% disagreement and a Spearman’s-Rho of 0.4 Hindi and 0.41 Marathi (p < 0.0001).

Conclusion: The Hindi , Marathi TESS-versions are reliable, consistent and valid in measuring patient reported functional outcome for patients treated with surgery for an extremity tumor.