Cross-cultural adaptation and validation of the Turkish version of the Toronto Extremity Salvage Score in patients with musculoskeletal tumors

Objective: The aim of the study was to translate the Toronto Extremity Salvage Score (TESS) into Turkish and perform across-cultural adaptation for patients with musculoskeletal tumors. Methods: Thirty-six patients (20 male, 16 female; mean age = 36.6 +/- 15.4 years) who were diagnosed with malignant bone and soft tissue sarcoma or benign aggressive bone tumors between the years 2007 and 2012 were included in the study. TESS was translated into Turkish and back translated to determine language validity. To test convergent validity, the Turkish versions of the Short Form 36 (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Disabilities of the Arm, Shoulder and Hand (DASH) were used. SF-36 was used on all patients while WOMAC and DASH were used onpatients with lower extremity tumors and upper extremity tumors respectively. The tests were repeated 15 days later and the intraclass correlation coefficient (ICC) was used to determine test-retest reliability. Results: The Turkish version of TESS was found to have a strong negative correlation with WOMAC (r = 0.702; P < 0.001) and DASH (r = 0.774; P < 0.001) as well as a strong negative correlation with ROMS (r = 0.601; P < 0.001). Turkish TESS also had a statistically significant correlation with SF-36-Physical functioning, SF-36-Role Physical, SF-36-Bodily Pain, and SF36-General Health at levels ranging from 0.326 to 0.669 (r values ranging from 0.326 to 0.669, P < 0.001). The internal consistency (Cronbach's a:0.96 for lower extremity and Cronbach's a:0.94 for upper extremity) and test-retest reliability of Turkish TESS were found to be excellent (ICC lower extremity: 0.96 [0.935 0.9831; P < 0.001 and ICC upper extremity: 0.99 [0.967 0.9971; P < 001). ICC values varied between 0.674 and 0.967 for each item of the scale for both extremities. Conlusion: The Turkish version of TESS seems to be a valid and reliable patient-reported outcome measure to evaluate physical function after musculoskeletal tumor surgery in Turkish patients.