Cultural adaptation, translation and validation of a functional outcome questionnaire (TESS) to Portuguese with application to patients with lower extremity osteosarcoma

Background. Evaluation of physical functioning is an important tool for planning rehabilitation. Instruments need to be culturally adapted for use in non-English speaking countries. The aim of this study was to culturally adapt, including translation and preliminary validation, the Toronto extremity salvage score (TESS) for Brazil, in a sample of adolescents and young adults treated for lower extremity osteosarcoma. Procedure. The process included two independent forward translations of TESS questionnaire, consensus between translators on a forward translation, back-translation by two independent translators, and a review of the back-translations. Internal consistency of the TESS and known groups validity were also evaluated. Results. internal consistency for the 30 item TESS was high (coefficient alpha=0.87). TESS score ranges from 0 to 100. Forty-eight patients completed the questionnaire and scores ranged from 56 to 100 (mean score: 89.6). Patients receiving no pain medications scored higher on the TESS than those who were receiving pain medication (P=0.014), and patients using walking aids had slightly higher but not statistically different scores. Those who were treated with amputation had higher scores than those who were treated with limb salvage procedures (P=0.003). Conclusion. Preliminary evidence suggests that Brazilian-Portuguese translation is acceptable, understandable, reliable, and valid for evaluating the function in adolescents and young adults with osteosarcoma in lower extremity in Brazil.