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Cross-cultural adaptation and validation of the Arabic version of the Pennsylvania Shoulder Score
Marc Boutros1, Guy Awad1, Caren Hassan1
1Faculty of Medicine, Université Saint-Joseph, Beyrouth, Lebanon.
Background:
The Pennsylvania Shoulder Score is a common patient-reported measure of shoulder pain, function, and satisfaction. Cross-cultural adaptation is essential for non-English-speaking populations.
Methods:
This prospective cross-sectional validation of the Arabic Pennsylvania Shoulder Score (PSS-AR) followed translation and cultural adaptation steps. Adults ≥18 years with shoulder pain/dysfunction were recruited from two outpatient clinics. Participants completed the PSS-AR (Pain 0-30; Satisfaction 0-10; Function 0-60; Total = sum, higher = better) and Arabic Simple Shoulder Test (SST-AR; 0-100). Readability was assessed using Automatic Arabic Readability Index (AARI). Stable participants repeated PSS-AR after 5-10 days.
Results:
219 patients participated; 102 stable individuals completed retesting. AARI showed readability levels of grade 5.24 for PSS-AR and 2.92 for SST-AR, below the recommended sixth-grade threshold. Function showed excellent internal consistency (Cronbach's α=0.96). Exploratory factor analysis supported essential mono-dimensionality: Factor 1 explained 54.90% of variance (factor 2 + 5.19%; cumulative 60.09%) with loadings 0.47-0.85. Convergent validity with SST-AR was strong (Spearman ρ: Total 0.792, function 0.788, pain 0.538; all p < 0.0001). Test-retest reliability was excellent: ICC(2,1) = 0.95 (95% confidence interval 0.93-0.97). Mean change was minimal (Δ=-0.47 ± 9.36) without systematic shift (F = 0.09, p = 0.76). SEM was 4.98; MDC individual=13.80 and MDC_group=1.37.
Conclusion:
The PSS-AR is reliable, valid, and culturally appropriate for Arabic-speaking patients.
