Translation, cultural adaptation, and validation of the Persian version of the 4-Domain Sports PROM questionnaire

Although most Patient-Reported Outcome Measures (PROMs) in sports medicine are anatomy-specific and limited in scope, the 4-Domain Sports PROM (4-DSP) offers a comprehensive, athlete-centered, and anatomy-independent alternative. Validating the Persian version addresses a critical need for Iran's substantial athletic community, which experiences a high prevalence of sports-related injuries.

To translate, culturally adapt, and validate the Persian 4-DSP for Persian-speaking athletes.

Cross-sectional observational study following COSMIN and STROBE guidelines.

Following Beaton and ISPOR guidelines, the 4-DSP underwent forward-backward translation. Psychometric evaluation involved 112 Persian-speaking athletes (61 men, 51 women; mean age: 27.45±4.52 years) with orthopedic injuries 3-12 months prior. Face validity was assessed by 20 athletes using I-FVI. Content validity was evaluated by 10 experts using I-CVI, S-CVI/Ave, S-CVI/UA, and modified Kappa. Test-retest reliability was assessed using ICC with 24-48-hour intervals. Internal consistency (Cronbach's alpha), measurement error (SEM, MDC), feasibility (missing data), and interpretability (floor/ceiling effects) were also evaluated. Analyses were performed using SPSS v29.

All items showed acceptable face validity (I-FVI≥0.83); scale-level indices were excellent (S-FVI/Ave=0.95, S-FVI/UA=0.36). Content validity was robust (I-CVI≥0.78, S-CVI/Ave=0.95, modified kappa=0.94; S-CVI/UA=0.45). Test-retest reliability was excellent for the total score (ICC=0.91; 95% CI: 0.87-0.94) and good-to-excellent across domains (ICC: 0.84-0.93). Internal consistency was acceptable (α=0.77). Missing data were <2%, and no floor/ceiling effects were detected (<15%). SEM and MDC values supported clinical interpretation.

The Persian 4-DSP demonstrates excellent face and content validity, very good reliability, and acceptable internal consistency, supporting its use as a feasible, culturally adapted tool for assessing treatment outcomes in Persian-speaking athletes. Future research should address convergent validity and responsiveness to fully establish construct validity.