Cross-Cultural Adaptation and Validation of the Chinese Version of the Exercise Adherence Rating Scale (EARS) in...

Adherence is central to the effectiveness of prescribed pelvic floor muscle training after radical prostatectomy, yet standardized tools for assessing home-exercise adherence in older Chinese patients are limited. The Exercise Adherence Rating Scale (EARS) is a brief patient-reported measure of adherence behavior. This study aimed to culturally adapt the EARS for Chinese use and evaluate its reliability and validity among older patients with post-prostatectomy urinary incontinence.

The EARS was translated and culturally adapted through forward translation, back-translation, multidisciplinary expert review, and pre-testing. Psychometric properties were evaluated in 177 older patients with post-prostatectomy urinary incontinence. Content and structural validity were assessed using content validity indices and confirmatory factor analysis for ordered categorical data, respectively. Reliability was evaluated using Cronbach's α, odd-even split-half reliability, and two-week test-retest reliability in 30 participants. Pearson correlations examined associations between the supplementary reasons items and the six-item adherence score.

The mean six-item score was 15.71 ± 5.92. The item-level content validity index ranged from 0.883 to 1.000, and the average scale-level index was 0.990. The prespecified one-factor model showed good fit: comparative fit index = 1.000, Tucker-Lewis index = 1.013, root mean square error of approximation = 0.000 (90% confidence interval, 0.000-0.101), and standardized root mean square residual = 0.036. Standardized factor loadings ranged from 0.355 to 0.872 (all P < 0.001). Internal consistency and split-half reliability were acceptable (Cronbach's α = 0.787; Spearman-Brown coefficient = 0.811), and test-retest reliability was good (intraclass correlation coefficient = 0.879; 95% CI, 0.762-0.940; P < 0.001). Confidence, perceived health benefits, and enjoyment showed the strongest correlations with adherence (r = 0.448-0.554; all P < 0.01).

The EARS-C demonstrated satisfactory content validity, acceptable internal consistency, good reproducibility, and support for the original one-factor structure in this single-center sample. These findings support its use for assessing self-reported exercise adherence while independent multicenter confirmation is pursued.