Cross-Cultural Adaptation and Preliminary Validation of the Arabic Version of the Amputee Body Image Scale

Background. Assessing the patient’s perceived body image is essential to measure the impact of lower limb amputation on quality of life and psychological well-being. Objective. The aim of this study was to develop a Spanish version of the Amputee Body Image Scale (ABIS-E) for Spanish-speaking lower limb amputees. Methods. A cross-sectional study was conducted including amputee patients in Madrid, Spain. Clinical outcomes of body image (Amputee Body Image Scale, ABIS), health-related quality of life (EuroQol-5D-5L), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), pain (Brief Pain Inventory-Short Form, BPI-SF), and functional capacity (Prosthesis Evaluation Questionnaire, PEQ) were collected. Results. Seventy-three participants were assessed. Excellent test–retest reliability (ICC = 0.847) and good internal consistency (Cronbach’s alpha = 0.753) were obtained. Factor analyses extracted three factors. Convergent validity with Pearson’s and Spearman’s correlation coefficients were calculated for depression and anxiety questionnaires (HADS) (values between 0.57 and 0.67), functional capacity (PEQ) (values between −0.35 and 0.71), and quality of life (EQ-5D-5L) (values between −0.37 and 0.61). Conclusions. The ABIS-E is a reliable and valid instrument to measure body image in the Spanish population with lower limb amputation, potentially useful in primary care to identify psychosocial problems.

The Amputee Body Image Scale (ABIS) is a self assessed questionnaire with 20 items created to measure body image perception of amputees. The questions assess how an individual perceives and feels about his or her body experience. But no Turkish version is available. The aim of this study was to cross-culturally adapt the ABIS for use with Turkish speaking lower limb amputees and to determine reliability. The sample consisted of 50 transtibial amputees. The mean age of the participants was 43.14, SD: 14.66. The ABIS has been filled by the patients for two times. Internal consistency of the ABIS was very high (Cronbach alpha 0.834 for test and 0.842 for retest). The test-retest reliability was excellent for the ABIS (ICC = 0.939, 95% CI 0.895-0.965). The Turkish version of the ABIS is a reliable instrument to assess body image in lower limb amputees.

Introduction: Limb amputation not only brings functional and sensory loss, but also leads to loss or change of body image. These changes have significant effect on the Quality of Life (QoL) of an individual. Amputee adaptation varies widely between individuals. For an amputee a prosthesis not only bring back near normal physical appearance but also it significantly repair his disturbed body image. There is a significant correlation between body image and life satisfaction. Aim: To investigate the correlation between body image and prosthetic satisfaction among lower limb amputee. Materials and Methods: This cross-sectional study was conducted from July 2018 to January 2020 at King George’s Medical University, Lucknow, Uttar Pradesh, India. Participants with unilateral lower limb prosthesis using amputees of either sex from Regional Artificial Limb Centre, Lucknow were included in the study. Each participant was subjected offline questionnaire based assessment of satisfaction with respect to their prosthesis related to it`s function, aesthetic (cosmesis), weight of prosthesis and general (overall) by Revised Trinity Amputation and Prosthesis Experience Scale (R-TAPES). Change in body image was assessed by Amputee Body Image Scale (ABIS). Results were analysed by computer-based software Statistical Package for the Social Sciences (SPSS) windows version 20.0. Analysis of Variance (ANOVA) t-test was used for normally distributed and Mann-Whitney U test was used for abnormally distributed variables. Results: The study enrolled 119 patients in which the most common cause of amputation was an accident (69). Statistically significant difference was found for satisfaction between males and females for weight of prosthesis (p-value=0.038). Statistically significant difference was found between male and female for amputee body image with ABIS score (p-value=0.001). Significant correlation was found between ABIS and functional satisfaction (p-value=0.001; r=-0.38)) and between ABIS and weight satisfaction (p-value=0.001; r=-0.36). Conclusion: Amputation causes significantly deterioration of body image among the amputee, with such deteriorated body image prosthetic satisfaction remains a big challenge for healthcare worker and prosthetist.

Background: The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. Our aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F).Methods: Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations. Construct validity was assessed by measuring the correlation between ABIS-F or ABIS-R-F scores and quality of life, pain, anxiety, and depression. Internal consistency was measured with Cronbach’s α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability.Results: A highest body image disturbance was associated with lowest quality of life, higher pain, and higher anxiety, and depression. Cronbach’s α was 0.91/0.89 (ABIS-F/ABIS-R-F). The standard error of measurement was 5.35/2.28 (ABIS-F/ABIS-R-F). The smallest detectable change was 14.82/6.31 (ABIS-F/ABIS-R-F). The mean difference in ABIS-F score was −3.90 with limits of agreement from −18.71 to 10.92. For ABIS-R-F, the mean difference was −2.12 with limits of agreement from −8.43 to 4.19. Intraclass correlation was 0.87/0.82 (ABIS-F/ABIS-R-F).Conclusions: The French versions ABIS-F and ABIS-R-F share similar psychometric properties, both are as reliable, but ABIS-R-F has a better response structure and is more feasible.Implications for rehabilitationThe quality of life of amputees is impacted by their satisfaction with body imageThe Amputee Body Image Scale questionnaire measures this perception and is available for French-speaking amputeesThe Standard Errors of Measurement proposed could be useful for clinical and research purposesBoth ABIS and ABIS-R showed satisfactory construct validity, internal consistency, and reliabilityThe shortened version has a better response structure and is more readily feasible.

Objective: To adapt the Amputee Body Image Scale (ABIS) into Turkish and to assess the reliability of the original and revised Amputee Body Image Scale (ABIS-R) in lower limb amputees. Method: Turkish version of the ABIS (20 items; ratings of 1?5) was administered to 91 lower-limb amputee patients wearing prosthesis. One month later, retest was applied to 37 patients. SF?36 was also administered to 37 patients for validity. The scores have been reevaluated for the reliability of the ABIS-R (14 items; ratings of 0?2). Results: Turkish version of the ABIS and ABIS-R fitted the unidimensional construct that the scale was intended to measure and demonstrated good reliability. Cronbach?s alpha was 0.88 for the ABIS and 0.86 for the ABIS-R. Items-total correlation ranged from 0.25 (item 3) to 0.75 (items 8 and 14) for the ABIS. Items-total correlation ranged from 0.33 (item 3) to 0.76 (items 6 and 8) for the ABIS-R. Test-retest correlation coefficient was 0.78 for the ABIS and 0.74 for the ABIS-R. Negative correlations with SF-36 subscales ranged from 0.33 (mental health) to 0.60 (physical functioning) for the ABIS and ranged from 0.31 (mental health) to 0.60 (physical functioning) for the ABIS-R. Conclusions: We conclude that the Turkish versions of ABIS and ABIS-R demonstrate good reliability for measuring body image disturbances in individuals with lower-limb amputations. Moreover, the two scales displayed significant correlations with SF?36.

The aim of this study was to examine the psychometric properties of the Amputee Body Image Scale (ABIS) through Rasch analysis, investigating the quality of its rating categories and its reliability and validity. The ABIS (20 items; ratings of 1-5) and Trinity Amputation Prosthesis Experience Scales (TAPES) were administered by post and completed by 145 people with a lower-limb amputation and currently wearing a prosthesis. According to Rasch analysis and expert review, some response categories were collapsed and six items were deleted. The remaining 14 items created a revised ABIS (ABIS-R) rated with a three-level rating scale. ABIS-R fitted the unidimensional construct that the scale was intended to measure and demonstrated good reliability (Cronbach's alpha and person separation reliability = 0.87), targeting, and internal construct validity. Moreover, the correlations with the nine TAPES subscales (in particular, r = -0.54 with the general adjustment, r = -0.43 with the social activity restriction, and r = -0.40 with social adjustment) supported the convergent validity of ABIS-R. The 14-item ABIS-R demonstrates good psychometric characteristics for measuring body image disturbances in people with lower-limb amputation. These preliminary results suggest the general adequacy of the new instrument and provide a good foundation on which further validation and psychometric studies of the ABIS-R can be conducted.

Negative cognitions related to one’s own body, here referred to as body image disturbances (BID), are common after lower limb amputation and correlate with weak psychological functioning. The Amputee Body Image Scale (ABIS) is internationally used to assess BID in persons with lower limb amputation. However, there is no psychometrically evaluated German adaptation available. Including a sample of 191 individuals with lower limb amputation, the present study developed and psychometrically evaluated the German ABIS. Results suggest high reliability in terms of internal consistency and stability of the measure over two years. Meaningful and significant relationships to sex, amputation level, post-amputation pain, mobility, and psychopathology indicate validity of the instrument. Multivariate analyses emphasize a specific and inverse relationship between BID and psychosocial adaptation to the prosthesis including its embodiment. Focussing on ABIS items that are independent of the type of amputation or rehabilitation experiences resulted in an ABIS short form with psychometric properties comparable to the long form. This instrument could be prospectively used in diverse limb loss populations, such as individuals with upper limb amputation or persons not using a prosthesis. The present results thus crucially contribute to the repertoire of patient-reported outcome measures in the context of post-amputation rehabilitation.

The relationships between body image, self-esteem and quality of life in adults with trauma-related limb loss sustained in the Syrian war

Introduction This study aimed to translate and cross-culturally adapt the Arabic version of the Prosthesis Embodiment Scale for Individuals with lower-limb amputation (AR-PEmbS-LLA) and evaluate its validity and reliability. Methods The AR-PEmbS-LLA was developed using a forward-backward translation process, expert reviews, and pilot testing with 10 individuals with lower-limb amputation (LLA). A cross-sectional, correlational study was conducted with 60 Lebanese adults with major LLAs who used prosthetic devices. Participants completed the AR-PEmbSLLA and the Houghton scale for prosthetic use, the revised Trinity Amputation and Prosthesis Experience Scale (TAPES-R) for adjustment and satisfaction, and the Locomotor Capabilities Index (LCI) for locomotor abilities. Internal consistency, test-retest reliability, and exploratory factor analysis were performed to assess the psychometric properties of the AR-PEmbS-LLA. Convergent validity was evaluated using Spearman correlations with the other scales. Results The AR-PEmbS-LLA demonstrated high internal consistency (Cronbach α = 0.97) and test-retest reliability (intraclass correlation coefficient = 0.95, P < 0.01). Exploratory factor analysis confirmed a single-factor structure explaining 78.23% of the variance. Significant correlations were found with TAPES-R general adjustment (r = 0.37, P < 0.001), social adjustment subscales (r = 0.33, P = 0.001), and the LCI basic activities score (r = 0.39, P < 0.001), and the LCI advanced activities score (r = 0.35, P < 0.01). Conclusions The AR-PEmbS-LLA is a reliable and valid instrument for assessing prosthesis embodiment in Arabic-speaking individuals with LLA. It can be effectively used in clinical and research settings to understand and enhance the prosthesis integration experience. Clinical Relevance The AR-PEmbS-LLA represents a valuable addition to the limited toolkit for evaluating and optimizing prosthetic outcomes in Arabic-speaking individuals with LLA, enhancing clinical practice and research endeavors in this field.

Cross-cultural adaptation and validation of the Amputation Body Image Scale (ABIS®) and its shortened version (ABIS-R®)for French speaking patients with lower limb amputation

Problems related to quality of life and body images of amputee patients are important. This study was performed to assess body image and quality of life with problems experienced of patients with lower limb amputation. This study was performed using mixed quantitative dominant study design. The study was carried out in orthopedics and cardiovascular surgery units of a university hospital. Quantitative data were collected from 30 patients via questionnaires including the Short Form-36 Quality of Life (SF-36 QoL) and Amputee Body Image Scale (ABIS) tools. Qualitative data were gathered from 20 patients using an interview form. In this research, quantitative data have been analyzed by using a statistical program and qualitative data have been analyzed by using content analysis. Age mean of 30 patients with amputation 47.23±16.08. They were 80 % male, 70% have a chronic illness, 63.3% knee disarticulation or transfemoral amputation, and 53.3% use prosthetic. The average SF-36 QoL sub-dimension scores of the patients were: physical 30.11±20.00, social 36.66±27.45, physical roles 18.33±30.03, emotional roles 37.77±22.71, mental health 48.0±22.89, vitality 36.50±20.64, pain 48.13±28.33, and general health 43.96±28.59. The ABIS average score was 60.1±19.62. The most common problem of patients after amputation involves issues related to motion. Three main categories of patients experience with amputation were designated that the reactions after learning that the amputation will be done, problems experienced in the early period after amputation and post-discharge problems. Quality of life of patients with amputation was below the intermediate level. Deterioration in body image perception was above average. The most common problem after amputation was issues related mobilization. Training related the amputation process and social support might significantly reduce problems with amputation.

Background: Lower limb amputation is a great event in the life of individual’s which having an counteractive effect on overall physical, psychological and social functioning of an individual so the study aim is to measure relation of motor capabilities of lower limb amputated patients on body image and depression level. Methods: Design: The descriptive correctional research design was utilized to achieve the aim of the study. Sample: A convenient sample of sixty four participant consisted of male and female adult amputee patients. Setting : This study was conducted in Rheumatology and Rehabilitation Department at Minia University Hospital. Tools of data collection: Three scales and one tool were utilized; Bio socio-demographic characteristic and structured interview, Locomotor Capabilities Index, Amputee Body Image Scale and Beck Depression Inventory (BDI) scale. Results: 73.5% of the amputated patients have low locomotor capabilities while 93.7% of the study sample has a low body image and 31.2% of the study sample suffers from moderate depression after 6 month from amputation and high positive significant correlation between locomotor capabilities and body image, while that there was a high negative significant correlation between locomotor capabilities and depression level among the imputed patients. Conclusions: The recent amputee patients that are have lower limb prosthesis suffer from low locomotor capabilities and theses have negative impact on their body image and depression level. Recommendation: A well planned structured rehabilitation program should be done to the specific needs of people with limb amputation in order to be able to find out its impact on their functional abilities, body image and depression level. Keywords: Amputation, locomotors capabilities, Body image, Depression. DOI : 10.7176/JHMN/64-03 Publication date :July 31 st 2019

Background: Body image perceptions and satisfaction are known to influence health behaviors; however, data on body image concerns in medical students, especially in the Middle East, are scarce, with no studies on the differences in body image perceptions and satisfaction across the years of medical training. Objectives: The objective was to study the body image concerns and weight control behaviors among medical students in a private medical college in Oman and analyze differences among various groups of medical students (premedical, preclinical, and clinical). Materials and Methods: A cross-sectional study was conducted among students of a private medical college in Oman. Information regarding their body image perceptions, image satisfaction, and attempts to control weight was obtained through a self-administered questionnaire. Students' responses on self-reported body mass index (BMI), perceived body image, body image satisfaction, and weight control measures were collected, tabulated, analyzed, and interpreted. Results: A total of 351 medical students participated in the study (mean age of 21.56 ± 2.2 years, mean BMI of 22.7 ± 4.3 kg/m2, 87.7% females), of these 129 (36.8%), 112 (31.9%), and 110 (31.3%) students belonged to the premedical, preclinical, and clinical years, respectively. There were 226 (64.4%) students with normal BMI, 43 (12.3%) were underweight, and 82 (23.3%) overweight/obese. Incorrect image perceptions were observed in 204 (58.1%). One hundred and nine students (31.1%) were dissatisfied with their body image and 245 (69.5%) attempted to lose weight (earlier/currently). Perceived body image and body image satisfaction were significantly associated (P < 0.001); however, there was no association of body image perceptions/image dissatisfaction with self-reported BMI. Weight control measures such as exercise, calorie restriction, fasting, crash diet, and liquid diet were noted. Attempts to change weight were significantly related to students' perceived image (P < 0.001) and body image satisfaction (P = 0.011) but not to their self-reported BMI. No differences were found between students belonging to premedical, preclinical, and clinical years with respect to their body image perceptions, image satisfaction, BMI, attempts to change weight, and weight control methods (except fasting). Conclusions: Results indicate that body image misperceptions (58.1%) and image dissatisfaction (31.1%) exist among our medical students from Oman. Exposure to the knowledge of body image issues and eating disorders during their medical training did not positively impact their image perceptions/image satisfaction and weight control attempts across the years of study. This underlines the need to revise the medical curriculum through the introduction of awareness modules and psychoeducation sessions focusing on body image issues and healthy weight control behaviors.

Outcomes and evaluation in lower limb amputees

Purpose The purpose of this study was to cross-culturally adapt and validate the Simplified Chinese version of the Lower Extremity Functional Scale (SC-LEFS). Methods The original English version of the Lower Extremity Functional Scale was translated and cross-culturally adapted into Simplified Chinese according to international guidelines. The SC-LEFS and 36-Item Short-Form Health Survey were administered to 213 patients with lower extremity musculoskeletal disorders. Psychometric properties including internal consistency, test-retest reliability, content validity, and construct validity were tested. Results There were no floor or ceiling effects for the SC-LEFS. The scale had high values for internal consistency (Cronbach α = 0.97) and test-retest reliability (intraclass correlation coefficient = 0.97). Corrected item-total correlations for every item ranged from 0.67 to 0.89. And the item-level content validity index (I-CVI) for each item ranged from 0.78 to 1.00. Principal component analysis revealed a one-factor structure. Nine of ten prior hypotheses were confirmed, which further supports good construct validity within the SC-LEFS. Conclusion The SC-LEFS has high internal consistency, good test-retest reliability and content validity, convergent construct validity, and a one-factor structure. Thus, it could be regarded as a reliable and valid tool to assess activity limitations in Chinese patients with lower extremity musculoskeletal disorders.