Cross-cultural Adaptation Research Articles

Reliability and validity of the Arabic version of the Swiss spinal stenosis questionnaire among Saudi patients with lumbar spinal stenosis

Objectives: The Swiss spinal stenosis questionnaire (SSSQ) is a standard tool to assess the severity of symptoms, physical function characteristics, and satisfaction in patients suffering from lumbar spinal stenosis. The aim was to perform a cross-cultural adaptation and validation of the Arabic version of the SSSQ and test it on Saudi patients with lumbar spinal stenosis. Methods: One hundred and twenty participants were recruited for this cross-sectional trial from January 2021 to December 2022. The cross-cultural adaption procedure utilized the American Association of Orthopedic Surgeon Outcomes Committee Method. All patients completed the Arabic version of the SSSQ and SF-12 preoperatively and 6 months postoperatively. The intra-class correlation coefficient (ICC), Cronbach alpha (CA), and Pearson correlation coefficient were used to verify the validity and internal consistency. Results: We analyzed the results of 120 patients. The average age was 64 ± 6.4 years (55–75 years). The SSSQ’s total domain CA was 0.90. On the other hand, the functional disability scale (Q8-12) and the symptom severity scale (Q1-7) had corresponding CA of 0.88 and 0.92, respectively. The ICC was 0.92, 0.93, and 0.84 for all items, symptom severity scale, and functional disability scale, respectively. High Pearson correlation coefficients were found between the SF-12 score and the total score of the SSSQ (0.69). Conclusion: The Arabic version of the SSSQ is a reliable and valid instrument and can be applied to evaluate the surgical outcome of patients with lumbar spinal stenosis.

Adaptation and validation of a tool for the quality assessment of genetic counseling in Brazil: perspectives from clinical geneticists.

In 2018, Portuguese researchers proposed the "Tool for Quality Assessment of Genetic Counseling," a 5-point Likert scale comprising 50 items across five dimensions, designed to assess genetic counseling from the professional's perspective. This descriptive, cross-sectional study aimed to adapt this tool to Brazilian Portuguese, validate it among Brazilian clinical geneticists, and conduct a preliminary assessment of the quality of genetic counseling in Brazil. The adaptation process involved expert-driven content validation and calculation of the Content Validity Index (CVI) to ensure equivalence between the original and adapted versions. The adapted tool was subsequently administered to 81 clinical geneticists, including physicians and nurses, and the data were analyzed using Principal Component Analysis. Items with factor loadings above 0.4 were retained for interpretive purposes. Results were normalized and categorized. The adapted items achieved acceptable CVIs, ranging from 0.831 to 1.0, demonstrating strong validity. Scale results revealed that the dimensions "genetic counseling outcomes" (100%), "education" (86.41%), and "individual attributes" (80%) were rated as very good, "counselor-client relationship" (76.33%) as good, and "service functioning" (59.95%) as sufficient. These findings indicated that although participants perceived the genetic counseling they provided as achieving desired outcomes, deficiencies in service functioning negatively impacted perceptions of overall quality, highlighting the need for systemic improvements to enhance service delivery. This cross-cultural adaptation validated a reliable new instrument for Brazilian professionals, providing a robust foundation for future research and applications in diverse clinical settings.

Translation, cross-cultural adaptation and psychometric evaluation of the Serbian Ankylosing Spondylitis Quality of Life (ASQoL) Questionnaire (refers to r-axSpA) and its relations with disease activity and functional status indices

ObjectivesTo translate, cross-culturally adapt and validate the Serbian Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, e.g. according to the new nomenclature Radiographic-Axial Spondyloarthritis (r-axSpA), and to relate it to disease activity and functional status domains.MethodsFour stages were accomplished: (1) Bilingual and lay panel for translation and cross-cultural adaptation (2) Cognitive debriefing interviews (assessing the language and cultural equivalence of the concepts used in the Serbian ASQoL translation) for face and content validity (3) Psychometric evaluation: (a) convergent validity by NHP as a comparator scale and (b) known group validity by correlations with disease activity and overall health status and reliability (internal consistency and test-retest reliability) (4) Independent regression analyses for relations between ASQoL and ASDAS, BASDAI, BASFI, Schober’s test, respiratory index and SPARCC were used. The statistical program SPSS (version 21; IBM, Armonk, NY, USA) was used.ResultsThe bilingual panel made a unified version of the translated documents, a lay panel confirmed the clarity of the questionnaire. Cognitive debriefing interviews with 10 patients evaluated the Serbian ASQoL as clear, precise, easy to complete. The psychometric properties with 60 randomly selected patients showed good convergent validity between ASQoL and NHP domains of pain (r = 0.79), emotional reactions (r = 0.78), physical activity (r = 0.77) and energy (r = 0.75). The internal reliability was 0.95 and 0.91 (1st and 2nd administration), respectively, and the test-retest reliability was 0.84. Regression analyses showed highly significant relationships (p < 0.001) between ASQoL and ASDAS (R²=0.403), BASDAI (R²=0.564) and BASFI (R²=0.444).ConclusionThe Serbian ASQoL demonstrated good psychometric properties and significant relationships with disease activity and functional status and is recommended for quality of life assessment in Serbian-speaking ankylosing spondylitis (radiographic axial spondyloarthritis) patients, both in clinical practice and clinical research.

Cross-cultural adaptation and evidence of validity of the interprofessional collaboration scale (IPC-BR) for Brazil

ABSTRACT We aimed to perform cross-cultural adaptation of the Interprofessional Collaboration Scale (IPC-BR) and to evaluate evidence of its validity for the Brazilian hospital context. The research consisted of six steps: translation of the instrument into the new language, synthesis of the translated versions, back-translation, synthesis of the versions in the original language, evaluation of the syntheses by an expert committee, and pilot testing or pretesting and validation of the internal structure of the items of the instrument. The pilot testing involved 4 translators, 14 judges, and 30 healthcare professionals; the validation of the internal structure involved 686 professionals including nurses, physicians and physiotherapists. Translation and cross-cultural adaptation revealed no significant changes or discrepancies in meaning from the original model. Exploratory, confirmatory, and parallel factor analyses confirmed that the Brazilian scale is unidimensional. We found unidimensional characteristics and satisfactory factor loadings, with good levels of reliability, which makes the instrument provide consistent and reliable internal evidence for measuring the construct. Thus, the possibility of using it to assess interprofessional collaboration among different target groups in the Brazilian scenario was confirmed.

Validity and Reliability of the M.D. Anderson Dysphagia Inventory in Turkish Patients with Neurological Disease.

Dysphagia is a prevalent symptom of various neurological diseases and is associated with decreased quality of life. The M.D. Anderson Dysphagia Inventory (MDADI) is globally utilized tool to assess the impact of dysphagia on quality of life. However, a Turkish version of the scale is not yet available. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Turkish version of the MDADI. One hundred twenty-four patients who were diagnosed with definite neurological disease completed the study. The cross-cultural adaptation and translation process of the MDADI adhered to the World Health Organization's guidelines using the forward-backward translation method. The feasibility and the floor and ceiling effects were evaluated. Cronbach's alpha was used to assess internal consistency. The Bland and Altman method and Interclass Correlation Coefficient (ICC) were used to evaluate test-retest reliability. Absolute reliability was determined using the standard error of the measurement (SEM) and minimal detectable change (MDC). Construct validity was assessed using Pearson's correlation coefficient between the MDADI and the Turkish Swallowing Quality of Life (T-SWAL-QOL) questionnaire. Our study had a feasibility rate of 100%. No floor or ceiling effects were determined for any subscale or composite scores of the T-MDADI. The T-MDADI demonstrated excellent reliability, with Cronbach's alpha coefficients ranging from 0.89 to 0.96 and ICC values from 0.81 to 0.95, confirming strong internal consistency and test-retest reliability. Measurement precision was supported by a SEM of 3.96 and an MDC of 10.97 for the composite score. In terms of validity, significant correlations were observed between T-MDADI subdomains and T-SWAL-QOL subdomains (r = 0.61-0.80 for food selection, mental health, and social functioning; r = 0.41-0.60 for eating duration and communication; p < 0.01), demonstrating good to very good convergent validity. The T-MDADI demonstrates validity and reliability as a questionnaire for assessing dysphagia-related quality of life in Turkish patients with neurological diseases.

TRADUÇÃO, ADAPTAÇÃO TRANSCULTURAL E VALIDAÇÃO DA ESCALA SANE PARA PACIENTES SUBMETIDOS À ARTROPLASTIA TOTAL DE JOELHO

This study conducted the translation, cross-cultural adaptation, and validation of the Single Assessment Numeric Evaluation (SANE) Scale into Brazilian Portuguese, aimed at assessing the functionality of patients undergoing Total Knee Arthroplasty (TKA). The process included translation, back-translation, expert committee review, and semantic validation with patients, following rigorous methodological guidelines. The adapted version of the SANE proved to be understandable, culturally relevant, and appropriate for the Brazilian population, facilitating the accurate collection of data on functional recovery. Psychometric analyses demonstrated high reliability (Cronbach’s alpha &gt; 0.70) and excellent reproducibility (ICC &gt; 0.75). Construct validity was confirmed through significant correlations with established measures such as the KOOS and IKDC. The SANE Scale has shown to be an effective tool for quick and objective assessment, standing out for its practicality in clinical settings. The study concludes that SANE is a valid and reliable alternative for orthopedic practice, with the potential to simplify functional assessment in post-TKA patients.

Translation and psychometric evaluation of the Danish version of the knee outcome survey - activities of daily living scale in patients with anterior cruciate ligament injuries

BackgroundThe Knee Outcome Survey – Activities of Daily Living Scale (KOS-ADLS) is a patient-reported outcome measure (PROM) developed to assess symptoms and functional limitations in patients with various knee disorders. The aim of this study was to translate and culturally adapt the KOS-ADLS to Danish and to evaluate the psychometric properties of the Danish version (KOS-ADLS-DK) in patients with anterior cruciate ligament (ACL) injury.MethodsThe KOS-ADLS was translated and culturally adapted to Danish in accordance with recommended guidelines. To evaluate psychometric properties in a test-retest design 115 Danish patients with ACL injury completed KOS-ADLS-DK and other knee specific PROMs at baseline and after 14 days. A sub-population of 79 patients completed the KOS-ADLS-DK before and after 3 months of rehabilitation. Structural validity (factor analysis), Internal consistency (Cronbach`s alpha), construct validity (hypothesis testing), test-retest reliability (Intraclass Correlation Coefficient [ICC]), test-retest agreement (Bland-Altman plots with 95% Limits of Agreement), Standard Error of Measurement (SEM), Smallest Detectable Chance (SDC), responsiveness (construct approach with hypothesis testing) and floor/ceiling effects were assessed.ResultsNo major problems were revealed in the cross-cultural adaptation process. The KOS-ADLS-DK was uni-dimensional and showed a high internal consistency (Chronbach’s alpha = 0.90). Construct validity was not perfect as only five of seven hypotheses were confirmed, but there was a good reliability (ICC = 0.88) and test-retest agreement showed equal distribution of measurement error across the scale and the SEM was 4.9% and SDC was 13.6%. However, hypotheses testing on change scores revealed the KOS-ADLS-DK to be responsive and there were no floor/ceiling effects.ConclusionOverall, the Danish version of KOS-ADLS is considered a valid, reliable and responsive PROM for assessing symptoms and functional limitations in patients with ACL injury but may show some limitations in its construct validity.

Cross-cultural adaptation and validation of a Norwegian version of the Goodman Satisfaction Score (GSS-NO) for patients with total hip and knee arthroplasty.

Measuring patient satisfaction after total hip (THA) and total knee arthroplasty (TKA) is important. We aimed to cross-culturally adapt and examine the psychometric properties of the self-reported Goodman Satisfaction Score (GSS) in a sample of Norwegian patients following primary THA and TKA. The GSS was translated and adapted into Norwegian (GSS-NO) following standard guidelines. 800 patients from the Norwegian Arthroplasty Register who had undergone surgery 6-11 months prior were invited to complete GSS-NO and questions on sociodemographic factors, pain, and function in a cross-sectional study. We examined validity in relation to internal structure, response processes, and precision using Rasch analysis, relationships between the GSS-NO and pain and function using Pearson's correlation coefficients, and test-retest reliability using linear weighted kappa statistics. The GSS-NO was adapted with few challenges. 404 patients (49% THA, 51% TKA) returned complete answers. The GSS-NO met all criteria regarding the rating scale functioning. Local independence among items and unidimensionality was supported and there was acceptable goodness-of-fit. The internal consistency was 0.94. We found no systematic differential item functioning by age, sex, work status, education, cohabitation status, or hip or knee surgery. The correlation coefficients between GSS-NO and pain and function outcomes were 0.79 (95% confidence interval [CI] 0.76-0.82) and 0.79 (CI 0.76-0.82), respectively. Test-retest reliability with weighted kappa ranged from 0.43-0.55 for THA and 0.54-0.81 for TKA. The cross-cultural adaptation of GSS-NO proved to be a valid and reliable measure for use in Norwegian-speaking patients following primary THA and TKA.

Translation and validation of the 8-item contact lens dry eye questionnaire (CLDEQ-8) among Chinese soft contact lens wearers.

To develop a Chinese version of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) with cross-cultural adaption and clinical validation among soft contact lens wearers (SCL) in China. The translation and adaptation of the Chinese CLDEQ-8 (C-CLDEQ-8) followed a rigorous methodological process based on cross-cultural research guidelines consisting of three main phases: 1) forward and backward translation of original CLDEQ-8 into Chinese, 2) cross-cultural adaptation performed by medical advising committee, and 3) clinical validation and repeatability test of the translated questionnaire on Chinese SCL wearers. Rasch analysis was also performed to investigate the psychometric properties of C-CLDEQ-8. 134 experienced SCL wearers aged 18-45 completed the C-CLDEQ-8. C-CLDEQ-8 score was linearly related to the overall opinion of SCLs (beta=2.16, p=0.002), gestalt eye dryness response (beta=2.90, p<0.001), and sensitivity response (beta=1.83, p=0.001). The questionnaire showed excellent test-retest repeatability with an intra-class correlation coefficient (ICC) of 0.95 and great internal consistency with a Cronbach's alpha of 0.83. The corrected index of homogeneity for each item was more significant than 0.5. In Rasch analysis, the infit and outfit values for eight items were all within 0.6-1.4, suggesting a good fit for the Rasch model. Martin-Löf test result indicated that the Rasch model was unidimensional (p=1.0). Item characteristics curves suggested combining categories 3-4 and 5-6 in item 5 of C-CLDEQ-8. This study produced a Chinese version of CLDEQ-8 with great validity and reliability and proved capable of evaluating SCL-related symptoms.

COping with Rheumatic Stressors (CORS) questionnaire: validated German translation and cross-cultural adaptation for patients with axSpA

BackgroundPatients with Rheumatic and Musculoskeletal Diseases, including axial spondyloarthritis (axSpA), may suffer from stressors like pain and functional impairments leading to limitations in their self-perceived health status. The COping with Rheumatic Stressors (CORS) questionnaire was developed to analyze how patients cope with these stressors. The CORS is currently not available in German.ObjectiveFirst, to translate, cross-culturally adapt and to linguistically validate the original Dutch CORS into German. Second, to test the pre-final German translation through cognitive debriefing in patients with axSpA.MethodologyThe original Dutch CORS underwent a multistep cross-cultural adaptation process, as described by Beaton. It was first independently translated into German by bilingual Dutch-German lay and expert translators. Subsequently, it was translated back from the German version into Dutch. Remaining discrepancies were resolved by a scientific committee, resulting in a pre-final German version. This version was then tested through cognitive debriefing by 10 patients with axSpA across a broad spectrum of sociodemographic backgrounds.ResultsForward and backward translations of the CORS revealed minor discrepancies, mainly based on the degree of formal versus informal language usage, minor semantic errors or unusual syntax, which led to minor modifications in the wording. Reviewed by the scientific committee, the pre-final consensus German version was linguistically validated by cognitive debriefing by 10 patients with axSpA. Cognitive debriefing confirmed and ensured closest linguistic validity for German in Germany and highest equivalence to the Dutch original version.ConclusionThe German CORS was shown to have high cross-cultural and face validity for the assessment of coping with rheumatic stressors.

The Process of Translation and Cross-Cultural Adaptation of Functional Assessment Tools for Dementia: A Systematized Review.

A decline in function related to impairment in cognitive abilities is required for diagnosing dementia. Cultural diversity influences everyday functioning, suggesting that functional assessment tools need to be culturally dependent. Therefore, this systematized review aimed to explore the translation and cross-cultural adaptation of functional assessment tools designed to support dementia diagnosis. A systematic search of five electronic databases (CINAHL Plus, EMBASE, PubMed/MEDLINE, PsycINFO) was conducted from inception until September 2023. Quality assessment criteria were then utilized to evaluate the process of cross-cultural adaptation and psychometric properties of identified functional assessment tools. Fifteen studies relating to adapted functional assessment tools in 11 languages were identified. It was found that less than half of these studies fully adhered to established guidelines for the translation and cross-cultural adaptation of instruments. Regarding psychometric properties, while the internal consistency and reliability of included measures were generally strong, there was variability in evaluating other psychometric properties, notably structural validity, measurement error, and cross-cultural validity. This review underscores the need for researchers and clinicians to follow standardized guidelines for translating and cross-culturally adapting functional assessment tools for dementia and ensuring the comprehensive evaluation of psychometric properties in cross-cultural settings. Researchers and clinicians should consider whether the psychometric properties and characteristics of an adapted functional activity measure are suitable for use in their population of interest.

Development of the Marathi Version of the Quebec Back Pain Disability Scale: A Cross-Cultural Adaptation and Validation in Patients With Chronic Low Back Pain

Development of the Marathi Version of the Quebec Back Pain Disability Scale: A Cross-Cultural Adaptation and Validation in Patients With Chronic Low Back Pain

Comprehensive Review of Multilingual Patient-Reported Outcome Measures for Dysphonia.

Patient-reported outcome measures (PROMs) represent an important part of a comprehensive voice assessment for clinical care and research. Access to multilingual PROMs enables inclusion of information from diverse patient populations. This review compares available translated and validated PROMs for adult dysphonia. A comprehensive review of Cochrane Library, PubMed, and OnBase was performed for PROMs evaluating adult dysphonia in all languages. References were additionally queried. PROM development process, available languages, and study group demographics were compared between PROMs available in at least one language other than English. Cultural validation for each PROM was assessed against Beaton et al's six-stage cross-cultural adaptation guidelines. Of 21 PROMs assessing adult dysphonia, 13 (62%) were available in one or more language other than English, and nine (43%) were available in seven or more. Voice Handicap Index (VHI) and VHI-10 were the most widely available translated questionnaires (n=29, n=15) followed by Vocal Fatigue Index (VFI), Singing-VHI (S-VHI), and Voice-Related Quality of Life (V-RQOL) (n=11). Identified questionnaires were available in English (n=21), Persian (n=9), Kannada (n=8), and Turkish (n=7) as the most common languages. Females averaged 60% (range 13%-81%) of dysphonic subject groups and 59% of non-dysphonic subject groups (range 20%-88%). Of the 113 articles that reported cultural validation techniques, 16 (14%) adequately fulfilled the cross-cultural adaptation guidelines used. Multilingual PROMs for dysphonia are widely available, but linguistic representation varied. VHI, VFI, S-VHI, and V-RQOL are the most widely translated. The most represented languages were Persian, Kannada, and Turkish. Few studies adequately followed cross-cultural adaptation standards. Efforts to translate and validate questionnaires into different languages may allow more diverse assessment and comparison of larger populations with dysphonia. This review identifies translated PROMs for dysphonia and analyzes their level of cultural validation for future use.

Cross-cultural adaptation and metric analysis of the Adult Difficult Intravenous Access Scale for use in Brazil.

to cross-culturally adapt and analyze the metric properties of the Adult Difficult Intravenous Access Scale into Brazilian Portuguese. methodological study carried out in two stages: 1) Translation of the scale from the original version in English to Brazilian Portuguese, including an assessment by a committee of nine judges, back-translation and semantic analysis; 2) Analysis of metric properties with 130 adults admitted to a hemodynamics unit in which difficult peripheral venipunctures occurred. Participants were followed up to check for the occurrence of difficult peripheral venipunctures. The instrument's inter-rater reliability and predictive validity were analyzed. Data collection was carried out from February 2021 to April 2023 in Minas Gerais, Brazil. in the assessment carried out by the committee of judges, the items presented a Content Validity Index above 0.80, after the second round of assessment. Regarding semantic analysis, professionals considered the scale relevant, easy to apply and understand. The Kappa coefficient for individual items ranged between 0.68 and 1.0. For each item scored, adult patients are three times more likely to have difficult peripheral venipuncture. the final version of the scale was considered clear, reliable, and easy to understand. The instrument enables a predictive score of difficult peripheral venipuncture in adults.

Italian Vocal Fatigue Index: Cross-Cultural Adaptation and Validation.

Vocal fatigue involves self-perceived vocal symptoms and reduced physiological capacity. This study aimed to adapt and validate the Vocal Fatigue Index (VFI), a tool originally designed to distinguish between patients with vocal fatigue and vocally healthy individuals, for Italian speakers. A four-step translation and validation process was employed. First, four bilingual clinicians specializing in voice disorders translated the English VFI into Italian. An expert committee of six bilingual Italian-English voice disorder specialists then reviewed and refined these translations, leading to a preliminary Italian version. This version was then back-translated into English by one of the authors, ensuring semantic equivalence with the original. Finally, the resulting Italian VFI (VFI-I) was pretested in a study involving 669 participants (386 normal voices and 283 disordered voices) from diverse regions. Nonparametric tests showed significantly higher VFI-I scores for all factors among participants with voice disorders compared with participants with healthy voices. The VFI-I showed good internal consistency and reliability, with Cronbach alpha coefficients ranging from 0.92 to 0.97. Treatment-induced changes were captured, showing a significant decrease in Factor-1 scores post therapy. Convergent validity analysis indicated moderate correlations between VFI-I factors and VHI-I subscales. Multivariate analysis confirmed the association of VFI-I factors with diagnosed voice disorders. This study established the VFI-I as a reliable and valid tool for identifying Italian speakers with vocal fatigue, with good sensitivity to clinical diagnosis, and the ability to track treatment progress highlighting its potential for improving voice care in Italian-speaking populations.

Cross-cultural Adaptation of the Oswestry Disability Index: From English to Ilokano Version

Cross-cultural Adaptation of the Oswestry Disability Index: From English to Ilokano Version

Research on the Impact of Social and Emotional Support Provided by Chinese Social Media on Overseas Chinese Students

This study investigated the impact of Chinese social media on social and emotional support for overseas Chinese students. The survey results of 120 Chinese students overseas showed that most used Chinese social media to stay connected with family and friends and relieve negative emotions. The study showed that Chinese social media platforms play an important role in promoting the maintenance of emotional connections, alleviating loneliness, and supporting cross-cultural adaptation. In addition, although most students reported positive mental health outcomes, the emotional support provided by social media may not fully address cross-cultural adaptation issues and psychological stress from academic pressure, cultural differences, and language barriers. Although these platforms are important tools for emotional support, they have limitations in providing comprehensive social interactions and psychological support compared to offline interactions. This study emphasizes the need for all sectors of Chinese society to establish a more complete emotional support system for international students to enhance the happiness and cross-cultural adaptation of overseas Chinese students.

Turkish adaptation of the behavioral flexibility scale for children with autism spectrum disorder: cross-cultural adaptation and psychometric evaluation

PurposeThe purpose of this study is to adapt the “Behavioral Flexibility Scale for Children with Autism Spectrum Disorder” to Turkish culture and evaluate its psychometric properties.Design/methodology/approachThe Behavioral Inflexibility Scale (BIS), developed by Luc Lecavalier and her colleagues, is used in diagnostic tests for autistic children. The research used a methodological design. Data were collected between March and September 2021. The study included 254 parents of children with autism. Content validity, construct validity and criterion validity were assessed. Reliability was examined using adjusted item-total correlation, Cronbach’s coefficient, composite reliability and split-second reliability.FindingsThe Turkish version of the “Behavioral Flexibility Scale for Children with Autism Spectrum Disorder” was found to have good content and criterion validity. The single-factor structure of the scale was confirmed for the Turkish version as a result of confirmatory factor analysis. The Cronbach alpha coefficient of the scale was determined as 0.97, and the item/total correlation coefficients were found to be between 0.544 and 0.807. In the first factor analysis conducted for BIS, the KMO value was 0.958, and in the BTS test results, it was determined that the scales were suitable for factor analysis (X2 = 7,296.05; df = 705; p < 0.001). As a result of the explanatory factor analysis, it was found that the items forming the scale were gathered under a single factor, and the factor loadings varied between 0.564 and 0.822. It was found that the items constituting the scale explained 52% of the variance, and the Pearson correlation coefficient was r = 0.775, p < 0.001.Research limitations/implicationsIn this study, there are some limitations that need to be acknowledged. First, the sample that the study is based on was collected from parents from a single city in our country, and therefore, in future studies, it is recommended to use a stratified sampling method to include participants from all regions of the country. Another limitation is that the behavioral flexibility of children and adolescents with autism spectrum disorder (ASD) was assessed only based on the information provided by their parents. This leads to a one-sided evaluation of the results. Therefore, in future studies, it is recommended to include various sources such as special education teachers and attending physicians to assess the behavioral flexibility of children and adolescents with ASD.Practical implicationsThe Behavioral Flexibility Scale was found to be a valid and reliable tool that can be used in diagnostic testing in children with ASD.Social implicationsIt is aimed to early identify and intervene in the behavioral problems experienced by autistic children.Originality/valueThe Behavioral Flexibility Scale was found to be a valid and reliable tool that can be used in diagnostic testing in children with ASD.

Balancing Universality and Cultural Diversity in the Search for Inclusive Moral Frameworks

Purpose. The article aims to draw the attention of researchers to the creation of an ethical framework that harmoniously incorporates universal principles and cultural diversity taking into account the rights and dignity of every individual as a key actor in ethical discussions. It argues that an effective ethical framework gives the opportunity to each person to take part in moral deliberations and ethical decision-making. Theoretical basis. The article, based on the approach of Kant, Rolls, Singer and others, insists on the need to define and agree on the universal principles. They should form the basis of all subsequent ethical discussions. The protection of personal identity is emphasized through intercultural sensitivity (Herskovits, Benedict). People with diverse cultural contexts should be included in ethical debates. The importance in research of the flexibility of ethical concepts in accordance with the cosmopolitanism of Appiah and the approach to the capabilities of Nussbaum is also emphasized. Ethical theories need to balance between cultural pluralism and universality. Cultural sensitivity in ethical theories must recognize, respect, and give space to other moralities, paving the way for the formulation of open ethical theories. Anthropological and philosophical insights contribute to achieving the necessary balance between core principles and flexibility to create avenues for dialogue and consensus. Finally, while attempting to achieve universality, cultural sensitivity, and adaptability, ethical frameworks in an interconnected world should apply the principles across various societies, respect diversity in values, and take into account changes in those societies. Originality. The article outlines the contours of a possible balanced approach emphasizing universality as the central core of ethical theory and cross-cultural sensitivity, flexibility, and adaptability. That allows each person to preserve identity and feel to be involved in ethics. Conclusions. The article demonstrated that it is necessary to promote such qualities as understanding cultural specificity, empathy for other cultures and cooperation in solving moral dilemmas on the path towards ethical excellence. Only a balanced approach that combines universal principles and takes into account cultural diversity recognizes the rights and dignity of each person and transcends cultural differences.

Cross-cultural adaptation, reliability, validity and responsiveness of Urdu version of hip disability and osteoarthritis outcome score

Purpose To linguistically and cross-culturally translate Hip Disability and Osteoarthritis Outcome Score into Urdu language (HOOS-U), and test its psychometric properties among patients with hip pain. Materials and methods Translation and cross-cultural adaptation of English version of HOOS were carried out following international guidelines. Psychometric testing included reliability (internal consistency and test-retest reliability), validity (content and construct validity) and responsiveness. Baseline assessments included self-structured questionnaire, HOOS-U, SF-36, VAS-pain, and VAS-disability. After three weeks of advised physiotherapy intervention, patients fulfilled the aforementioned questionnaires along with Global Rating of Change (GROC) scale. Results HOOS-U exhibited satisfactory internal consistency (Cronbach’s alpha: 0.86 to 0.96) and excellent test-retest reliability (Intraclass correlation coefficient [ICC]: 0.97 to 0.99). No floor or ceiling effects were observed. Discriminant validity was confirmed by significant differences in HOOS-U scores between patients and controls (p-value <0.001). For convergent validity, HOOS-U subscales showed strong Pearson Correlation Coefficient with PF and BP subscale of SF-36, specifically the ADL subscale of HOOS-U (PF = 0.82 and BP = 0.74). HOOS-U also demonstrated strong correlations with VAS pain (-0.70 to −0.83) and VAS disability (-0.69 to 0.82). For responsiveness, all subscales improved significantly after treatment (p-value < 0.001). Conclusion HOOS-U demonstrated good psychometric properties, making it a suitable tool for assessing outcomes in Urdu-speaking individuals.