title: Cross-cultural adaptation and validation of the Japanese version of the Toronto Extremity Salvage Score (TESS) for patients with malignant musculoskeletal tumors in the lower extremities.
abstract: BACKGROUND
  Before this work a Japanese version of the Toronto Extremity Salvage Score (TESS), a disease-specific patient-completed questionnaire widely used to assess the physical function of patients with musculoskeletal tumors, had not been developed. The purpose of this study was cross-cultural adaptation and validation of the English-language version of the TESS to facilitate international comparisons of treatment results.
  
  
  METHODS
  The TESS was translated into Japanese, back-translated into English, and reviewed by a committee to develop a consensus Japanese version of the TESS. One hundred and two patients were assessed by use of this Japanese version to examine its reliability and validity.
  
  
  RESULTS
  Test-retest reliability and internal consistency determined by using the intraclass correlation coefficient (0.941) and Cronbach's alpha test (0.978), respectively, were excellent. Factor analysis showed that the structure consisted of a three-item cluster; the Akaike information criterion (AIC) network also demonstrated that the items could be divided into three domains in accordance with their content. The Japanese version of the TESS correlated with the Musculoskeletal Tumor Society rating scale (r = 0.811; P < 0.001) and the Short Form-36 physical component summary (r = 0.785; P < 0.001).
  
  
  CONCLUSIONS
  Our study suggested that the Japanese version of the TESS is a reliable and valid instrument for measuring patient-reported functional outcome for patients with lower extremity sarcoma, and that it enables international comparisons of treatment results. The spatial association of each item demonstrated by using the AIC network also suggested that the underlying structure of the TESS reflected its coverage of a wide range of physical functions.
authors: Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. ogura-tky@umin.ac.jp.|Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan. ogura-tky@umin.ac.jp.
authors: Koichi
authors: K
authors: Ogura
authors: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors: Kosuke
authors: K
authors: Uehara
authors: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors: Toru
authors: T
authors: Akiyama
authors: Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan.
authors: Shintaro
authors: S
authors: Iwata
authors: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors: Yusuke
authors: Y
authors: Shinoda
authors: Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors: Eisuke
authors: E
authors: Kobayashi
authors: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors: Kazuo
authors: K
authors: Saita
authors: Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan.
authors: Tsukasa
authors: T
authors: Yonemoto
authors: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors: Hirotaka
authors: H
authors: Kawano
authors: Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors: Hirokazu
authors: H
authors: Chuman
authors: Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada.|Institute of Health Policy, Management and Evaluation, Rehabilitation Institute, University of Toronto, Toronto, Canada.
authors: Aileen M
authors: AM
authors: Davis
authors: Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors: Akira
authors: A
authors: Kawai
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007564:Japan; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018570:Risk Assessment; D012737:Sex Factors; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D014177:Translations; D055815:Young Adult