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 upper extremities.
abstract: BACKGROUND
  The Toronto Extremity Salvage Score (TESS) is a widely used disease-specific patient-completed questionnaire for the assessment of physical function in patients with musculoskeletal tumors; however, there had not been the validated Japanese version of the TESS. The aim of this study was to validate the Japanese version of the TESS in patients with musculoskeletal tumors in the upper extremity.
  
  
  METHODS
  After developing a Japanese version of the TESS, the questionnaire was administered to 53 patients to examine its reliability and validity in comparison with the Musculoskeletal Tumor Society (MSTS) scoring system and Short Form-36 (SF-36).
  
  
  RESULTS
  Test-retest reliability with intraclass correlation coefficient (0.93) and internal consistency with Cronbach's alpha (0.90) were excellent. Factor analysis showed that the construct structure consisted of 3-item clusters, and the Akaike Information Criterion network also demonstrated that the items could be divided into 3 domains according to their content. The TESS strongly correlated with the MSTS rating scale (r = 0.750; P < 0.001) and the SF-36 physical functioning scale (r = 0.684; P < 0.001). However, as expected, the TESS had low correlations with the SF-36 mental health and role-emotional subscales and the MSTS scoring system manual dexterity domain.
  
  
  CONCLUSIONS
  Our study suggests that the TESS is a reliable and valid instrument to measure patient-reported physical functioning in patients with upper extremity sarcoma.
authors.affiliation: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Uehara
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan; Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan. Electronic address: ogura-tky@umin.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ogura
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shinoda
authors.affiliation: Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Saita
authors.affiliation: Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Tanzawa
authors.affiliation: Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nakatani
authors.affiliation: Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Yonemoto
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kawano
authors.affiliation: Health Care and Outcomes Research, Krembil Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation and Rehabilitation Institute, University of Toronto, Toronto, Canada.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kawai
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan; D023821:Limb Salvage / Q000379:methods* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009864:Ontario; D018570:Risk Assessment; D012983:Soft Tissue Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D034941:Upper Extremity; D055815:Young Adult