Institute of Global Health and Human Ecology, American University in Cairo and Clinical Research Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
Institute of Global Health and Human Ecology, American University in Cairo, Cairo, Egypt.
Health Qual Life Outcomes. 2023 Jul 29;21(1):81. doi: 10.1186/s12955-023-02165-3.
Validated self-reporting tools are required to evaluate the functional outcome and health-related quality of life (HRQOL) for those who had extremity bone sarcomas in their childhood or adolescence. Our study pursued cross-cultural adaptation and validation of the pediatric Toronto Extremity Salvage Score (pTESS) and Toronto Extremity Salvage Score (TESS) to assess the functional outcome for Egyptian children and adult survivors following surgeries of extremity bone sarcomas. In the modified versions of pTESS and TESS, mental domains were added to allow the evaluation of HRQOL using a specific instrument for childhood bone cancer.
The internal consistency and test-retest reliability of the studied forms were assessed with Cronbach's alpha and Intra-class coefficients (ICC), respectively. For convergent validity, correlations between scores of the generic Pediatric Quality of Life Inventory (PedsQL 4.0) and pTESS /TESS scores were reported. Factor Analysis was feasible for pTESS-leg; due to the insufficient samples, only the average inter-item correlation coefficients were reported for the remaining versions.
Out of 233 participants, 134 responded to pTESS-leg, 53 to TESS-leg, 36 to pTESS-arm, and only 10 to TESS-arm. All versions showed excellent internal consistency (Cronbach's alpha >0.9), good test-retest reliability (ICC >0.8), moderate to strong correlations with PedsQL, and acceptable average inter-item correlation coefficients (≥0.3). Three factors were extracted for the pTESS-leg, in which all mental items were loaded on one separate factor with factor loadings exceeding 0.4. Active chemotherapy, less than one year from primary surgery, or tibial tumors were associated with significantly inferior pTESS/TESS scores in the lower extremity group.
The Egyptian pTESS and TESS are valid and reliable self-reporting tools for assessing the functional outcome following surgeries for extremity bone sarcomas. The modified pTESS and TESS versions, which include additional mental domains, enabled the assessment of the overall health status of our population. Future studies should include a larger sample size and evaluate the ability of pTESS/TESS to track progress over time.
需要经过验证的自我报告工具来评估那些在儿童或青少年时期患有肢体骨肉瘤的患者的功能结果和健康相关生活质量（HRQOL）。我们的研究旨在对儿科多伦多肢体挽救评分（pTESS）和多伦多肢体挽救评分（TESS）进行跨文化适应性和验证，以评估埃及儿童和成年肢体骨肉瘤手术后的功能结果。在 pTESS 和 TESS 的修订版本中，增加了心理领域，以便使用针对儿童骨癌的特定工具来评估 HRQOL。
使用 Cronbach's alpha 和 Intra-class 系数（ICC）分别评估研究形式的内部一致性和重测信度。为了评估收敛效度，报告了通用儿科生活质量量表（PedsQL 4.0）评分与 pTESS/TESS 评分之间的相关性。由于样本量不足，仅报告了 pTESS-leg 的因子分析结果，而对于其余版本，则仅报告平均项目间相关系数。
在 233 名参与者中，有 134 名参与者对 pTESS-leg 进行了回复，53 名参与者对 TESS-leg 进行了回复，36 名参与者对 pTESS-arm 进行了回复，而只有 10 名参与者对 TESS-arm 进行了回复。所有版本均表现出良好的内部一致性（Cronbach's alpha >0.9）、良好的重测信度（ICC >0.8）、与 PedsQL 呈中度至强相关性，以及可接受的平均项目间相关系数（≥0.3）。pTESS-leg 提取出三个因子，其中所有心理项目都加载在一个单独的因子上，因子负荷超过 0.4。下肢组中，接受主动化疗、距初次手术不到 1 年或胫骨肿瘤与 pTESS/TESS 评分明显降低相关。
埃及 pTESS 和 TESS 是评估肢体骨肉瘤手术后功能结果的有效且可靠的自我报告工具。修改后的 pTESS 和 TESS 版本，包含了额外的心理领域，使我们能够评估人群的整体健康状况。未来的研究应包括更大的样本量，并评估 pTESS/TESS 随时间跟踪进展的能力。
