Cross-cultural adaptation of the Arabic version of the patient reported impact of spasticity measure in Arabic speaking people with spinal cord injury in Saudi Arabia



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Spasticity is present in 65 to 78% of people with spinal cord injury (SCI). Its impact on quality of life (QoL) can be perceived by patients with SCI and clinicians as either problematic or beneficial. Spasticity management practice can improve greatly using standardized assessments with an appropriate battery of tools, including patient reported measures. The Patient Reported Impact of Spasticity Measure (PRISM) is a tool used to measure the impact of abnormal muscle control or involuntary muscle movement in people with spastic SCI. The PRISM assesses both positive and negative effects of spasticity and provides the overall impact of spasticity on an individual. The purpose of this dissertation was to adapt the PRISM for Arabic-speaking people with SCI living in Saudi Arabia, a country with one of the highest incidences of SCI around the world. This dissertation is composed of three studies to achieve its purpose. The first study aimed to translate and cross-culturally adapt the PRISM into Arabic language (PRISM-Arabic). Thirty-five subjects with SCI, and five expert committee members participated in this cross-cultural adaptation process. The produced PRISM-Arabic was deemed valid in terms of face and content validity and was ready to be evaluated further. The second study aimed to investigate the reliability and validity of the PRISM-Arabic in patients with SCI in Saudi Arabia. The results showed that the PRISM-Arabic had adequate internal consistency, test-retest reliability and construct validity. However, the Positive Impact subscale demonstrated poor measurement properties, and it should be interpreted cautiously when inferring the positive experience from spasticity on QoL. The third study investigated the PRISM-Arabic’s responsiveness to change in patients with SCI reporting spasticity during their in-patient rehabilitation admission period. The results showed that PRISM-Arabic was not sensitive to changes in the subjective impact of spasticity after receiving treatment and lacks the ability to distinguish those patients who did and did not improve. This dissertation concluded that the PRISM-Arabic is an adequate assessment tool measuring the impact of spasticity for Arabic speakers with Spastic SCI. It enhances patient’s communication with healthcare providers and promote their participation in clinical decision making concerning spasticity management.



Spinal cord injury, Spasticity, Patient reported impact of spasticity measure, Arabic, Saudi Arabia, Translation, Cross-cultural adaptation