Reliability, validity, and cultural adaptation of the Persian version of the Exercise Adherence Rating Scale (EARS) in patients with knee osteoarthritis

Zohreh Gholami; Seyedeh Tahereh Faezi; Raghad Mimar; Elham Madreseh

doi:10.1016/j.jisako.2024.02.011

Reliability, validity, and cultural adaptation of the Persian version of the Exercise Adherence Rating Scale (EARS) in patients with knee osteoarthritis

J ISAKOS. 2024 Mar 6:S2059-7754(24)00039-7. doi: 10.1016/j.jisako.2024.02.011. Online ahead of print.

Authors

Zohreh Gholami¹, Seyedeh Tahereh Faezi², Raghad Mimar³, Elham Madreseh⁴

Affiliations

¹ Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sport Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran. Electronic address: Zzohreh.Ggholami@gmail.com.
² Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: s.t_faezi@yahoo.com.
³ Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran. Electronic address: m_raghad@yahoo.com.
⁴ Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran. Electronic address: emadreseh@yahoo.com.

PMID: 38453021
DOI: 10.1016/j.jisako.2024.02.011

Abstract

Objectives: The aim of this study was to culturally adapt and assess the validity and reliability of the Exercise Adherence Rating Scale (EARS) in Persian language for patients with knee osteoarthritis.

Methods: The original English version of the EARS was forward-translated to Persian (by an expert and a non-expert in the field of exercise and health science) and then backward-translated to English by two people, and then by a committee of five, pre-final Persian version of EARS was created. Patients were provided with a three-month exercise program, three times a week, through telerehabilitation. After completion of the exercise program, patients filled out the Persian version of EARS and the Scanlan questionnaire. Three weeks later, patients completed the EARS and Scanlan questionnaire again. During the study, patients recorded the number of exercise sessions weekly in a standardized diary form. Face validity was assessed by ten patients, using the item impact method. Content validity was assessed by five experts and quantified using the content validity ratio and content validity index. Agreement between EARS and Scanlan questionnaire was assessed using Spearman test and Bland-Altman plot. The reliability of the Persian version of EARS was assessed using the intraclass correlation coefficient and Cronbach's α.

Results: A total of 30 patients (3 men, 27 women), with a mean age of 59 years (SD = 10), participated in this study. All items of the Persian version of EARS had item impact method scores above 1.5, indicating acceptable face validity. The scale-content validity index/average for relevancy and simplicity components were calculated as 0.87 and 0.85, respectively, indicating good content validity. Bland-Altman plot showed good agreement between EARS and Scanlan questionnaire at baseline and three weeks later. Cronbach's alpha was 0.96, indicating excellent internal consistency. The intraclass correlation coefficient (95% CI) was 0.996 (0.991, 0.998), indicating excellent reliability.

Conclusions: The Persian version of EARS demonstrated acceptable cultural adaptation, reliability, and validity in patients with knee osteoarthritis. The use of the Persian version of EARS can be a reliable and valid tool to assess exercise adherence in patients with knee osteoarthritis.

Level of the evidence: II.

Keywords: Adherence; Cultural adaptation; Knee osteoarthritis; Prescribed exercise; Reliability; Translation; Validity.