Translation of the Patient Scar Assessment Scale (PSAS) to French with cross-cultural adaptation, reliability evaluation and validation

Background: Patient esthetic satisfaction related to scarring after orthopedic surgery was rarely assessed before the development of the Patient Scar Assessment Scale (PSAS). The purpose of our study was to translate and validate the PSAS and assess the psychometric properties of the French version. Methods: We conducted a staged validation with forward and backward translation and concurrent validation. The validation committee comrpised bilingual experts. The patient validation sample comprised 53 orthopedic surgery patients who were assessed at a minimum of 1 year postoperatively. We followed a standardized process for cross-cultural adaptation to develop and assess the French version. First, 2 in dependent translators completed the forward translation of the PSAS and then met to achieve a consensus version. This consolidated version was then backward translated into English and cross-verified with the original version. A group of orthopedic and plastic surgeons assessed this version for content validity. We assessed the test-retest reliability of the new French scale, which was filled out twice by a cohort of 53 patients, using scale distribution analysis, internal consistency (Chronbach alpha) and absolute agreement (intraclass correlation coefficients [ICC ( 2,1)]). Results: The level of agreement on the translation process between the translators initially and then later among the expert panel was high. The reliability of the translated version (PSAS-Fr) and its internal consistency was high (Chronback a 0.87-0.98 for each of the 6 questions), and the test-retest reliability was excellent ( ICC 0.96). On the other hand, there was no bias between occasions (retests difference -0.24) and the scores fell within 2 standard deviations of 5. Older patients had higher satisfaction about scar appearance. Conclusion: The PSAS-Fr was successfully translated from the original English version and demonstrated strong cross-sectional psychometric properties. Further assessment in longitudinal studies is warranted.