Translation, cross-cultural adaptation and validation of the Arabic version of the quality-of-life assessment in spina bifida for children and teenagers.

INTRODUCTION

The Quality-of-Life Assessment in Spina Bifida (QUALAS) is a condition-specific, self-administered health-related quality of life (HRQOL) instrument, available in three age-specific versions and recommended for application within spina bifida (SB) populations. The present study sought to translate, culturally adapt, and validate the Arabic versions of the questionnaire for children (QUALAS-C-Ar) and teenagers (QUALAS-T-Ar).

PATIENTS AND

METHODS

The QUALAS-C and QUALAS-T questionnaires were translated and culturally adapted into Arabic using a forward-backward protocol, expert review, and pilot testing. Children (8-12 years) and teenagers (13-17 years) with SB who met the inclusion and exclusion criteria were enrolled. The psychometric evaluation of the Arabic versions included internal consistency (Cronbach's alpha), 2-4-week test-retest reliability (ICC), exploratory factor analysis, and construct validity through correlations with the generic HRQOL instrument KIDSCREEN-27 and comparison between continence groups.

RESULTS

Ninety-one participants completed the study (42 QUALAS-C-Ar, 49 QUALAS-T-Ar; mean ages 9.8 and 15.0 years old, respectively). Both tools showed good internal consistency (alpha = 0.70-0.89) and test-retest reliability (ICC = 0.77-0.88). Factor analysis was consistent with the two-factor structure of the original instrument (KMO = 0.76-0.84). Correlations with KIDSCREEN-27, a generic pediatric HRQOL questionnaire, indicated that QUALAS captures SB-relevant HRQOL domains not fully captured by generic HRQOL measures (r = 0.18-0.39, r = 0.24-0.61 for QUALAS-C-Ar and QUALAS-T-Ar, respectively). QUALAS-Ar scores were significantly higher among children with continence, but not significantly higher in teenagers.

COMMENT: The Arabic versions of QUALAS-C and QUALAS-T were successfully adapted and validated. Both tools showed good reliability, validity, and cross-cultural applicability. Similar to other language versions, bladder and bowel concerns had the greatest negative impact on HRQOL. Although limited by a single-center design and relatively small sample size, after only minor cultural adjustments, the Arabic versions of the QUALAS, like the original tool, were able to capture SB-specific dimensions not measured by generic instruments.

CONCLUSION

This study validates the first disease-specific HRQOL tools for Arabic-speaking children and adolescents with SB, supporting their use in clinical and research settings.