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Validity and Reliability of the Swahili (Tanzania) Version of the AO Spine Patient Reported Outcome Spine Trauma (PROST): A Single-Center Cross-Sectional Validation Study.

Friday, May 3, 2024

Presenting Author(s)

Chibuikem A. Ikwuegubenyi, MD

Research Fellow
Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York

Co-Author(s)

mA

maysecilia Abiud, MD

Researcher
Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States
MC

Magalie Cadieux, MD

Neurosurgeon
Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
Roger Hartl, MD

Director of Spinal Surgery
Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine
New York, NY, US
Ibrahim Hussain, MD

Assistant Professor
Department of Neurological Surgery, Weill Cornell Medical College
New York, NY, US
HM

Halinder S. Mangat, MD

Physician
Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA., United States
RS

Romani Sabas, MD

Researcher
Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States
HS

Hamisi K. Shabani, MD; PhD

Neurosurgeon
Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States
ZS

Zarina Shabhay, MD

Neurosurgeon
Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States
NS

Naomi Siima, MD

Resident
Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States
FW

Francois Waterkeyn, MD

Neurosurgeon
Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium, United States
JW

Julie Woodfield, MD; PhD

Neurosurgeon
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, United States

Introduction: Traumatic spinal injuries (TSI) represent a significant global health challenge, especially in low and middle-income countries with scarce resources. It's essential to have a specialized tool for assessing and treating TSI patients effectively. The AO Spine Patient Reported Outcome Spine Trauma (AO Spine PROST) tool was created to address this need. While it has been validated in English and Dutch, no Swahili version is available. This study seeks to translate and validate the AO Spine PROST tool in Swahili, the most widely spoken African language with over 200 million speakers.

Methods: This validation study was conducted at the Muhimbili Orthopedic Institute (MOI) in Dar es Salaam, Tanzania. Patients were administered the AO Spine (PROST) instrument, with a one-week retest period, either in person or by phone. Concurrent validity was assessed using the EQ-5D-5L questionnaire. Measurement properties were evaluated, including content validity, internal consistency, and test-retest reliability. Spearman correlation tests were conducted within PROST items and with EQ-5D-5L. Statistical significance was set at 0.05, and R studio was used for data analysis.

Results: The study included 73 patients with a median age of 33 years at the time of injury. The median follow-up time-period duration was 11 months, and it took an average of 9 minutes to complete the questionnaire. The translated version exhibited robust content validity, with no observed floor or ceiling effects. Internal consistency was excellent (Cronbach α = 0.93). Item-total correlation coefficients were acceptable (0.25 to 0.82). Test-retest reliability was excellent for the total score (intraclass correlation coefficient = 0.96). Construct validity revealed excellent correlations between the PROST and EQ-5D-5L (ρ = .83, p < 0.001) and a very good correlation with EQ VAS (ρ = .74, p < 0.001).

Conclusion : The new Swahili version of the AO Spine PROST demonstrated very favorable reliability and validity for outcomes. This validated tool is recommended for use by treating surgeons in the East African region, both in clinical practice and research, to facilitate evidence-based and patient-centered care outcomes.