Transcultural Adaptation and Psychometric Validation of the Persian Version of the 4-Domain Sports Patient-Reported Outcome Measure Questionnaire Publisher Pubmed



Vosoughi F ; Menbari Oskouie I ; Torkamanzadeh P ; Poursalehian M ; Yazdanmehr A ; Ayati Firoozabadi A
Source: Journal of ISAKOS Published:2026

Abstract

Introduction/objectives: Patient-reported outcome measures (PROMs) are essential tools in sports medicine for assessing subjective treatment outcomes in athletic populations who have higher functional demands. The 4-Domain Sports patient-reported outcome measure (4-DSP) is a recently developed questionnaire evaluating injury perception, treatment expectations, and outcomes. However, no validated Persian version currently exists. The aim of this study was to perform adaptation and psychometric validation of the Persian 4-DSP questionnaire in patients undergoing anterior cruciate ligament reconstruction (ACLR). Methods: The 4-DSP questionnaire was translated and culturally adapted into Persian following Beaton guidelines and COnsensus-based Standards for the selection of health Measurement INstruments recommendations. Ninety-seven ACLR patients (mean age: 34.9 ± 12.1 years) completed the Persian 4-DSP questionnaire twice at a 1-week interval. Internal consistency was assessed using Cronbach’s alpha, and test-retest reliability using intraclass correlation coefficients (ICCs). Construct validity was examined through correlations with the Persian versions of the International Knee Documentation Committee Subjective Form (IKDC-SF) and Lysholm knee score (LKS). Floor and ceiling effects were also evaluated. Results: The Persian 4-DSP questionnaire demonstrated acceptable internal consistency (Cronbach’s α = 0.67). Test-retest reliability was good overall (ICC = 0.693), with excellent item-level stability (ICC range: 0.96–1.00). Construct validity showed low to moderate correlations with Persian version of IKDC-SF and LKS, consistent with the instrument’s multidimensional and sports-specific construct. Floor effects were minimal (0–2%), while ceiling effects ranged from 14% to 48% across domains. No meaningful improvement in internal consistency was observed after item deletion, supporting structural stability of the instrument. Conclusion: The Persian version of the 4-DSP questionnaire is a valid, reliable, and culturally adapted PROM for ACLR patients. It provides complementary information to conventional knee-specific instruments and is suitable for use in Persian-speaking athletic populations. Level of Evidence: III. © 2026 The Author(s). Published by Elsevier Inc. on behalf of International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/