TRANSLATION, ADAPTATION, VALIDATION AND RELIABILITY OF ARABIC VERSION OF KERLAN-JOBE ORTHOPAEDIC CLINIC SHOULDER AND ELBOW SCORE IN EGYPTIAN SYMPTOMATIC OVERHEAD ATHLETES

Ziad Mohamed Mohamed Abdalla Haroun100 enrolled

Overview

PURPOSE: To perform a cross-cultural adaption of the KJOC Shoulder and Elbow score into the Arabic language, then to test its validity and reliability. BACKGROUND: Shoulder and elbow injuries are highly prevalent among overhead and throwing athletes, particularly in sports such as baseball, handball, volleyball, and tennis throwing. Accurate assessment of upper extremity function in this athletic population is essential for injury prevention, clinical decision-making, and monitoring return-to-sport outcomes. The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score is a sport-specific, patient-reported outcome measure (PROM) developed to evaluate functional performance, pain, and sport-related limitations in overhead athletes. It has been widely used and validated in several languages including Spanish, Germany, Japanese, and Greek; however, no validated Arabic version is currently available. Simple literal translation is insufficient for patient-reported outcome measures. Instead, a structured process of translation, cultural adaptation, and comprehensive psychometric validation is required to ensure linguistic accuracy, conceptual equivalence, cultural relevance, and measurement reliability for Arabic-speaking athletes. HYPOTHESES: The study hypothesizes that the Arabic version of the KJOC shoulder and elbow score will demonstrate strong validity and reliability as an assessment tool for evaluating upper extremity function in symptomatic Arabic-speaking overhead athletes. RESEARCH QUESTION: Is the adapted Arabic version of the KJOC Shoulder and Elbow score valid and reliable for assessing upper extremity function in Egyptian symptomatic overhead athletes?

This study will use a Descriptive, Methodological Design (Cross-Cultural Adaptation). Description of Research Methodology: The study will follow standard international guidelines for cross-cultural adaptation (e.g., Beaton et al.). PHASE 1: CROSS-CULTURAL ADAPTATION The process includes five stages: 1\) translation, 2) synthesis of translations, 3) back-translation to the original language, 4) committee analysis, and 5) pre-testing. Forward Translation: Two independent translators (one medical, one naive) translate English to Arabic. Synthesis: Merging translations into one Arabic version. Backward Translation: Translating the Arabic version back to English by two native translators. Expert Committee Review: Reviewing all reports to reach a pre-final version. Pre-testing (Cognitive Debriefing): Testing the pre-final version on a pilot sample of athletes to ensure clarity and cultural relevance. PHASE 2: VALIDATION AND RELIABILITY TESTING By comparing the KJOC-Arabic's concurrent validity to the Arabic DASH questionnaire and using statistical and discriminant analyses to determine its construct validity, the validity of the test will be thoroughly evaluated. Participants will complete the questionnaire twice over the course of one to two weeks in order to assess test-retest reliability. An Intraclass Correlation Coefficient (ICC) of more than 0.80 is the target. Lastly, the Cronbach's alpha-coefficient of the translated assessment tool will be determined to assess its internal consistency.

Interventions

Questionnaire and Physical ExamDIAGNOSTIC_TEST

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion criteria (Almeida et al., 2025) * Male or female symptomatic athletes who participates in overhead sports (badminton, water polo, basketball, baseball, softball, handball, volleyball, or tennis) at least twice a week (Paraskevopoulos et al., 2024). * Age ranges from 18 to 45 years old (Schulz et al., 2022). * Non illiterate native Arabic speakers Exclusion criteria: * History of upper limb injury or any other injury that prevents the athlete from actively participating in their sport (Sukanen et al., 2022). * History of recent upper limb trauma, neuropathic pain, or surgery (Sasagawa et al., 2024). * Asymptomatic athletes who participate in overhead sports * Occurrence of a new injury during the study's reliability assessment interval (Sedighimehr, 2020). * Surgery that prevents full sports participation * Arabic speakers who are not native speakers. * Being illiterate or unable to read Arabic. * Visual or cognitive difficulties that make it difficult to read the questionnaire or take part in the interview.

Outcomes

Primary Outcomes

The KJOC Shoulder and Elbow score

The KJOC Shoulder and Elbow score is used to evaluate the functional status of athletes with shoulder and elbow disorders (Appendix II) (Silva et al., 2024). The KJOC is a 10-item visual analogue scale questionnaire given to patients; lower scores indicate a lower function or performance level, while higher scores indicate a greater function or performance level. The total score, which ranges from 0 to 100 points, is determined by adding together each individual item (Alberta et al., 2010). The KJOC score is the most sensitive for distinguishing minor differences in a throwing athlete's performance (Domb et al., 2010). KJOC is valid (Spearman: KJOC and DASH sports module =- 0.8036, KJOC and DASH =-0.6933) and reliable (Cronbach alpha of 0.9, indicating a high level of inter-item reliability (Domb et al., 2010), ICC= 0.802 (Erickson et al., 2018)).

Time frame: 4 weeks

Arabic version of DASH

The DASH is a 30-item self-report survey with 5-point Likert scales. The range of scores is 0 (no disability) to 100 (the most severe disability). It is a general non-specific PROM helpful for individuals with any upper limb musculoskeletal condition (Hudak et al., 1996). Items include 21 questions evaluating particular physical tasks (e.g., using a knife or turning a key), 5 items evaluating symptoms (e.g., pain, tingling), and 4 questions evaluating social functions (e.g., sleep and confidence) (David et al., 2022). DASH has been transculturally adapted to Arabic language (Alotaibi, 2010). The DASH-Arabic is a valid, responsive, and dependable upper extremity outcome measure (Alotaibi et al., 2016), (Appendix IV).