CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE NEPALI VERSION OF THE PROSTHETIC LIMB USERS SURVEY OF MOBILITY SHORT-FORM (PLUS-M™/NEPALI-12SF) IN LOWER LIMB PROSTHESIS USERS
Authors: Ratna Bajracharya Amit , Seng-iad Sirirat , Sasaki Kazuhiko , Guerra Gary 
Published: August 2023

BACKGROUND: Objective mobility measurement of Nepali prosthesis users is lacking.
OBJECTIVE: The objective of this study was to cross-culturally adapt, translate and evaluate construct validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M™/Nepali-12 Short Form (SF)) instrument in lower limb prosthesis users residing in Nepal.
 METHODOLOGY: Two forward translations, review and reconciliation, back translation, expert review, developer review to create the PLUS-M™/Nepali-12SF. Psychometric testing for internal consistency, test-retest reliability and construct validity against the Two-Minute Walk Test (2MWT) and Amputee Mobility Predictor with Prosthesis (AMPPRO) were performed on sixty-six lower limb prosthesis users.
FINDINGS: The majority of populations were with transtibial amputation 45 (68%), with transfemoral amputation 15 (23%), with knee disarticulation 5 (7.5%) and with syme’s amputation 1 (1.5%). The most common cause of amputation among the population was trauma and the least was tumor. Chronbach’s alpha for the PLUS-M™/Nepali-12SF was 0.90, mean T-Score was 52.90, test-retest intraclass correlation coefficient (ICC) was 0.94 (95% confidence interval 0.90-0.96). Construct validity with the 2MWT was good (r = 0.62, p< 0.001) and moderately positive with the AMPPRO (r = 0.57, p< 0.001).
CONCLUSION: Our research evidenced that the PLUS-M™/Nepali -12SF had excellent reproducibility. The significance of this work is that it may allow for the measurement of mobility in austere locations of Nepal.
Layman's Abstract
In this research, the authors performed a cross-cultural translation and validation of a Prosthetic Limb Users Survey of Mobility (PLUS-MTM). Understanding mobility of lower limb prosthesis user is important for understanding effect of prosthetic limb treatment. One simple and valid way to measure this is to administer a short survey. The PLUS-MTM survey was designed for lower limb prosthesis users whom can walk independently without assistance; however, a Nepali version did not exist.  Translation of the PLUS-MTM occurred and Nepali lower limb prosthesis users were provided the survey. Moreover, survey scores were compared with users performances on a walking performance test called the Two-Minute Walk Test (2MWT) and Amputee Mobility Predictor with Prosthesis (AMPPRO). After comparison, it was found that the PLUS-MTM survey was more appropriate with Nepali culture, with good association between of PLUS-MTM with 2MWT, and AMPPRO scores. Meaning, if users scored high on the mobility survey they were also likely to score high on the walking test. The PLUS-MTM can now be confidently used in Nepal to track mobility of independent lower limb prosthesis users who can walk without other person’s assistance. 
Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/41310/31816
How To Cite: Bajracharya AR, Seng-iad S, Sasaki K, Guerra G. Cross-cultural adaptation and validation of the Nepali version of the Prosthetic Limb Users Survey of Mobility Short-Form (PLUS-M™/Nepali-12SF) in lower limb prosthesis users. Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.1. https://doi.org/10.33137/cpoj.v6i1.41310
Corresponding Author: Sirirat-Seng-iad, Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.E-Mail: sirirat.sen@mahidol.edu ORCID ID: https://orcid.org/0009-0008-7187-3593