Dear Dr. Ahmed Farag,
We really appreciate your opinion and your suggestions, and I’d like to reply
to the points that you mentioned.
First: In the translation, adaptation, and validation process, we used a clear and
user-friendly guideline [1], which was mentioned
clearly in the paper. It is not the one that you reference. Nonetheless, all the
instructions were translated into Arabic. If you want the the full version that the
participants used to answer the questions you can email me directly or you can find
it in the ResearchGate website. Due to the policy of the Sports Medicine
International Open journal, I couldn’t attach the AR-ICOAP in the main
Article. The policy allows to attach the figures/files that written in
English language
Second: It is mentioned that we deviated from the original ICOAP by changing and
unifying all the answers of the ICOAP. The original ICOAP for each subscale for the
knee/hip consists of 11 items for each subscale. In the original scale, 10
items are already unified as follows: Not at all, mildly, moderately, severely, and
extremely. We basically followed the answers of the original ICOAP. However, item 7
was unified to the other items based on the recommendation of one of the Arabic
translators (forward process).
Furthermore, cultural adaptation attempts to render the meaning of the questionnaire
based on common words that are used. We obtained permission from Dr. Gillian Hawker
to translate and adapt the scale based on our culture. Although Dr. Hawker did
request we have a rheumatologist translate the scale, we used an orthopedic surgeon.
Dr. Hawker approved this change and asked that we specifically mention this fact in
the paper. Also, many studies adapt the translation based on commonly used words in
the specific culture. A Turkish study [2]
translated and adapted the Harris Hip score into Turkish. The English version used
the word “block” to define walking distance. The Turkish authors
changed the measurement into “minutes” because that is how this
would normally be expressed in the Turkish culture.
As to the third point, none of the participants understood that the items were asking
about the nature of the pain per se. The context of the question made it very clear
that the severity of the pain was meant. Also, a pilot study was done before giving
the questionnaire to the participants, and no one reported that we were asking about
the effect of the nature of the pain.
Fourth, I think you suggested a literal translation while ours is context one.
You state that “Critical appraisal of the ICOAP-AR reveals that its
content
validity is not established because of significant flaws in the translation and
cross-cultural adaptation process, which render it inequivalent to the original
ICOAP and, consequently, invalid and inappropriate for assessing osteoarthritis pain
in the Arab population in its current state.”
This research was based on statistical methods and results, and we did use
constructive validity to correlate the AR-ICOAP with the KOOS Score. There was a
correlation between the Arabic ICOAP and the Arabic KOOS that verifies the relevance
of the questions ((Cohen & Swerdlik, 2005).
Lastly, if you review the results section again you will see that the AR-ICOAP is
valid and reliable, and correlated with the Ar-KOOS (constructive validity) based on
numbers and statistics.
