Cross-Cultural Adaptation and Validation of the Hindi Version of the Fukushima Lumbar Spinal Stenosis Scale-25 in Indian Patients with Lumbar Spinal Stenosis: A Cross-Sectional Psychometric Study.
- 1Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
Lumbar spinal stenosis (LSS) contributes substantially to disability in older populations, yet no disease-specific patient-reported outcome measure exists in Hindi. The Fukushima LSS scale (FLS), developed in Japan, has been cross-culturally adapted in several countries with good reliability and validity. This cross-sectional psychometric study aimed to develop a Hindi translation of the scale and to examine its reliability, validity, factor structure, and responsiveness among Indian patients with LSS. We performed cross-cultural adaptation following established guidelines, including forward and backward translation, expert committee review, and pilot testing. The Hindi scale was administered to 160 patients with radiologically confirmed LSS at one of the largest tertiary referral institutes in North India; participants also completed the Hindi Oswestry Disability Index (ODI) and a Visual Analog Scale (VAS) for back and leg pain. We assessed internal consistency, test-retest reliability, construct validity, known-groups validity, factor structure (exploratory factor analysis), and responsiveness to surgical treatment. Measurement error (standard error of measurement [SEM] and smallest detectable change) and a distribution-based minimal important change (MIC) were also estimated. Internal consistency was high (Cronbach's alpha was 0.89 for the total score and above 0.80 for most domains), and test-retest reliability was excellent (intraclass correlation coefficient 0.92 for the total score). Strong correlations with both the ODI and the VAS (r > 0.70, P < 0.001) supported construct validity, and patients with severe stenosis scored significantly higher than those with mild-to-moderate stenosis. Factor analysis yielded a five-factor structure explaining over 60% of total variance. Scale scores showed large effect sizes for change following surgery. The SEM of the total score was 3.7 points, the smallest detectable change was 10.3 points, and the distribution-based MIC was estimated at 6.6 points. The Hindi FLSS is a reliable, valid, disease-specific instrument for assessing symptom severity and functional limitation in Indian patients with LSS, suitable for use in both clinical practice and research with Hindi-speaking populations. Confirmatory analysis in independent, multicenter cohorts is the logical next step.
Related
- Cross-cultural adaptation and psychometric evaluation of the Chinese version of the Digital and Technological Self-Efficacy Scale among nursing students: a three-phase validation study.
- Cross-Cultural Adaptation and Psychometric Validation of the Arabic Duruöz Hand Index: A Reliable Patient-Reported Measure for Hand Disability in Arabic-Speaking Populations
- Psychometric properties and cross-cultural adaptation of the HPV testing knowledge scale: a cross-sectional methodological study among Turkish women
- Cross-cultural adaptation and psychometric evaluation of the Japanese version of the scale for the assessment of non-experts’ AI literacy among medical trainees in a multicenter cross-sectional study
- Cross-Cultural Adaptation and Psychometric Validation of the Arabic Chronic Venous Insufficiency Quality-of-Life Questionnaire (CIVIQ-20) in Saudi Arabia.
BibTeX
@article{raj2026crosscultural,
title = {{Cross-Cultural Adaptation and Validation of the Hindi Version of the Fukushima Lumbar Spinal Stenosis Scale-25 in Indian Patients with Lumbar Spinal Stenosis: A Cross-Sectional Psychometric Study.}},
author = {Sharath Raj and Vishal Kumar and Aduri Tharun Teja and Rahul Uppal and F Basil and Vijay G Goni},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8538},
url = {https://europepmc.org/article/MED/42997070},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Cross-Cultural Adaptation and Validation of the Hindi Version of the Fukushima Lumbar Spinal Stenosis Scale-25 in Indian Patients with Lumbar Spinal Stenosis: A Cross-Sectional Psychometric Study.
AU - Sharath Raj
AU - Vishal Kumar
AU - Aduri Tharun Teja
AU - Rahul Uppal
AU - F Basil
AU - Vijay G Goni
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8538
UR - https://europepmc.org/article/MED/42997070
AB - Lumbar spinal stenosis (LSS) contributes substantially to disability in older populations, yet no disease-specific patient-reported outcome measure exists in Hindi. The Fukushima LSS scale (FLS), developed in Japan, has been cross-culturally adapted in several countries with good reliability and validity. This cross-sectional psychometric study aimed to develop a Hindi translation of the scale and to examine its reliability, validity, factor structure, and responsiveness among Indian patients with LSS. We performed cross-cultural adaptation following established guidelines, including forward and backward translation, expert committee review, and pilot testing. The Hindi scale was administered to 160 patients with radiologically confirmed LSS at one of the largest tertiary referral institutes in North India; participants also completed the Hindi Oswestry Disability Index (ODI) and a Visual Analog Scale (VAS) for back and leg pain. We assessed internal consistency, test-retest reliability, construct validity, known-groups validity, factor structure (exploratory factor analysis), and responsiveness to surgical treatment. Measurement error (standard error of measurement [SEM] and smallest detectable change) and a distribution-based minimal important change (MIC) were also estimated. Internal consistency was high (Cronbach's alpha was 0.89 for the total score and above 0.80 for most domains), and test-retest reliability was excellent (intraclass correlation coefficient 0.92 for the total score). Strong correlations with both the ODI and the VAS (r > 0.70, P < 0.001) supported construct validity, and patients with severe stenosis scored significantly higher than those with mild-to-moderate stenosis. Factor analysis yielded a five-factor structure explaining over 60% of total variance. Scale scores showed large effect sizes for change following surgery. The SEM of the total score was 3.7 points, the smallest detectable change was 10.3 points, and the distribution-based MIC was estimated at 6.6 points. The Hindi FLSS is a reliable, valid, disease-specific instrument for assessing symptom severity and functional limitation in Indian patients with LSS, suitable for use in both clinical practice and research with Hindi-speaking populations. Confirmatory analysis in independent, multicenter cohorts is the logical next step.
SN - 2250-0685
SN - 2321-3817
ER -