Translation and psychometric validation of the Persian version of amyotrophic lateral sclerosis cognitive behavioral screen (ALS-CBS) and revised amyotrophic lateral sclerosis  functional rating scale (ALSFRS-R)

Elnaz  Naserzadeh; Nahid  Olfati; Saeed  Akhlaghi; Maryam  Emadzadeh; Azra  Rashidnezhad; Shahriar  Nafissi; Farzad  Fatehi; Payam  Sarraf; Bahram  Haghi-Ashtiani; Bentolhoda  Ziaadini; Behnaz  Ansari; Ali Asghar  Okhovat; Keivan  Basiri; Reza  Boostani

doi:10.18502/cjn.v24i1.20299

Elnaz Naserzadeh School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Nahid Olfati Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Saeed Akhlaghi Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Maryam Emadzadeh Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Azra Rashidnezhad Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Shahriar Nafissi Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Farzad Fatehi Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Payam Sarraf Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Bahram Haghi-Ashtiani Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Bentolhoda Ziaadini Department of Neurology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Behnaz Ansari Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Ali Asghar Okhovat Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Keivan Basiri Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Reza Boostani Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

DOI: https://doi.org/10.18502/cjn.v24i1.20299

Keywords: Reliability and Validity; Cognition; Behavioral; Functional; Amyotrophic Lateral Sclerosis; Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen; Amyotrophic Lateral Sclerosis Functional Rating Scale

Abstract

Background: The Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen (ALS-CBS) and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) are widely recognized tools for evaluating cognitive, behavioral, and functional changes in patients with amyotrophic lateral sclerosis (ALS). Given the increasing number of ALS cases in Persian-speaking communities, there is a critical need for culturally and linguistically adapted versions of these instruments. The objective of this study was to translate the ALS-CBS and ALSFRS-R into Persian and evaluate their validity and reliability to ensure their applicability in clinical practice and research.

Methods: The Persian versions of the ALS-CBS and ALSFRS-R questionnaires were developed using the translation-back translation method. The translated questionnaires were administered to 36 individuals diagnosed with ALS. To assess content validity, neuromuscular specialists evaluated each item based on relevance, clarity, simplicity, necessity, and comprehensiveness, using content validity ratio (CVR) and content validity index (CVI) measures. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Test-retest reliability was evaluated using the intra-class correlation coefficient (ICC). Statistical analysis was conducted using SPSS software.

Results: All questionnaire items demonstrated satisfactory face validity after expert-guided revisions. The minimum acceptable values for CVI (≥ 0.78) and CVR (≥ 0.62) were achieved by correcting items that initially scored below the threshold. Reliability analysis revealed ICC values of 0.969 and 0.816 for the cognitive and behavioral sections of the ALS-CBS, respectively, and 0.909 for the ALSFRS-R. Cronbach’s alpha coefficients were 0.791 for the ALS-CBS behavioral section and 0.825 for the ALSFRS-R, indicating acceptable internal consistency.

Conclusion: The Persian versions of the ALS-CBS and ALSFRS-R have been shown to be both valid and reliable. These adapted tools provide valuable resources for assessing the cognitive, behavioral, and functional status of patients with ALS in Persian-speaking populations, ultimately supporting more accurate diagnosis, monitoring, and disease management.