Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis
Abstract Background The Fukushima Lumbar Spinal Stenosis Scale (FLS-25) is a disease-specific patient-reported outcome measure developed to assess the symptoms and functional impact of lumbar spinal stenosis (LSS). However, no Korean version of the FLS-25 has been validated to date. This study aimed...
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BMC
2025-08-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-06188-y |
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| author | Il-Soo Eun Hak Sang Kim Yoon Jae Cho Tae Sik Goh Jung Sub Lee |
| author_facet | Il-Soo Eun Hak Sang Kim Yoon Jae Cho Tae Sik Goh Jung Sub Lee |
| author_sort | Il-Soo Eun |
| collection | DOAJ |
| description | Abstract Background The Fukushima Lumbar Spinal Stenosis Scale (FLS-25) is a disease-specific patient-reported outcome measure developed to assess the symptoms and functional impact of lumbar spinal stenosis (LSS). However, no Korean version of the FLS-25 has been validated to date. This study aimed to assess the reliability, validity, and responsiveness of a Korean adaptation of the FLS-25 (K-FLS-25) using a structured cross-cultural adaptation process. Methods The original FLS-25 questionnaire was translated into Korean following established guidelines for cross-cultural adaptation, including forward translation, synthesis, back-translation, expert committee review, and pretesting. The finalized Korean version (K-FLS-25) was initially administered to 140 consecutive patients diagnosed with LSS. Of these, 123 patients completed both the baseline and follow-up assessments and were included in the final analysis. To evaluate construct validity, participants also completed the validated Korean version of the Oswestry Disability Index (ODI) and a Visual Analog Scale (VAS) for back and leg pain. Reliability was assessed through item-wise agreement using kappa statistics, test-retest reliability via the intraclass correlation coefficient (ICC [2,1]), and internal consistency using Cronbach’s α. Construct validity was evaluated by calculating Pearson’s correlation coefficients between K-FLS-25, ODI, and VAS scores. Results All items of the K-FLS-25 demonstrated substantial agreement, with kappa values exceeding 0.6. The test-retest reliability was excellent (ICC [2,1] = 0.93), and internal consistency was high (Cronbach’s α = 0.901). Construct validity was supported by significant Pearson’s correlation coefficients between the total and domain scores of K-FLS-25 and the scores of the ODI and VAS for both back and leg pain. As part of cultural adaptation, a prefinal version was tested in 30 Korean-speaking LSS patients, who reported good comprehension without major issues. The final version was confirmed by expert consensus. Conclusions The K-FLS-25 was successfully translated and culturally adapted for Korean-speaking patients. It demonstrated excellent reliability, validity, and responsiveness, supporting its suitability as a disease-specific instrument for evaluating symptoms, functional disability, and treatment-related changes in patients with lumbar spinal stenosis in Korea. |
| format | Article |
| id | doaj-art-bf869db6a6f74061b86d19e90ec6e835 |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-bf869db6a6f74061b86d19e90ec6e8352025-08-20T03:43:14ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-08-012011810.1186/s13018-025-06188-yCross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosisIl-Soo Eun0Hak Sang Kim1Yoon Jae Cho2Tae Sik Goh3Jung Sub Lee4Department of Orthopaedic Surgery, Good Samsun HospitalDepartment of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of MedicineDepartment of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of MedicineDepartment of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of MedicineDepartment of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of MedicineAbstract Background The Fukushima Lumbar Spinal Stenosis Scale (FLS-25) is a disease-specific patient-reported outcome measure developed to assess the symptoms and functional impact of lumbar spinal stenosis (LSS). However, no Korean version of the FLS-25 has been validated to date. This study aimed to assess the reliability, validity, and responsiveness of a Korean adaptation of the FLS-25 (K-FLS-25) using a structured cross-cultural adaptation process. Methods The original FLS-25 questionnaire was translated into Korean following established guidelines for cross-cultural adaptation, including forward translation, synthesis, back-translation, expert committee review, and pretesting. The finalized Korean version (K-FLS-25) was initially administered to 140 consecutive patients diagnosed with LSS. Of these, 123 patients completed both the baseline and follow-up assessments and were included in the final analysis. To evaluate construct validity, participants also completed the validated Korean version of the Oswestry Disability Index (ODI) and a Visual Analog Scale (VAS) for back and leg pain. Reliability was assessed through item-wise agreement using kappa statistics, test-retest reliability via the intraclass correlation coefficient (ICC [2,1]), and internal consistency using Cronbach’s α. Construct validity was evaluated by calculating Pearson’s correlation coefficients between K-FLS-25, ODI, and VAS scores. Results All items of the K-FLS-25 demonstrated substantial agreement, with kappa values exceeding 0.6. The test-retest reliability was excellent (ICC [2,1] = 0.93), and internal consistency was high (Cronbach’s α = 0.901). Construct validity was supported by significant Pearson’s correlation coefficients between the total and domain scores of K-FLS-25 and the scores of the ODI and VAS for both back and leg pain. As part of cultural adaptation, a prefinal version was tested in 30 Korean-speaking LSS patients, who reported good comprehension without major issues. The final version was confirmed by expert consensus. Conclusions The K-FLS-25 was successfully translated and culturally adapted for Korean-speaking patients. It demonstrated excellent reliability, validity, and responsiveness, supporting its suitability as a disease-specific instrument for evaluating symptoms, functional disability, and treatment-related changes in patients with lumbar spinal stenosis in Korea.https://doi.org/10.1186/s13018-025-06188-yLumbarSpinal stenosisQuestionnaireKorea |
| spellingShingle | Il-Soo Eun Hak Sang Kim Yoon Jae Cho Tae Sik Goh Jung Sub Lee Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis Journal of Orthopaedic Surgery and Research Lumbar Spinal stenosis Questionnaire Korea |
| title | Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis |
| title_full | Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis |
| title_fullStr | Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis |
| title_full_unstemmed | Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis |
| title_short | Cross-cultural validation of the Fukushima lumbar spinal stenosis scale in Korean patients with degenerative lumbar spinal stenosis |
| title_sort | cross cultural validation of the fukushima lumbar spinal stenosis scale in korean patients with degenerative lumbar spinal stenosis |
| topic | Lumbar Spinal stenosis Questionnaire Korea |
| url | https://doi.org/10.1186/s13018-025-06188-y |
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