@article{e6f675557faf4fc9b7100be7abc77706,
title = "Validation of the Arabic version of the ocular surface disease index questionnaire",
abstract = "AIM: To develop an Arabic version of the ocular surface disease index (OSDI) and to assess its reliability and validity. METHODS: A cross sectional study was carried out to validate the Arabic version of the OSDI questionnaire. Initially, forward-backward translation was used to translate the English version of OSDI into Arabic. The translated questionnaire was tested for equivalence and cultural adaptability. Totally 200 subjects were then recruited from a non-clinical population and asked to complete the Arabic version of the OSDI (ARB-OSDI). The reliability of the questionnaire was assessed using Cronbach{\textquoteright}s-α. A subgroup of 30 participants was asked to complete the questionnaire on two occasions to test the test-retest reliability. RESULTS: A total of 200 participants were enrolled in the study. The average age of the study participants was 31.21±13.2y and 57% were male. An acceptable internal consistency level for the ARB-OSDI questionnaire measured by Cronbach{\textquoteright}s-α was revealed. All questions showed good internal consistency. Test-retest reliability analysis revealed good stability (interclass correlation coefficient, r=0.832, P<0.001). The construct validity for the questionnaire was also high. CONCLUSION: The ARB-OSDI questionnaire shows very good psychometric properties (acceptable internal consistency and test-retest reliability). That makes the questionnaire a valid potential tool to use in Arabic-speaking countries to monitor symptoms of dry eye disease in a larger population.",
keywords = "Arabic, Arabic version of the OSDI, Dry eye disease, OSDI questionnaire, Psychometrics analysis, Validation",
author = "Bakkar, {May M.} and El-Sharif, {Ahmad K.} and {Al Qadire}, Mohammad",
note = "Funding Information: validity to be used for the assessment of DED symptoms. The process of validation went through two main steps: a back-forward translation into Arabic, and a validation that aimed to ensure that the questionnaire retains psychometric properties of the original OSDI among Arabic speaking population in Jordan. The researchers found that the grammar (the syntactic component) of the original English text does not impose significant challenges to the translator. Thus, the accredited Arabic translation was straightforward and unproblematic. This allowed the translators to come up with an equivalent translation that is both grammatical and idiomatic. Hence, no significant difficulty or miscomprehension in this regard have been observed by the researchers. In few cases, the discrepancy between the four translators{\textquoteright} back translation was due to polysemy (the capacity for a word or phrase to have multiple meanings). For example, there is the case of the attributive adjective {\textquoteleft}poor{\textquoteright} (da3if) in {\textquoteleft}poor vision{\textquoteright} which is translated in the accredited translation as (da3if) and the noun phrase is (da3f fel naZar). When back-translated from Arabic to English, two of the translations involved the word {\textquoteleft}weakness{\textquoteright} instead of {\textquoteleft}poor{\textquoteright} (and the phrase was {\textquoteleft}weakness in vision{\textquoteright}). A similar case was reported when the technical (highly-specialized) term {\textquoteleft}sensitive{\textquoteright} in {\textquoteleft}sensitive to light{\textquoteright} (Hasasah lelDuu{\textquoteright}) which was back-translated as {\textquoteleft}allergic{\textquoteright} by two translators. In few cases, the relative discrepancy between the four translations and the original one is attributed to some required modifications in the syntactic structure of the phrase, or word class, because there is no one-to-one correspondence between some of the English and Arabic phrases or words in the accredited Arabic translation of the questionnaire. This was the case of the translation of the units {\textquoteleft}feel gritty{\textquoteright}, {\textquoteleft}problems with your eyes{\textquoteright}, {\textquoteleft}windy conditions{\textquoteright}. The accredited translation has opted to modify the internal structure of the original English text. For example, the phrase {\textquoteleft}gritty eyes{\textquoteright} has been translated into Arabic as a larger phrase that involves a noun phrase {\textquoteleft}sand{\textquoteright} and a prepositional phrase complement {\textquoteleft}in the eyes{\textquoteright} to make the phrase {\textquoteleft}sand in the eyes{\textquoteright} (ramlun fel 3ayn). In all, such insignificant discrepancies were accounted for, and they were treated by the researchers while conducting the experiments by explaining to the respondents their meanings. The questionnaire distributors and data gatherers were notified and made aware of such discrepancies. They were told to clarify to the respondents the intentions of their questions and the sort of data they are expected to receive. In this regard, the validated ARB-OSDI questionnaire demonstrated good psychometric properties including both high internal consistency and test-retest reliability. Internal consistency measures whether all items of the questionnaire measure the same characteristics[30]. The results showed that all the three subscales in the questionnaire; ocular symptoms, environmental triggers vision related functions had good internal consistency of the answers obtained and high correlation coefficient. The corrected item to scale (item to total) correlation coefficients for most items in the different subscales of the ARB-OSDI showed acceptable level, except for item 2; eyes that feels gritty. This may indicate that this question item may require further clarification to respondents by interviewers or by adding clarifying sentence if self-completed by subjects. In conclusion, the ARB-OSDI shows consistent psychometric properties that makes it applicable to use in the assessment of DED in Arabic-speaking communities. Using the ARB-OSDI questionnaire could also be a rapid and instrumental tool in assessing and monitoring of subjective symptoms of DED in routine clinical practice and in future population-based studies in Arabic-speaking countries. Furthermore, the questionnaire is presented in Standard Arabic (AL-Fosha), a variety of Arabic that is highly esteemed by Arabs as it is the variety used in the Holy Qur{\textquoteright}an, literature, and media. In addition, this variety is mutually understandable by the different speakers of regional Arabic dialects regardless of their social backgrounds. On the other hand, this study has several limitations. First, discriminant validity of the ARB-OSDI was not tested. In future work, this could be possible by using the ARB-OSDI in two groups of subjects; a group with clinical diagnosis of DED and a group with no DED to test if the ARB-OSDI can discriminate between the two groups. Second, the study did not recognize what would be the cut-off value for suspecting DED. This would be possible if the ARB-OSDI applied in DED patients{\textquoteright} group beside other clinical tests such as TFBUT, osmolarity and corneal staining. Finally, the 72h for testing test-retest reliability might be short interval. However, this interval was considered short enough to avoid changes in ocular symptoms as the DED status of patients can change within days and long enough for patients not to remember the answers[47], relying on the fact that the OSDI was designed to provide assessment of dryness symptoms for the previous week[16]. ACKNOWLEDGEMENTS We would like to thank all participants who agreed to participate in this study. The researcher would like to thank the anonymous translators at the translation company who were in charge of translating the English version of the OSDI to Arabic. In addition, the researchers are grateful to the four linguists from Al-AlBayt University who preferred to remain anonymous, for their time and effort in doing the back-translation of the accredited translation to English. Foundation: Supported by the Deanship of Research at Jordan University of Science and Technology. Conflicts of Interest: Bakkar MM, None; El-Sharif AK, None; Al Qadire M, None. REFERENCES 1 The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5(2):93-107. 2 Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu ZG, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II definition and classification report. Ocular Surf 2017;15(3):276-283. 3 Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. Publisher Copyright: {\textcopyright} 2021 International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.",
year = "2021",
month = oct,
day = "18",
doi = "10.18240/ijo.2021.10.18",
language = "English",
volume = "14",
pages = "1595--1601",
journal = "International Journal of Ophthalmology",
issn = "2222-3959",
publisher = "Press of International Journal of Ophthalmology",
number = "10",
}