Translation, cross-cultural adaptation, and psychometric validation of the Hindi version of the AO Spine Patient Reported Outcome Spine Trauma questionnaire

Study Design: A cross-sectional validation study. Purpose: To translate, culturally adapt, and validate the Hindi version of the AO Spine Patient-Reported Outcome Spine Trauma (PROST) questionnaire among native Hindi-speaking individuals with spinal trauma. Overview of Literature: Patient-reported outcome measures play a crucial role in spine trauma research; however, only a few have been culturally adapted for South Asian populations. The AO Spine PROST has shown excellent reliability and validity in Dutch, English, German, and Nepali cohorts, yet no validated Hindi version currently exists. Considering India's large Hindi-speaking population and significant spinal trauma burden, a Hindi adaptation is required to facilitate standardized evaluation and ensure cross-study comparability. Methods: The AO Spine PROST was translated and culturally adapted into Hindi following international protocols, including forward- backward translation, expert committee review, and pretesting. A total of 101 patients with recent spinal trauma were included. Psychometric evaluation involved assessing internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient [ICC]), and construct validity through correlation with the 36-Item Short-Form Health Survey. Feasibility, along with floor and ceiling effects, was also evaluated. Results: The Hindi AO Spine PROST exhibited excellent internal consistency (Cronbach's α=0.984) and strong test-retest reliability (Spearman's ρ=0.897; ICC=0.658; 95% confidence interval, 0.578-0.729). Correlation with the original English version was high (ρ=0.999), confirming strong conceptual equivalence. Construct validity was supported by strong correlations with EuroQol Visual Analog Scale (ρ=0.897) and relevant EuroQoL 5-Dimension 3-Level domains (e.g., walking vs. mobility; ρ=-0.84). Conclusions: The Hindi version of the AO Spine PROST is a reliable, valid, and culturally suitable tool for assessing functional outcomes following spinal trauma in Hindi-speaking populations. Its implementation promotes standardized, patient-centered outcome evaluation and enhances the inclusion of underrepresented linguistic groups in spine trauma research.