Cross-cultural validation of the low anterior resection syndrome (LARS) score incorporating Chinese and Taiwanese media-guide administration

Abstract Background Low anterior resection syndrome (LARS) is a frequent outcome of sphincter-preserving surgery for rectal cancer, significantly affecting long-term quality of life. Despite translation into multiple languages, the LARS score remains underutilized among older patients with limited literacy or visual decline in Taiwan. This study aimed to validate an online LARS score incorporating Chinese and Taiwanese media-guided administration. Methods The LARS score was rigorously re‑translated into traditional Chinese through a standardized forward‑ and back‑translation process, establishing the foundation for both the Chinese and Taiwanese media‑guided versions. Between March 4, 2025, and April 7, 2026, patients from three hospitals completed the questionnaire. Convergent validity was examined through correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‑C30), and discriminant validity was evaluated by distinguishing patients with differing clinical characteristics, while reliability and test–retest reliability were assessed. Results A total of 103 patients were enrolled, with 53 completing the Chinese version and 50 the Taiwanese version of the online LARS score. Convergent validity was supported by significant correlations with multiple quality‑of‑life domains, as greater LARS severity was consistently linked to poorer global health and functioning, with significant negative correlations for physical, emotional, and social functioning, and additional positive correlations with fatigue and pain in the Taiwanese version. Discriminant validity was confirmed in both versions by subgroup differences related to tumor location, prior experience of temporary stoma, and previous receipt of radiotherapy. For the Chinese and Taiwanese versions, Cronbach’s α was 0.84 and 0.86, and Spearman’s correlation coefficients for test–retest reliability was 0.89 and 0.92, respectively. Cohen’s kappa values for item‑level agreement and across the three LARS categories were around 39.000 to 141.500 and statistically significant. Conclusions The online LARS score, administered through Chinese and Taiwanese media‑guided formats, demonstrated appropriate convergent validity, discriminant validity, and strong internal consistency with satisfactory test–retest reliability, while providing an additional assessment option for older patients with limited literacy or age‑related visual decline. Moreover, it offers healthcare professionals a real‑time screening tool to support timely clinical care, thereby affirming its value as an inclusive patient‑reported outcome measure for both clinical practice and cross‑cultural research.