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BackgroundThe Short Questionnaire to Assess Health-enhancing physical activity (SQUASH) is a validated tool measuring the duration, frequency, and intensity of physical activity. The modified version of the SQUASH (mSQUASH) has been developed, in collaboration between spondyloarthritis (SpA) experts and axial (ax)SpA patients, to better address the needs of these patients in the assessment physical activity (1).ObjectivesTo translate and cross-cultural adapt the mSQUASH into Turkish as well as its cognitive debriefing to test the conceptual equivalence of the translated version among patients with axSpA.MethodsThe mSQUASH was translated into Turkish by 2 bilingual translators, native speakers of Turkish one from medical (informed) and the other is without medical background (uninformed). The consensus on forward-translation was reached by the team included two rheumatologist (GA and LK) and the translators. Backward-translation into Dutch was performed by 2 bilingual translators, native speakers of Dutch and who were blinded to the original mSQUASH version. After the review of the Turkish version by an expert committee that included translators, two patients and the research team a pre-final version was prepared. This version was used in a field-test with cognitive debriefing and involved a sample of 10 axSpA patients (7 radiographic- and 3 non-radiographic axSpA patients) with variation in gender, age, disease duration, and educational background. The final Turkish mSQUASH version was reached after the patients were interviewed to check understandability, interpretation and cultural relevance of the translation. The whole process was performed according to the Beaton method (Figure 1) (2).Figure 1.Flow-chart of the translation and cross-cultural adaptation processResultsAfter the forward-backward translation process, small incompatibilities were resolved during the expert committee meeting. For example: `Ander transport (heen en terug)` was translated as `Diğer hedeflere (gidip gelmek)`. The meaning in English is `Other transport (round trip)’. This item questions the way of going to other places and the discrepancy raised whether to use `transportation` or the `target` as the title. To make it culturally adaptable consensus reached to use a word equivalent to `the target` which is semantically equal to the Dutch version. A total of 10 patients with axSpA [7 females, mean (SD) age of 38 (10)] participated in the field test. Mean (SD) time to complete the mSQUASH was 6.1 (2.4) minutes. Cognitive debriefing showed that items of the mSQUASH are clear, relevant, understandable, and easy to complete. None of the patients indicate any important aspect of physical activity that is missing from the questionnaire items. During the cognitive debriefing, 2 patients suggested a change in the wording of one item to make it more suitable to the Turkish culture. This item inquires after sport activities and patients raised the concern that the example activities, ice-skating, tennis, handball are not culturally suitable. According to their comments these items were replaced by other examples such as football.ConclusionThe final Turkish version of the mSQUASH showed acceptable linguistic validity and can be used in both clinical practice and for research purposes. However, to implement the Turkish version of the mSQUASH, further assessment of its psychometric properties (validity and reliability) is needed.References[1]Carbo MJ, et al. Semin Arthritis Rheum. 2021 Aug;51(4):719-727.[2]Beaton DE, et al.. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91Disclosure of InterestsGizem Ayan: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Fernando M Pimentel-Santos Speakers bureau: Abbvie, Novartis, UCB, Tecnimed, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, Tecnimed, UCB, Grant/research support from: Abbvie, Janssen, Novartis, Anneke Spoorenberg Speakers bureau: AbbVie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Consultant of: AbbVie, Novartis Pharma, Pfizer, UCB Pharma, Lilly, Grant/research support from: AbbVie, Novartis Pharma, Pfizer, Suzanne Arends: None declared, Levent Kiliç: None declared

BackgroundCoping with Rheumatic Stressors (CORS) is a valid and reliable instrument that measures eight coping strategies directed at pain, limitations and dependency as the most prominent chronic stressors of Rheumatoid Arthritis (RA) (1). This questionnaire has also been used in axial Spondyloarthritis (ax-SpA) previously (2).ObjectivesTo describe the translation and cross-cultural adaptation process of the CORS into Turkish as well as its cognitive debriefing to test the conceptual equivalence of the translated version among patients with RA, radiographic (r) and non-radiographic (nr) axSpA.MethodsThe CORS was firstly translated into Turkish (by 2 bilingual translators who are native speaker for Turkish) and then back-translated into Dutch (by 2 bilingual translators who are native speaker for Dutch) following the Beaton’s method (Figure 1) (3). Back-translation procedure was done totally blinded to the original version. After the review of the Turkish version by an expert committee that included translators, two patients and the research team, a consensus was reached on the pre-final version. Using the pre-final version, the field test with cognitive debriefing involved a sample of 10 RA and 10 axSpA patients with different gender, age, disease duration, and educational background. After some small changes resulting from the feedback from patients the final version was obtained.Figure 1.Flow-chart of the translation and cross-cultural adaptation processResultsThe CORS was translated into Turkish following the forward-backward procedure. Minor incompatibilities arose from the translation process of CORS which have been easily resolved by the expert committee meetings. For example, `Ik concentreer me op iets anders` was translated as `Başka seylere odaklanirim` which is in English `I concentrate on something else`. The discrepancy was raised whether to use a word equivalent `to concentrate` or `to focus` and decision was made to use `to focus` while there was no exact Turkish word of `to concentrate`. A total of 10 patients with RA [9 females, mean (SD) age of 49 (13)] and 10 patients with axSpA [7 females, mean (SD) age of 38 (10), r-AxSpA, n=7, nr-AxSpA, n= 3] participated in the field test. Mean (SD) time to complete the CORS was 8.3 (3.4) minutes. Cognitive debriefing showed that items of the CORS are clear, relevant, understandable, and easy to complete. Cognitive debriefing revealed that the wording of one item had to be changed to provide better understanding (Section B, item 22 the word `stop` in Dutch and `stop` in English which was translated as `durdurmak` in Turkish changed to `sonlandirmak`.ConclusionThe final Turkish version of the CORS showed acceptable linguistic validity and can be used in both clinical practice and for research purposes, in patients with RA and in patients with axSpA. However, to implement Turkish-CORS, further assessment is ongoing to test its psychometric properties (validity and reliability).References[1]van Lankveld W, et al. Br J Rheumatol. 1994;33(11):1067-73.[2]Boonen A, et al. Ann Rheum Dis. 2004;63(10):1264-8.[3]Beaton DE, et al. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91Disclosure of InterestsGizem Ayan: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Fernando M Pimentel-Santos Speakers bureau: Abbvie, Novartis, UCB, Tecnimed, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, Tecnimed, UCB, Grant/research support from: AbbVie, Janssen, Novartis, Wim van Lankveld: None declared, Levent Kiliç: None declared