Transcultural adaptation and psychometric validation of the Persian version of the 4-Domain Sports patient-reported outcome measure questionnaire.

INTRODUCTION/OBJECTIVES: Patient-reported outcome measures (PROMs) are essential tools in sports medicine for assessing subjective treatment outcomes in athletic populations who have higher functional demands. The 4-Domain Sports Patient-reported outcome measures (4-DSP) is a recently developed questionnaire evaluating injury perception, treatment expectations, and outcomes. However, no validated Persian version currently exists. The aim was to perform adaptation and psychometric validation of the Persian 4-DSP in patients undergoing anterior cruciate ligament reconstruction (ACLR). METHODS: The 4-DSP was translated and culturally adapted into Persian following Beaton guidelines and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. Ninety-seven ACLR patients (mean age 34.9 ± 12.1 years) completed the Persian 4-DSP twice at a 1-week interval. Internal consistency was assessed using Cronbach's alpha, and test-retest reliability using Intraclass correlation coefficients (ICC). Construct validity was examined through correlations with the Persian versions of the International Knee Documentation Committee Subjective Form (IKDC-SF) and Lysholm Knee Score (LKS). Floor and ceiling effects were also evaluated. RESULTS: The Persian 4-DSP demonstrated acceptable internal consistency (Cronbach's α = 0.67). Test-retest reliability was good overall (ICC = 0.693), with excellent item-level stability (ICC range: 0.96-1.00). Construct validity showed low-to-moderate correlations with Persian version of IKDC-SF and LKS, consistent with the instrument's multidimensional and sports-specific construct. Floor effects were minimal (0-2%), while ceiling effects ranged from 14% to 48% across domains. No meaningful improvement in internal consistency was observed after item deletion, supporting structural stability of the instrument. CONCLUSION: The Persian version of the 4-DSP is a valid, reliable, and culturally adapted PROM for ACLR patients. It provides complementary information to conventional knee-specific instruments and is suitable for use in Persian-speaking athletic populations. LEVEL OF EVIDENCE: III.