Cross-Cultural Adaptation and Validation of the Chinese Version of the Exercise Adherence Rating Scale (EARS) in Older Patients with Urinary Incontinence After Prostate Cancer Surgery.

BACKGROUND: Adherence is central to the effectiveness of prescribed pelvic floor muscle training after radical prostatectomy, yet standardized tools for assessing home-exercise adherence in older Chinese patients are limited. The Exercise Adherence Rating Scale (EARS) is a brief patient-reported measure of adherence behavior. This study aimed to culturally adapt the EARS for Chinese use and evaluate its reliability and validity among older patients with post-prostatectomy urinary incontinence. METHODS: The EARS was translated and culturally adapted through forward translation, back-translation, multidisciplinary expert review, and pre-testing. Psychometric properties were evaluated in 177 older patients with post-prostatectomy urinary incontinence. Content and structural validity were assessed using content validity indices and confirmatory factor analysis for ordered categorical data, respectively. Reliability was evaluated using Cronbach's α, odd-even split-half reliability, and two-week test-retest reliability in 30 participants. Pearson correlations examined associations between the supplementary reasons items and the six-item adherence score. RESULTS: The mean six-item score was 15.71 ± 5.92. The item-level content validity index ranged from 0.883 to 1.000, and the average scale-level index was 0.990. The prespecified one-factor model showed good fit: comparative fit index = 1.000, Tucker-Lewis index = 1.013, root mean square error of approximation = 0.000 (90% confidence interval, 0.000-0.101), and standardized root mean square residual = 0.036. Standardized factor loadings ranged from 0.355 to 0.872 (all P < 0.001). Internal consistency and split-half reliability were acceptable (Cronbach's α = 0.787; Spearman-Brown coefficient = 0.811), and test-retest reliability was good (intraclass correlation coefficient = 0.879; 95% CI, 0.762-0.940; P < 0.001). Confidence, perceived health benefits, and enjoyment showed the strongest correlations with adherence (r = 0.448-0.554; all P < 0.01). CONCLUSION: The EARS-C demonstrated satisfactory content validity, acceptable internal consistency, good reproducibility, and support for the original one-factor structure in this single-center sample. These findings support its use for assessing self-reported exercise adherence while independent multicenter confirmation is pursued.