{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:45:45Z","timestamp":1785818745144,"version":"3.56.0"},"reference-count":42,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100019345","name":"King Salman Center for Disability Research","doi-asserted-by":"crossref","award":["KSRG-2026-131"],"award-info":[{"award-number":["KSRG-2026-131"]}],"id":[{"id":"10.13039\/501100019345","id-type":"DOI","asserted-by":"crossref"}]},{"award":["KSRG-2026-131"],"award-info":[{"award-number":["KSRG-2026-131"]}],"id":[{"id":"https:\/\/ror.org\/01ht2b307","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objective: The Patient-Specific Functional Scale (PSFS) is a patient-centered outcome measure that captures limitations in activities that are personally meaningful to patients. Although the Arabic PSFS has demonstrated acceptable validity and reliability, its responsiveness in individuals with lower extremity musculoskeletal disorders has not been established. This study aimed to examine the responsiveness of the Arabic PSFS in detecting changes in lower extremity function over time. Methods: A prospective cohort study was conducted in three outpatient physical therapy clinics in Riyadh, Saudi Arabia. Seventy-two adults with lower extremity musculoskeletal disorders receiving physical therapy care completed the Arabic PSFS, RAND-36, and Numeric Pain Rating Scale (NPRS) at baseline and follow-up. At the follow-up, participants also completed the Global Rating of Change (GRC). Responsiveness was evaluated using eight a priori hypotheses following COSMIN recommendations. Change scores were analyzed using correlation coefficients, paired t-tests, effect size (ES), and standardized response mean (SRM). Results: Sixty participants (83.3%) reported improvement in the GRC. PSFS scores improved significantly (mean difference = 1.66; p &lt; 0.001), demonstrating a large magnitude of improvement (ES = 0.80; SRM = 0.92). PSFS change scores correlated moderately with RAND-36 physical functioning (r = 0.51) and GRC (r = 0.55) and weakly with emotional well-being (r = 0.26) and showed smaller-than-expected associations with pain measures. Six out of eight (75%) predefined hypotheses were confirmed. Conclusions: The Arabic PSFS demonstrates sufficient responsiveness in detecting improvement in lower extremity function and is suitable for monitoring rehabilitation outcomes in Arabic-speaking adults with lower extremity musculoskeletal disorders receiving outpatient physical therapy.<\/jats:p>","DOI":"10.3390\/jcm15156009","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:50:21Z","timestamp":1785757821000},"page":"6009","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Arabic Patient-Specific Functional Scale Demonstrates Responsiveness in Detecting Changes in Lower Extremity Function Among Individuals with Lower Extremity Musculoskeletal Disorders"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5168-1975","authenticated-orcid":false,"given":"Mishal M.","family":"Aldaihan","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9891-3390","authenticated-orcid":false,"given":"Abdulrahman M.","family":"Alsubiheen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia"},{"name":"King Salman Center for Disability Research, Riyadh 11614, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1946-0739","authenticated-orcid":false,"given":"Ali H.","family":"Alnahdi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia"},{"name":"King Salman Center for Disability Research, Riyadh 11614, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1136\/bjsports-2018-099878","article-title":"What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: Systematic review","volume":"54","author":"Lin","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102434","DOI":"10.1016\/j.msksp.2021.102434","article-title":"Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person","volume":"57","author":"Hutting","year":"2022","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40945-021-00107-0","article-title":"Providing value-based care as a physiotherapist","volume":"11","author":"Cook","year":"2021","journal-title":"Arch. Physiother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1370\/afm.1239","article-title":"The values and value of patient-centered care","volume":"9","author":"Epstein","year":"2011","journal-title":"Ann. Fam. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"831","DOI":"10.2147\/PPA.S81975","article-title":"Measuring the quality of patient-centered care: Why patient-reported measures are critical to reliable assessment","volume":"9","author":"Tzelepis","year":"2015","journal-title":"Patient Prefer. Adherence"},{"key":"ref_6","first-page":"371","article-title":"The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application","volume":"79","author":"Binkley","year":"1999","journal-title":"N. Am. Orthop. Rehabil. Res. Netw. Phys. Ther."},{"key":"ref_7","first-page":"1833","article-title":"Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy","year":"1988","journal-title":"J. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/03009740310000409","article-title":"Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index","volume":"32","author":"Klassbo","year":"2003","journal-title":"Scand. J. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0140-6736(99)06140-1","article-title":"Disability in cross-cultural perspective: Rethinking disability","volume":"354","author":"Groce","year":"1999","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3138\/ptc.47.4.258","article-title":"Assessing disability and change on individual patients: A report of a patient specific measure","volume":"47","author":"Stratford","year":"1995","journal-title":"Physiother. Can."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"310","DOI":"10.2522\/ptj.20090382","article-title":"Mapping Patient-Specific Functional Scale (PSFS) items to the International Classification of Functioning, Disability and Health (ICF)","volume":"92","author":"Fairbairn","year":"2012","journal-title":"Phys. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3138\/ptc-2020-0042","article-title":"Psychometric Properties of the Patient-Specific Functional Scale in Patients with Low Back Pathology: A Systematic Review and Meta-Analysis","volume":"74","author":"Nazari","year":"2022","journal-title":"Physiother. Can."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2958","DOI":"10.1080\/09638288.2020.1851784","article-title":"Psychometric properties of Patient-Specific Functional Scale in patients with upper extremity disorders. A systematic review","volume":"44","author":"Nazari","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"262","DOI":"10.2519\/jospt.2022.10727","article-title":"Measurement Properties of the Patient-Specific Functional Scale and Its Current Uses: An Updated Systematic Review of 57 Studies Using COSMIN Guidelines","volume":"52","author":"Pathak","year":"2022","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4104","DOI":"10.1080\/09638288.2021.1880651","article-title":"Cross-cultural adaptation and measurement properties of the Arabic version of the Patient-Specific Functional Scale in patients with lower extremity musculoskeletal disorders","volume":"44","author":"Alnahdi","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jclinepi.2010.02.006","article-title":"The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes","volume":"63","author":"Mokkink","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"de Vet, H.C.W., Terwee, C.B., Mokkink, L.B., and Knol, D.L. (2011). Measurement in Medicine: A Practical Guide, Cambridge University Press.","DOI":"10.1017\/CBO9780511996214"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1097\/00005650-199803000-00018","article-title":"Reliability of an Arabic version of the RAND-36 Health Survey and its equivalence to the US-English version","volume":"36","author":"Coons","year":"1998","journal-title":"Med. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.3109\/09638288.2015.1129441","article-title":"The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain","volume":"38","author":"Alghadir","year":"2016","journal-title":"Disabil. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1179\/jmt.2009.17.3.163","article-title":"Global rating of change scales: A review of strengths and weaknesses and considerations for design","volume":"17","author":"Kamper","year":"2009","journal-title":"J. Man. Manip. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"897","DOI":"10.3109\/09638288.2015.1066452","article-title":"Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale","volume":"38","author":"Alnahdi","year":"2016","journal-title":"Disabil. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1002\/hec.4730020305","article-title":"The rand 36-item health survey 1.0","volume":"2","author":"Hays","year":"1993","journal-title":"Health Econ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)","volume":"63","author":"Hawker","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3839","DOI":"10.1080\/09638288.2020.1754927","article-title":"Measurement properties of the 15-item Arabic lower extremity functional scale","volume":"43","author":"Alnahdi","year":"2021","journal-title":"Disabil. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s11136-017-1765-4","article-title":"COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures","volume":"27","author":"Mokkink","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s11136-018-1798-3","article-title":"COSMIN guideline for systematic reviews of patient-reported outcome measures","volume":"27","author":"Prinsen","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1186\/s13063-016-1555-2","article-title":"How to select outcome measurement instruments for outcomes included in a \u201cCore Outcome Set\u201d\u2014A practical guideline","volume":"17","author":"Prinsen","year":"2016","journal-title":"Trials"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Diedenhofen, B., and Musch, J. (2015). Cocor: A comprehensive solution for the statistical comparison of correlations. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0121945"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1037\/0033-2909.111.1.172","article-title":"Comparing correlated correlation coefficients","volume":"111","author":"Meng","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_30","unstructured":"Portney, L.G., and Watkins, M.P. (2009). Foundations of Clinical Research: Applications to Practice, Pearson\/Prentice Hall. [3rd ed.]."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_32","unstructured":"(JASP, 2026). JASP, Computer Software."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s11136-011-9960-1","article-title":"Rating the methodological quality in systematic reviews of studies on measurement properties: A scoring system for the COSMIN checklist","volume":"21","author":"Terwee","year":"2012","journal-title":"Qual. Life Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1097\/01.brs.0000201241.90914.22","article-title":"The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy","volume":"31","author":"Cleland","year":"2006","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00586-010-1521-8","article-title":"The patient-specific functional scale is more responsive than the Roland Morris disability questionnaire when activity limitation is low","volume":"20","author":"Hall","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jclinepi.2013.11.002","article-title":"The Patient-Specific Functional Scale was valid for group-level change comparisons and between-group discrimination","volume":"67","author":"Abbott","year":"2014","journal-title":"J. Clin. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"550","DOI":"10.2519\/jospt.2015.5825","article-title":"The Patient-Specific Functional Scale: Its Reliability and Responsiveness in Patients Undergoing a Total Knee Arthroplasty","volume":"45","author":"Berghmans","year":"2015","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6493","DOI":"10.1080\/09638288.2025.2507719","article-title":"Minimal important change and responsiveness of the arabic patient-specific functional Scale in patients with upper extremity musculoskeletal disorders","volume":"47","author":"Alnahdi","year":"2025","journal-title":"Disabil. Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Rysstad, T., Grotle, M., Klokk, L.P., and Tveter, A.T. (2020). Responsiveness and minimal important change of the QuickDASH and PSFS when used among patients with shoulder pain. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03289-z"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1093\/ptj\/77.8.820","article-title":"The Patient-Specific Functional Scale: Measurement properties in patients with knee dysfunction","volume":"77","author":"Chatman","year":"1997","journal-title":"Phys. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1007\/s11136-021-02925-y","article-title":"Minimal important change (MIC): A conceptual clarification and systematic review of MIC estimates of PROMIS measures","volume":"30","author":"Terwee","year":"2021","journal-title":"Qual. Life Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jclinepi.2016.12.015","article-title":"The anchor-based minimal important change, based on receiver operating characteristic analysis or predictive modeling, may need to be adjusted for the proportion of improved patients","volume":"83","author":"Terluin","year":"2017","journal-title":"J. Clin. Epidemiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6009\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:19:36Z","timestamp":1785817176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":42,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156009"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156009","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]}}}