Cross-cultural adaptation and psychometric validation of the Turkish version of Paper and Pencil Test in patients with multiple sclerosis

Background & Objective: Multiple Sclerosis (MS) is a chronic neurological disease that impairs patients’ cognitive abilities and motor functions, making it difficult to maintain independent living. This condition leads to significant challenges in complex self-care tasks such as clean intermittent catheterization (CIC). The aim of this study was to adapt the Paper and Pencil Test (PP-Test) into Turkish and evaluate its psychometric properties, thereby providing a reliable tool for assessing CIC skills in patients with MS. Methods: This methodological study was conducted between June and December 2023 at a university hospital with 61 MS patients who perform CIC. Data were collected using the PP-Test, Clean Intermittent Catheterization Learning Scale, Expanded Disability Status Scale (EDSS), and Functional Independence Measure (FIM). Reliability was assessed using Cronbach’s alpha and interrater agreement (Cohen’s kappa), and validity was analyzed through content validity index (CVI) and predictive validity based on the relationships between PP-Test, EDSS, and FIM scores. Results: Cronbach’s alpha was 0.97 for female and 0.74 for male participants. Interrater reliability was excellent (κ=0.87). The CVI was 0.85. PP-Test scores were negatively correlated with EDSS (r=-0.50) and positively correlated with both FIM and CIC ability scores (r=0.60). Conclusion: The Turkish version of the PP-Test is a valid and reliable instrument for assessing CIC proficiency in patients with MS. It can be effectively used in clinical and educational settings to evaluate and monitor catheterization learning.