quality of life is defined as individuals perception of their position in life , in the 
 context of the culture and value systems in which they live and in relation to their goals , 
 expectations , standards , and concerns . in addition , multiple factors including physical 
 health , level of independence , psychological state , social relationships , personal beliefs , 
 and their interactions to salient features of their environment are related to the quality 
 of life1 . rehabilitation practitioners 
 should keep up with quality of life of the patients while creating intervention targets for 
 rehabilitation programs2,3,4 . this approach is 
 particularly important in the management of lower limb amputee patients with prostheses . in 
 this context , in order to identify the perception of the user , measuring the quality of life 
 related to prosthesis is critical , as well as defining its functionality5 , 6 . despite the large number of studies focusing on limitations in the lower limb amputee 
 population , there are only a few health - related outcome measurement tools available that are 
 reliable and valid in patients with a lower limb amputation7 . the prosthetic evaluation questionnaire ( peq ) that was specifically 
 developed to assess prosthesis - related changes in quality of life is one of only a few 
 detailed instruments . peq is organized into nine functional domain scales that may be used 
 individually to measure a specific domain of interest8 . the trinity amputation and prosthesis experience scales ( tapes ) , 
 adapted to the turkish language by topuz et al . , is a self - report test that measures 
 health - related quality of life of lower limb amputee patients with prostheses9 . however , the authors were not able to 
 determine any correlation between the total score of the psychosocial adjustment subscale of 
 the turkish version of tapes and the emotional reaction subscale of the nottingham health 
 profile ( nhp ) or the nhp total score . hence , adaptation and validation of more instruments 
 in turkish are essential for assessing care outcomes in people with amputations . we preferred peq not only because it includes questions about measured prosthesis - related 
 quality of life in lower limb amputees , but also because it has a wide range of topics 
 relevant to amputation with good psychometric properties8 . we aimed to translate the peq to turkish and assess its reliability 
 and validity in lower limb amputees . peq is composed of 82 questions with 9 subscales including frustration ( fr ) , perceived 
 response ( pr ) , social burden ( sb ) , ambulation ( am ) , utility ( ut ) , residual limb health ( rl ) , 
 appearance ( ap ) , sounds ( so ) , and well - being ( wb ) . seventy - six of 82 questions in peq use a 
 visual analog scale with scores expressed in millimeters ( 0100  mm ) . some questions also 
 have check marks , which indicate that the question , scored on the visual analog scale , is 
 not applicable to the respondent . for some questions , a check mark is scored as a 100 , 
 whereas for others , it indicates  no response10 . the scores for each subscale are generated by computing the 
 arithmetic mean of all questions , and at least half of the questions of a single scale 
 should be answered with a number score and not with  no response  for correct 
 assessment6 . the peq scale refers to the 
 4 weeks preceding the administration of the instrument4 . the short form-36 ( sf-36 ) comprises 36 items with 8 multi - item subscales including bodily 
 pain ( bp ) , general health perception ( gh ) , general mental health ( mh ) , physical function 
 ( pf ) , role limitation due to emotional problems ( re ) , role limitation due to physical health 
 problems ( rp ) , social functioning ( sf ) , and vitality ( vt ) . all subscales are scored between 
 0 and 100 ( higher scores indicate higher wb or functionality ) and are summarized into 2 
 component summary scores ; the physical component summary ( pcs , consisting of vt , sf , re , and 
 mh subscales ) , and mental component summary ( mcs , consisting of pf , rp , bp , and gh)11,12,13 . sf-36 has recently been used in some 
 adaptation studies for peq8 , 14 , and we used pf and sf subscales as in the original peq 
 study by legro et al8 . sf-36 was 
 previously translated to turkish language , and it was proven to be valid and reliable15 . the translation team consisted of three bilingual native - turkish speaking health care 
 professionals as informed translators and one bilingual native - english speaking health care 
 professional as the uninformed translator , all of who were blinded to the study protocol . briefly , each informed translator 
 independently translated the peq and discussed the results with the other translators in 
 order to obtain a consolidated version ; the uninformed translator then re - translated that 
 consolidated version back to english . finally , the third native turkish - speaking 
 rehabilitation professional evaluated the disparity between the forward and backward 
 translations . the study participants were recruited from unilateral amputee patients who were admitted to 
 the ministry of health , ankara physical medicine and rehabilitation training and research 
 hospital between january 2012 and december 2013 . this is the biggest national inpatient 
 rehabilitation center as well as one of the national reference centers for amputees in 
 turkey . patients were eligible to participate if they had a lower limb amputation and had used 
 their current prosthesis for at least 6 months , and if they had given written informed 
 consent . exclusion criteria were as follows : bilateral lower limb or concomitant upper limb 
 amputation ; mental or other disorders limiting the proper usage of prosthesis or other aids , 
 participation in a prosthesis rehabilitation program within the previous six months ; 
 unstable medical conditions ; and withdrawal of informed consent . participants were asked to 
 complete the peq and sf-36 at the first visit and complete only the peq at the second visit . if the patient did not attend 
 within 4 weeks after the first evaluation , the patient was reminded via a phone call . all data were recorded on a computer database and analyzed using the spss 20.0 package 
 program ( spss , inc . , data are presented as percentages and numbers for 
 categorical variables , and means  standard deviations ( sd ) for continuous variables . the 
 kolmogorov - smirnov test was used to determine the distribution characteristics of the 
 variables . reliability of each subscale of the turkish version of peq was evaluated separately in 
 terms of test - retest reliability and internal consistency . the cronbach s alpha coefficient 
 was used to estimate the interrelation degree of constituent items . rasch analysis with the 
 person separation index the intraclass 
 correlation coefficient ( icc ) was considered as very good if ranged between 0.600.80 , and 
 excellent if over 0.8017 . the external construct validity of the peq was assessed by quantifying the relationships 
 ( pearson and spearman rank correlation coefficient [ r ] ) between the subscales of peq am vs. 
 sf-36 pf and peq sb vs. sf-36 sf . eighty - three participants completed the two visits with a very high completion rate of 
 items on the peq scale . seven subjects were excluded , as they did not come for the second 
 evaluation . the mean age of the participants was 41.012.2  years , with a male population of 
 94% ( n : 78 ) . the median peq re - test time was 28 days ( meansd : 2811 days ) the descriptive 
 and socio - demographic characteristics of participants were summarized in table 1table 1.participant characteristicscharacteristicsmeansd ( range)age ( years)41.012.2time since last prosthesis 
 ( months)746gender ( male)78 ( 94%)marital statusnever married13 ( 15.7%)married66 ( 79.5%)widowed or divorced4 ( 4.8%)education ( years)8.63.8work status : employed67 ( 80.7)household members4.11.6level of amputationhip disarticulation2 ( 2.4%)transfemoral35 ( 42.2%)knee disarticulation5 ( 6%)transtibial41 ( 49.4%)time since amputation060 months18 ( 21.7%)61120 months18 ( 21.7%)121 through 240 months20 ( 24.1%)241 or more months27 ( 32.5%)reason for amputationtrauma59 ( 71.1%)tumor10 ( 12%)congenital problem2 ( 2.4%)peripheral arterial disease7 ( 8.4%)other5 ( 6% ) . the causes of amputation were trauma in 71.1% ; tumor in 12% ; congenital 
 problems in 2.4% ; peripheral arterial disease in 8.4% ; and others in 6% . reliability of the peq scale was examined in terms of internal consistency and temporal 
 stability . the internal consistency represented by cronbach s alpha coefficient could be 
 sorted as follows : am=0.92 , sb=0.78 , ap=0.77 , fr=0.86 , pr=0.39 , rl=0.77 , so=0.65 , ut=0.90 , 
 and wb=0.64 . evaluation of mean scores of the first and second visits on each subscale 
 showed a temporal stability with interclass correlation , ranging from 0.69 to 0.89 ( table 2table 2.the prosthesis evaluation questionnaire scale summaryscale namemeansdrangecronbach s alphatemporal stabilityambulation32.918.05920.920.84 ( 0.760.89)social burden56.626.431000.780.73 ( 0.610.82)appearance35.520.24880.770.77 ( 0.670.85)frustration63.734.421000.860.89 ( 0.830.93)perceived response62.121.651000.390.82 ( 0.720.88)residual limb health48.123.35920.770.69 ( 0.550.79)sound37.028.831000.650.83 ( 0.750.89)utility31.319.81870.900.87 ( 0.80.91)well being44.823.44960.640.77 ( 0.670.85 ) ) . additionally , a high association between peq sb and sf-36 sf ( r=0.63 , p<0.01 ) and 
 moderate association between peq am and sf-36 pf ( r=0.48 , p<0.01 ) were determined in the 
 external construct validity assessment of peq . the turkish version of peq was reported to be reliable and partially valid for unilateral 
 amputee patients as well as feasible for implementation in daily practice . the current study 
 was designed to assess the validity of the sb and am subscales of peq and not for the wb 
 subscale of peq . validity assessment of the wb was not included in the current study due to 
 the requirement of another questionnaire to compare with which would most likely diminish 
 the completion rates of all scales . so that , our design allows us to reach very high 
 completion rates for all scales applied to participants . however , the questions that offered 
 the option of a check mark beside the visual analog scale to indicate that the question is 
 not applicable to responder were marked to large extend for the pr subscale ( for group 
 3-question d ,  no response  rate was 27% ; for group 3-question e , 
 rate was 19% ; for group 3- question g rate was 8% ; for group 3- 
 question h , rate was 7% ) . therefore , this might have resulted in a 
 particularly low cronbach s alpha coefficient that was 0.39 for the pr subscale in this 
 study . all other cronbach s alpha coefficients in this study were ranging from 0.64 to 0.92 
 and were consistent with those reported by ferrioro et al.14 , but were slightly lower than those reported by legro et al8 . the icc results of am , fr , pr , so , and ut were over 0.80 ( range 0.820.89 ) , while the rest 
 of the parameters of the icc subscales ranged from 0.69 to 0.79 . the icc results in our 
 study were lower than the arabic version of the peq , which ranged from 0.82 to 0.97 in the 
 study by day and buis7 . however , the design of the study performed by day and buis had limited comparisons in both 
 results . they assessed icc by comparing the english and arabic versions of peq when 
 examining patients who were bilingual in arabic and english for both scales , and the re - test 
 time was relatively shorter than ours ( approximately 28 days in our study ) . however , the 
 original validation study of peq was performed with mean re - test time of 30 days8 . in comparison with the reported icc 
 distribution ranging from 0.56 to 0.90 by legro et al . , we obtained better results in our 
 study ( ranging from 0.69 to 0.89 ) . although , our study sample ( n=83 ) was smaller compared to 
 that in the study by legro et al.(n=92)8 , 
 we did not lose any patients at follow - up . we believe that the higher re - test rate in our 
 sample had better icc results . in addition , we could not compare our icc results with those 
 reported by ferrigo et al.14 due to the 
 absence of a re - test evaluation in their study design . the external construct validity in our study was evaluated in the same manner as the 
 original peq questionnaire trial by legro et al . according to this , they found that the sb 
 score strongly correlated with the sf subscale of sf-36 ( r=0.59)8 . moreover , we determined a moderate correlation between the am score and sf-36 
 subscale of pf , while strong correlations were reported by legro et al . the subjects were 
 not recruited randomly and they represented a specific population in terms of the education 
 level and employed state . additionally , our study population was predominantly male . in conclusion , the findings of the present study indicate that the peq is a useful tool for 
 assessment of mobility and the psychosocial status in unilateral lower extremity amputees . 
 for the turkish speaking population , future studies are warranted to adapt similar tools in 
 pediatric patients as well as upper limb amputees .
[ purpose ] currently , there are a limited number of amputee - specific instruments for 
 measuring prosthesis - related quality of life with good psychometric properties in turkey . 
 this study translated the prosthetic evaluation questionnaire to turkish and analyzed as 
 well as discussed its construct validity and internal consistency . 
 [ subjects and methods ] 
 the prosthetic evaluation questionnaire was adapted for use in turkish by forward / backward 
 translation . 
 the final turkish version of this questionnaire was administered to 90 
 unilateral amputee patients . 
 second evaluation was possible in 83 participants within a 
 median 28 day time period . 
 [ results ] point estimates for the intraclass correlation 
 coefficient ranged from 0.69 to 0.89 for all 9 prosthetic evaluation questionnaire scales , 
 indicating good correlation . 
 overall cronbach s alpha coefficients ranged from 0.64 to 
 0.92 , except for the perceived response subscale of 0.39 . 
 the ambulation subscale was 
 correlated with the physical functioning subscales of short form-36 ( sf-36 ) ( r=0.48 ) . 
 the 
 social burden subscale score of the prosthetic evaluation questionnaire was correlated 
 with social functioning subscales of sf-36 ( r= 0.63 ) . 
 [ conclusion ] the turkish version of 
 the prosthetic evaluation questionnaire is a valid and reliable tool for implementation in 
 the turkish unilateral amputee population .