HAL Id: hal-03623447
https://amu.hal.science/hal-03623447
Submitted on 16 May 2022
HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entic research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.
L’archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diusion de documents
scientiques de niveau recherche, publiés ou non,
émanant des établissements d’enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.
Cross-cultural adaptation into French and validation of
the SCAR-Q questionnaire
Thomas Radulesco, Julien Mancini, Martin Penicaud, Jean-Jacques Grob,
Marie-Aleth Richard, Patrick Dessi, Nausicaa Malissen, Justin Michel
To cite this version:
Thomas Radulesco, Julien Mancini, Martin Penicaud, Jean-Jacques Grob, Marie-Aleth Richard, et
al.. Cross-cultural adaptation into French and validation of the SCAR-Q questionnaire. Quality of
Life Research, 2021, 30 (4), pp.1225-1231. �10.1007/s11136-020-02719-8�. �hal-03623447�
Titlepage
Title:Cross‐culturaladaptationintoFrenchandvalidationoftheSCAR‐Qquestionnaire.
Authors:
ThomasRadulesco
1
*
JulienMancini
2
*
MartinPenicaud
3
†
Jean‐JacquesGrob
4
†
Marie‐AlethRichard
5
‡
PatrickDessi
3
‡
NausicaaMalissen
4
JustinMichel
1
*jointfirstauthors,†jointsecondauthors,‡jointbeforelastauthors, jointseniorauthors
Affiliation:
1.AixMarseilleUniv,APHM,IUSTI,LaConceptionUniversityHospital,ENT‐HNS,Department,
Marseille,France
2
Aix‐MarseilleUniv,INSERM,IRD,APHM, UMR1252, SESSTIM, DepartmentofPublicHealth
(BIOSTIC),Aix‐MarseilleUniversity,HôpitaldelaTimone,Marseille,France
3
APHM, Department of Oto‐Rhino‐Laryngology and Head and Neck Surgery, La Conception
UniversityHospital,13385MarseilleCedex,France
4
INSERM, CRCM, APHM, CHU Timone, Department of Dermatology and Skin Cancer, Aix
MarseilleUniversity,Marseille,France.
5
CEReSS‐EA3279,ResearchCentrerinHealthServicesandQualityofLifeAixMarseille
University,DermatologyDepartment,UniversitaryHospitalTimone,AssistancePublique
HôpitauxdeMarseille,APHM,13385,Marseille,France
Shorttitle:SCAR‐Q:Frenchversion
CORRESPONDINGAUTHOR:ThomasRadulesco
Address:Department of Oto‐Rhino‐LaryngologyandHead and NeckSurgery,LaConception
UniversityHospital,147BdBaille,13005Marseille,France
Tel:+33491435858Fax:+33491435810
Email:Thomas.radulesco@ap‐hm.fr
ORCID‐ID:0000‐0002‐5939‐5372

Acknowledgments:none

Declarations
Funding(informationthatexplainswhetherandbywhomtheresearchwassupported):none
Conflictsofinterest/Competinginterests(includeappropriatedisclosures):none
Ethics approval (include appropriate approvals or waivers) : YES: We obtained an Ethical
CommitteeAuthorization(AuthorizationN°2020‐67).
Consenttoparticipate(includeappropriatestatements):YES
Consentforpublication(includeappropriatestatements):YES
Availabilityofdataandmaterial(datatransparency):Alldataavailable
Codeavailability(softwareapplicationorcustomcode):Notapplicable
Authors'contributions:ThomasRadulesco:Conceptualization,Methodology.JulienMancini:
Statistics. Martin Penicaud.: Data curatio; Jean‐Jacques grob: Original draft preparation.
MariealethRichard:Supervision,PatrickDessi:Datacuration.NausicaaMalissen:co‐writing.:
JustinMichel:Validation.
1
INTRODUCTION
Scarsarenaturalconsequencesofcicatrizationfollowingsurgery,traumaorburninjury.Ithas
beenshownthatpooraspectscarringcanresultinseriousmentaldisordersorpoorself‐esteem
[1,2].
Patient‐reportedoutcomeandexperiencemeasures(PROMsandPREMs)arenowpartofthe
qualityassessmentoftheoverallcareofpatients[3].Klassenetal.recentlydevelopedaspecific
PROinstrumentregardingscarevaluation[4].TheSCAR‐Qself‐questionnaireiscomposedof
three scales evaluating scar appearance(12 items),symptoms (12 items)and psychological
impact(5items).TheSCAR‐Qwasdesignedtoevaluateallscartypesinchildrenandadults.It
wasconsideredusefulinresearchwhereappearanceisanimportantoutcome.Indeedwhen
treatmentsaimtospecificallyimprovetheappearanceofscars,askingpatientswhattheythink
about how their scar looks seems a fundamental and practical measure [4]. After rigorous
development, a studyamong 731 patients validated the scale [5].Like most questionnaires
designedto evaluatescarringfrom thepointof view ofpatients, SCAR‐Q wasdevelopedin
Englishlanguage[6,7].Unfortunately,suchaquestionnairecannotbeusedinpatientswith
anothermotherlanguage.Toourknowledge,noquestionnaireregardingscarringevaluation
bypatientsisavailableinFrench.
TheobjectiveofourstudywastotranslatetheSCAR‐QinstrumentintoFrench[8–11]using
International guidelines issued by ISPOR (International Society for Pharmacoeconomics and
Outcomes Research) and by WHO (World Health Organization) [12, 13], then to test the
reliabilityandvalidityofthetranslatedversion.
MATERIALSANDMETHODS
2
Ethicalconsiderations
WeobtainedpermissiontousetheSCAR‐Qself‐questionnairefromtheoriginaldevelopment
team.Allparticipatingpatientsgavetheirwrittenconsentbeforejoiningthisstudy,whichwas
carried out in accordance with the Declaration of Helsinki (1983). We obtained an Ethical
Committee Authorization (Authorization N° 2020‐67, Assistance Publique des Hôpitaux de
Marseille,Marseille,France).
Translation
ISPORandWHOrecommendationswereusedtocarryoutthetranslationprocess[12,13].
Thetranslationprocesscomprised4steps:1/forwardtranslation2/backtranslation3/back‐
translation review, and4/ patientinterviews. Thetranslationprocess required 3 individuals
whowerefluentinbothEnglishandFrench.TwoindividualswhosemothertonguewasFrench
served as forward translators (English to French). One was a surgeon and the other one
professionaltranslatorspecializedinmedicaltranslations.Oncethetwoforwardtranslations
werecompleted,cognitivedebriefingwasconductedtoestablishconsensustomergethe2
translations and produce a single version. The last professional translator, whose mother
tonguewasEnglishandwasfluentinFrenchservedasbacktranslator.Thebacktranslatordid
notseeorreviewtheoriginalEnglishversionoftheSCAR‐Q.Oncethebacktranslationwas
complete,thequestionnairewasreturnedtotheoriginaldevelopmentteamandanalyzedby
an expert review panel including various 4 medical specialists and 2 paramedics. The
development team provided feedback and instructions prior to conducting the cognitive
debriefing interviews. The cognitive debriefing interviews engagetenpatientsinthetarget
patientpopulationtodeterminethequalityofthetranslation.Thefinalversionwasnotaimed
toprovidealiteraltranslation,butratheraconceptuallyequivalenttranslatedversionworded
inlanguagepatientscanunderstandeasily.AssuggestedbythedeveloperofthescaleSCAR‐Q
3
scale scores were transformed into 0 (worst) to 100 (best) based on logits from Rasch
measurementtheoryanalysis[5].
Population
Inclusioncriteriawere:French nationalityand Frenchastheirfirstlanguage;age≥18years;
havingavisiblescar,whateverthelocation,size(centimeters),dateoretiology.Wedidour
besttocoverthevariabilityoflocation,sizeofscarsandthedemographicvariability.Exclusion
criteriawere:illiteratepatientsorthoseunabletounderstandandrespondtothesurvey,and
personswithcognitivelimitation.
Thepatientswere recruitedforthe consultation ofdermatologyorsurgery.Thereasonfor
consultationwasnotalwaysthescar,butthepresenceofavisiblescar made it possible to
include the patient if he agreed and if the inclusion and exclusion criteria were met. The
statisticalpowerwascalculated.ComputingpowerandminimumsamplesizeforRMSEA:with
200patientsandaRMSEA=0.065wehada95.7%power(withanalpharisk=5%)toshowthat
thisRMSEAwaslowerthan0.08.Thefirst200patientsthatfullyansweredthequestionnaire
wereincludedinthestudy.Themajorityofthepatientsapproachedtocompletethesurvey
participated;however,wedonothavedemographicinformationonpersonswithdeclinedto
participate.
Statisticalvalidation
Weusedquestionnairescompletedbypatientsandstoredinasecuredatabase.Allanalyses
were conducted using IBM SPSS Statistics 20.0 (IBM Inc., New York, USA) and the lavaan
packageforR.3.6.3(RFoundationforStatisticalComputing,Vienna,Austria).Alltestsweretwo‐
sidedandp‐values<0.05wereconsideredsignificant.
Continuousand categorical variableswere describedusing,respectively,means (± standard
deviation)andcounts(percentages).Atscalelevel,floorandceilingeffectswereconsideredto
4
bepresentifmorethan15%ofrespondentsachieved,respectively,thelowestorthehighest
possiblescore,[14].Atitemlevel,theseeffectswereconsideredtobepresentifmorethan
95% of respondents answered in the lowest or highest response category [15].Items were
consideredredundantifthepolychoricinter‐itemcorrelationwas>0.7andirrelevantif<0.2
[15]. Reliability was assessed using ordinal Cronbach’s alpha (α) [16] and considered
satisfactoryif≥0.7[17].Structuralvaliditywastestedusingconfirmatoryfactoranalysis(CFA)
withtherobustweightedleastsquares(WLSMV)estimatorandDeltaparameterization,based
on the original 3‐factor structure of the initial version. Model fit of a correlated 3‐factor
structurewasexaminedusingtherootmeansquareerrorofapproximation(RMSEA,goodfit
if<0.06,poorfitif≥0.10,acceptableelsewhere),thecomparativefitindex(CFI)andtheTucker‐
Lewisindex(CFIandTLI,goodfitif>0.95,poorfitif<0.90,acceptableelsewhere)[18].
TheSpearmanrankcoefficient(ρ)wasusedtoassesscorrelationsbetweensubscales.Three
hypotheses were identified based on previous findings to determine known group validity:
higherSCAR‐Qscoreswereexceptedwhenthescarswerebigger,morerecent,andlocalized
ontheface[5].UnivariateanalyseswereperformedusingANOVAs.
Totesttherepeatabilityofthisnewscale,test‐retestreliabilitywasassessedin10patients
(giventheICCestimated(≥0.94)wehadan87%powertodetectanICChigherthanalowest
acceptableICC of 0.6with a two‐sidedtest). We consideredthat no clinicalchangeswould
occurinonemonthgiventhelong‐timescarsofthepatientsincluded(75%ofscarolderthan
12 months, scars were more than 13 years old on average). Patients answered the
questionnaireagainunderthesameconditions1monthlater.Consistencybetweenresponses
was evaluated using intra‐class correlation coefficient. The closerthecoefficientto1,the
highertherepeatability.Thistestwasperformedforeachsubscale.
5
Before initiating the study, all researchers were trained in patient interviewing. As all
questionnaireswerecompleted,therewerenoconcernsregardingmissingdata.
RESULTS
Translation
Some differences were found between the two forward translations, regarding both
instructionsand items. Forexample,“Howdoesyour scarlook?”wastranslatedas“Aquoi
ressemblevotrecicatrice?”byonetranslator(literally“whatdoesyourscarlooklike?”)andas
“Quelestl’aspectdevotrecicatrice?”(literally“whatistheaspectofyourscar?”bytheother.
A “reconciled” version containing both instructions and items was submitted to the back
translator.Nomajorcommentsweremadebythedevelopmentteamconcerningthe
backtranslation.Patientinterviewsincludedtenpatients(meanage=37yearsold,range25‐
62)withdifferenttypesofscars(burns,surgicalortraumaticscars).Thisstepentailedminor
modificationsofitemwording.Forexample,foritemn°6oftheSCARAppearancescalethe
word“irrégulière”wasaddedtothescardescription.
Statisticalvalidation
Twohundredpatientscompletedthequestionnaire.Populationcharacteristicsarereportedin
Table1.Weincluded109females(54.5%)and91males(46.5%).Mean age(SD)was53.3
(18)years‐old(min=18;max=84).Meanscarsizewas6.8(6.3)cm (min=1; max=35) and
meanscardatewas156.7(169)months(min=1;max=651).
Regarding item description, no floor or ceiling effect was found (max=85%) for all items.
Regardingscaledescription,wefoundaceilingeffectforall3subscales:in34.0%,33.0%,and
56.0% of patients for the appearance, symptoms, and psychological impact subscales
respectively (Figure 1). Forty‐one patients (20.5%) were not impaired at all in the three
dimensions.InternalconsistencywasconsideredsatisfactorywithaCronbach’salpha>0.7for
6
all subscales (0.97, 0.90 and 0.97, respectively, for SCAR‐Q Appearance, Symptom and
Psychological impact scales). Several items from the Appearance and Psychosocial impact
scalesshowedredundancy,withmanyinter‐itemcorrelationsabove0.7.TheCFAoftheoriginal
structuredisplayedreasonablefit,withRMSEA=0.065(90%ConfidenceInterval:0.057‐0.072),
CFI=0.974, and TLI=0.972. Subscales were positively correlated butnotstrongly
(0.45<rho<0.65,p<0.001).
Repeatabilitywastestedonarandomizedsubgroupof10patientswhodidnotdifferfromthe
other patients regarding their main characteristics and initial SCAR‐Q scores. Intra‐class
correlationcoefficientswere0.95(95%ConfidenceInterval:0.83‐0.99),0.94(0.59‐0.99),and
0.99(0.94‐1.00),forAppearance,SymptomandPsychologicalimpactscalesrespectively.
DISCUSSION
Modern practitioners are committed to the diagnosis and treatment of patients and to
addressing the patient’s objectives and assessing patient satisfaction, as part of a
comprehensiveapproachtocare[19].Scarisapartofsurgicaloutcome.Effortstoassessthe
patient’sperspectivewillresultinbettertherapeuticinterventionstoimprovescarqualityand
acceptance [20]. For that purpose, an instrument like SCARQ must be available in other
languagesthanEnglish,foramuchbroaderuse.Frenchaloneisestimatedtobespokendaily
in Metropolitan France by 76 million native speakers and by 235 million fluent speakers
worldwide.
Ourtranslationprocesshasalreadybeenusedinotherstudies[21,22].Itensuresatranslation
oftheideaorconcept,moremeaningfulandaccuratethanamereliteraltranslation[23].ISPOR
and WHO recommendations were chosen for the translation process,inordertoobtain
culturally‐adapted French version of the SCAR‐Q questionnaire. Combining forth and back
translation methods, we reduced potential biases in the process. Two‐way translation,
7
combined with a panel expert review and patient interviews, guarantees a culturally and
sociallyadaptedversion.Notranslationcanperfectlymatchtheoriginaldocumentbecauseof
conceptualdifferencesduetodiverginglanguageshistories.However,backtranslationintothe
original language ensures a conceptually valid translation[23]. By incorporating different
medical specialties and paramedics in the panel of experts, we tried to make an easily
understandable questionnaire. Actual patients were integrated intothisprocess,tocheck
whethertheproposedversionwasalsosuitablefornon‐medicalornon‐paramedicalusers.To
coverthevariabilityofsituations,weincludedpatientswithdifferenttypes(keloid,contracture,
hypertrophic)andlocations(faceandneck,chest,upperandlowermembers)ofscarsinorder
tobeasrepresentativeaspossibleoftargetpatients.
Cronbach’salphasoftheFrenchversionofSCAR‐Qwerehigh(0.97,0.90and0.97forSCAR‐Q
Appearance,Symptoms,andPsychologicalscales,respectively)thusdemonstratingahighlevel
ofinternalreliability.ThisisconsistentCronbach’salphavaluesoftheoriginalscale[4],ie0.96,
0.91,and0.95,respectively.Theceilingeffectfoundoneachsubscalewasprobablyrelatedto
thefactthatscarswerenotthemainreasonforconsultationinourcohort,explainingthehigh
numberofhighscores(Figure1).Moreover,themajorityofpatientshadscarsformorethan1
year,thusprobably increasing patients’ acceptanceandincreasingthescores.Thismustbe
confirmed by multiple patients’ evaluation at different time. As expected, subscales were
positivelycorrelated,butnottoostrongly(0.45<rho<0.65)whichsupportstheideathatthey
measure distinct dimensions. The repeatability analysis attests to the efficacy of the
questionnairealthoughgeneratedbytranslationintoFrench.
No translation process is perfect and conceptual differences may remain. However, the
combinationoftwomethodologiesaimedtominimizebiasandstatisticalvalidationprovided
8
acceptableresults. Another studylimit is thatwedo not havedemographicinformation on
personswhodeclinedtoparticipate.
Generalizabilityofstudyfindingmaybelimitedduetothesamplecharacteristics.Thesample
includedahighpercentageofpersonswhohadtheirscarsforsurgeryortrauma.Oursample,
smallerthaninZiolkowskietal.study[5],resultedinhighceilingeffectsacrossthe3scales.
Furthermore,oursampleonlyincluded2patientswithburnscarsandourresultsmaynotbe
generalizabletopatientswithburns.Whilethesefindingdemonstratetheinitialvalidityofthe
Frenchtranslationof the SCAR‐Q,futurestudiesarerequired toexamine the reliability and
validityinothersamples,inparticularwithamongpersonswithmorerecentandseverescars.
Infurtherstudies,theFrenchSCAR‐QcouldalsobeusedsimultaneouslywithEnglishversionin
astudyincludingbothEnglishandFrench‐speakingpatients.Thiswouldallowexaminationof
measurementequivalence.
CONCLUSION
TheSCAR‐Qquestionnaireisareferenceinthefieldofpatient‐reportedoutcomesregarding
scar evaluation.The 4‐steptranslation‐backtranslation processmadeitpossibletoobtaina
high‐qualityFrenchversioninlinewiththeoriginaldocument.Thistranslatedversionisnow
usableinFrance.

9
REFERENCES
1. FinlayAY,KhanGK,LuscombeDK,SalekMS.(1990).ValidationofSicknessImpact
ProfileandPsoriasisDisabilityIndexinPsoriasis.BrJDermatol,123:751–756.
https://doi.org/10.1111/j.1365‐2133.1990.tb04192.x
2. ZhangX,LiuY,DengX,etal.(2019).TheCorrelationBetweenQualityofLifeand
AcceptabilityofDisabilityinPatientsWithFacialBurnScars.FrontBioengBiotechnol,7:329.
https://doi.org/10.3389/fbioe.2019.00329
3. BaumhauerJF.(2017).Patient‐ReportedOutcomes‐AreTheyLivingUptoTheir
Potential?NEnglJMed,377:6–9.https://doi.org/10.1056/NEJMp1702978
4. KlassenAF,ZiolkowskiN,MundyLR,etal.(2018).DevelopmentofaNewPatient‐
reportedOutcomeInstrumenttoEvaluateTreatmentsforScars:TheSCAR‐Q.PlastReconstr
SurgGlobOpen,6:e1672.https://doi.org/10.1097/GOX.0000000000001672
5. ZiolkowskiNI,PusicAL,FishJS,etal.(2020).PsychometricFindingsfortheSCAR‐Q
Patient‐ReportedOutcomeMeasureBasedon731ChildrenandAdultswithSurgical,
Traumatic,andBurnScarsfromFourCountries.Plastic&ReconstructiveSurgery,146:331e–
338e.https://doi.org/10.1097/PRS.0000000000007078
6. MundyLR,MillerHC,KlassenAF,etal.(2016).Patient‐ReportedOutcomeInstruments
forSurgicalandTraumaticScars:ASystematicReviewoftheirDevelopment,Content,and
PsychometricValidation.AestheticPlastSurg,40:792–800.https://doi.org/10.1007/s00266‐
016‐0642‐9
7. VercelliS,FerrieroG,SartorioF,etal.(2003).Howtoassesspostsurgicalscars:A
reviewofoutcomemeasures.DisabilityandRehabilitation,25:2055–2063.
https://doi.org/10.3109/09638280902874196
8. GuilleminF,BombardierC,BeatonD.(1993).Cross‐culturaladaptationofhealth‐
relatedqualityoflifemeasures:literaturereviewandproposedguidelines.JClinEpidemiol,
46:1417–1432.https://doi.org/10.1016/0895‐4356(93)90142‐n
9. BeatonDE,BombardierC,GuilleminF,FerrazMB.(2000).Guidelinesfortheprocess
ofcross‐culturaladaptationofself‐reportmeasures.Spine,25:3186–3191.
https://doi.org/10.1097/00007632‐200012150‐00014
10. ChakkaS,WerthVP.(2019).Cross‐culturaladaptationsofhealth‐relatedqualityoflife
measures.BrJDermatol,181:659–660.https://doi.org/10.1111/bjd.18272
11. VasquezD,AguirreD‐C,SanclementeG.(2019).Constructvalidityandresponsiveness
oftheColombianversionofSkindex‐29.BrJDermatol,181:770–777.
https://doi.org/10.1111/bjd.17742
12. WildD,GroveA,MartinM,etal(2005)PrinciplesofGoodPracticefortheTranslation
andCulturalAdaptationProcessforPatient‐ReportedOutcomes(PRO)Measures:reportof
theISPORTaskForceforTranslationandCulturalAdaptation.ValueHealth,8:94–104.
https://doi.org/10.1111/j.1524‐4733.2005.04054.x
10
13. WHO|Processoftranslationandadaptationofinstruments.In:WHO.
https://www.who.int/substance_abuse/research_tools/translation/en/.Accessed25Apr
2020
14. TerweeCB,BotSDM,deBoerMR,etal.(2007).Qualitycriteriawereproposedfor
measurementpropertiesofhealthstatusquestionnaires.JClinEpidemiol,60:34–42.
https://doi.org/10.1016/j.jclinepi.2006.03.012
15. VetHCWde,TerweeCB,MokkinkLB,KnolDL.(2011).MeasurementinMedicine:A
PracticalGuide.In:CambridgeCore./core/books/measurement‐in‐
medicine/8BD913A1DA0ECCBA951AC4C1F719BCC5.Accessed25Apr2020
16. GadermannA,GuhnM,ZumboB.(2012).EstimatingordinalreliabilityforLikert‐type
andordinalitemresponsedata:Aconceptual,empirical,andpracticalguide.Practical
Assessment,Research&Evaluation,17:1–13
17. BlandJM,AltmanDG(1997)Cronbach’salpha.BMJ,314:572.
https://doi.org/10.1136/bmj.314.7080.572
18. Cutoffcriteriaforfitindexesincovariancestructureanalysis:Conventionalcriteria
versusnewalternatives:StructuralEquationModeling:AMultidisciplinaryJournal:Vol6,No
1.https://www.tandfonline.com/doi/abs/10.1080/10705519909540118.Accessed25Apr
2020
19. TredgetEE,ShuppJW,SchneiderJC.(2017).ScarManagementFollowingBurnInjury.J
BurnCareRes,38:146–147.https://doi.org/10.1097/BCR.0000000000000548
20. KimB,SgariotoM,HewittD,etal.(2018).Scaroutcomesindermatologicalsurgery.
AustralasJDermatol,59:48–51.https://doi.org/10.1111/ajd.12570
21. PoulsenL,RoseM,KlassenA,etal(2017)Danishtranslationandlinguisticvalidationof
theBODY‐Q:adescriptionoftheprocess.EurJPlastSurg,40:29–38.
https://doi.org/10.1007/s00238‐016‐1247‐x
22. RadulescoT,PenicaudM,SantiniL,etal.(2018).FrenchvalidationoftheFACE‐Q
Rhinoplastymodule.ClinicalOtolaryngology,https://doi.org/10.1111/coa.13267
23. LacasseY,SérièsF.(2004).Health‐relatedqualityoflifemeasurement:areaders’
guide].RevMalRespir,21:S63‐70.https://doi.org/10.1016/s0761‐8425(04)71462‐x

11
Figurelegends
Figure1.Bargraphshowingscoresofpatientsforallsubscales.Aceilingeffectwasobservedin
allsubscales.

12
Table

Test‐retestparticipant
No(n=190) Yes(n=10)
Mean SD Mean SD P‐value
AppearanceScale(0‐100) 73.6 23.1 80.0 23.8 0.54
SymptomScale(0‐100) 81.3 16.4 81.8 13.5 0.95
PsychosocialImpact(0‐
100)
85.3 21.6 86.3 20.1
0.90

N % N %
Sex Female 104 54.7% 5 50.0% 0.99
Male 86 45.3% 5 50.0%
Age(y) <=30 29 15.3% 1 10.0% 0.11
31‐60 92 48.4% 2 20.0%
>60 69 36.3% 7 70.0%
Scarsize(cm) <=2 31 16.3% 1 10.0% 0.60
3‐10 130 68.4% 6 60.0%
>10 29 15.3% 3 30.0%
Scardate
(months)
<=3 25 13.2% 2 20.0%
0.48
4‐12 23 12.1% 0 0.0%
>12 142 74.7% 8 80.0%
Scarlocation Abdomen 50 26.3% 3 30.0% 0.33
Neck 16 8.4% 0 0.0%
Back 7 3.7% 1 10.0%
Face 70 36.8% 5 50.0%
Lower
extremity
27 14.2% 0 0.0%
13
Upper
extremity
15 7.9% 0 0.0%
Breast 5 2.6% 1 10.0%
Scaretiology Burn 2 1.1% 0 0.0% 0.72
Surgical 153 80.5% 9 90.0%
Traumatic 35 18.4% 1 10.0%
Table1.Samplecharacteristics.
1
Tables
Characteristics N(total=200) (%)
Sex
Female 109 54.5
Male 91 46.6
Age(years)
Min18;max=84;mean=53.3(
18)
൑30 30 15
31‐60 94 47
>60 76 38
Scarsize(cm)
൑2cm
3‐10cm
>10cm
Min=1;Max=35,mean=6.8(
6.3)
32 16
136 68
32 16
Scardate(months)
Min=1;max=651,mean156.7(
169)
൑3months 27 13.5
4months–1year 23 11.5
>1year 150 75
Scaretiology
Surgical 162 81
Traumatic 36 18
Burn 2 1
Scarlocation
Face 75 37.5
Abdomen 53 26.5
Neck 16 8
Back 8 4
Lowerextremity 27 13.5
Upperextremity 15 7.5
Breast 6 3
Table1.Samplecharacteristics.
2
SCAR‐QAppearancescale
App App2 App3 App4 App5 App6 App7 App8 App9 App10 App11
Appr1 1.00
App2 0.76 1.00
App3 0.77 0.80 1.00
App4 0.67 0.74 0.75 1.00
App5 0.75 0.81 0.83 0.76 1.00
App6 0.62 0.77 0.77 0.76 0.79 1.00
App7 0.57 0.70 0.73 0.68 0.72 0.72 1.00
App8 0.63 0.73 0.70 0.69 0.76 0.77 0.84 1.00
App9 0.67 0.77 0.80 0.74 0.80 0.87 0.72 0.80 1.00
App10 0.68 0.82 0.83 0.72 0.90 0.86 0.78 0.80 0.87 1.00
App11 0.70 0.80 0.83 0.81 0.86 0.84 0.74 0.78 0.84 0.88 1.00
App12 0.60 0.71 0.65 0.61 0.76 0.66 0.64 0.59 0.66 0.72 0.74
SCAR‐QSymptomscale
Sym1 Sym2 Sym3 Sym4 Sym5 Sym6 Sym7 Sym8 Sym9 Sym10 Sym11
Sym1 1.00
Sym2 0.49 1.00
Sym3 0.51 0.59 1.00
Sym4 0.60 0.34 0.40 1.00
Sym5 0.37 0.51 0.62 0.48 1.00
Sym6 0.47 0.54 0.53 0.35 0.40 1.00
Sym7 0.53 0.63 0.48 0.43 0.54 0.58 1.00
Sym8 0.44 0.72 0.48 0.30 0.53 0.41 0.43 1.00
Sym9 0.52 0.59 0.45 0.44 0.66 0.35 0.52 0.61 1.00
Sym10 0.40 0.43 0.68 0.35 0.46 0.54 0.44 0.34 0.39 1.00
Sym11 0.46 0.38 0.52 0.45 0.35 0.46 0.25 0.21 0.27 0.50 1.00
Sym12 0.36 0.47 0.40 0.46 0.38 0.33 0.58 0.21 0.37 0.47 0.43
SCAR‐QPsychologicalimpact
Psy1 Psy2 Psy3 Psy4 Psy5
Psy1 1.00
Psy2 0.83 1.00
Psy3 0.81 0.87 1.00
Psy4 0.69 0.82 0.80 1.00
Psy5 0.79 0.83 0.85 0.76 1.00
AdditionalTable1.Polychoricinter‐itemcorrelationsforthe3subscales.App=Appearance;
Sym=symptom.