Development and Validation of the Awareness Scale for Physiotherapy in Individuals with Breast Cancer

Abstract

Objective

Breast cancer treatment may lead to short- and long-term side effects, many of which can be effectively managed with physiotherapy. This study aimed to develop and validate a scale to assess awareness of these side effects.

Materials and Methods

The study included 438 women with breast cancer. A 50-item pool was created after a literature review, reviewed by 20 experts for content validity, and tested in a 50-person pilot study. Construct validity was assessed through exploratory (205) and confirmatory (183) factor analyses. Internal consistency analyses ensured reliability. Criterion validity was tested using the European Organization for Research and Treatment of Cancer Quality of Life Scale and the Breast Cancer Specific Quality of Life Scale.

Results

The final scale had 32 items under three factors: lymphedema, exercise, and quality of life. It showed strong reliability (Cronbach’s alpha=0.910). Bartlett's test indicated significant correlations (p<0.05), and the Kaiser-Meyer-Olkin statistic was>0.70, confirming sample adequacy. Fit indices showed acceptable model fit.

Conclusions

Awareness Scale for Physiotherapy in Individuals with Breast Cancer shows strong reliability and validity, offering a useful tool for clinical assessment and research, and guiding future patient education and rehabilitation studies.

Zusammenfassung

Hintergrund und Ziel

Im Rahmen einer Brustkrebstherapie kann es zu kurz- und langfristigen Nebenwirkungen kommen, von denen viele mit Physiotherapie wirksam behandelt werden können. Ziel der vorliegenden Studie war es, eine Skala zur Erfassung des Bewusstseins für diese Nebenwirkungen zu entwickeln und zu validieren.

Material und Methode

Insgesamt wurden 438 Frauen mit Mammakarzinom in die Studie aufgenommen. Nach einer Literaturrecherche wurde ein Pool mit 50 Items erstellt, der von 20 Experten auf seine Inhaltsvalidität überprüft und in einer Pilotstudie mit 50 Personen getestet wurde. Die Konstruktvalidität wurde durch explorative (n=205) und konfirmatorische (n=183) Faktorenanalyse geprüft. Die interne Konsistenz sicherte die Reliabilität. Die Kriteriumsvalidität wurde mit der European Organization for Research and Treatment of Cancer Quality of Life Scale (EORTC-QOL-30) und der Breast Cancer Specific Quality of Life Scale (BC-QOL-23) geprüft.

Ergebnisse

Die endgültige Skala umfasst 32 Items, die drei Faktoren zugeordnet sind: Lymphödem, Bewegung und Lebensqualität. Sie zeigte eine hohe Reliabilität (Cronbachs Alpha=0,910). Der Bartlett-Test zeigte signifikante Korrelationen (p<0,05) und der Kaiser-Meyer-Olkin-Koeffizient lag über 0,70, was die Eignung der Stichprobe bestätigt. Die Modellanpassung war akzeptabel.

Schlussfolgerung

Die Awareness Scale für Physiotherapie bei Brustkrebspatientinnen weist eine hohe Reliabilität und Validität auf, bietet ein nützliches Instrument für klinische Beurteilungen und Forschung und kann zukünftigen Studien zur Patientenaufklärung und Rehabilitation als Orientierungshilfe dienen.

Keywords

awareness - breast cancer - cancer - complication - physiotherapy

Schlüsselwörter

Bewusstsein - Brustkrebs - Krebs - Komplikation - Physiotherapie

Publication History

Received: 14 July 2025

Accepted after revision: 15 December 2025

Article published online:
22 January 2026

• References

• 1 Zhang Y, Xia KR, Li CY. et al. Review of Breast Cancer Pathologigcal Image Processing. Biomed Res Int 2021; 2021
• 2 Barzaman K, Karami J, Zarei Z. et al. Breast cancer: Biology, biomarkers, and treatments. Int Immunopharmacol 2020; 84: 106535
• 3 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249
• 4 Desai P, Aggarwal A. Breast Cancer in Women Over 65 years- a Review of Screening and Treatment Options. Clin Geriatr Med 2021; 37: 611-623
• 5 Ben-Dror J, Shalamov M, Sonnenblick A. The History of Early Breast Cancer Treatment. Genes (Basel) 2022; 13: 960
• 6 Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol 2020; 50: 225-229
• 7 Cardoso F, Loibl S, Pagani O. et al. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer 2012; 48: 3355-3377
• 8 Runowicz CD, Leach CR, Henry NL. et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin 2016; 66: 43-73
• 9 Schmidt ME, Scherer S, Wiskemann J. et al. Return to work after breast cancer: The role of treatment-related side effects and potential impact on quality of life. Eur J Cancer Care (Engl) 2019; 28
• 10 Bernstein LJ, McCreath GA, Komeylian Z. et al. Cognitive impairment in breast cancer survivors treated with chemotherapy depends on control group type and cognitive domains assessed: A multilevel meta-analysis. Neurosci Biobehav Rev 2017; 83: 417-428
• 11 Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W. et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Research 2018; 20: 124
• 12 Lahart IM, Metsios GS, Nevill AM. et al. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database of Systematic Reviews 2018; 2018
• 13 Kleckner IR, Kamen C, Gewandter JS. et al. Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Supportive Care in Cancer 2018; 26: 1019-1028
• 14 Toohey K, Pumpa K, McKune A. et al. The impact of high-intensity interval training exercise on breast cancer survivors: a pilot study to explore fitness, cardiac regulation and biomarkers of the stress systems. BMC Cancer 2020; 20: 787
• 15 Maindet C, Burnod A, Minello C. et al. Strategies of complementary and integrative therapies in cancer-related pain—attaining exhaustive cancer pain management. Supportive Care in Cancer 2019; 27: 3119-3132
• 16 Khosrow-Khavar F, Filion KB, Al-Qurashi S. et al. Cardiotoxicity of aromatase inhibitors and tamoxifen in postmenopausal women with breast cancer: a systematic review and meta-analysis of randomized controlled trials. Annals of Oncology 2017; 28: 487-496
• 17 Gillespie TC, Sayegh HE, Brunelle CL. et al. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg 2018; 7: 379-403
• 18 McLaughlin SA, Brunelle CL, Taghian A. Breast Cancer–Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment. Journal of Clinical Oncology 2020; 38: 2341-2350
• 19 Bryman A, Cramer D. Quantitative Data Analysis with SPSS Release 8 for Windows. London, New York: Taylor & Francis e-Library, Routledge. 1999
• 20 Nunnally J. Psychometric Theory. New York: McGraw-Hill Companies; 1978
• 21 Demirci S, Eser E, Ozsaran Z. et al. Validation of the Turkish versions of EORTC QLQ-C30 and BR23 modules in breast cancer patients. Asian Pac J Cancer Prev 2011; 12: 1283-1287
• 22 Ayre C, Scally AJ. Critical Values for Lawshe’s Content Validity Ratio. Measurement and Evaluation in Counseling and Development 2014; 47: 79-86
• 23 Yeşilyurt S, Çapraz C. Ölçek Geliştirme Çalışmalarında Kullanılan Kapsam Geçerliği İçin Bir Yol Haritası. Erzincan Üniversitesi Eğitim Fakültesi Dergisi 2018; 20: 251-264
• 24 Choi J, Peters M, Mueller R. Correlational analysis of ordinal data: from Pearson’s r to Bayesian polychoric correlation. Asia Pac Educ Rev 2010; 11: 459-466
• 25 Howard MC. A Review of Exploratory Factor Analysis Decisions and Overview of Current Practices: What We Are Doing and How Can We Improve. Int J Hum Comput Interact 2016; 32: 51-62
• 26 Shinn E, Basen-Engquist K, Le T. et al. Distress after an abnormal Pap smear result: scale development and psychometric validation. Prev Med (Baltim) 2004; 39: 404-412
• 27 Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999; 6: 1-55
• 28 Mulaik SA, James LR, Van Alstine J. et al. Evaluation of goodness-of-fit indices for structural equation models. Psychol Bull 1989; 105: 430-445
• 29 Gültekin S. Eğitimde Ölçme ve Değerlendirme. In: Demirtaşlı R, Hrsg. Testlerde kullanılacak madde türleri, hazırlama ilkeleri ve puanlaması. Ankara: Anı Yayıncılık; 2017: 145-222
• 30 DeVellis R. Scale Development: Theory and Applications. Thousand Oaks: Sage; 2016
• 31 Esin M. Veri toplama yöntem ve araçları & veri toplama araçlarının güvenirlik ve geçerliği. In: Hemşirelikte Araştırma. Istanbul: Nobel Tıp Kitabevleri; ; 2014: 193-232
• 32 Atılgan H, Kan A, Doğan N. Eğitimde ölçme ve değerlendirme. 6th Aufl. Ankara: Anı Yayıncılık; 2013
• 33 Doğan N, Başokçu T. İstatistik Tutum Ölçeği İçin Uygulanan Faktör Analizi ve Aşamalı Kümeleme Analizi Sonuçlarının Karşılaştırılması. J Meas Eval Educ Psychol 2010; 1: 65-71
• 34 Korkmaz A. Faktör analizi ve parametrik olmayan teknikler ile ceza yargılama sürecinin son oluşturma sürecinin incelenmesi [Examination of the Finalization Process of the Penal Trial Process Using Factor Analysis and Nonparametric Techniques]. Ankara: Hacettepe University; 2000
• 35 Uyumaz G, Mor Dirlik E, Çokluk Ö. Açımlayıcı Faktör Analizinde Tekrar Edilebilirlik: Kavram Ve Uygulama. Abant İzzet Baysal Üniversitesi Eğitim Fakültesi Dergisi 2016; 16
• 36 Orcan F. Exploratory and Confirmatory Factor Analysis: Which One to Use First ?. Egit Psikol Olcme Deger Derg 2018; 9: 414-421
• 37 Bandalos D, Finney S. Factor analysis: Exploratory and confirmatory. In: Hancock G, Mueller R, Hrsg. The reviewer’s guide to quantitative methods in the social sciences. New York, NY: Routledge; 2010: 93-114
• 38 Schumacker R, Lomax R. A beginner’s guide to structural equation modeling. 3rd Aufl. New York, NY: Routledge; 2010
• 39 Karakoç AGDrFY DönmezProfDrL. Ölçek Geliştirme Çalışmalarında Temel İlkeler. Tıp Eğitimi Dünyası 2014; 13: 39-49
• 40 Jebb AT, Ng V, Tay L. A Review of Key Likert Scale Development Advances: 1995–2019. Front Psychol 2021; 12