Development and validation of Rumination Scale for Traumatic Amputees while utilizing a Pakistani cohort; first part

Objective: To construct a scale for measurement of rumination among traumatic amputees while utilizing a Pakistani cohort. Methodology: This was the first part of a scale development and validation study carried out from February 2018 to March 2019 including amputees from multiple centers. We carried out thematic analysis of lived experiences and perspectives on complex phenomenon on 30 amputees and generated an item pool. Seven experts first evaluated the item pool and then Content Validity Ratio (CVR) was calculated. Item reduction analysis was carried out while recruiting 50 amputees using Cronbach's alpha evaluation. Factorial Validity and Internal Consistency of the scale was determined on evaluating 200 amputees through Exploratory Factor Analysis (EFA). Results: The CVR >= 0.99 and pilot study indices were the criterion for item inclusion. Items were selected for the scale measuring rumination. This scale comprised of three sub scales, each having value of Cronbach's alpha as 0.90, 0.87, and 0.89. To establish factorial validity, EFA identified three-factor solution and all three emerged factors had Eigen values > 3. Six items, each for three factors, accounted for almost 44% of the total variance. Conclusion: Rumination Scale for Traumatic Amputees is a new scale developed in Urdu for the measurement of rumination among traumatic amputees in Pakistan.