Validity and reliability of the Persian version of the SARC-F Questionnaire among Iranian older adults

Validity and reliability of the Persian version of the SARC-F Questionnaire among Iranian older adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validity and reliability of the Persian version of the SARC-F Questionnaire among Iranian older adults Sanay Toloueinasab, Ahmad Delbari, Marjan Haghi, Vahid Rashedi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5020242/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Background : Sarcopenia is recognized as a geriatric condition marked by a progressive decline in muscle mass and function. The SARC-F questionnaire was developed as a brief, self-reported, and cost-effective tool for screening sarcopenia. This study aims to translate and culturally adapt the SARC-F questionnaire into Persian and evaluate its psychometric properties for older adults attending outpatient geriatric clinics. Methods : The study was conducted in two phases: translation and cultural adaptation, followed by psychometric evaluation. The Persian SARC-F was translated using the WHO forward-backward protocol and assessed for content validity using the Lawshe method. A cross-sectional study was conducted with 200 older adults aged 65 and above attending outpatient geriatric clinics in Tehran. Concurrent validity was assessed through a comparison of the Persian SARC-F with AWGS 2019 criteria for possible sarcopenia. Construct validity was assessed using the LEIPAD questionnaire, anticipating strong correlations with similar domains and weaker correlations with different domains. Internal consistency was determined using Cronbach’s alpha, and test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). The diagnostic characteristics were determined by constructing a receiver operating characteristic (ROC) curve using the AWGS 2019 criteria for possible sarcopenia. Results : The Persian SARC-F showed adequate content validity with S-CVI/Ave values of 0.97 for relevancy and clarity and 1 for simplicity. The CVR values for individual items ranged from 0.80 to 1. Concurrent validity was demonstrated with Spearman’s correlations of (r = -0.73) for hand grip strength and (r = -0.76) for gait speed. Construct validity was supported by convergent and divergent validity. The Cronbach’s alpha was 0.79, indicating good internal consistency. The ICC was 0.99, showing excellent test-retest reliability. The area under the curve (AUC) was 0.91 (95%CI: 0.86–0.95). Sensitivity, specificity, PPV, and NPV for the optimal cut point (≥ 4) were 84.9%, 96.5%, 96.9%, and 83.1%, respectively. Conclusions : The Persian version of the SARC-F questionnaire is a valid and reliable tool with high diagnostic accuracy. It can be used for screening sarcopenia in Persian-speaking community-dwelling older adults. Trial registration: Clinical trial number: not applicable. Sarcopenia Frailty Psychometrics Older adults Figures Figure 1 Background Sarcopenia is identified as a geriatric condition characterized by a progressive reduction in muscle mass and function ( 1 ). Depending on the diagnostic criteria used in different studies, its prevalence varies between 5.2% and 62.7% in community-dwelling older adults ( 2 ). Hospitalization, functional decline, and increased risk of falls and fractures are among the negative health outcomes linked to sarcopenia ( 3 ). Early identification and intervention of sarcopenia are imperative, as they can significantly reduce mortality and morbidity rates, and contribute to the enhancement of overall quality of life ( 4 ). Multiple operational working groups have provided different diagnostic criteria for sarcopenia ( 5 ). According to the International Working Group for Sarcopenia (IWGS), low muscle mass and low physical performance are the diagnostic criteria for sarcopenia ( 6 ). The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposes three principal criteria for diagnosing sarcopenia: muscle strength, quantity or quality, and physical performance. Based on these criteria, probable sarcopenia is recognized when low muscle strength is present ( 7 ). The diagnostic criteria provided by the Asian Working Group for Sarcopenia (AWGS) are also aligned with the European approach. They advocate for the evaluation of muscle strength, muscle mass, and physical performance ( 8 ). Assessing muscle mass, strength, and function is a time-consuming process that requires specialized equipment. Consequently, employing these diagnostic criteria may not be feasible in routine clinical practice ( 9 , 10 ). Therefore, more cost-effective and simpler-to-apply approaches are essential ( 10 ). The SARC-F is a self-reported, brief, and inexpensive tool that was published by Malmstrom and Morley for screening sarcopenia. This questionnaire consists of 5 items ( 11 , 12 ), and it is widely regarded as a highly effective tool for increasing awareness of sarcopenia diagnosis in primary care settings ( 13 ). The AWGS and EWGSOP2 advocate for using the SARC-F questionnaire during the initial case-finding stage within their respective diagnostic algorithms ( 7 , 8 ). Globally, various translations and validations of the SARC-F have been conducted, including German ( 14 ), Italian ( 15 ), Polish ( 10 ), French ( 16 ), and Spanish ( 9 ) versions. Despite its widespread use internationally, there is currently no validated Persian version of the SARC-F questionnaire specifically adapted for the Iranian population. Addressing this gap is essential, considering the significant cultural and linguistic nuances that may impact the questionnaire’s relevance and accuracy. The endorsement of the SARC-F as a practical case-finding tool by leading professional working groups further highlights the critical need for its cultural adaptation and validation in Persian. Moreover, the definitive diagnosis of sarcopenia—typically involving the measurement of skeletal muscle mass through costly and resource-intensive methods—is often impractical for many older adults in Iran due to financial and logistical constraints. Consequently, developing and validating a culturally appropriate Persian version of the SARC-F questionnaire could facilitate more accessible, cost-effective, and early detection of sarcopenia within this population. We hypothesize that the Persian adaptation of the SARC-F will exhibit satisfactory validity, reliability, and diagnostic accuracy in identifying probable sarcopenia among Persian-speaking older adults, thereby establishing it as a feasible screening tool for community-dwelling older adults in Iran. This research aims to translate and culturally adapt the SARC-F questionnaire into Persian and evaluate its psychometric characteristics for older adults attending outpatient geriatric clinics. Methods The study was carried out in two distinct phases: the initial phase involved translation and cultural adaptation; the second phase was centered on assessing psychometric properties. First phase The Persian version of the SARC-F questionnaire was translated in this phase and evaluated for its content validity. With authorization from the original developer, John Morley (11), we translated the SARC-F questionnaire into Persian, adhering to the WHO forward-backward protocol. Two bilingual gerontology and geriatric medicine experts initially translated the tool from English to Persian . Subsequently, an expert panel, including the initial translators and two additional specialists in gerontology and tool development, refined the translation to align with cultural nuances. Then, two independent translators, unaware of the original SARC-F, performed a back-translation. A group discussion was held involving the initial and back translators and the expert panel to compare the back-translation with the original SARC-F. This process resolved all discrepancies and led to the creation of the pre-final Persian SARC-F. Lastly, a pre-test was conducted with ten cognitively intact older adults, comprising an equal number of males and females, aged 65 or above. Each participant was asked to complete the translated questionnaire independently. Following completion, structured cognitive interviews were conducted to assess their comprehension of each item. Participants were encouraged to articulate their interpretation of the questions and report any ambiguities or difficulties they encountered. Their feedback was carefully reviewed and was considered to finalize the Persian SARC-F. Persian SARC-F's content validity was assessed by geriatric medicine, gerontology, and psychiatry experts with geriatric specialization. For the Content Validity Ratio (CVR), ten experts responded to a 3-point Likert scale determining the essentiality of the items. For the Content Validity Index (CVI), seven experts utilized a 4-point scale for relevancy, clarity, and simplicity, resulting in the calculation of the item-level CVI (I-CVI) and the Scale-level CVI Average (S-CVI/Ave). Second phase A cross-sectional study was carried out during this phase. The sample size was determined using the subject-to-item ratio method (17). To ensure robust statistical power, we adopted a ratio of 30:1. Given that the SARC-F questionnaire consists of five items, the estimated sample size was 150 participants. To account for potential dropout during the study, an additional 50 participants were included, resulting in a final sample size of 200. A convenience sampling was used to include individuals aged 65 and older who visited outpatient clinics of geriatric medicine in Tehran from July 2023 to December 2023. Inclusion criteria were familiar with the Persian language and the ability to establish verbal communication; exclusion criteria included any acute conditions, such as severe respiratory or cardiovascular disorders, acute musculoskeletal injuries, neurologic conditions, recent surgery, cognitive impairment beyond mild levels, severe arthritis, and advanced peripheral neuropathy, as well as any other condition that could significantly hinder the assessment of physical measurements, such as walking speed, hand grip strength, height, and weight. The reliability of the Persian SARC-F was confirmed by establishing internal consistency through Cronbach’s alpha coefficient and the correlation between individual items and the overall scale score. Temporal consistency was gauged by a test-retest method with a two-week interval among a subset of 25 participants. The concurrent validity was evaluated through a comparative analysis involving the Persian SARC-F, handgrip strength, and gait speed based on AWGS 2019 criteria for possible sarcopenia. To assess construct validity, participants were asked to complete the LEIPAD questionnaire, a validated tool designed to measure health-related quality of life in older adults across multiple domains, including physical function, self-care, depression and anxiety, cognitive functioning, social functioning, sexual functioning, and life satisfaction (18). Strong correlations between the SARC-F scores and the LEIPAD questionnaire domains measuring similar constructs (Self-care, Physical function) were anticipated, indicative of convergent validity. Conversely, weaker correlations were expected between domains assessing different constructs, demonstrating divergent validity. The diagnostic characteristics of the questionnaire was determined by calculating the measures of sensitivity, specificity, positive predictive value, and negative predictive value. The cut-off point was also calculated following the AWGS 2019 criteria for possible sarcopenia (8). Definition of sarcopenia Possible sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS) 2019, is characterized by ‘low muscle strength with or without reducing physical performance.’ Muscle strength was measured using a calibrated hydraulic hand dynamometer. Hand Grip Strength (HGS) of <18 kg for women and <28 kg for men was considered low. A 6-meter walk test was conducted for physical performance assessment, and a gait speed <1.0 m/s indicated reduced physical performance (8). SARC-F Questionnaire The SARC-F has been created as a possible rapid diagnostic tool for sarcopenia. It has 5 items : Strength, how much difficulty you have in lifting and carrying 10 lb; assistance in walking, how much difficulty you have walking across a room; rise from a chair, how much difficulty you have transferred from a chair or bed; climb stairs, how much difficulty do you have climbing a flight of 10 stairs; falls, how many times have you fallen in the past year. Each item is scored on a range of 0 to 2, and an overall score equal to or greater than 4, predicts sarcopenia (11). Measurements Weight was measured in a standing position with minimal clothing using a digital scale (Camry EB5636-B). Height was measured in a standing position without shoes using the Seca 206 roller measuring tape. Body mass index was calculated by dividing weight by the square of height. Hand grip strength was assessed using the Jamar hydraulic hand dynamometer (Sammons Preston, INC. Bolingbrook, IL 60440-4989). Participants were seated with their elbows flexed at 90 degrees. During two trials, participants exerted maximum effort in an isometric contraction for each hand while in a sitting position with 90 degrees of elbow flexion. The highest value from these trials was recorded (8). Participants stood with their feet shoulder-width apart to measure the calf circumference while their body weight was evenly distributed on both legs. The widest part of the right calf was measured using a non-elastic tape (19). To measure the Upper Arm Circumference (UAC), the widest part of the right arm was measured while the elbow was bent at a 90-degree angle and the biceps muscle was flexed. Two measurements were taken using a stopwatch to determine the time required to walk 6 meters at a normal pace from a moving start, without any reduction. The average of these measurements was then recorded (8). Subsequently, the gait speed was calculated in meters per second. During an interview, the LEIPAD quality of life questionnaire (18), and the Persian SARC-F were completed for the participants. Data on age, gender, education level, marital status, living arrangement, and number of medications were collected. Statistical Analysis Analysis of the dataset was conducted using SPSS, version 27.0 (Armonk, NY: IBM Corp.).: Participants were categorized into two groups based on their SARC-F scores. individuals with scores <4 and those with scores ≥4. The threshold of ≥4 was originally established as predictive of sarcopenia (11). Descriptive statistics were presented as means ± SD for variables on a continuous scale and as frequency counts and percentages for categorical variables. Statistical comparisons were performed between these groups using a Two-sample t-test or Mann–Whitney U-test for continuous variables, and a Chi-square test or Fisher’s exact test for categorical variables. The Kolmogorov-Smirnov test was utilized to evaluate the normality of the variables. The Spearman rank correlation was used to assess non-normally distributed measurements. We evaluated test-retest reliability using the intraclass correlation coefficient (ICC) along with its 95% confidence interval, categorizing the agreement level as poor ( 0.90) (20). The Cronbach’s alpha and item-total correlation coefficients were used to measure internal consistency, with a Cronbach’s alpha of ≥0.70 indicating acceptable consistency (21). The item-total correlation coefficients, based on Spearman’s correlation, range from 0 to 1, with higher values denoting greater consistency. A p-value of <0.05 was set as the threshold for statistical significance. Content validity was determined by a Content Validity Ratio (CVR) greater than 0.62 (22), an Item-Content Validity Index (I-CVI) of at least 0.78, and a Scale-Content Validity Index-average (SCVI-Ave) of 0.90 or higher (23). In the context of the AWGS 2019 criteria (8) for possible sarcopenia, we performed a receiver operating characteristic (ROC) curve analysis to compute the area under the curve (AUC), thereby assessing the SARC-F’s diagnostic performance. The optimal cut-point value was ascertained using the Closest to (0,1) Criterion (24). Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated for different cut-points . Results First phase The translation and cross-cultural adaptation of the SARC-F from English to Persian was accomplished without any significant challenges. In the first component, ‘strength,’ the original weight specification of 10 lb (pounds) was converted to kilograms (4.5 kg). In the pre-test performed on 10 subjects (5 men and 5 women, with a mean age of 70.5 ± 4.35 years), no problems were reported in understanding all five components of the translated questionnaire. The content validity of the questionnaire was validated (Table 1). Table 1. Content validity index and content validity ratio of the Persian SARC-F items Relevancy Clarity Simplicity Essentiality Items Ne I-CVI I-CVI I-CVI Ne CVR Strength 7 1 1 1 10 1 Assistance in walking 7 1 1 1 10 0.8 Rise from a chair 7 0.85 0.85 1 10 0.8 Climb stairs 7 1 1 1 10 1 Falls 7 1 1 1 10 1 S-CVI/Ave 0.97 0.97 1 Abbreviations: Ne, Number of Experts Evaluated the Item; I-CVI, Item-Level Content Validity Index; CVR, Content Validity Ratio; S-CVI/Ave, Scale-Level Content Validity Index Average. Second phase Two hundred participants with a mean age of 73.1 ± 6.6 years, ranging from 65 to 91 years were included in this phase. The majority were female, and most participants had either primary education or no formal education. Table 2 displays the characteristics of the participants. The Cronbach alpha was calculated at 0.792. All items within the scale exhibited positive correlations with the total score, with correlation coefficients ranging from 0.41 to 0.81 (Table 3). The ICC was estimated to be 0.99 with a 95% confidence interval ranging from 0.979 to 0.996. Table 2. Characteristics of Participants Characteristic Total (N=200) SARC-F≥ 4 (N=99) SARC-F<4 (N=101) P-value Age (years) 73.13 ± 6.66 74.85 ± 7.23 71.45 ± 5.58 <0.001* Gender Female Male 119 (59.5) 81 (40.5) 67 (67.7) 32 (32.3) 52 (51.5) 49 (48.5) 0.02 ƚ Education level No formal education Primary Lower Secondary Upper secondary Academic 55 (27.5) 63 (31.5) 29 (14.5) 28 (14) 25 (12.5) 37 (37.4) 28 (28.3) 13 (13.1) 15 (15.1) 6 (6.1) 18 (17.8) 35 (34.7) 16 (15.8) 13 (12.9) 19 (18.8) 0.006 ƚ Number of medications 4.52 ± 2.95 5.59 ± 2.93 3.47 ± 2.57 <0.001* Polypharmacy 98 (49) 65 (65.7) 33 (32.7) <0.001 ƚ Living alone 37 (18.5) 19 (19.2) 18 (17.8) 0.364 ƚ Marital status Married Unmarried 124 (62) 76 (38) 56 (56.6) 43 (43.4) 68 (67.3) 33 (32.7) 0.117 ƚ LEIPAD 57.06 ± 17.01 47.72 ± 16.36 66.22 ± 11.93 <0.001* Height (cm) 161.79 ± 9.47 159.82 ± 9.13 163.73 ± 9.451 0.003ǂ Weight (kg) 68.91 ± 12.83 68.18 ± 14.45 69.62 ± 11.04 0.429ǂ BMI (kg/m 2 ) 26.41 ± 4.8 26.77 ± 5.54 26.05 ± 3.94 0.293ǂ SARC-F 3.58 ± 2.59 5.75 ± 1.78 1.46 ± 1.04 <0.001* UAC (cm) 30.47 ± 3.96 30.32 ± 4.32 30.62 ± 3.58 0.771* CC (cm) 36.68 ± 4.02 36.19 ± 4.39 37.16 ± 3.59 0.207* Gait speed (m/s) 1.18 ± 0.35 0.94 ± 0.31 1.41 ± 0.207 <0.001* HGS (kg) 18.54 ± 8.99 12.26 ± 5.59 24.7 ± 7.28 <0.001* Abbreviations: BMI, Body Mass Index; HGS, Handgrip Strength; UAC, Upper Arm Circumferences; CC, Calf circumference. * Mann–Whitney U test . ǂ Two-sample t-test . ƚ Chi-square test . Table 3. Internal Consistency of the Persian SARC-F SARC-F Item Correlation P-value Strength 0.779 <.001 Assistance in walking 0.817 <.001 Rise from a chair 0.804 <.001 Climb stairs 0.787 <.001 Falls 0.410 <.001 Cronbach alpha = 0.792. The item-total score correlations were analyzed using the Spearman test. The correlations Between the Persian SARC-F (Each Domain and Total Score) and Other Related Measurements are presented in Table 4. The Persian SARC-F demonstrated concurrent validity by showing significant correlations with grip strength and gait speed. Additionally, construct validity was supported by strong correlations between SARC-F scores and the Physical Functioning and Self-Care domains of the LEIPAD questionnaire, while weaker correlations were observed with other domains. No significant correlation existed between the SARC-F score and either UAC or CC. Table 4. Correlations Between the Persian SARC-F (Each Domain and Total Score) and Other Related Measurements Strength Assistance in Walking Rise from a Chair Climb Stairs Falls Total Score Age .148* .301** .282** .178* .032 .257** LEIPAD -.514** -.508** -.518** -.556** -.269** -.646** LEIPAD/ PF -.517** -.548** -.557** -.595** -.276** -.675** LEIPAD/ SC -.659** -.723** -.668** -.770** -.284** -.863** LEIPAD/ DA -.198** -.125 -.174* -.157* -.179* -.230** LEIPAD/ CF -.270** -.325** -.325** -.316** -.170* -.371** LEIPAD/ SF -.245** -.192** -.190** -.229** -.080 -.251** LEIPAD/ SX -.419** -.303** -.265** -.295** -.173* -.410** LEIPAD/ LS -.323** -.314** -.350** -.380** -.152* -.418** UAC .046 -.028 -.108 .109 -.218** -.019 CC -.009 -.120 -.126 -.001 -.222** -.113 Gait speed -.498** -.704** -.666** -.617** -.269** -.765** HGS -.592** -.595** -.577** -.551** -.342** -.739** Abbreviations: PF, Physical Functioning; SC, Self-Care; DA, Depression and Anxiety; CF, Cognitive Functioning; SF, Social Functioning; SX, Sexual Functioning; LS, Life Satisfaction; UAC, Upper Arm Circumferences; CC, Calf circumferences; HGS, Handgrip Strength ** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed). The correlations were analyzed using the Spearman test. The receiver operating characteristic (ROC) curve for the performance of the Persian SARC-F as a screening tool, based on the AWGS 2019 criteria for possible sarcopenia, is presented in Figure 1. The AUC was 0.91 (95%CI: 0.86–0.95). The optimal cut-off point, determined using the Closest to (0,1) Criterion, was ≥4. Table 5 provides sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for different cut-off points. Notably, the optimal cut-off point demonstrated a sensitivity of 84.9% and specificity of 96.5%. Table 6 shows the distribution of samples according to the Persian SARC-F and AWGS 2019 criteria; the SARC-F questionnaire identified 96 of the 113 individuals with possible sarcopenia. There was a significant association between SARC-F and AWGS 2019 criteria in identifying sarcopenia and possible sarcopenia (p < 0.001). Table 5. Diagnostic characteristics of the Persian SARC-F based on different cut-points Sensitivity (%) Specificity (%) PPV (%) NPV (%) SARC-F ≥ 5 56.6 97.7 96.6 63.4 SARC-F ≥ 4 84.9 96.5 96.9 83.1 SARC-F ≥ 3 87.6 78.2 83.8 82.9 SARC-F ≥ 2 94.7 51.7 71.8 88.2 Abbreviations: PPV, positive predictive value; NPV, negative predictive value. Table 6. Sample Distribution by Persian SARC-F and AWGS 2019 Criteria for Possible Sarcopenia AWGS 2019 criteria Possible Sarcopenia No sarcopenia Total P-value SARC-F Sarcopenia (≥4) 96 3 99 <0.001* No sarcopenia (<4) 17 84 101 Total 113 87 200 Abbreviations: AWGS, Asian Working Group for Sarcopenia. *Fisher’s exact test. Discussion This study translated and culturally adapted the SARC-F into Persian and evaluated its psychometric properties for older adults attending outpatient geriatric clinics. The results indicate that the Persian adoption of the SARC-F is both reliable and valid for possible sarcopenia screening. The translation and pre-testing process to achieve a culturally adapted version was similar to the methods used for various other translations, including the German version (14). The values of CVI and CVR indicated that the questionnaire had appropriate content validity and none of the items required modification. Trivedi et al. also reported similar results for the Gujarati version of the SARC-F (25). The translated SARC-F demonstrated satisfactory reliability. Specifically, the test-retest reliability was excellent, closely aligning with the Greek version (ICC = 0.93) (26). The internal consistency was also acceptable, with a Cronbach’s alpha of 0.79, similar to the original version reported by Malmstrom et al., with values ranging from 0.76 to 0.81 (12). Overall, various versions of this tool have shown good reliability (27). The Persian SARC-F showed strong negative correlations with handgrip strength (HGS) and gait speed, which are criteria for possible sarcopenia, thereby confirming concurrent validity. It also showed a significant positive correlation with age (ρ = 0.257) and a significant negative correlation with LEIPAD scores (ρ = -0.646). Similarly, Parra-Rodriguez et al. reported significant correlations between SARC-F scores and handgrip strength, gait speed, quality of life, and age (9). This result is consistent with findings from other studies (26, 28). Contrary to expectations, no significant correlation was found between SARC-F scores and calf circumference (CC). CC is acknowledged as an indicator of muscle mass in older adults. It serves as a proxy for measuring muscle mass (19). While the SARC-F questionnaire is a suitable screening tool for detecting impaired physical performance, it may not directly reflect muscle mass. This is consistent with the findings of Drey et al., who also reported a lack of association between SARC-F scores and muscle mass (14). CC is not a reliable indicator of the functional aspects of sarcopenia. Additionally, several factors can affect the accuracy of CC measurements. For example, calf edema can exaggerate the muscle volume, thereby compromising the precision of CC as a screening tool for sarcopenia (29). Another possible reason can be the presence of sarcopenic obesity (SO), which is defined as the simultaneous presence of obesity and sarcopenia (30). The study’s findings underscore the significant differences in various variables between individuals with SARC-F scores of ≥ 4 and < 4. These differences in age, gender, education level, number of medications, polypharmacy, gait speed, handgrip strength, and height can highlight the multifaceted nature of sarcopenia. The investigation of construct validity confirmed convergent validity with the strong correlation between the physical functioning and self-care domains of the LEIPAD questionnaire and the Persian SARC-F and established divergent validity with the weaker correlations between the Persian SARC-F and other domains such as depression and anxiety, cognitive functioning, and social functioning. While the Persian SARC-F's strong correlations with the physical functioning and self-care domains support the construct validity, it's important to note that these domains do not directly measure sarcopenia. They are relevant to the functional impairments commonly associated with sarcopenia. The self-care domain measures older adults’ capacity to do daily activities independently (31). Meanwhile, the SARC-F questionnaire is a suitable screening tool for identifying individuals with impaired physical performance (14). Both physical performance and muscle strength can predict decreases in activities of daily living (ADL) and instrumental activities of daily living (IADL). Older adults who are dependent on ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities (32). Gasparik et al. reported similar findings, confirming the convergent validity of the SARC-F questionnaire through significant correlations with similar domains of the 36-Item Short Form Health Survey (SF-36) questionnaire and Sarcopenia quality-of-life (SarQoL) questionnaire. Additionally, they demonstrated divergent validity, evidenced by weaker correlations between SARC-F scores and the domains of the SF-36 and SarQoL questionnaires that differ from the SARC-F (33). In numerous studies, the SARC-F questionnaire has demonstrated low to medium sensitivity, medium to high specificity, low positive predictive value, and high negative predictive value (27). However, in the present study, all these measures were high. This could be due to the use of AWGS 2019-possible sarcopenia diagnostic criteria in the present study. In addition to the diagnostic criteria for sarcopenia, the AWGS and EWGSOP2 have outlined criteria for 'possible sarcopenia,' as defined by the AWGS, and 'probable sarcopenia,' as outlined by the EWGSOP2. These criteria exclude the assessment of muscle mass, instead focusing on muscle strength. Additionally, the AWGS recommends the assessment of physical performance. In most studies, these criteria have not been used to determine diagnostic characteristics. The SARC-F has the capability to identify impaired physical function (14). Its items just focus on muscle strength and performance; they do not assess muscular mass (MM) (34). Therefore, using possible/probable sarcopenia diagnostic criteria seems more reasonable. In the study by Drey et al., the German SARC-F demonstrated higher sensitivity, specificity, and PPV with EWGSOP2 probable sarcopenia criteria compared to EWGSOP2 sarcopenia criteria (14). Similarly, Gasparik et al. reported the same results for the Romanian version of SARC-F (33). The high sensitivity, specificity, PPV, and NPV observed in this study highlight the Persian SARC-F’s robust performance in both identifying and ruling out possible sarcopenia. For a definitive diagnosis of sarcopenia, additional tests are necessary. In this study, we conducted the first cross-cultural translation of the SARC-F questionnaire into Persian and evaluated its psychometric properties among Persian-speaking older adults. This study has several limitations that should be acknowledged. First, socioeconomic factors—including income levels and social support—were not assessed, despite their potential influence on functional outcomes. Second, the study population was recruited exclusively from a limited number of outpatient geriatric clinics within a single urban setting, which may constrain the generalizability of the findings to older adults in other regions, particularly rural communities. Additionally, the demographic characteristics of the sample may not comprehensively represent all socioeconomic or cultural subgroups within Iran, and variations in living conditions could impact the tool’s applicability across diverse populations. Furthermore, cultural differences—such as caregiving traditions, healthcare-seeking behaviors, and societal attitudes toward aging—may influence the relevance of the study’s findings in other Persian-speaking regions. Financial constraints prevented the inclusion of direct muscle mass measurements, which could affect the estimated sensitivity and specificity of the Persian SARC-F. If muscle mass data had been available, the study could have applied the Asian Working Group for Sarcopenia (AWGS) diagnostic criteria to assess sarcopenia more rigorously. Moreover, because this was not a longitudinal or interventional study, it cannot show changes over time or responsiveness of the Persian SARC-F to interventions aimed at improving sarcopenia. Finally, the reliance on self-reported components in the SARC-F introduces a potential source of bias, as participants' perceptions and memory—particularly in reporting falls—may be affected by recall inaccuracies. Although efforts were made to exclude individuals with acute cognitive impairments, some degree of recall bias may persist. Finally, we recommend further investigation into the psychometric properties of the Persian SARC-F in hospitalized older adults and nursing home residents, as well as an assessment of its responsiveness in interventional and longitudinal studies. Additionally, we suggest utilizing definitive sarcopenia diagnostic criteria to refine the calculation of the Persian SARC-F’s diagnostic accuracy. Conclusion The SARC-F questionnaire was systematically translated and cross-culturally adapted into Persian following established methodological guidelines to ensure linguistic and conceptual equivalence. Subsequently, its psychometric properties were rigorously evaluated in a sample of older adults attending outpatient geriatric clinics. The Persian version demonstrated strong validity and reliability metrics, as well as high diagnostic accuracy in both identifying individuals at risk for sarcopenia and effectively ruling out those without the condition. These robust findings underscore the utility of the Persian SARC-F as a practical and efficient screening tool for sarcopenia among community-dwelling older adults in Iran. By facilitating early identification, the use of this validated questionnaire has the potential to promote timely clinical interventions, optimize resource allocation, and ultimately improve health outcomes and quality of life for the aging population. Abbreviations ADL: Activities of Daily Living; AUC: Area Under the Curve; AWGS: Asian Working Group for Sarcopenia; BMI: Body Mass Index; CVI: Content Validity Index; CVR: Content Validity Ratio; EWGSOP2: European Working Group on Sarcopenia in Older People 2; HGS: Hand Grip Strength; IADL: Instrumental Activities of Daily Living; ICC: Intraclass Correlation Coefficient; I-CVI: Item-level Content Validity Index; IWGS: International Working Group for Sarcopenia; MM: Muscular Mass; NPV: Negative Predictive Value; PPV: Positive Predictive Value; ROC: Receiver Operating Characteristic; SarQoL: Sarcopenia Quality of Life; S-CVI/Ave: Scale-level Content Validity Index/Average; SF-36: 36-Item Short Form Health Survey; SO: Sarcopenic Obesity; UAC: Upper Arm Circumference. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.1402.067) and was conducted according to the principles of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Participants were provided with a detailed explanation of the study’s objectives, procedures, potential risks, and benefits. They were given ample time to ask questions and express concerns before voluntarily signing a consent form. Measures were taken to ensure privacy protection, including anonymizing data, securely storing collected information, and restricting access to authorized personnel only. Consent for publication Not applicable Availability of data and materials The data that supports the findings of this study are available from the corresponding author, upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors’ contributions S.T., Zh.Z., V.R., A.D. and M.H. contributed to the design and implementation of the research, the analysis of the results, and the writing of the manuscript. Acknowledgments We would like to express our sincere gratitude to the staff and administration of Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, and Firoozabadi Medical Education Center, Iran University of Medical Sciences, Tehran, for their invaluable support in facilitating the sampling process. Special thanks to Dr. Maryam Niksolat for their dedicated assistance and guidance throughout the data collection phase. We also extend our gratitude to the contributors who participated in the content validity assessment and to those involved in the translation process of the questionnaire. References Cruz-Jentoft AJ, Sayer AA. Sarcopenia. The Lancet. 2019;393(10191):2636-46. Liu J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Sarcopenia among Elderly Individuals Residing in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis. Nutrients. 2023;15(20). Xu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia is associated with mortality in adults: a systematic review and meta-analysis. Gerontology. 2022;68(4):361-76. Haase CB, Brodersen JB, Bülow J. Sarcopenia: early prevention or overdiagnosis? Bmj. 2022;376:e052592. Giovannini S, Brau F, Forino R, Berti A, D'Ignazio F, Loreti C, et al. Sarcopenia: Diagnosis and Management, State of the Art and Contribution of Ultrasound. J Clin Med. 2021;10(23). Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249-56. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019;48(1):16-31. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21(3):300-7.e2. Parra-Rodríguez L, Szlejf C, García-González AI, Malmstrom TK, Cruz-Arenas E, Rosas-Carrasco O. Cross-cultural adaptation and validation of the Spanish-language version of the SARC-F to assess sarcopenia in Mexican community-dwelling older adults. Journal of the American Medical Directors Association. 2016;17(12):1142-6. Zasadzka E, Pieczyńska A, Trzmiel T, Pawlaczyk M. Polish translation and validation of the SARC-F tool for the assessment of sarcopenia. Clinical Interventions in Aging. 2020;15:567. Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. Journal of the American Medical Directors Association. 2013;14(8):531-2. Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC‐F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. Journal of cachexia, sarcopenia and muscle. 2016;7(1):28-36. Beaudart C, McCloskey E, Bruyère O, Cesari M, Rolland Y, Rizzoli R, et al. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016;16(1):170. Drey M, Ferrari U, Schraml M, Kemmler W, Schoene D, Franke A, et al. German version of SARC-F: translation, adaption, and validation. Journal of the American Medical Directors Association. 2020;21(6):747-51. e1. Perna S, Gasparri C, Ferraris C, Barrile GC, Cavioni A, Mansueto F, et al. Validation of the Italian Version of the SARC-F Questionnaire to Assess Sarcopenia in Older Adults. Nutrients. 2022;14(12):2533. Beaudart C, Locquet M, Bornheim S, Reginster J-Y, Bruyère O. French translation and validation of the sarcopenia screening tool SARC-F. European geriatric medicine. 2018;9:29-37. Anthoine E, Moret L, Regnault A, Sébille V, Hardouin JB. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014;12:176. Hesamzadeh A, Maddah SB, Mohammadi F, Fallahi Khoshknab M, Rahgozar M. Comparison of elderlys" quality of life" living at homes and in private or public nursing homes. Iranian Journal of Ageing. 2010;4(4):0-. Piodena-Aportadera MRB, Lau S, Chew J, Lim JP, Ismail NH, Ding YY, et al. Calf circumference measurement protocols for sarcopenia screening: Differences in agreement, convergent validity and diagnostic performance. Annals of Geriatric Medicine and Research. 2022;26(3):215. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63. Tavakol M, Dennick R. Making sense of Cronbach's alpha. International journal of medical education. 2011;2:53. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4):563-75. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-67. Unal I. Defining an optimal cut-point value in ROC analysis: an alternative approach. Computational and mathematical methods in medicine. 2017;2017. Trivedi K, KhaTri S. Reliability and Validity of Gujarati Version of SARC-F Tool Used as Screening of Sarcopenia: A Cross-sectional Study. Journal of Clinical & Diagnostic Research. 2022;16(9). Tsekoura M, Billis E, Tsepis E, Lampropoulou S, Beaudart C, Bruyere O, et al. Cross-cultural adaptation and validation of the Greek Version of the SARC-F for evaluating sarcopenia in Greek older adults. Journal of musculoskeletal & neuronal interactions. 2020;20(4):505. Voelker SN, Michalopoulos N, Maier AB, Reijnierse EM. Reliability and concurrent validity of the SARC-F and its modified versions: a systematic review and meta-analysis. Journal of the American Medical Directors Association. 2021;22(9):1864-76. e16. Sánchez-Rodríguez D, Marco E, Dávalos-Yerovi V, López-Escobar J, Messaggi-Sartor M, Barrera C, et al. Translation and validation of the Spanish version of the SARC-F questionnaire to assess sarcopenia in older people. The journal of nutrition, health & aging. 2019;23(6):518-24. Kandinata SG, Widajanti N, Ichwani J, Firdausi H, Aryana IGPS, Alkaff FF. Diagnostic performance of calf circumference, SARC-F, and SARC-CalF for possible sarcopenia screening in Indonesia. Scientific Reports. 2023;13(1):9824. Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts. 2022;15(3):321-35. De Leo D, Diekstra RF, Lonnqvist J, Lonnqvist J, Cleiren MH, Frisoni GB, et al. LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behavioral Medicine. 1998;24(1):17-27. Wang DXM, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11(1):3-25. Gasparik A, Demián M, Pascanu I. Romanian translation and validation of the Sarc-F questionnaire. Acta Endocrinologica (Bucharest). 2020;16(2):216. Barbosa-Silva TG, Menezes AMB, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: improving sarcopenia screening in the clinical practice. Journal of the American Medical Directors Association. 2016;17(12):1136-41. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 09 Jun, 2025 Reviews received at journal 05 Jun, 2025 Reviews received at journal 30 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers invited by journal 21 May, 2025 Editor assigned by journal 21 May, 2025 Submission checks completed at journal 06 May, 2025 First submitted to journal 02 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5020242","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460115902,"identity":"b621f654-eec6-4fe3-b7cd-6468020feb94","order_by":0,"name":"Sanay Toloueinasab","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sanay","middleName":"","lastName":"Toloueinasab","suffix":""},{"id":460115903,"identity":"0be4c5ed-a1f1-47a3-bf95-334a0f8a910c","order_by":1,"name":"Ahmad Delbari","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Delbari","suffix":""},{"id":460115904,"identity":"1225d475-0e01-40ee-b4ab-3d8ad11056a9","order_by":2,"name":"Marjan Haghi","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Marjan","middleName":"","lastName":"Haghi","suffix":""},{"id":460115905,"identity":"66646842-6dd4-48ca-9ada-55bd68f42bc0","order_by":3,"name":"Vahid Rashedi","email":"","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":false,"prefix":"","firstName":"Vahid","middleName":"","lastName":"Rashedi","suffix":""},{"id":460115906,"identity":"4a6fa288-492e-435a-b3dd-ed32cd818855","order_by":4,"name":"Zhale Zandieh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDACCRDBJsHAD6ITCkjRItkA0mJAvBYGBoMDIAYxWuRntz/8XFBmIWd8fnXihwcGDPL8Ygfwa2GccyBZesY5CWOzG283SwAdZjhzdgJ+LcwSCQekedskErfdOLsBpCXB4DYBLWwSic2/gVrqN884u/kHUVp4JJLZQLYkGPD3biPOFgmJNDZrnnMShjNu8G6zSDCQIOwX+Rnpj2/zlNXJ8/ef3XzzR4WNPL80AS1I9oFVShCrHAT4D5CiehSMglEwCkYSAACyuz4Cit2aWgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Social Welfare and Rehabilitation Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zhale","middleName":"","lastName":"Zandieh","suffix":""}],"badges":[],"createdAt":"2024-09-02 18:25:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5020242/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5020242/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06214-y","type":"published","date":"2025-07-28T16:29:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83478859,"identity":"fa40a3d7-8be6-46c3-9686-273cfbb93119","added_by":"auto","created_at":"2025-05-27 06:02:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15913,"visible":true,"origin":"","legend":"\u003cp\u003eThe ROC curve of SARC-F against the AWGS 2019 criteria for possible sarcopenia\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5020242/v1/5a04a4545b4644c5bf3e7de5.png"},{"id":88268832,"identity":"910deea6-79b2-483e-87f3-12bd15bc91d4","added_by":"auto","created_at":"2025-08-04 16:52:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":927070,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5020242/v1/aeb8eef2-99f6-419e-9800-701a55ffee38.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validity and reliability of the Persian version of the SARC-F Questionnaire among Iranian older adults","fulltext":[{"header":"Background","content":"\u003cp\u003eSarcopenia is identified as a geriatric condition characterized by a progressive reduction in muscle mass and function (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Depending on the diagnostic criteria used in different studies, its prevalence varies between 5.2% and 62.7% in community-dwelling older adults (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Hospitalization, functional decline, and increased risk of falls and fractures are among the negative health outcomes linked to sarcopenia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Early identification and intervention of sarcopenia are imperative, as they can significantly reduce mortality and morbidity rates, and contribute to the enhancement of overall quality of life (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultiple operational working groups have provided different diagnostic criteria for sarcopenia (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to the International Working Group for Sarcopenia (IWGS), low muscle mass and low physical performance are the diagnostic criteria for sarcopenia (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposes three principal criteria for diagnosing sarcopenia: muscle strength, quantity or quality, and physical performance. Based on these criteria, probable sarcopenia is recognized when low muscle strength is present (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The diagnostic criteria provided by the Asian Working Group for Sarcopenia (AWGS) are also aligned with the European approach. They advocate for the evaluation of muscle strength, muscle mass, and physical performance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Assessing muscle mass, strength, and function is a time-consuming process that requires specialized equipment. Consequently, employing these diagnostic criteria may not be feasible in routine clinical practice (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Therefore, more cost-effective and simpler-to-apply approaches are essential (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The SARC-F is a self-reported, brief, and inexpensive tool that was published by Malmstrom and Morley for screening sarcopenia. This questionnaire consists of 5 items (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and it is widely regarded as a highly effective tool for increasing awareness of sarcopenia diagnosis in primary care settings (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The AWGS and EWGSOP2 advocate for using the SARC-F questionnaire during the initial case-finding stage within their respective diagnostic algorithms (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Globally, various translations and validations of the SARC-F have been conducted, including German (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Italian (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), Polish (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), French (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and Spanish (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) versions.\u003c/p\u003e \u003cp\u003eDespite its widespread use internationally, there is currently no validated Persian version of the SARC-F questionnaire specifically adapted for the Iranian population. Addressing this gap is essential, considering the significant cultural and linguistic nuances that may impact the questionnaire\u0026rsquo;s relevance and accuracy. The endorsement of the SARC-F as a practical case-finding tool by leading professional working groups further highlights the critical need for its cultural adaptation and validation in Persian. Moreover, the definitive diagnosis of sarcopenia\u0026mdash;typically involving the measurement of skeletal muscle mass through costly and resource-intensive methods\u0026mdash;is often impractical for many older adults in Iran due to financial and logistical constraints. Consequently, developing and validating a culturally appropriate Persian version of the SARC-F questionnaire could facilitate more accessible, cost-effective, and early detection of sarcopenia within this population.\u003c/p\u003e \u003cp\u003eWe hypothesize that the Persian adaptation of the SARC-F will exhibit satisfactory validity, reliability, and diagnostic accuracy in identifying probable sarcopenia among Persian-speaking older adults, thereby establishing it as a feasible screening tool for community-dwelling older adults in Iran.\u003c/p\u003e \u003cp\u003eThis research aims to translate and culturally adapt the SARC-F questionnaire into Persian and evaluate its psychometric characteristics for older adults attending outpatient geriatric clinics.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was carried out in two distinct phases: the initial phase involved translation and cultural adaptation; the second phase was centered on assessing psychometric properties.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFirst phase\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Persian version of the SARC-F questionnaire was translated in this phase and evaluated for its content validity.\u003c/p\u003e\n\u003cp\u003eWith authorization from the original developer, John Morley (11), we translated the SARC-F questionnaire into Persian, adhering to the WHO forward-backward\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eprotocol. Two bilingual gerontology and geriatric medicine experts initially translated the tool from English to Persian\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e Subsequently, an expert panel, including the initial translators and two additional specialists in gerontology and tool development, refined the translation to align with cultural nuances. Then, two independent translators, unaware of the original SARC-F, performed a back-translation. A group discussion was held involving the initial and back translators and the expert panel to compare the back-translation with the original SARC-F. This process resolved all discrepancies and led to the creation of the pre-final Persian SARC-F. Lastly, a pre-test was conducted with ten cognitively intact older adults, comprising an equal number of males and females, aged 65 or above. Each participant was asked to complete the translated questionnaire independently. Following completion, structured cognitive interviews were conducted to assess their comprehension of each item. Participants were encouraged to articulate their interpretation of the questions and report any ambiguities or difficulties they encountered. Their feedback was carefully reviewed and was considered to finalize the Persian SARC-F.\u003c/p\u003e\n\u003cp\u003ePersian SARC-F\u0026apos;s content validity was assessed by geriatric medicine, gerontology, and psychiatry experts with geriatric specialization. For the Content Validity Ratio\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(CVR), ten experts responded to a 3-point Likert scale determining the essentiality of the items. For the Content Validity Index (CVI), seven experts utilized a 4-point scale for relevancy, clarity, and simplicity, resulting in the calculation of the item-level CVI (I-CVI) and the Scale-level CVI Average (S-CVI/Ave).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSecond phase\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was carried out during this phase. The sample size was determined using the subject-to-item ratio method\u0026nbsp;(17). To ensure robust statistical power, we adopted a ratio of 30:1. Given that the SARC-F questionnaire consists of five items, the estimated sample size was 150 participants. To account for potential dropout during the study, an additional 50 participants were included, resulting in a final sample size of 200. A convenience sampling was used to include individuals aged 65 and older who visited outpatient clinics of geriatric medicine in Tehran from July 2023 to December 2023. Inclusion criteria were familiar with the Persian language and the ability to establish verbal communication; exclusion criteria included any acute conditions, such as severe respiratory or cardiovascular disorders, acute musculoskeletal injuries, neurologic conditions, recent surgery, cognitive impairment beyond mild levels, severe arthritis, and advanced peripheral neuropathy, as well as any other condition that could significantly hinder the assessment of physical measurements, such as walking speed, hand grip strength, height, and weight.\u003c/p\u003e\n\u003cp\u003eThe reliability of the Persian SARC-F was confirmed by establishing internal consistency through Cronbach\u0026rsquo;s alpha coefficient and the correlation between individual items and the overall scale score. Temporal consistency was gauged by a test-retest method with a two-week interval among a subset of 25 participants.\u003c/p\u003e\n\u003cp\u003eThe concurrent validity was evaluated through a comparative analysis involving the Persian SARC-F, handgrip strength, and gait speed based on AWGS 2019 criteria for possible sarcopenia. To assess construct validity, participants were asked to complete the LEIPAD questionnaire,\u0026nbsp;a validated tool designed to measure health-related quality of life in older adults across multiple domains, including physical function, self-care, depression and anxiety, cognitive functioning, social functioning, sexual functioning, and life satisfaction (18). Strong correlations between the SARC-F scores and the LEIPAD questionnaire domains measuring similar constructs (Self-care, Physical function) were anticipated, indicative of convergent validity. Conversely, weaker correlations were expected between domains assessing different constructs, demonstrating divergent validity.\u003c/p\u003e\n\u003cp\u003eThe diagnostic characteristics of the questionnaire was determined by calculating the measures of sensitivity, specificity, positive predictive value, and negative predictive value. The cut-off point was also calculated following the AWGS 2019 criteria for possible sarcopenia (8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDefinition of sarcopenia\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePossible sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS) 2019, is characterized by \u0026lsquo;low muscle strength with or without reducing physical performance.\u0026rsquo; Muscle strength was measured using a calibrated hydraulic hand dynamometer. Hand Grip Strength (HGS) of \u0026lt;18 kg for women and \u0026lt;28 kg for men was considered low. A 6-meter walk test was conducted for physical performance assessment, and a gait speed \u0026lt;1.0 m/s indicated reduced physical performance\u0026nbsp;(8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSARC-F Questionnaire\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SARC-F has been created as a possible rapid diagnostic tool for sarcopenia. It has 5 items\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e Strength, how much difficulty you have in lifting and carrying 10 lb; assistance in walking, how much difficulty you have walking across a room; rise from a chair, how much difficulty you have transferred from a chair or bed; climb stairs, how much difficulty do you have climbing a flight of 10 stairs; falls, how many times have you fallen in the past year. Each item is scored on a range of 0 to 2, and an overall score equal to or greater than 4, predicts sarcopenia (11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasurements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWeight was measured in a standing position with minimal clothing using a digital scale (Camry EB5636-B). Height was measured in a standing position without shoes using the Seca 206 roller measuring tape. Body mass index was calculated by dividing weight by the square of height. Hand grip strength was assessed using the Jamar hydraulic hand dynamometer (Sammons Preston, INC. Bolingbrook, IL 60440-4989). Participants were seated with their elbows flexed at 90 degrees. During two trials, participants exerted maximum effort in an isometric contraction for each hand while in a sitting position with 90 degrees of elbow flexion. The highest value from these trials was recorded (8). Participants stood with their feet shoulder-width apart to measure the calf circumference while their body weight was evenly distributed on both legs. The widest part of the right calf was measured using a non-elastic tape (19). To measure the Upper Arm Circumference (UAC), the widest part of the right arm was measured while the elbow was bent at a 90-degree angle and the biceps muscle was flexed. Two measurements were taken using a stopwatch to determine the time required to walk 6 meters at a normal pace from a moving start, without any reduction. The average of these measurements was then recorded (8). Subsequently, the gait speed was calculated in meters per second. During an interview, the LEIPAD quality of life questionnaire (18), and the Persian SARC-F were completed for the participants. Data on age, gender, education level, marital status, living arrangement, and number of medications were collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis of the dataset was conducted using SPSS, version 27.0 (Armonk, NY: IBM Corp.).: Participants were categorized into two groups based on their SARC-F scores.\u0026nbsp;individuals with scores \u0026lt;4 and those with scores \u0026ge;4. The threshold of \u0026ge;4 was originally established as predictive of sarcopenia (11). Descriptive statistics were presented as means \u0026plusmn; SD for variables on a continuous scale and as frequency counts and percentages for categorical variables. Statistical comparisons were performed between these groups using a Two-sample t-test or Mann\u0026ndash;Whitney U-test for continuous variables, and a Chi-square test or Fisher\u0026rsquo;s exact test for categorical variables. The Kolmogorov-Smirnov test was utilized to evaluate the normality of the variables. The Spearman rank correlation was used to assess non-normally distributed measurements. We evaluated test-retest reliability using the intraclass correlation coefficient (ICC) along with its 95% confidence interval, categorizing the agreement level as poor (\u0026lt; 0.5), moderate (0.50\u0026ndash;0.75), good (0.75\u0026ndash;0.90), and excellent (\u0026gt; 0.90)\u0026nbsp;(20). The Cronbach\u0026rsquo;s alpha and item-total correlation coefficients were used to measure internal consistency, with a Cronbach\u0026rsquo;s alpha of \u0026ge;0.70 indicating acceptable consistency\u0026nbsp;(21). The item-total correlation coefficients, based on Spearman\u0026rsquo;s correlation, range from 0 to 1, with higher values denoting greater consistency. A p-value of \u0026lt;0.05 was set as the threshold for statistical significance. Content validity was determined by a Content Validity Ratio (CVR) greater than 0.62\u0026nbsp;(22), an Item-Content Validity Index (I-CVI) of at least 0.78, and a Scale-Content Validity Index-average (SCVI-Ave) of 0.90 or higher\u0026nbsp;(23). In the context of the AWGS 2019 criteria\u0026nbsp;(8)\u0026nbsp;for possible sarcopenia, we performed a receiver operating characteristic (ROC) curve analysis to compute the area under the curve (AUC), thereby assessing the SARC-F\u0026rsquo;s diagnostic performance. The optimal cut-point value was ascertained using the Closest to (0,1) Criterion\u0026nbsp;(24). Sensitivity, specificity,\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ePositive Predictive Value (PPV), and Negative Predictive Value (NPV) were calculated for different cut-points\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFirst phase\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe translation and cross-cultural adaptation of the SARC-F from English to Persian was accomplished without any significant challenges. In the first component, \u0026lsquo;strength,\u0026rsquo; the original weight specification of 10 lb (pounds) was converted to kilograms (4.5 kg). In the pre-test performed on 10 subjects (5 men and 5 women, with a mean age of 70.5 \u0026plusmn; 4.35 years), no problems were reported in understanding all five components of the translated questionnaire. The content validity of the questionnaire was validated (Table 1).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eContent validity index and content validity ratio of the Persian SARC-F items\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelevancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClarity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimplicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEssentiality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI-CVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI-CVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI-CVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eStrength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAssistance in walking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eRise from a chair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eClimb stairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFalls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eS-CVI/Ave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e Ne, Number of Experts Evaluated the Item; I-CVI, Item-Level Content Validity Index;\u003c/p\u003e\n\u003cp\u003eCVR, Content Validity Ratio; S-CVI/Ave, Scale-Level Content Validity Index Average.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSecond phase\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo hundred participants with a mean age of 73.1 \u0026plusmn; 6.6 years, ranging from 65 to 91 years were included in this phase. The majority were female, and most participants had either primary education or no formal education. Table 2 displays the characteristics of the participants. The Cronbach alpha was calculated at 0.792. All items within the scale exhibited positive correlations with the total score, with correlation coefficients ranging from 0.41 to 0.81 (Table 3). The ICC was estimated to be 0.99 with a 95% confidence interval ranging from 0.979 to 0.996.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eCharacteristics of Participants\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=200)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARC-F\u0026ge; 4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARC-F\u0026lt;4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e73.13 \u0026plusmn; 6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74.85 \u0026plusmn; 7.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e71.45 \u0026plusmn; 5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119 (59.5)\u003c/p\u003e\n \u003cp\u003e81 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e67 (67.7)\u003c/p\u003e\n \u003cp\u003e32 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52 (51.5)\u003c/p\u003e\n \u003cp\u003e49 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.02 ƚ\u003c/p\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; No formal education\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Primary\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Lower Secondary\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Upper secondary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Academic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55 (27.5)\u003c/p\u003e\n \u003cp\u003e63 (31.5)\u003c/p\u003e\n \u003cp\u003e29 (14.5)\u003c/p\u003e\n \u003cp\u003e28 (14)\u003c/p\u003e\n \u003cp\u003e25 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (37.4)\u003c/p\u003e\n \u003cp\u003e28 (28.3)\u003c/p\u003e\n \u003cp\u003e13 (13.1)\u003c/p\u003e\n \u003cp\u003e15 (15.1)\u003c/p\u003e\n \u003cp\u003e6 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (17.8)\u003c/p\u003e\n \u003cp\u003e35 (34.7)\u003c/p\u003e\n \u003cp\u003e16 (15.8)\u003c/p\u003e\n \u003cp\u003e13 (12.9)\u003c/p\u003e\n \u003cp\u003e19 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006 ƚ\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNumber of medications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.52 \u0026plusmn; 2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5.59 \u0026plusmn; 2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.47 \u0026plusmn; 2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePolypharmacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e98 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e65 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cspan dir=\"RTL\"\u003e\u0026nbsp;ƚ\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLiving alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.364\u0026nbsp;ƚ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Married\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Unmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e124 (62)\u003c/p\u003e\n \u003cp\u003e76 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56 (56.6)\u003c/p\u003e\n \u003cp\u003e43 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (67.3)\u003c/p\u003e\n \u003cp\u003e33 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.117\u0026nbsp;ƚ\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLEIPAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e57.06 \u0026plusmn; 17.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e47.72 \u0026plusmn; 16.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66.22 \u0026plusmn; 11.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e161.79 \u0026plusmn; 9.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e159.82 \u0026plusmn; 9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e163.73 \u0026plusmn; 9.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003ǂ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e68.91 \u0026plusmn; 12.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e68.18 \u0026plusmn; 14.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e69.62 \u0026plusmn; 11.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.429ǂ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26.41 \u0026plusmn; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26.77 \u0026plusmn; 5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26.05 \u0026plusmn; 3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.293ǂ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSARC-F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.58 \u0026plusmn; 2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5.75 \u0026plusmn; 1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.46 \u0026plusmn; 1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUAC (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30.47 \u0026plusmn; 3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30.32 \u0026plusmn; 4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30.62 \u0026plusmn; 3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.771*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCC (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e36.68 \u0026plusmn; 4.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e36.19 \u0026plusmn; 4.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37.16 \u0026plusmn; 3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.207*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGait speed (m/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.18 \u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.41 \u0026plusmn; 0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHGS (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18.54 \u0026plusmn; 8.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e12.26 \u0026plusmn; 5.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e24.7 \u0026plusmn; 7.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e BMI, Body Mass Index; HGS, Handgrip Strength;\u003c/p\u003e\n\u003cp\u003eUAC,\u0026nbsp;Upper Arm Circumferences; CC, Calf circumference.\u003c/p\u003e\n\u003cp\u003e*\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eMann\u0026ndash;Whitney U test\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eǂ\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eTwo-sample t-test\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eƚ\u0026nbsp;Chi-square test\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eInternal Consistency of the Persian SARC-F\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARC-F Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eStrength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAssistance in walking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eRise from a chair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eClimb stairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eFalls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCronbach alpha = 0.792. The item-total score correlations were analyzed using the Spearman test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe correlations Between the Persian SARC-F (Each Domain and Total Score) and Other Related Measurements are presented in Table 4. The Persian SARC-F demonstrated concurrent validity by showing significant correlations with grip strength and gait speed. Additionally, construct validity was supported by strong correlations between SARC-F scores and the Physical Functioning and Self-Care domains of the LEIPAD questionnaire, while weaker correlations were observed with other domains. No significant correlation existed between the SARC-F score and either UAC or CC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eCorrelations Between the Persian SARC-F (Each Domain and Total Score) and Other Related Measurements\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrength\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssistance in\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWalking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRise from a Chair\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClimb Stairs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.148*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.301**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.282**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.178*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.257**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.514**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.508**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.518**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.556**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.269**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.646**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ PF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.517**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.548**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.557**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.595**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.276**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.675**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ SC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.659**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.723**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.668**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.770**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.284**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.863**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ DA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.198**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.174*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.157*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.179*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.230**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ CF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.270**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.316**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.170*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.371**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ SF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.245**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.192**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.190**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.229**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.251**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ SX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.419**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.303**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.265**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.295**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.173*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.410**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLEIPAD/ LS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.323**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.314**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.350**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.380**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.152*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.418**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eUAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.218**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.222**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eGait speed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.498**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.704**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.666**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.617**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.269**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.765**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHGS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.592**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.595**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-.577**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.551**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-.342**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.739**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e PF, Physical Functioning; SC, Self-Care; DA, Depression and Anxiety; CF, Cognitive Functioning; SF, Social Functioning; SX, Sexual Functioning; LS, Life Satisfaction; UAC, Upper Arm Circumferences; CC, Calf circumferences; HGS, Handgrip Strength\u003c/p\u003e\n\u003cp\u003e**\u0026nbsp;Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\n\u003cp\u003e* Correlation is significant at the 0.05 level (2-tailed).\u003c/p\u003e\n\u003cp\u003eThe correlations were analyzed using the Spearman test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe receiver operating characteristic (ROC) curve for the performance of the Persian SARC-F as a screening tool, based on the AWGS 2019 criteria for possible sarcopenia, is presented in Figure 1. The AUC was 0.91 (95%CI: 0.86\u0026ndash;0.95). The optimal cut-off point, determined using the Closest to (0,1) Criterion, was \u0026ge;4. Table 5 provides sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for different cut-off points. Notably, the optimal cut-off point demonstrated a sensitivity of 84.9% and specificity of 96.5%. Table 6 shows the distribution of samples according to the Persian SARC-F and AWGS 2019 criteria; the SARC-F questionnaire identified 96 of the 113 individuals with possible sarcopenia.\u0026nbsp;There was a significant association between SARC-F and AWGS 2019 criteria in identifying sarcopenia and possible sarcopenia (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eDiagnostic characteristics of the Persian SARC-F based on different cut-points\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecificity (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePPV (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNPV (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSARC-F \u0026ge; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e56.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e96.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e63.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSARC-F \u0026ge; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e84.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e96.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSARC-F \u0026ge; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e87.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e78.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e83.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSARC-F \u0026ge; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e94.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e71.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e88.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e PPV, positive predictive value; NPV, negative predictive value.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003eSample Distribution by Persian SARC-F and AWGS 2019 Criteria for Possible Sarcopenia\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAWGS 2019 criteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePossible Sarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo sarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSARC-F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSarcopenia (\u0026ge;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo sarcopenia (\u0026lt;4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e AWGS, Asian Working Group for Sarcopenia.\u003c/p\u003e\n\u003cp\u003e*Fisher\u0026rsquo;s exact test.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study translated and culturally adapted the SARC-F into Persian and evaluated its psychometric properties for older adults attending outpatient geriatric clinics. The results indicate that the Persian adoption of the SARC-F is both reliable and valid for possible sarcopenia screening.\u003c/p\u003e\n\u003cp\u003eThe translation and pre-testing process to achieve a culturally adapted version was similar to the methods used for various other translations, including the German version (14).\u0026nbsp;The values of CVI and CVR indicated that the questionnaire had appropriate content validity and none of the items required modification. Trivedi et al. also reported similar results for the Gujarati version of the SARC-F\u0026nbsp;(25).\u003c/p\u003e\n\u003cp\u003eThe translated SARC-F demonstrated satisfactory reliability. Specifically, the test-retest reliability was excellent, closely aligning with the Greek version (ICC = 0.93) (26). The internal consistency was also acceptable, with a Cronbach\u0026rsquo;s alpha of 0.79, similar to the original version reported by Malmstrom et al., with values ranging from 0.76 to 0.81 (12). Overall, various versions of this tool have shown good reliability (27).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Persian SARC-F showed strong negative correlations with handgrip strength (HGS) and gait speed, which are criteria for possible sarcopenia, thereby confirming concurrent validity. It also showed a significant positive correlation with age (\u0026rho; = 0.257) and a significant negative correlation with LEIPAD scores (\u0026rho; = -0.646).\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eSimilarly, Parra-Rodriguez et al. reported significant correlations between SARC-F scores and handgrip strength, gait speed, quality of life, and age (9). This result is consistent with findings from other studies (26, 28). Contrary to expectations, no significant correlation was found between SARC-F scores and calf circumference (CC). CC is acknowledged as an indicator of muscle mass in older adults. It serves as a proxy for measuring muscle mass\u0026nbsp;(19). While the SARC-F questionnaire is a suitable screening tool for detecting impaired physical performance, it may not directly reflect muscle mass. This is consistent with the findings of Drey et al., who also reported a lack of association between SARC-F scores and muscle mass\u0026nbsp;(14).\u0026nbsp;CC is not a reliable indicator of the functional aspects of sarcopenia. Additionally, several factors can affect the accuracy of CC measurements. For example, calf edema can exaggerate the muscle volume, thereby compromising the precision of CC as a screening tool for sarcopenia\u0026nbsp;(29). \u0026nbsp;Another possible reason can be the presence of sarcopenic obesity (SO), which is defined as the simultaneous presence of obesity and sarcopenia\u0026nbsp;(30).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study\u0026rsquo;s findings underscore the significant differences in various variables between individuals with SARC-F scores of \u0026ge; 4 and \u0026lt; 4. These differences in age, gender, education level, number of medications, polypharmacy, gait speed, handgrip strength, and height can highlight the multifaceted nature of sarcopenia.\u003c/p\u003e\n\u003cp\u003eThe investigation of construct validity confirmed convergent validity with the strong correlation between the physical functioning and self-care domains of the LEIPAD questionnaire and the Persian SARC-F and established divergent validity with the weaker correlations between the Persian SARC-F and other domains such as depression and anxiety, cognitive functioning, and social functioning. While the Persian SARC-F\u0026apos;s strong correlations with the physical functioning and self-care domains support the construct validity, it\u0026apos;s important to note that these domains do not directly measure sarcopenia. They are relevant to the functional impairments commonly associated with sarcopenia. The self-care domain measures older adults\u0026rsquo; capacity to do daily activities independently (31). Meanwhile, the SARC-F questionnaire is a suitable screening tool for identifying individuals with impaired physical performance (14). Both\u0026nbsp;physical performance and muscle strength can predict decreases in activities of daily living (ADL) and instrumental activities of daily living (IADL).\u0026nbsp;Older adults who are dependent on ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities\u0026nbsp;(32).\u0026nbsp;Gasparik et al. reported similar findings, confirming the convergent validity of the SARC-F questionnaire through significant correlations with similar domains of the 36-Item Short Form Health Survey (SF-36) questionnaire and Sarcopenia quality-of-life (SarQoL) questionnaire. Additionally, they demonstrated divergent validity, evidenced by weaker correlations between SARC-F scores and the domains of the SF-36 and SarQoL questionnaires that differ from the SARC-F\u0026nbsp;(33).\u003c/p\u003e\n\u003cp\u003eIn numerous studies, the SARC-F questionnaire has demonstrated low to medium sensitivity, medium to high specificity, low positive predictive value, and high negative predictive value (27). However, in the present study, all these measures were high.\u0026nbsp;This could be due to the use of AWGS 2019-possible sarcopenia diagnostic criteria in the present study. In addition to the diagnostic criteria for sarcopenia, the AWGS and EWGSOP2 have outlined criteria for \u0026apos;possible sarcopenia,\u0026apos; as defined by the AWGS, and \u0026apos;probable sarcopenia,\u0026apos; as outlined by the EWGSOP2. These criteria exclude the assessment of muscle mass, instead focusing on muscle strength. Additionally, the AWGS recommends the assessment of physical performance. In most studies, these criteria have not been used to determine diagnostic characteristics. The SARC-F has the capability to identify impaired physical function (14).\u0026nbsp;Its items just focus on muscle strength and performance; they do not assess muscular mass (MM)\u0026nbsp;(34).\u0026nbsp;Therefore, using possible/probable sarcopenia diagnostic criteria seems more reasonable. In the study by Drey et al., the German SARC-F demonstrated higher sensitivity, specificity, and PPV with EWGSOP2 probable sarcopenia criteria compared to EWGSOP2 sarcopenia criteria\u0026nbsp;(14). Similarly, Gasparik et al. reported the same results for the Romanian version of SARC-F\u0026nbsp;(33). The high sensitivity, specificity, PPV, and NPV observed in this study highlight the Persian SARC-F\u0026rsquo;s robust performance in both identifying and ruling out possible sarcopenia. For a definitive diagnosis of sarcopenia, additional tests are necessary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, we conducted the first cross-cultural translation of the SARC-F questionnaire into Persian and evaluated its psychometric properties among Persian-speaking older adults. This study has several limitations that should be acknowledged. First, socioeconomic factors\u0026mdash;including income levels and social support\u0026mdash;were not assessed, despite their potential influence on functional outcomes. Second, the study population was recruited exclusively from a limited number of outpatient geriatric clinics within a single urban setting, which may constrain the generalizability of the findings to older adults in other regions, particularly rural communities. Additionally, the demographic characteristics of the sample may not comprehensively represent all socioeconomic or cultural subgroups within Iran, and variations in living conditions could impact the tool\u0026rsquo;s applicability across diverse populations. Furthermore, cultural differences\u0026mdash;such as caregiving traditions, healthcare-seeking behaviors, and societal attitudes toward aging\u0026mdash;may influence the relevance of the study\u0026rsquo;s findings in other Persian-speaking regions. Financial constraints prevented the inclusion of direct muscle mass measurements, which could affect the estimated sensitivity and specificity of the Persian SARC-F. If muscle mass data had been available, the study could have applied the Asian Working Group for Sarcopenia (AWGS) diagnostic criteria to assess sarcopenia more rigorously. Moreover, because this was not a longitudinal or interventional study, it cannot show changes over time or responsiveness of the Persian SARC-F to interventions aimed at improving sarcopenia. Finally, the reliance on self-reported components in the SARC-F introduces a potential source of bias, as participants\u0026apos; perceptions and memory\u0026mdash;particularly in reporting falls\u0026mdash;may be affected by recall inaccuracies. Although efforts were made to exclude individuals with acute cognitive impairments, some degree of recall bias may persist.\u003c/p\u003e\n\u003cp\u003eFinally, we recommend further investigation into the psychometric properties of the Persian SARC-F in hospitalized older adults and nursing home residents, as well as an assessment of its responsiveness in interventional and longitudinal studies. Additionally, we suggest utilizing definitive sarcopenia diagnostic criteria to refine the calculation of the Persian SARC-F\u0026rsquo;s diagnostic accuracy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe SARC-F questionnaire was systematically translated and cross-culturally adapted into Persian following established methodological guidelines to ensure linguistic and conceptual equivalence. Subsequently, its psychometric properties were rigorously evaluated in a sample of older adults attending outpatient geriatric clinics. The Persian version demonstrated strong validity and reliability metrics, as well as high diagnostic accuracy in both identifying individuals at risk for sarcopenia and effectively ruling out those without the condition. These robust findings underscore the utility of the Persian SARC-F as a practical and efficient screening tool for sarcopenia among community-dwelling older adults in Iran. By facilitating early identification, the use of this validated questionnaire has the potential to promote timely clinical interventions, optimize resource allocation, and ultimately improve health outcomes and quality of life for the aging population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADL: Activities of Daily Living; AUC: Area Under the Curve; AWGS: Asian Working Group for Sarcopenia; BMI: Body Mass Index; CVI: Content Validity Index; CVR: Content Validity Ratio; EWGSOP2: European Working Group on Sarcopenia in Older People 2; HGS: Hand Grip Strength; IADL: Instrumental Activities of Daily Living; ICC: Intraclass Correlation Coefficient; I-CVI: Item-level Content Validity Index; IWGS: International Working Group for Sarcopenia; MM: Muscular Mass; NPV: Negative Predictive Value; PPV: Positive Predictive Value; ROC: Receiver Operating Characteristic; SarQoL: Sarcopenia Quality of Life; S-CVI/Ave: Scale-level Content Validity Index/Average; SF-36: 36-Item Short Form Health Survey; SO: Sarcopenic Obesity; UAC: Upper Arm Circumference.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.1402.067) and was conducted according to the principles of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Participants were provided with a detailed explanation of the study\u0026rsquo;s objectives, procedures, potential risks, and benefits. They were given ample time to ask questions and express concerns before voluntarily signing a consent form. Measures were taken to ensure privacy protection, including anonymizing data, securely storing collected information, and restricting access to authorized personnel only.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that supports the findings of this study are available from the corresponding author, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.T., Zh.Z., V.R., A.D. and M.H. contributed to the design and implementation of the research, the analysis of the results, and the writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the staff and administration of Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, and Firoozabadi Medical Education Center, Iran University of Medical Sciences, Tehran, for their invaluable support in facilitating the sampling process. Special thanks to Dr. Maryam Niksolat for their dedicated assistance and guidance throughout the data collection phase. We also extend our gratitude to the contributors who participated in the content validity assessment and to those involved in the translation process of the questionnaire.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCruz-Jentoft AJ, Sayer AA. Sarcopenia. The Lancet. 2019;393(10191):2636-46.\u003c/li\u003e\n\u003cli\u003eLiu J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Sarcopenia among Elderly Individuals Residing in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis. Nutrients. 2023;15(20).\u003c/li\u003e\n\u003cli\u003eXu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia is associated with mortality in adults: a systematic review and meta-analysis. Gerontology. 2022;68(4):361-76.\u003c/li\u003e\n\u003cli\u003eHaase CB, Brodersen JB, B\u0026uuml;low J. Sarcopenia: early prevention or overdiagnosis? Bmj. 2022;376:e052592.\u003c/li\u003e\n\u003cli\u003eGiovannini S, Brau F, Forino R, Berti A, D\u0026apos;Ignazio F, Loreti C, et al. Sarcopenia: Diagnosis and Management, State of the Art and Contribution of Ultrasound. J Clin Med. 2021;10(23).\u003c/li\u003e\n\u003cli\u003eFielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249-56.\u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruy\u0026egrave;re O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019;48(1):16-31.\u003c/li\u003e\n\u003cli\u003eChen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21(3):300-7.e2.\u003c/li\u003e\n\u003cli\u003eParra-Rodr\u0026iacute;guez L, Szlejf C, Garc\u0026iacute;a-Gonz\u0026aacute;lez AI, Malmstrom TK, Cruz-Arenas E, Rosas-Carrasco O. Cross-cultural adaptation and validation of the Spanish-language version of the SARC-F to assess sarcopenia in Mexican community-dwelling older adults. Journal of the American Medical Directors Association. 2016;17(12):1142-6.\u003c/li\u003e\n\u003cli\u003eZasadzka E, Pieczyńska A, Trzmiel T, Pawlaczyk M. Polish translation and validation of the SARC-F tool for the assessment of sarcopenia. Clinical Interventions in Aging. 2020;15:567.\u003c/li\u003e\n\u003cli\u003eMalmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. Journal of the American Medical Directors Association. 2013;14(8):531-2.\u003c/li\u003e\n\u003cli\u003eMalmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC‐F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. Journal of cachexia, sarcopenia and muscle. 2016;7(1):28-36.\u003c/li\u003e\n\u003cli\u003eBeaudart C, McCloskey E, Bruy\u0026egrave;re O, Cesari M, Rolland Y, Rizzoli R, et al. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016;16(1):170.\u003c/li\u003e\n\u003cli\u003eDrey M, Ferrari U, Schraml M, Kemmler W, Schoene D, Franke A, et al. German version of SARC-F: translation, adaption, and validation. Journal of the American Medical Directors Association. 2020;21(6):747-51. e1.\u003c/li\u003e\n\u003cli\u003ePerna S, Gasparri C, Ferraris C, Barrile GC, Cavioni A, Mansueto F, et al. Validation of the Italian Version of the SARC-F Questionnaire to Assess Sarcopenia in Older Adults. Nutrients. 2022;14(12):2533.\u003c/li\u003e\n\u003cli\u003eBeaudart C, Locquet M, Bornheim S, Reginster J-Y, Bruy\u0026egrave;re O. French translation and validation of the sarcopenia screening tool SARC-F. European geriatric medicine. 2018;9:29-37.\u003c/li\u003e\n\u003cli\u003eAnthoine E, Moret L, Regnault A, S\u0026eacute;bille V, Hardouin JB. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014;12:176.\u003c/li\u003e\n\u003cli\u003eHesamzadeh A, Maddah SB, Mohammadi F, Fallahi Khoshknab M, Rahgozar M. Comparison of elderlys\u0026quot; quality of life\u0026quot; living at homes and in private or public nursing homes. Iranian Journal of Ageing. 2010;4(4):0-.\u003c/li\u003e\n\u003cli\u003ePiodena-Aportadera MRB, Lau S, Chew J, Lim JP, Ismail NH, Ding YY, et al. Calf circumference measurement protocols for sarcopenia screening: Differences in agreement, convergent validity and diagnostic performance. Annals of Geriatric Medicine and Research. 2022;26(3):215.\u003c/li\u003e\n\u003cli\u003eKoo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63.\u003c/li\u003e\n\u003cli\u003eTavakol M, Dennick R. Making sense of Cronbach\u0026apos;s alpha. International journal of medical education. 2011;2:53.\u003c/li\u003e\n\u003cli\u003eLawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28(4):563-75.\u003c/li\u003e\n\u003cli\u003ePolit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-67.\u003c/li\u003e\n\u003cli\u003eUnal I. Defining an optimal cut-point value in ROC analysis: an alternative approach. Computational and mathematical methods in medicine. 2017;2017.\u003c/li\u003e\n\u003cli\u003eTrivedi K, KhaTri S. Reliability and Validity of Gujarati Version of SARC-F Tool Used as Screening of Sarcopenia: A Cross-sectional Study. Journal of Clinical \u0026amp; Diagnostic Research. 2022;16(9).\u003c/li\u003e\n\u003cli\u003eTsekoura M, Billis E, Tsepis E, Lampropoulou S, Beaudart C, Bruyere O, et al. Cross-cultural adaptation and validation of the Greek Version of the SARC-F for evaluating sarcopenia in Greek older adults. Journal of musculoskeletal \u0026amp; neuronal interactions. 2020;20(4):505.\u003c/li\u003e\n\u003cli\u003eVoelker SN, Michalopoulos N, Maier AB, Reijnierse EM. Reliability and concurrent validity of the SARC-F and its modified versions: a systematic review and meta-analysis. Journal of the American Medical Directors Association. 2021;22(9):1864-76. e16.\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;nchez-Rodr\u0026iacute;guez D, Marco E, D\u0026aacute;valos-Yerovi V, L\u0026oacute;pez-Escobar J, Messaggi-Sartor M, Barrera C, et al. Translation and validation of the Spanish version of the SARC-F questionnaire to assess sarcopenia in older people. The journal of nutrition, health \u0026amp; aging. 2019;23(6):518-24.\u003c/li\u003e\n\u003cli\u003eKandinata SG, Widajanti N, Ichwani J, Firdausi H, Aryana IGPS, Alkaff FF. Diagnostic performance of calf circumference, SARC-F, and SARC-CalF for possible sarcopenia screening in Indonesia. Scientific Reports. 2023;13(1):9824.\u003c/li\u003e\n\u003cli\u003eDonini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts. 2022;15(3):321-35.\u003c/li\u003e\n\u003cli\u003eDe Leo D, Diekstra RF, Lonnqvist J, Lonnqvist J, Cleiren MH, Frisoni GB, et al. LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behavioral Medicine. 1998;24(1):17-27.\u003c/li\u003e\n\u003cli\u003eWang DXM, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11(1):3-25.\u003c/li\u003e\n\u003cli\u003eGasparik A, Demi\u0026aacute;n M, Pascanu I. Romanian translation and validation of the Sarc-F questionnaire. Acta Endocrinologica (Bucharest). 2020;16(2):216.\u003c/li\u003e\n\u003cli\u003eBarbosa-Silva TG, Menezes AMB, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: improving sarcopenia screening in the clinical practice. Journal of the American Medical Directors Association. 2016;17(12):1136-41.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sarcopenia, Frailty, Psychometrics, Older adults","lastPublishedDoi":"10.21203/rs.3.rs-5020242/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5020242/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Sarcopenia is recognized as a geriatric condition marked by a progressive decline in muscle mass and function. The SARC-F questionnaire was developed as a brief, self-reported, and cost-effective tool for screening sarcopenia. This study aims to translate and culturally adapt the SARC-F questionnaire into Persian and evaluate its psychometric properties for older adults attending outpatient geriatric clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The study was conducted in two phases: translation and cultural adaptation, followed by psychometric evaluation. The Persian SARC-F was translated using the WHO forward-backward protocol and assessed for content validity using the Lawshe method. A cross-sectional study was conducted with 200 older adults aged 65 and above attending outpatient geriatric clinics in Tehran. Concurrent validity was assessed through a comparison of the Persian SARC-F with AWGS 2019 criteria for possible sarcopenia. Construct validity was assessed using the LEIPAD questionnaire, anticipating strong correlations with similar domains and weaker correlations with different domains. Internal consistency was determined using Cronbach’s alpha, and test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). The diagnostic characteristics were determined by constructing a receiver operating characteristic (ROC) curve using the AWGS 2019 criteria for possible sarcopenia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The Persian SARC-F showed adequate content validity with S-CVI/Ave values of 0.97 for relevancy and clarity and 1 for simplicity. The CVR values for individual items ranged from 0.80 to 1. Concurrent validity was demonstrated with Spearman’s correlations of (r = -0.73) for hand grip strength and (r = -0.76) for gait speed. Construct validity was supported by convergent and divergent validity. The Cronbach’s alpha was 0.79, indicating good internal consistency. The ICC was 0.99, showing excellent test-retest reliability. The area under the curve (AUC) was 0.91 (95%CI: 0.86–0.95). Sensitivity, specificity, PPV, and NPV for the optimal cut point (≥ 4) were 84.9%, 96.5%, 96.9%, and 83.1%, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The Persian version of the SARC-F questionnaire is a valid and reliable tool with high diagnostic accuracy. It can be used for screening sarcopenia in Persian-speaking community-dwelling older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"Validity and reliability of the Persian version of the SARC-F Questionnaire among Iranian older adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-27 06:02:23","doi":"10.21203/rs.3.rs-5020242/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-09T12:27:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-05T12:51:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-30T15:27:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312348781863126440957814649575001847386","date":"2025-05-21T23:38:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317352756285273910810484899435974327982","date":"2025-05-21T14:21:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55510353140001185451453312551562489839","date":"2025-05-21T14:18:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-21T14:04:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-21T06:16:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-06T09:38:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-05-02T17:33:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"540347cd-6639-4fc9-a12d-602e8d98bb2f","owner":[],"postedDate":"May 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:47:56+00:00","versionOfRecord":{"articleIdentity":"rs-5020242","link":"https://doi.org/10.1186/s12877-025-06214-y","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-07-28 16:29:30","publishedOnDateReadable":"July 28th, 2025"},"versionCreatedAt":"2025-05-27 06:02:23","video":"","vorDoi":"10.1186/s12877-025-06214-y","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06214-y","workflowStages":[]},"version":"v1","identity":"rs-5020242","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5020242","identity":"rs-5020242","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}