Adaptation and validation of the brief-satisfaction with appearance scale into Hungarian for patients with systemic sclerosis

Abstract Background Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis and visible skin changes that often result in body image dissatisfaction and impaired quality of life. Despite this, appearance-related concerns remain under-investigated in SSc. The Brief Satisfaction with Appearance Scale (Brief-SWAP) is a concise, validated instrument designed to assess body image dissatisfaction and social discomfort in individuals with visible disfigurement due to SSc. Objective To adapt and validate the Brief-SWAP scale into Hungarian using internationally accepted methodology. Methods Sixty patients with systemic sclerosis (53 women, 7 men; mean age 57.7 ± 13.5 years; 51.7% diffuse cutaneous SSc) and 31 age- and sex-matched healthy controls (mean age 57.9 ± 14.9 years) participated in the study. The adaptation process followed the OMERACT filter methodology, including forward-backward translation and cultural adaptation. Psychometric evaluation included structural validity (via principal component analysis) reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity) and content validity. Results Structural validity confirmed a two subdomains model consistent with the original structure: dissatisfaction with appearance and social discomfort. Reliability was high: internal consistency was acceptable (Cronbach’s alpha= 0.716; p < 0.001) and test-retest reliability was strong (ICC= 0.828). Regarding construct validity, discriminant validity was demonstrated by significantly higher Brief-SWAP scores in SSc patients versus controls (median 13.0 [IQR 6.0; 18.0] vs. 3.0 [1.0; 9.0]; p < 0.001) with no significant difference between limited and diffuse cutaneous SSc subgroups. Convergent validity showed moderate correlations with depression scales and SF-36 components. Content validity was confirmed, with no floor or ceiling effects observed. Conclusions The Hungarian version of the Brief-SWAP is a valid and reliable instrument for assessing body image dissatisfaction and its psychosocial impact in patients with SSc. Its brevity and ease of use make it suitable for clinical and research applications focused on health-related quality of life.