Development of a simplified Chinese version of the Hip Disability and Osteoarthritis Outcome Score (HOOS): cross-cultural adaptation and psychometric evaluation

Translation, cross-cultural adaptation, reliability, and convergent and known-group validity of the Turkish full version of the Hip Disability and Osteoarthritis Outcome Score in patients with hip osteoarthritis

Objectives

The study aimed to culturally adapt the full version of the Hip Disability and Osteoarthritis Outcome Score (HOOS) into Turkish and evaluate its reliability and validity.

Patients and methods

Patients with hip osteoarthritis were included in the methodological crosscultural adaptation study between May 2022 and December 2022. We translated and adapted the HOOS into a Turkish version and validated it in a cohort of native Turkish-speaking patients with hip osteoarthritis. The HOOS includes five subscales named symptoms, pain, activities of daily living (ADL), sport and recreation (Sport/Rec), and quality of life (QoL). The psychometric properties of the Turkish HOOS were assessed. The reliability was investigated using test-retest reliability (intraclass correlation coefficient; ICC) and internal consistency methods (Cronbach's alpha). The convergent validity of the Turkish HOOS was evaluated by testing the predefined hypotheses using the correlations with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the European Quality of Life Scale (EQ-5D-3L), a generic QoL scale.

Results

A total of 202 patients (131 females, 71 males; mean age: 55.2±9.7 years; range, 50 to 70 years) were recruited for the study. Cronbach's alpha values for each subscale of the HOOS were as follows: symptoms=0.76, pain=0.94, ADL=0.96, Sport/Rec=0.87, QoL=0.78, and total score=0.98, indicating it has high internal consistency. For all subscales and total score of the HOOS, the ICC values were between 0.77 and 0.86, indicating good to excellent test-retest reliability. All correlations between each subscale and total score of the Turkish HOOS, WOMAC, and EQ-5D-3L were moderate to strong. Therefore, 23 predefined hypotheses out of 24 were confirmed with a confirmation rate of 96%, indicating the Turkish version of the HOOS had adequate convergent validity.

Conclusion

This study shows that the Turkish version of the HOOS has a convergent and knowngroup validity, internal consistency, and test-retest reliability. It can be used to assess the patient's perception of their hip and associated difficulties, as well as their symptoms and functional limitations.

Simplified Chinese version of the core outcome measures index (COMI) for patients with neck pain: cross-cultural adaptation and validation

PURPOSE

The aim of this study was to translate and cross-culturally adapt the Core Outcome Measures Index for (COMI) into a Simplified Chinese version (COMI-SC) and to evaluate the reliability and validity of COMI-SC in patients with neck pain.

METHODS

The COMI-neck was translated into Chinese according to established methods. The COMI-neck questionnaire was then completed by 122 patients with a hospital diagnosis of neck pain. Reliability was assessed by calculating Cronbach's alpha and intraclass correlation coefficient (ICC). Construct validity was assessed by correlating the COMI-neck with the Neck Pain and Disability Scale (NPDS), the Neck Disability Index (NDI), the VAS and the Short Form (36) Health Survey (SF-36). Using confirmatory factor analysis to validate the structural, convergent and discriminant validity of the questionnaire.

RESULTS

The COMI-neck total scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach's alpha = 0.861). Moderate to substantial correlations were found between COMI-neck and NPDS (r = 0.420/0.416/0.437, P < 0.001), NDI (r = 0.890, P < 0.001), VAS (r = 0.845, P < 0.001), as well as physical function (r = - 0.989, P < 0.001), physical role (r = - 0.597, P < 0.001), bodily pain (r = - 0. 639, P < 0.001), general health (r = - 0.563, P < 0.001), vitality (r = - 0.702, P < 0.001), social functioning (r = - 0.764, P < 0.001), role emotional (r = - 0.675, P < 0.001) and mental health (r = - 0.507, P < 0.001) subscales of the SF-36. An exploratory factor analysis revealed that the 3-factor loading explained 71.558% of the total variance [Kaiser-Mayer-Olkin (KMO) = 0.780, C2 = 502.82, P < 0.001]. CMIN/DF = 1.813, Tucker-Lewis index (TLI) = 0.966 (> 0.9), Comparative Fit Index (CFI) = 0.982 (> 0.9), Normed Fit Index (NFI) = 0.961 (> 0.9), RMSEA = 0.082 (< 0.5) indicating that the model fits well.

CONCLUSION

COMI-neck was shown to have acceptable reliability and validity in patients with non-specific chronic neck pain and could be recommended for patients in mainland China.

LEVEL OF EVIDENCE

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Assessing perceived participation among older adults total hip arthroplasty and total knee arthroplasty patients six months post-surgery: a cross-sectional study

Aims

This research sought to assess the perceived levels of participation and autonomy in senior patients who had received total hip arthroplasty (THA) or total knee arthroplasty (TKA) in Hangzhou, China. Furthermore, the study aimed to identify the factors linked to these outcomes.

Study design

This investigation will utilize a cross-sectional study design to assess perceived participation and autonomy among older adults total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. The research was conducted in Hangzhou, China, at a tertiary hospital.

Methods

Convenient sampling was utilized to select 139 patients who underwent THA or TKA between March 2022 and March 2023 and met the inclusion criteria at a tertiary hospital in Hangzhou. The Impact on Participation and Autonomy Questionnaire, Hip/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS), 5-Item Geriatric Depression Scale, Multidimensional Scale of Perceived Social Support, and Elders Health Empowerment Scale were used to assess perceived participation, hip/knee-related symptoms and functional restrictions, depression symptoms, social support, and health empowerment.

Results

The mean score for perceived participation and autonomy was 22.554 (SD: 13.042). The mean scores for participation in indoor autonomy, outdoor autonomy, family roles, and social relations were 0.654 (SD: 0.608), 1.324 (SD: 0.792), 1.053 (SD: 0.657), and 0.664 (SD: 0.542), respectively. Negative correlations were observed between perceived participation/autonomy scores and HOOS/KOOS, social support, and health empowerment scores. Conversely, a positive correlation was found between perceived participation/autonomy scores and depression scores. The detrimental effect of HOOS/KOOS, social support, and health empowerment scores on perceived participation and autonomy was notable, while the impact of depressive symptoms was comparatively minor.

Conclusion

Older Chinese patients, at first six months post THA/TKA surgery, reported higher levels of perceived participation compared to individuals with other conditions, such as stroke patients. Functional limitations resulting from hip/knee-related symptoms, as well as social support and health empowerment, emerged as significant influencing factors for perceived participation and autonomy. This research enhances our comprehension of the elements influencing perceived participation among older adults individuals who have undergone THA/TKA procedures.

Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity

Background

A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown.

Purpose

The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization.

Study design

Literature Review.

Methods

PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data.

Results

Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use.

Conclusion

Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use.

Level of evidence

3a.

Cross-cultural adaptation and validation of the simplified chinese version of the fremantle back awareness questionnaire in patients with low back Pain

PURPOSE

The Fremantle back awareness questionnaire (FreBAQ) was recently developed as simple and quick tool to assess back-specific body perception in Low back pain (LBP) patients. The aim of the present study was to translate and cross-culturally adapt the Fremantle back awareness questionnaire (FreBAQ) into a Simplified Chinese version (FreBAQ-C), and evaluate the reliability and validity of the FreBAQ-C in patients with non-specific Chronic Low back pain (CLBP).

METHODS

The FreBAQ was translated into Chinese according to established methods. Internal consistency was assessed according to Cronbach's alpha. Test-retest reliability was estimated by Intraclass correlation coefficient (ICC). Construct validity was evaluated by correlations between the FreBAQ-C and Visual analogue scale (VAS), Roland-Morris disability questionnaire (RDQ), Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK) as well as Hospital anxiety and depression scale (HADS).

RESULTS

A total of 105 participants (38 males and 67 females) were included in this study with the mean age of 54.1 ± 15.6 years, mean duration of LBP of 6.8 ± 4.6 years. The FreBAQ-C total scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach's alpha = 0.833). ICC of test-retest reliability was good (0.897, 95% confidence interval: 0.852-0.929). The limits of agreement (LOA) ranged from - 5.8 to 6.3. The Standard error of measurement (SEM) and Minimum detectable change (MDC) were 2.16 and 5.99. Construct validity was confirmed by significant correlation of The FreBAQ-C and VAS during motion (r = 0.274, p = 0.005) and rest (r = 0.243, p = 0.012), RDQ (r = 0.377, p < 0.001), PCS (r = 0.439, p < 0.001), and TSK(r = 0.311, p = 0.001).

CONCLUSIONS

The FreBAQ-C was demonstrated to have acceptable reliability and validity for patients with non-specific CLBP in Chinese mainland. It will allow evaluating body preception of the back in the Chinese population with CLBP.

Systematic review and standardised assessment of Chinese cross-cultural adapted hip Patient Reported Outcome Measures (PROMs)

PURPOSE

To perform a systemic literature search to identify Chinese cross culturally adapted and new designed Patient Reported Outcome Measures (PROMs) used for hip assessment, then a standardized evaluation of available instruments in order to provide evidence of high-quality PROMs for clinical use and adoption in future hip registries.

METHODS

A Systematic Review of the following databases: PUBMED, CINAHL, EMBASE, CNKI was performed to identify relevant PROMs. Instruments underwent standardized assessment and scoring using the EMPRO tool by two independent reviewers. Inter-rater reliability was assessed using intra-class correlation coefficients (ICC).

RESULTS

2188 articles were retrieved, with seven articles fitting the inclusion criteria consisting of six hip PROMs. Five PROMs were cross culturally adapted and one was originally designed in Mandarin Chinese. Total scores (/100) after EMPRO evaluation: Osteoarthritis of Knee and Hip Quality of Life (OAKHQOL): 55; Copenhagen Hip and Groin Outcome Score (HAGOS): 52; International Hip Outcome Tool (SC-iHOT-33): 45; Hip Disability and Osteoarthritis Outcome Score (HOOS): 37; Questionnaire on the Perceptions and Functions of Patients about Total Hip Arthroplasty (QPFPTHA): 36; Oxford Hip Score (OHS): 35. ICC values were 0.73 for the SC-iHOT-33 and ranged between 0.83-0.93 for the other PROMs indicating good to excellent inter-rater agreement.

CONCLUSION

Among the commonly used hip-specific PROMs found in arthroplasty registries, none of the Chinese adapted versions evaluated by EMPRO is currently rated acceptable for clinical use. Only OAKHQOL and HAGOS reached acceptability threshold. Further research on the attributes of cross-cultural adaptation, interpretability and burden assessment would be helpful.

Cross-cultural Adaptation and Validation of the Simplified Chinese Version of the Copenhagen Neck Function Disability Scale

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

Th aim of this study was to translate and cross-culturally adapt Copenhagen Neck Function Disability Scale into a Simplified Chinese version (CNFDS-C), and evaluate the reliability and validity of CNFDS-C in patients with nonspecific chronic neck pain.

SUMMARY OF BACKGROUND DATA

The CNFDS is a reliable and valid evaluation instrument for chronic neck pain. However, Simplified Chinese version of CNFDS hasn't been validated.

METHODS

A total of 150 participants were included in this study. Internal consistency was estimated according to Cronbach alpha. Test-retest reliability was assessed by intra-class correlation coefficient (ICC). Construct validity was analyzed by correlations between CNFDS-C and the Neck Disability Index (NDI), Visual Analogue Scale (VAS) as well as the short form (36) health survey (SF-36).

RESULTS

The original version of the CNFDS was cross-culturally adapted and translated into Simplified Chinese. CNFDS-C was indicated to have excellent reliability (Cronbach alpha = 0.810, ICC = 0.927). Moderate to substantial correlations between CNFDS-C and NDI (r = 0.642, P < 0.001), VAS (r = 0.581, P < 0.001), as well as Physical Function (r = -0.583, P < .001), Role Physical (r = -0.478, P < 0.001), Bodily Pain (r = -0.610, P < 0.001), and General Health (r = -0.439, P < 0.001) subscales of SF-36 were observed.

CONCLUSION

CNFDS-C was demonstrated to have acceptable reliability and validity in patients with nonspecific chronic neck pain, which could be recommended for patients in Chinese mainland.Level of Evidence: 3.

Development of a valid Chinese version of the Cumberland Ankle Instability Tool in Chinese-speaking patients with chronic ankle instability disorders

As an effective scale for the condition assessment of patients with chronic ankle instability (CAI), the Cumberland Ankle Instability Tool (CAIT) is the most widely used scale, and its original version is written in English. Therefore, the purpose of our study is to apply the CAIT to Chinese patients and evaluate its responsiveness, reliability, and validity in terms of Chinese patients with CAI. First, we adapted the CAIT into the Chinese edition (CAIT-C), through which cross-cultural adaptation and translation can be carried out in a five-step procedure. Next, recruited patients completed the three periods of the Foot and Ankle Ability Measure (FAAM), CAIT-C, and the Medical Outcomes Study Short-Form 36 (SF-36) scales. Afterward, to assess the responsiveness, reliability, and validity, we calculated the standardized response mean (SRM), effect size (ES), Spearman's correlation coefficient (r_s), minimal detectable change (MDC), standard error of measurement (SEM), intraclass correlation coefficient (ICC), and Cronbach’s alpha. Generally, in the use of CAI, 131, 119, and 86 patients favorably completed the three periods of the scales. The CAIT-C was proven to have good test–retest reliability (ICC = 0.930) and fine internal consistency (Cronbach’s alpha = 0.845–0.878). The low-value of MDC (0.04–2.28) and SEM (1.73) show it is possible to detect clinical changes when we take advantage of CAIT-C. Good or moderate correlations (r_s = 0.422–0.738) were gained from the physical subscales of the SF-36 and the subscales of the FAAM and the CAIT-C. Fair or poor correlations (r_s = 0.003–0.360) were gained between the mental subscales of the SF-36 and the CAIT-C, which sufficiently indicated that the CAIT-C had good validity. Moreover, good responsiveness was observed in the CAIT-C (ES = 1.316, SRM = 1.418). The CAIT-C scale is an effective, valid, and reliable tool to evaluate Chinese CAI patients.

Cross-Cultural Adaptation and Validation of the Simplified Chinese Version of the Lower Extremity Functional Scale

Purpose

The purpose of this study was to cross-culturally adapt and validate the Simplified Chinese version of the Lower Extremity Functional Scale (SC-LEFS).

Methods

The original English version of the Lower Extremity Functional Scale was translated and cross-culturally adapted into Simplified Chinese according to international guidelines. The SC-LEFS and 36-Item Short-Form Health Survey were administered to 213 patients with lower extremity musculoskeletal disorders. Psychometric properties including internal consistency, test-retest reliability, content validity, and construct validity were tested.

Results

There were no floor or ceiling effects for the SC-LEFS. The scale had high values for internal consistency (Cronbach α = 0.97) and test-retest reliability (intraclass correlation coefficient = 0.97). Corrected item-total correlations for every item ranged from 0.67 to 0.89. And the item-level content validity index (I-CVI) for each item ranged from 0.78 to 1.00. Principal component analysis revealed a one-factor structure. Nine of ten prior hypotheses were confirmed, which further supports good construct validity within the SC-LEFS.

Conclusion

The SC-LEFS has high internal consistency, good test-retest reliability and content validity, convergent construct validity, and a one-factor structure. Thus, it could be regarded as a reliable and valid tool to assess activity limitations in Chinese patients with lower extremity musculoskeletal disorders.

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Polish Version of the Hip Disability and Osteoarthritis Outcome Score (HOOS)

Background and Objectives: This study aimed to translate the Hip disability and Osteoarthritis Outcome Score (HOOS) into the Polish language, to determine its validity and reliability, and to assess its main psychometric properties. Materials and Methods: A total of 332 hip osteoarthritis (OA) subjects were recruited to the study group and 90 healthy subjects to the control group. The study consisted of the HOOS translation and the assessment of the discriminative power, internal consistency, and the potential floor and ceiling effects followed by the determination of the construct validity and test-retest reliability. The analysis was performed using Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and SF-36 questionnaires. Results: The translation process consisted of forward translation, reconciliation, backward translation, review, harmonization, and proofreading. The hip OA patients reported a reduced HOOS score when compared to the control subjects. The discriminant validity of the questionnaire was confirmed. A Cronbach’s alpha of 0.97 was found, indicating a high internal consistency. The HOOS showed a significant correlation with the SF-36 and WOMAC, which ranged from r = −0.93, p-value < 0.05 for WOMAC total score to r = 0.92, and p-value < 0.05 for WOMAC daily living. No floor or ceiling effects were found. A very high intraclass correlation coefficient (ICC) was found (0.93–0.97) for the total score and the individual domains of the HOOS. Conclusions: The Polish HOOS is valid and reliable for evaluating the outcomes of hip OA patients in Poland. This questionnaire may be used with confidence for clinical and research purposes.

Reliability, validity and responsiveness of the Chinese version of the Rotator Cuff Quality of Life Index (RC-QOL) in patients with rotator cuff disorders

Background

The Rotator Cuff Quality of Life Index (RC-QOL) is a scale designed to evaluate the impact of rotator cuff (RC) disorders on the general quality of life of patients. Our study aims to adapt the RC-QOL into Chinese and to assess its reliability, validity and responsiveness in Chinese patients with RC disorders.

Methods

First, we developed the Chinese version of RC-QOL (C-RC-QOL) through a five-step procedure. Next, the recruited patients gave three rounds of responses to the C-RC-QOL, Medical Outcomes Study Short Form 36 (SF-36) and Oxford Shoulder Score scales (OSS). Then, we calculated the Cronbach’s alpha, standard error of measurement (SEM), minimally detectable change (MDC), intra-class correlation coefficient (ICC), Pearson's correlation coefficient (r), effect size (ES) and standardized response mean (SRM) to evaluate the reliability, validity and responsiveness of the C-RC-QOL respectively. The unidimensionality of each subscale was assessed by principal component analysis (PCA) of the residuals.

Results

Overall, 124 patients with RC disorders successfully completed the first two rounds of the scales, and 108 patients completed the last round of the scales. Good or excellent internal consistency (Cronbach’s alpha = 0.953) was found in the overall scale and subscales of the C-RC-QOL, and good or excellent test-retest reliability (ICC = 0.854) was found as well. The SEM and MDC values of the C-RC-QOL were 4.6 and 12.8 respectively. Moderate, good or excellent correlations (r = 0.452–0.839) were obtained between the physical subscales of the C-RC-QOL and the OSS, as well as the physical subscales of the SF-36; similar results were obtained between the emotion subscale of the C-RC-QOL and the mental subscales of the SF-36 (r = 0.490–0.733), which, illustrated the good validity of the C-RC-QOL. In addition, high responsiveness was observed in the overall scale and subscales of the C-RC-QOL (ES = 1.77, SRM = 1.98). The unidimensionality of five subscales was respected according to PCA of the residuals.

Conclusions

The C-RC-QOL scale is reliable, valid and responsive for the evaluation of Chinese-speaking patients with RC disorders and it would be an effective instrument.

Cross-cultural adaptation and validation of the Simplified Chinese version of Copenhagen Hip and Groin Outcome Score (HAGOS) for total hip arthroplasty

Background

To translate and cross-culturally adapt the Copenhagen Hip and Groin Outcome Score (HAGOS) into a Simplified Chinese version (HAGOS-C) and evaluate the reliability, validity, and responsiveness of the HAGOS-C in total hip arthroplasty (THA) patients.

Methods

The cross-cultural adaptation was performed according to the internationally recognized guidelines of the American Academy of Orthopaedic Surgeons Outcome Committee. A total of 192 participants were recruited in this study. The intra-class correlation coefficient (ICC) was used to determine reliability. Construct validity was analyzed by evaluating the correlations between HAGOS-C and EuroQoL 5-dimension (EQ-5D), as well as the short form (36) health survey (SF-36). Responsiveness of HAGOS-C was evaluated according to standard response means (SRM) and standard effect size (ES) between the first test and the third test (6 months after primary THA).

Results

The original version of the HAGOS was well cross-culturally adapted and translated into Simplified Chinese. HAGOS-C was indicated to have excellent reliability (ICC = 0.748–0.936, Cronbach’s alpha = 0.787–0.886). Moderate to substantial correlations between subscales of HAGOS-C and EQ-5D (r = 0.544–0.751, p < 0.001), as well as physical function (r = 0.567–0.640, p < 0.001), role physical (r = 0.570–0.613, p < 0.001), bodily pain (r = 0.467–0.604, p < 0.001), and general health (r = 0.387–0.432, p < 0.001) subscales of SF-36, were observed. The ES of 0.805–1.100 and SRM of 1.408–2.067 revealed high responsiveness of HAGOS-C.

Conclusions

HAGOS-C was demonstrated to have excellent acceptability, reliability, validity, and responsiveness in THA, which could be recommended for patients in mainland China.

Cross-cultural adaptation and validation of the Italian version of the Hip disability and Osteoarthritis Outcome Score (HOOS)

Objective

To create a translated version of the HOOS to fit the Italian population and to test its psychometric properties and validity in hip osteoarthritis (OA) patients undergoing total hip arthroplasty (THA).

Design

The HOOS Italian version was developed according to published international guidelines that include preparation, forward translation and reconciliation, backward translation, review and harmonization, and proof reading. The Italian HOOS was administered to 145 patients (mean age 65.7 ± 11.6 years, 34–89, 58.6% women) undergoing THA. The following psychometric properties were evaluated: internal consistency (Cronbach’s alpha); test-retest reliability (Pearson’s r and intra-class correlation coefficient, ICC); convergent validity (Spearman’s rho between HOOS and SF-36); responsiveness (comparison of pre/post-THA scores, Wilcoxon signed rank test). Interpretability (floor and ceiling effects, skewness and kurtosis indexes) and acceptability (time to compiling, missing answers, and autonomy in compilation) were also evaluated.

Results

Translation and transcultural adaptation were conducted in accordance with the international recommendation. The translation was deemed understandable and appropriate as to the transcultural adaptation. None of the patients reported to have met any difficulties in reading and understanding the HOOS items. Internal consistency and test-retest reliability were good for each HOOS subscale (Cronbach’s alpha ≥0.7, Pearson’s r and ICC > 0.80). Convergent validity showed the highest correlations (Spearman’s rho > 0.5) between HOOS and SF-36 subscales relating to similar dimensions. As to responsiveness, all HOOS subscales scores improved significantly after THA (p < 0.01). Interpretability was acceptable despite ceiling effect in post-THA assessment. Acceptability was good: HOOS resulted easy and quick to fill out (12 min on average).

Conclusions

The HOOS was successfully cross-culturally adapted into Italian. The Italian HOOS showed good psychometric properties therefore it can be useful to assess outcomes in OA patients after THA. This study provided a basis for its use within the Italian Arthroplasty Registry and for future clinical trials.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0935-6) contains supplementary material, which is available to authorized users.

Translation and validation of the Simplified Chinese version of Western Ontario Osteoarthritis of the Shoulder Index (WOOS)

To produce a cross-cultural adaptation and translation of the English version of the Western Ontario Osteoarthritis of the Shoulder index (WOOS) into Simplified Chinese and to validate its reliability, validity, and responsiveness.A total of 52 consecutive patients were included. The inclusion criteria were as follows: diagnosed to have primary shoulder osteoarthritis (OA) and referred to undergo conservative treatment, able to speak Chinese, and able to read Simplified Chinese. WOOS, the Oxford Shoulder Score (OSS), and Short Form 36 (SF-36) were filled at the first visit, and WOOS alone was filled at the second visit with an interval of 3 to 7 days after the first visit. Four months after appropriate treatments, the WOOS was again sent to patients by e-mail for the evaluation of responsiveness.The intraclass correlation coefficient ranged from 0.90 to 0.98, which showed good test-retest reliability. As we had hypothesized, construct validity was high according to a significant correlation among WOOS, SF-36 (3 subscales, namely physical functioning, bodily pain, and role-physical), and OSS. High responsiveness was documented by the evaluation of standard response mean (from 1.09 to 1.33) and effect size (from 0.80 to 0.97).The Simplified Chinese version of WOOS (SC-WOOS) was shown to be a reliable, valid instrument for evaluating the quality of life of patients suffering from shoulder OA in China.

Translation and validation of the Chinese Social Role Participation Questionnaire in patients with ankylosing spondylitis

Social Role Participation Questionnaire (SRPQ) is used to evaluate the social participation with ankylosing spondylitis (AS). Although the SRPQ has English and Dutch versions, there is no Chinese version even though China has the largest population of patients with AS. The objective of our study was to translate the SRPQ into Chinese version and assess its reliability and validity in Chinese patients with AS. The C-SRPQ was developed in a five-step translation and cross-cultural adaptation procedure. A total of 105 patients with AS were recruited during the time from September 2014 to June 2017. The intraclass correlation coefficient (ICC), Cronbach's alpha (α), and Spearman correlation coefficient (r) were used to evaluate test-retest reliability, internal consistency reliability, and the construct validity of C-SRPQ, respectively. All of the 105 patients with AS successfully completed the questionnaires. Ninety-eight patients (93.33%) participated in at least nine roles for satisfaction dimensions. No floor or ceiling effects were checked. The high value of ICC (> 0.8, 0.831-0.895) indicated the excellent test-retest reliability. In internal consistency reliability, most of Cronbach's alpha coefficient was strong (α ≥ 0.7, 0.534-0.962). In construct validity, more than half of the correlations between the dimensions of C-SRPQ and other questionnaires were good (r > 0.6). The correlations between all dimensions of C-SRPQ and BASDAI, BASFI, and ASQoL were strong negative (P < 0.01). There was a strong positive correlation (P < 0.01) between all dimensions of C-SRPQ and SF-36 physical component score (SF-36PCS), SF-36 mental component role score (SF-36MCS). The C-SRPQ is a reliable and valid questionnaire to evaluate the social participation in Chinese patients with AS.

Assessment of reliability, validity, responsiveness and minimally important change of the German Hip dysfunction and osteoarthritis outcome score (HOOS) in patients with osteoarthritis of the hip

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures. The intention of this study was to evaluate reliability, validity, responsiveness and minimally important change of the German version of the Hip dysfunction and osteoarthritis outcome score (HOOS). The German HOOS was investigated in 251 consecutive patients before and 6 months after total hip arthroplasty. All patients completed HOOS, Oxford-Hip Score, Short-Form (SF-36) and numeric scales for pain and disability. Test-retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German HOOS demonstrated excellent test-retest reliability with intraclass correlation coefficient values > 0.7. Cronbach´s alpha values demonstrated strong internal consistency. As hypothesized, HOOS subscales strongly correlated with corresponding OHS and SF-36 domains. All subscales showed excellent (effect size/standardized response means > 0.8) responsiveness between preoperative assessment and postoperative follow-up. The HOOS and all subdomains showed higher changes than the minimal detectable change which indicates true changes. The German version of the HOOS demonstrated good psychometric properties. It proved to be valid, reliable and responsive to the changes instrument for use in patients with hip osteoarthritis undergoing total hip replacement.

Simplified Chinese Version of University of California at Los Angeles Activity Score for Arthroplasty and Arthroscopy: Cross-Cultural Adaptation and Validation

BACKGROUND

To translate and cross-culturally adapt the University of California at Los Angeles (UCLA) activity score into a simplified Chinese version (UCLA-C) and evaluate the reliability and validity of the UCLA-C for patients with both knee arthroscopy and total knee arthroplasty.

METHODS

Cross-cultural adaptation was performed according to the internationally recognized guidelines of the American Academy of Orthopaedic Surgeons Outcome Committee. A total of 200 participants (100 arthroscopy and 100 total knee arthroplasty) were recruited in this study. An intraclass correlation coefficient (ICC) was used to determine reliability. Construct validity was analyzed by evaluating the correlations between UCLA-C and the Tegner activity score, Knee Injury and Osteoarthritis Outcome Score, and the short-form (36) health survey.

RESULTS

The original version of the UCLA activity score was cross-culturally well adapted and translated into simplified Chinese. UCLA-C was found to have excellent reliability in both arthroscopy (ICC = 0.984, 95% confidence interval 0.976-0.989) and arthroplasty (ICC = 0.946, 95% confidence interval 0.920-0.964). Absolute reliability as evaluated by minimal detectable change was 0.789 and 0.837 for both arthroscopy and arthroplasty groups. Moderate to high correlations between UCLA-C and Tegner activity score (0.799, P < .001); Knee Injury and Osteoarthritis Outcome Score (0.449-0.715, P < .001); and Physical Functioning, Pain, General Health, and Social Functioning (0.549-0.746, P < .001) subdomains of short-form (36) health survey were observed.

CONCLUSION

UCLA-C was demonstrated to have excellent acceptability, reliability, and validity in both arthroscopy and arthroplasty, and could be recommended for patients in mainland China.

Cross-cultural translation of the Western Ontario Cuff Index in Chinese and its validation in patients with rotator cuff disorders

Background

The Western Ontario Rotator Cuff Index (WORC) is a scale designed to evaluate the impact of rotator cuff (RC) disorders on patients’ general quality of life. Our study aims to adapt the WORC for Chinese patients and to assess its reliability, validity, and responsiveness in Chinese patients with RC disorders.

Methods

First, we developed the Chinese version of the WORC (C-WORC) in a five-step procedure of translation and cross-cultural adaptation. Next, the recruiting patients finished all three rounds of scales of the C-WORC, the Medical Outcomes Study Short-Form 36 (SF-36), and the Oxford Shoulder score (OSS). Then we calculated Cronbach’s alpha, the intra-class correlation coefficient (ICC), Pearson’s or Spearman’s correlation coefficient (r or r_s), the effect size (ES), and the standardized response mean (SRM) to evaluate the reliability, validity and responsiveness of the C-WORC, respectively.

Results

Overall, 124 patients with RC disorders successfully completed the first two rounds of the scales, and 108 patients completed the last round of the scales. Good or excellent internal consistency (Cronbach’s alpha = 0.872–0.954) was found in the overall scale and subscales of C-WORC, as well as good or excellent test-retest reliability (ICC = 0.828–0.961). Moderate or good correlations (r/r_s  = 0.472–0.787) were obtained between the physical subscales of the C-WORC and the OSS and the physical subscales of SF-36; the results were also obtained for the emotions subscale of the C-WORC and the mental subscales of SF-36 (r/r_s  = 0.520–0.713), which, adequately illustrated that good validity was included in the C-WORC. In addition, good responsiveness was also observed in the overall scale and subscales of the C-WORC (ES = 1.57–2.27, SRM = 1.52–2.28).

Conclusions

The C-WORC scale is reliable, valid and responsible for the evaluation of Chinese-speaking patients with RC disorders and would be an effective instrument.

Simplified Chinese version of the Forgotten Joint Score (FJS) for patients who underwent joint arthroplasty: cross-cultural adaptation and validation

BACKGROUND

The Forgotten Joint Score (FJS) is a newly developed health-related quality of life (HRQoL) questionnaire designed to evaluate the awareness after total knee arthroplasty (TKA). This study cross-culturally adapted and psychometrically validated a simplified Chinese version of the FJS (SC-FJS).

METHODS

Cross-cultural adaptation was performed according to the internationally recognized guidelines. One-hundred and fifty participants who underwent primary TKA were recruited in this study. Cronbach's α and intra-class correlations were used to determine reliability. Construct validity was analyzed by evaluating the correlations between SC-FJS and the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the short form (36) health survey (SF-36).

RESULTS

Each of the 12 items was properly responded and correlated with the total items. SC-FJS had excellent reliability [Cronbach's α = 0.907, intra-class correlation coefficient (ICC) = 0.970, 95% CI 0.959-0.978). Elimination of any one item in all did not result in a value of Cronbach's α of <0.80. SC-FJS had a high correlation with symptoms (0.67, p < 0.001) and pain (0.60, p < 0.001) domains of KOOS and social functioning (0.66, p < 0.001) domain of SF-36, and it also moderately correlated with function in daily living (0.53, p < 0.001) and function in sport and recreation (0.40, p < 0.001) domains of KOOS, and physical subscale of SF-36 (0.49-0.53, p < 0.001) but had a low (r = 0.20) or not significant (p > 0.05) correlation with mental subscale of SF-36.

CONCLUSIONS

SC-FJS demonstrated excellent acceptability, internal consistency, reliability, and construct validity, which can be recommended for patients who underwent joint arthroplasty in Mainland China.

Development of a valid Simplified Chinese version of the International Hip Outcome Tool (SC-iHOT-33) in young patients having total hip arthroplasty

OBJECTIVE

The International Hip Outcome Tool (iHOT-33) is a questionnaire designed for young, active patients with hip disorders. It has proven to be a highly reliable and valid questionnaire. The main purpose of our study was to adapt the iHOT-33 questionnaire into simplified Chinese and to assess its psychometric properties in Chinese patients.

METHOD

The iHOT-33 was cross culturally adapted into Chinese and 138 patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the EuroQol-5D (EQ-5D), and the Chinese version of the iHOT-33(SC-iHOT-33) pre- or postoperatively within 6 months' follow-up. The Cronbach's alpha, intraclass correlation coefficient (ICC), Pearson's correlation coefficient (r), effect size (ES), and standardized response mean (SRM) were calculated to assess the reliability, validity, and responsiveness of the SC-iHOT-33, respectively.

RESULTS

Total Cronbach's alpha was 0.965, which represented excellent internal consistency of the SC-iHOT-33. The ICC ranges from 0.866 to 0.929, which shows excellent test-retest reliability. The subscales of SC-iHOT-33 had the highest correlation coefficient (r = 0.812) with the physical function subscales of the WOMAC, as well as good correlation between the social/emotional subscale of the SC-iHOT-33 and the EQ-5D (r = 0.740, r = 0.743). No floor or ceiling effects were found. The ES and SRM values indicated good responsiveness of 2.44 and 2.67, respectively.

CONCLUSION

The SC-iHOT-33 questionnaire is reliable, valid, and responsive for the evaluation of young, Chinese, active patients with hip disorders.

Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury

Background

The Lysholm Knee Score (LKS) is widely used and is one of the most effective questionnaires employed to assess knee injuries. Although LKS has been translated into multiple languages, there is no Chinese version even though China has the largest population of patients with knee-joint injuries. The objective of our study was to develop the Chinese version of LKS (C-LKS) and assess its reliability, validity and responsiveness in Chinese patients with anterior cruciate ligament (ACL) injuries.

Methods

Study participants were mainly recruited among patients with ACL injuries scheduled for arthroscopic ACL reconstruction at our hospital. First, we developed the C-LKS in a five-step translation and cross-cultural adaptation procedure. Next, we calculated the Cronbach’s alpha, intraclass correlation coefficient (ICC), Pearson’s correlation coefficient (r), effect size (ES), and standardized response mean (SRM) to evaluate the reliability, validity, and responsiveness of C-LKS respectively.

Results

Overall, 126 patients with ACL injuries successfully completed the questionnaires. Acceptable internal consistency (Cronbach’s alpha = 0.726) as well as excellent test-retest reliability (ICC = 0.935) was found for C-LKS. Good or moderate correlation (r = 0.514–0.837) was determined among C-LKS and International Knee Documentation Committee Subjective Knee Form (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), physical subscales of SF-36; C-LKS also had fair or moderate correlation (r = 0.207–0.462) with the other subscales of SF-36, which adequately illustrated that good validity was included in C-LKS. In addition, good responsiveness was also observed in C-LKS (ES = 1.36,SRM = 1.26).

Conclusions

We have shown that our developed C-LKS questionnaire is reliable, valid and responsible for the evaluation of Chinese-speaking patients with ACL injuries and it would be an effective instrument.

Cross-cultural Adaptation and Validation of the Simplified Chinese Version of the Knee Outcome Survey Activities of Daily Living Scale

PURPOSE

To perform a cross-cultural adaptation and translation of the original version of the Activities of Daily Living Scale of the Knee Outcome Survey into Simplified Chinese and validate of the Simplified Chinese version.

METHODS

The original version was translated and cross-culturally adapted into Simplified Chinese according to the guidelines and the recommendations of the American Academy of Orthopaedic Surgeons Outcome Committee. A total of 213 patients (96 male, 117 female) were selected to participate in our investigation. The inclusion criteria were as follows: 18 years of age and older, able to speak Chinese Mandarin and read Simplified Chinese, and referred to physical therapy for evaluation and treatment for a knee disorder. The exclusion criteria were as follows: patients who had disorders or impairments involving both knees, patients who had other conditions that could affect lower extremity function, patients with physical therapy related to the knee in the previous 1 month, and patients with psychological problems. Each participant was asked to complete the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), International Knee Documentation Committee Subjective Knee Form, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form 36 forms and to provide baseline demographic data. Each participant completed the KOS-ADLS twice on 2 nonconsecutive days for reliability evaluation. A portion of the participants (n = 161) finished the KOS-ADLS a third time 4 weeks after physical treatment to test responsiveness.

RESULTS

The original version of the KOS-ADLS was well adapted and translated into Simplified Chinese. Simplified Chinese of KOS-ADLS was shown to have good internal consistency (Cronbach's alpha = 0.855 to 0.929), great test-retest reliability (intraclass correlation coefficient = 0.935 to 0.961), high construct validity as we hypothesized (significant correlations with Short Form 36 subscales, Western Ontario and McMaster Universities Osteoarthritis Index, and International Knee Documentation Committee Subjective Knee Form), and high responsiveness (standard response means = 0.97 to 1.23, standard effect size = 0.81 to 0.91).

CONCLUSIONS

Simplified Chinese of KOS-ADLS was shown to have good reliability, validity, and responsiveness for use in patients with knee disorders in China.

LEVEL OF EVIDENCE

Level II, testing of previously developed diagnostic criteria in a series of consecutive patients with universally applied gold standard.

Development of a valid simplified Chinese version of the Osteoarthritis of Knee and Hip Quality of Life (OAKHQOL) in patients with knee or hip osteoarthritis

RATIONALE, AIMS AND OBJECTIVES

As the first specific questionnaire for knee or hip osteoarthritis (OA) patients' condition assessment, the Osteoarthritis of Knee and Hip Quality of Life (OAKHQOL) questionnaire is widely used and its original version is French. Although it has already been translated into multiple languages, a Chinese version is still unpublished, despite the fact that China has the largest population of OA patients in the world. The objectives of our study were to adapt the OAKHQOL questionnaire into simplified Chinese and to assess its psychometric properties in Chinese patients with knee or hip OA.

METHODS

First, we developed the simplified Chinese version of OAKHQOL (SC-OAKHOQL) in a five-step procedure of translation and cross-cultural adaptation. Next, we calculated the Cronbach's alpha, intraclass correlation coefficient (ICC), Pearson's correlation coefficient (r), effect size (ES) and standardized response mean (SRM) to evaluate the reliability, validity and responsiveness of the SC-OAKHQOL, respectively. Unidimensionality of subscales was assessed by the principal component analysis (PCA) of residuals.

RESULTS

Overall, 144 knee or hip OA patients successfully completed all of the questionnaires. Excellent or good internal consistency (alpha = 0.826-0.964) was found in the SC-OAKHQOL, as well as excellent test-retest reliability (ICC = 0.888-0.944). Good correlations were also obtained among physical subscales (r = 0.646-0.934), as well as mental subscales (r = 0.786-0.874) in the SC-OAKHQOL and other questionnaires, on which excellent or good validity of the SC-OAKHQOL shall be based. With the exception of the social support subscale, all others contained excellent or good responsiveness (ES, SRM = 1.02-2.92). The unidimensionality of five subscales was respected according to the PCA of residuals.

CONCLUSION

The SC-OAKHQOL questionnaire is reliable, valid and responsive for the evaluation of Chinese osteoarthritis patients of the knee or hip, and it would be an effective instrument.

Translation and validation of the simplified Chinese new Knee Society Scoring System

Background

The NKSS has recently been translated into Dutch version. The reliability and validity were also assessed. However, there is no Simplified Chinese version of New Society Knee Scoring System (SC-NKSS) for Chinese population.

Methods

The SC-NKSS was translated from the original English version following international guidelines. All patients undergoing total knee arthroplasty (TKA) between September 2012 and September 2013 were invited to participate in this study. Finally, a total of 105 did so. Patients (preoperative and postoperative) completed the Chinese version of NKSS, Oxford Knee Score (OKS), the Medical Outcomes General Health Survey (SF-36) and Visual analog scale (VAS). Psychometric testing of reliability, construct validity, content validity were conducted.

Results

All the 105 participants completed the questionnaires and no floor or ceiling effects were checked. Internal consistency was excellent with Cronbach’s alpha coefficient ranging from 0.71 to 0.85. Test-retest reliability was satisfactory with an intraclass correlation coefficient of 0.92 (95%confidence interval, 0.86–0.95). Construct validity was demonstrated to correlate well with the Chinese version of OKS (r =−0.78; p < 0.01), VAS (r =−0.70; p < 0.01), Physical Function (PF) (r = 0.74; p < 0.01), Body Pain (BP) (r = 0.63; p < 0.01) and General Health (GH) (r = 0.51; p < 0.01) of SF-36 domains.

Conclusion

The SC-NKSS was well accepted and demonstrated acceptable psychometric properties in mainland China.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-015-0854-1) contains supplementary material, which is available to authorized users.

Chinese cross-cultural adaptation and validation of the Oxford shoulder score

Background

The Oxford Shoulder Score (OSS) is a reliable and valid construct measuring non-specific shoulder pain, which are widely used to evaluate shoulder related quality of life. This study was to cross-culturally adapt and psychometrically validate a simplified Chinese version of the OSS (SC-OSS).

Methods

Cross-cultural adaptation was performed according to the international recognized guidelines. Consecutive patients with nonspecific shoulder pain were recruited to test the psychometric properties of SC-OSS. Item response trend and item-total correlation were evaluated to measure homogeneity. Principal component analysis (PCA) was used to evaluate the factorial structure. Cronbach's α and intra-class correlations were used to determine the reliability. Construct validity was analyzed by evaluating the correlations between SC-OSS and the Constant-Murley shoulder outcome score (CMSOS), the short form (36) health survey (SF-36) containing eight domains, and pain visual analogue scale (VAS).

Results

Overall, 121 patients were recruited. Each of the 12 items was properly responded and correlated with the total items. PCA extracted one factor for SC-OSS. SC-OSS had excellent reliability, with a Cronbach's α of 0.92 and intra-class correlation coefficient of 0.97 (95 % CI: 0.94-0.98). SC-OSS had a high correlation with CMSOS, physical functioning (PF) and bodily pain (BP) domains of SF-36 and VAS (r = -0.70, -0.65, -0.53, and -0.66, respectively). SC-OSS moderately correlated with role-physical (RP), social functioning (SF), general health perception (GH) and vitality (VT) (r = -0.45, -0.42, -0.39 and -0.36, respectively), but had a low correlation with role-emotional (RE) and mental health (MH) domains of SF-36 (r = -0.28 and -0.23, respectively).

Conclusions

SC-OSS demonstrated excellent acceptability, internal consistency, reliability and construct validity, which can be recommended for application in mainland China.

Chinese Adaptation of the Bad Sobernheim Stress Questionnaire for Patients With Adolescent Idiopathic Scoliosis Under Brace Treatment

Bad Sobernheim Stress Questionnaire (BSSQ)-Deformity and BSSQ-Brace are the most widely used instruments for evaluating stress levels in adolescent idiopathic scoliosis (AIS) patients under brace treatment, and good reliability and validity have been demonstrated across different cultures. Great stress has been found among many adolescents, becoming a major concern for professionals. However, no previous research has addressed the cultural adaptations and psychometric testing of BSSQ-Deformity and BSSQ-Brace in China or the stress levels in AIS patients. The purposes of our study were to evaluate the cross-cultural adaptation and validation of the BSSQ-Deformity and BSSQ-Brace and to investigate stress levels in Chinese (AIS) patients under brace treatment.The original (German) versions of BSSQ-Deformity and BSSQ-Brace were cross-culturally translated according to international guidelines. Psychometric properties such as reliability and construct validity were tested. Eighty-six AIS patients were included in our study, and 50 patients paid a second visit 3 to 7 days later to test reproducibility. Cronbach α and the intraclass coefficient were determined to assess internal consistency and reproducibility. Scoliosis Research Society patient questionnaire-22 (SRS-22) was applied to evaluate construct validity.The mean BSSQ-Deformity and BSSQ-Brace scores were 15.3 and 13.4 points, respectively. Severe stress was observed in 12% of patients due to brace treatment. Item analysis demonstrated that each item was scored under a normal distribution with no redundancy. Psychometric analysis revealed excellent internal consistency (Cronbach α = 0.85 and 0.80, respectively) and reproducibility (intraclass correlation coefficient = 0.85 and 0.90, respectively) for BSSQ-Deformity and BSSQ-Brace. The correlation coefficients of BSSQ-Deformity, BSSQ-Brace and SRS-22 were 0.48 and 0.63, respectively.In conclusion, BSSQ-Deformity and BSSQ-Brace have been successfully adapted to a Chinese background and psychometrically validated with excellent reliability and construct validity. Brace wearing is considered the main cause of stress in AIS patients under brace treatment.

Reliability and validity of the Chinese version of the Short Musculoskeletal Function Assessment questionnaire in patients with skeletal muscle injury of the upper or lower extremities

Background

The Short Musculoskeletal Function Assessment (SMFA) questionnaire is one of the most commonly used scales to evaluate functional status and quality of life (QOL) of patients with a broad range of musculoskeletal disorders. However, a Chinese version of the SMFA questionnaire for the psychometric properties of skeletal muscle injury patients in China is still lacking. The current study translated the SMFA into Chinese and assessed its reliability and validity among Chinese patients with skeletal muscle injury of the upper or lower extremities.

Methods

The original SMFA was translated from English into Chinese and culturally adapted according to cross-cultural adaptation guidelines. A multicenter cross-sectional study was conducted, comprising 339 skeletal muscle injury patients (aged 20–75 years) from 4 hospitals. The SMFA, the health survey short form (SF-36) along with a region-specific questionnaire (including the disabilities of the arm, shoulder, and hand questionnaire (DASH), the hip disability and osteoarthritis outcome score (HOOS), the knee injury and osteoarthritis outcome score (KOOS), and the foot function index (FFI)) were completed according to the region of injury. Reliability was estimated from the internal consistency using Cronbach’s α and validity was assessed via convergent validity, known-groups comparison, and construct validity.

Results

Cronbach’s α coefficient was over 0.75 for two subscales and four categories of the SMFA, suggesting that the internal consistency reliability of the SMFA was satisfactory. Known-groups comparison showed that the dysfunction index and the bother index of the SMFA discriminated well between patients who differed in age, gender, injury location, and operation status rather than in subgroups based on the body mass index (BMI). The convergent validity of the SMFA was good, as moderate to excellent correlations were found between the subscales of the SMFA and the four subscales of SF-36 (physical function, role-physical, bodily pain, and social functioning) and the region-specific questionnaires. The construct validity was proved by the presence of a six-factor structure that accounted for 66.85 % of the variance.

Conclusion

The Chinese version of the SMFA questionnaire is a reliable and valid instrument to measure patient-reported impact of musculoskeletal injuries in the upper or lower extremities.

Development of a valid simplified Chinese version of the Oxford Hip Score in patients with hip osteoarthritis

BACKGROUND

Although the Oxford Hip Score has been translated and validated in several languages, there is currently no Chinese version of the outcomes measurement. Our study aims to crossculturally adapt and validate the Oxford Hip Score into a simplified Chinese version.

QUESTIONS/PURPOSES

We tested the (1) reliability; (2) validity; and (3) responsiveness of the Chinese version of the Oxford Hip Score.

METHODS

First we translated the Oxford Hip Score into simplified Chinese, then back into English, then held a consensus meeting to achieve the final simplified Chinese version. Then we evaluated the psychometric properties of Chinese version of the Oxford Hip Score in patients undergoing total hip arthroplasty (THA). All patients undergoing THA between July and December 2012 were invited to participate in this study; a total of 108 (79% of 136 invited) did so. To assess the test-retest validity, all participants completed the Chinese version of the Oxford Hip Score again with a 2-week interval. Pearson correlation coefficient was used to evaluate the construct validity between the Chinese version of the Oxford Hip Score and visual analog scale (VAS), Harris hip score, and eight individual domains of the SF-36. Responsiveness was demonstrated by comparing the pre- and postoperative scores of the Chinese version of the Oxford Hip Score.

RESULTS

The test-retest reliability with intraclass correlation coefficient (0.937) and internal consistency with Cronbach's alpha (0.91) were excellent. The Chinese version of the Oxford Hip Score correlated with the Harris hip score (0.89, p < 0.01), VAS (-0.79, p < 0.01), and Physical Functioning (0.79, p < 0.01) and Bodily Pain (0.70, p < 0.01) domains of SF-36, which suggested construct validity. No floor or ceiling effects were found. The effect size and standardized response mean values were 3.52 and 3.31, respectively, indicating good responsiveness.

CONCLUSIONS

The Chinese version of the Oxford Hip Score showed good reliability, validity, and responsiveness in evaluating standard Chinese-speaking patients with hip osteoarthritis undergoing THA. It can be used by clinical surgeons as a complement to the traditional outcome measures.