Cross-cultural translation and validation of the Chinese Oxford Knee Score and the Activity and Participation Questionnaire

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.

Patellofemoral Pain, Q-Angle, and Performance in Female Chinese Collegiate Soccer Players

Background and objective: Female sports injuries have been neglected by science, and few relevant studies have considered female subjects. Knee pain in female soccer players is more common than in male soccer players. The number of days of absence from training and competition has been shown to be higher in females than males. The reporting of knee pain is common in female soccer players, but whether knee pain is associated with morphological features is unclear. The Q-angle of the knee has been hypothesized to be a causal factor in knee pain. Asian females have shown higher levels of valgus than non-sporting Caucasian populations, but no data exist for female Chinese players. The aim of our study was to investigate whether there are associations between knee pain, the Q-angle of the lower limb, jump performance, play time, and perceived exertion in female Chinese collegiate soccer players. Materials and Methods: We measured the Q-angle, patellofemoral/anterior knee pain (SNAPPS questionnaire), and CMJ and SJ performance of 21 subjects (age: 20.09 ± 1.13 years, weight: 56.9 ± 6.26 kg, height: 164.24 ± 4.48 cm, and >10 years of practice) before and after a match; Borg scale and play time results were also recorded. Results: We found that our studied group had higher Q-angles in comparison to other ethnic groups reported in the literature, as well as an association of the Q-angle with the age, height, and weight of the players; however, contrary to other studies, we did not find any association between the Q-angle and knee pain, jumps, play time, or perceived exertion. Knee pain was not associated with any of the measured variables. Conclusions: Female Chinese soccer players showed higher Q-angles than players of other ethnic groups, a result that was associated with anthropometrics. The Q-angle was not found to be associated with knee pain, for which the sole determinant was body height.

Translation, cross-cultural adaptation, reliability and construct validity of the Dutch Oxford Knee Score - Activity and Participation Questionnaire

Background

Patients undergoing total knee arthroplasty (TKA) tend to be younger and tend to receive TKA at an earlier stage compared to 20 years ago. The Oxford Knee Score – Activity and Participation (OKS-APQ) questionnaire evaluates higher levels of activity and participation, reflecting activity patterns of younger or more active people. The purpose of this study was to translate the OKS-APQ questionnaire into Dutch, and to evaluate its measurement properties in pre- and postoperative TKA patients.

Methods

The OKS-APQ was translated and adapted according to the forward–backward translation multi step approach and tested for clinimetric quality. Floor and ceiling effects, structural validity, construct validity, internal consistency and test–retest reliability were evaluated using COSMIN quality criteria. The OKS-APQ, the Oxford Knee Score (OKS), the Short Form-36 (SF-36), a Visual Analogue Scale (VAS) for pain and the Forgotten Joint Score (FJS) were assessed in 131 patients (72 preoperative and 59 postoperative TKA patients), and the OKS-APQ was administered twice in 50 patients (12 preoperative and 38 postoperative TKA patients), after an interval of minimal 2 weeks.

Results

Floor effects were observed in preoperative patients. Confirmatory factor analyses (CFA) indicated a good fit of a 1-factor model by the following indices: (Comparative Fit Index (CFI): 0.97, Tucker-Lewis Index (TLI): 0.96 and Standardized Root Mean Square Residual (SRMR): 0.03). Construct validity was supported as > 75% of the hypotheses were confirmed. Internal consistency (Cronbach α’s from 0.81 to 0.95) was good in the pooled and separate pre- and postoperative samples and test–retest reliability (Intraclass Correlation Coefficients (ICCs) from 0.63 – 0.85) were good in postoperative patients and moderate in preoperative patients. The standard Error of Measurements (SEMs) ranged from 8.5 – 12.2 and the Smallest Detectable Changes in individuals (SDC_ind) ranged from 23.5 – 34.0 (on a scale from 0 to 100).

Conclusions

Preliminary findings suggest that the Dutch version of the OKS-APQ is reliable and valid for a Dutch postoperative TKA patient sample. However, in a preoperative TKA sample, the OKS-APQ seems less suitable, because of floor effects and lower test–retest reliability. The Dutch version of the OKS-APQ can be used alongside the OKS to discriminate among levels of activity and participation in postoperative patients.