Use of the WOMAC questionnaire in Mumbai and the challenges of translation and cross cultural adaptation

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.

Physiotherapeutic assistance verse home care assistance in the early rehabilitation of total knee arthroplasty during COVID-19 lockdown

Background

The aim of this retrospective comparison study was to assess early functional recovery of total knee arthroplasty with home care assistance during COVID-19 lockdown.

Methods

A total of 16 patients (27 knees involved) were divided into a pre-lockdown group (10 patients; 17 knees) and a post-lockdown group (6 patients, 10 knees) in terms of the time of surgeries performed before and after lockdown, respectively, due to COVID-19 pandemic. Patients of pre-lockdown group underwent rehabilitation under the guidance of trained physiotherapists for at-home sessions and under assisted physiotherapy. Patients of post-lockdown group followed the rehabilitation protocol of at-home sessions and under home-care assistance during COVID-19 lockdown. Functional recovery of the knee was assessed against the Knee Injury and Osteoarthritis Outcome Score, Junior. A p < 0.05 was considered statistically significant.

Results

The pre- and postoperative mean KOOS Junior of pre-lockdown group were 48.73 ± 2.64 and 64.91 ± 2.74, respectively (p < 0.001). The pre- and postoperative scores of post-lockdown group were 48.83 ± 2.83 and 67.84 ± 4.31 (p < 0.001), respectively. Intergroup comparison between pre- and postoperative KOOS Jr. revealed no significant differences (p > 0.05).

Conclusion

Although the COVID-19 lockdown affected the routine postoperative rehabilitation after total knee arthroplasty, the coordination among the surgeon, therapists, and home caregivers can provide sustained assistance in rehabilitation. The guidelines for practitioners and physiotherapists can benefit functional recovery of the knee.

Patient's Experience in Pediatric Primary Immunodeficiency Disorders: Computerized Classification of Questionnaires

Introduction

Primary immunodeficiency disorders (PIDs) are a heterogeneous group of more than 200 rare diseases. Timely diagnosis is of uttermost importance. Therefore, we aimed to develop a diagnostic questionnaire with computerized pattern-recognition in order to support physicians to identify suspicious patient histories.

Materials and methods

Standardized interviews were conducted with guardians of children with PID. The questionnaire based on parental observations was developed using Colaizzis’ framework for content analysis. Answers from 64 PID patients and 62 controls were analyzed by data mining methods in order to make a diagnostic prediction. Performance was evaluated by k-fold stratified cross-validation.

Results

The diagnostic support tool achieved a diagnostic sensitivity of up to 98%. The analysis of 12 interviews revealed 26 main phenomena observed by parents in the pre-diagnostic period. The questions were systematically phrased and selected resulting in a 36-item questionnaire. This was answered by 126 patients with or without PID to evaluate prediction. Item analysis revealed significant questions.

Discussion

Our approach proved suitable for recognizing patterns and thus differentiates between observations of PID patients and control groups. These findings provide the basis for developing a tool supporting physicians to consider a PID with a questionnaire. These data support the notion that patient’s experience is a cornerstone in the diagnostic process.