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

Translation, Cross-Cultural Adaptation, and Validation of the Persian Version of the Harris Hip Score

Background

The Harris hip score (HHS), a self-administered questionnaire, is widely used to evaluate hip pathology affecting health-related quality of life and physical function. This study's purpose was HHS translation to Persian (HHS-Pr) and validation in patients with different hip pathologies.

Methods

Translation and cultural adaptation followed existing guidelines. Hip pathology patients (n = 151) completed the HHS, 12-Item Health Survey, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Criterion validity was determined from comparisons between the HHS measures and the different corresponding WOMAC domains. Internal consistency used Cronbach's alpha (α), content validity the "content validity index," and floor/ceiling effect the end-range 15%. Test-retest reliability used the intraclass correlation coefficient (subsample n = 30) at 3-7 days that compared baseline with a repeated measure. Measurement precision and change sensitivity used longitudinal assessment (subgroup n = 30) from the standard error of the measurement and minimal detectable change.

Results

Cross-cultural adaptation required minor wording changes. The mean HHS-Pr was 57.77 ± 19.69. Criterion validity was significant with the WOMAC (r = -0.76) and 12-Item Health Survey Physical Component Summary (r = 0.47). Internal consistency was high before (α = 0.75) and after standardization (α = 0.86). Content validity was satisfactory (content validity index = 0.88). No floor/ceiling effects were found. Test-retest reliability (intraclass correlation coefficient = 0.85) was excellent, as was standard error of the measurement (raw score = 5.8) and minimal detectable change (raw score = 11.4).

Conclusions

The HHS-Pr demonstrated adequate validity, reliability, and sensitivity to change. These psychometric properties sufficiently measure functional status in patients with hip pathologies in a Persian-speaking population.

Validity and Reliability of Inertial Measurement Units in Active Range of Motion Assessment in the Hip Joint

Measuring joint range of motion has traditionally occurred with a universal goniometer, inclinometer, or expensive laboratory systems. The popularity of the inertial measurement unit (IMU) is growing, enabling the small and even single portable device to measure the range of motion. Until now, they were not used to assess hip joint range of motion. Our study aimed to check the validity of IMUs in assessing hip range of motion and compare them to other measurement devices-universal goniometer and inclinometer. Twenty participants completed three hip movements (flexion in standing and prone internal and external rotation) on both hips. Two testers independently assessed each movement with a goniometer, digital inclinometer, and IMU at different time points. To assess the agreement of active hip ROM between devices, Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis were used. Furthermore, inter-rater and intra-rater reliability were also assessed by using ICC and Bland-Altman analysis. Limits of agreement (LOA) were calculated using Bland-Altman plots. The IMU demonstrated good to excellent validity (ICC: 0.87-0.99) compared to the goniometer and digital inclinometer, with LOAs < 9°, across all tested movements. Intra-rater reliability was excellent for all devices (ICC: 0.87-0.99) with LOAs < 7°. However, inter-rater reliability was moderate for flexion (ICC: 0.58-0.59, LOAs < 22.4) and poor for rotations (ICC: -0.33-0.04, LOAs < 7.8°). The present study shows that a single inertial measurement unit (RSQ Motion, RSQ Technologies, Poznan, Poland) could be successfully used to assess the active hip range of motion in healthy subjects, comparable to other methods accuracy.

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.

Polish Cross-Cultural Adaptation of the Lower Limb Functional Index (LLFI) Demonstrates a Valid Outcome Measure for the Lower Limb Region and Joints

This study aimed to perform linguistic and cross-cultural adaptation to establish a Polish version of the Lower Limb Functional Index (LLFI) as well as an evaluation of the psychometric properties. This was a two-stage, cross-sectional study. The first stage-linguistic and cultural adaptation, complied with the International Society for Pharmacoeconomics and Outcomes Research guidelines to produce the Lower Limb Functional Index, Polish version (LLFI-PL). The subjects were recruited to the second stage of the study from a sample of convenience (n = 125, age x- = 52.86 ± 19.53 years, 56% female, symptoms duration x- = 17.69 ± 18.39 weeks). Baseline reliability was performed on the LLFI-PL with retest period at 3-7 days. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), EuroQol Health Questionnaire 5-Dimensions 5-Level (EQ-5D-5L), and an 11-point Pain Numerical Rating Scale (P-NRS) were completed to assess the validity of the LLFI-PL. Statistical analysis showed high internal consistency (α = 0.94), and excellent test-retest reliability (ICC2.1 = 0.96). The measurement error was SEM = 1.69% with MDC90 = 3.93%. Construct validity demonstrated strong correlations between the LLFI-PL and WOMAC (r = 0.81) and moderate correlations with the EQ-5D-5L (r = -0.63) and P-NRS (r = -0.39). Exploratory factor analysis confirmed a single-factor structure. The LLFI-PL is a psychometrically sound questionnaire for Polish-speaking patients with lower limb musculoskeletal conditions. The results support findings from the previous original English, Spanish, and Turkish versions.

Psychometric properties of the Polish version of the 36-item WHODAS 2.0 in patients with hip and knee osteoarthritis

Purpose

To examine psychometric properties of the Polish version of the 36-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the population with hip and knee osteoarthritis (OA).

Methods

This was a longitudinal study with repeated measures during retest examinations. Subjects from a Polish Specialist Hospital (age = 68.3 ± 9.2years, 71% female, 44.2% knee OA, 55.8% hip OA) were tested three times. They completed the Polish version of the 36-item WHODAS 2.0, the SF-36 Health Survey 2.0, the Western Ontario and Macmaster Universities Osteoarthritis Index 3.1, the Hospital Anxiety and Depression Scale, and the Numerical Rating Scale.

Results

The 36-item WHODAS 2.0—Polish version demonstrated high internal consistency (Cronbach’s alpha for total = 0.94), and test–retest reliability (Total ICC_2,1 = 0.98). High construct validity was found as 12 out of 15 a priori hypotheses (80%) were confirmed. Most domains and Total Scores in the 36-item WHODAS 2.0 (Total ES = − 0.62, SMR = − 1.09) showed a moderate degree of responsiveness. Minimal clinically important difference (MCID) for the Total WHODAS 2.0 was 3.29 in patients undergoing rehabilitation for knee or hip OA.

Conclusions

The Polish version of the 36-item WHODAS 2.0 assesses disability according to ICF in a reliable, valid and responsive way. Therefore, it provides considerable support in clinical practice and national and international scientific research of patients with hip or knee OA.

Equal Opportunities for Stroke Survivors' Rehabilitation: A Study on the Validity of the Upper Extremity Fugl-Meyer Assessment Scale Translated and Adapted into Romanian

Background and objectives: The Upper Extremity Fugl-Meyer Assessment (UEFMA) is one of the most recommended and used methods of clinical evaluation not only for post-stroke motor function disability conditions but also for physiotherapy goal-setting. Up to the present, an official Romanian version has not been officially available. This study aims to carry out a translation, adaptation, and validation of UEFMA in Romanian, thus giving both patients and medical practitioners the equal opportunity of benefiting from its proficiency. Material and methods: The English version of the motor component of UEFMA was back and forth translated in the assent of best practice translation guidelines. The research was performed on a group of 64 post-stroke in-patients regarding psychometric properties for content validation and an exploratory and confirmatory factorial analysis was performed using the Bayesian model. To assess internal consistency and test–retest reliability, we used the Cronbach Alpha index and Intraclass Correlation Coefficient (ICC). We used Pearson correlation with the Functional Independence Measure (FIM) and Modified Rankin Scale (MRS) to determine concurrent validation. Standardized response mean (SRM) was applied to determine the responsiveness of the instrument used. Results: After performing the exploratory factor analysis, a single factor was extracted, with an Eigenvalue of 19.363, which explained 64.543% of the variation. The model was confirmed by Bayesian exploration, with Root Mean Square Residual (RMR) 0.051, Goodness-of-fit Index (GFI) 0.980, Normed-Fit Index (NFI) 0.978 and Relative Fit Index (RFI) 0.977. The Cronbach Alpha value was 0.981, the Intraclass Correlation Coefficient (ICC) index for average measures was 0.992, the Pearson correlation with FIM 0.789, and MRS −0.787, while the SRM was 1.117. Conclusions: The Romanian version of the UEFMA scale is a reliable, responsive and valid tool which can be used as a standardized assessment in post-stroke patients across Romania.

An update on joint-specific outcome measures in total hip replacement

This is the latest review of joint-specific tools used to evaluate patients undergoing total hip replacement (THR) surgery, which is an effective treatment for end-stage osteoarthritis. Due to the large number and multitude of scales and their variants used, a critical assessment of the available tools is necessary. In the article, we briefly describe six different clinical tools: the Western Ontario and McMaster Universities Osteoarthritis Index, the Hip Disability and Osteoarthritis Outcome Score, the Harris Hip Score, the Oxford Hip Score, the Mayo Hip Score, and the Rheumatoid and Arthritis Outcome Score. We present the advantages and constraints of the different outcome measures, providing a helpful resource of information for clinical trials and for everyday routine evaluation.