Cross-cultural adaptation, reliability and validity of the Fremantle Knee Awareness Questionnaire in Italian subjects with painful knee osteoarthritis

Abstract

Background and aim Growing attention is being given to utilising physical function measures to better understand and manage knee osteoarthritis (OA). The Fremantle Knee Awareness Questionnaire (FreKAQ), a self-reported measure of body-perception specific to the knee, has never been validated in Italian patients. The aims of this study were to culturally adapt and validate the Italian version of the FreKAQ (FreKAQ-I), to allow for its use with Italian-speaking patients with painful knee OA. Methods The FreKAQ-I was developed by means of forward–backward translation, a final review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included: internal structural validity by Rasch analysis; construct validity by assessing hypotheses of FreKAQ correlations with the knee injury and osteoarthritis outcome score (KOOS), a pain intensity numerical rating scale (PI-NRS), the pain catastrophising scale (PCS), and the Hospital anxiety and depression score (HADS) (Pearson’s correlations); known-group validity by evaluating the ability of FreKAQ scores to discriminate between two groups of participants with different clinical profiles (Mann–Whitney U test); reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficient, ICC2.1); and measurement error by calculating the minimum detectable change (MDC). Results It took one month to develop a consensus-based version of the FreKAQ-I. The questionnaire was administered to 102 subjects with painful knee OA and was well accepted. Internal structural validity confirmed the substantial unidimensionality of the FreKAQ-I: variance explained was 53.3%, the unexplained variance in the first contrast showed an eigenvalue of 1.8, and no local dependence was detected. Construct validity was good as all of the hypotheses were met; correlations: KOOS (rho = 0.38–0.51), PI-NRS (rho = 0.35–0.37), PCS (rho = 0.47) and HADS (Anxiety rho = 0.36; Depression rho = 0.43). Regarding known-groups validity, FreKAQ scores were significantly different between groups of participants demonstrating high and low levels of pain intensity, pain catastrophising, anxiety, depression and the four KOOS subscales (p ≤ 0.004). Internal consistency was acceptable (α = 0.74) and test–retest reliability was excellent (ICC = 0.92, CI 0.87–0.94). The MDC95 was 5.22 scale points. Conclusion The FreKAQ-I is unidimensional, reliable and valid in Italian patients with painful knee OA. Its use is recommended for clinical and research purposes.

The reliability of patient-reported outcomes in patients with chronic low back pain when answered in online, telephone, and face-to-face interview format

“…(2) the testretest reliability of questionnaires completed online was lower than that of the other formats; (3) questionnaires filled out online were completed in a shorter time compared to the other formats; (4) among the questionnaires filled out online, the RMDQ was more reliable than the other questionnaires regarding low back pain. The present study demonstrates strong ICCs similar to the originally reported test-retest reliability when performed using face-to-face interviews for the ODI, RMDQ, and FreBAQ (22)(23)(24). When looking at the ICC scores of the questionnaires in other formats, all scores except that of the ODI administered online indicated a good level of reliability, although they had lower reliability compared to face-to-face interviews.…”

Intra-Articular Injection of Botulinum Toxin for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

“…Given that OA is a heterogeneous disease encompassing various distinct phenotypes (i.e., subgroups of patients sharing different and specific pathological mechanisms and related structural and functional manifestations) [ 40 , 41 ], BTX showed a marked and peculiar effect in treating nociceptive pain compared with others (neuropathic or mixed pain). Based on these findings, patients’ phenotyping has been suggested for tailoring treatments based on the specific mechanism of pain pathogenesis.…”

Psychometric Analysis of the questionnaires for the assessment of lower limbs available in Italian version: a systematic review

“…All versions of the Italian questionnaires included for knee assessment (29)(30)(31)(32)(33)38) demonstrated internal consistency greater than 0.90 indicate excellent reliability with the exception of 4 questionnaires that have values between 0.75 and 0.9 indicate good reliability however all questionnaires in Italian analyzed are in line with the versions available in other languages but with some differences for example Italian FreKAQ (ICC= 0.92) which has a value higher than that of the original version (ICC= 0.76) (76) or the Forgotten Joint Score-12 (37) italian version presents reliability value (ICC= 0.9) higher than those observed in the Chinese version (ICC= 0.79) (77). About internal consistency, almost all versions of the Italian questionnaires (29)(30)(31)33,34,(36)(37)(38)) demonstrate a value equal to or higher than 0.9 however FJS-12 (37) reported a lower value (α=0.81) and nally the lowest value it was demonstrated by FreKAQ (32) (α=0.74) that it is acceptable but not ideal.…”

“…The criterion validity was assessed using correlation with KOOS in all analyzed versions (29)(30)(31)(32)(33)33,33,(33)(34)(35)(36) except the Norwegian version (84), which does not report the methodology. About AIMS Construct validity, the most used questionnaire is the VAS (36,78,85), apart from the Persian version (86), the only one that uses only the SF-36.…”

“…Considering an average of 10 min of a compilation of all questionnaires analyzed for the knee and considering the clinical evaluation time on average used in public clinics, the AIMS2 questionnaire (36), which requires 20 min of testing, is not exceptionally applicable since there are still two other questionnaires that allow evaluating arthritis (30,32).…”