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

Abstract

Objective: To cross-culturally translate and validate the Chinese versions of the Oxford Knee Score (OKS) and the Activity and Participation Questionnaire (APQ) in patients with end-stage knee osteoarthritis who are also candidates for knee replacement. Methods: The Chinese version of the OKS and APQ was completed by standard forward–backward translation and adaption. The feasibility was validated by a pretest in 30 patients. The final version together with the Short Form-36 (SF-36), EQ-5D, and EQ visual analog scale were assessed in 150 patients, and the OKS and APQ were repeated in 30 patients after a 2-week interval. The psychometric properties of the OKS and APQ were evaluated for test–retest reliability using intraclass correlation coefficients (ICCs), internal consistency using Cronbach’s α, and construct validity using Spearman’s correlation analysis. Results: All patients were able to understand and complete both the OKS and APQ without difficulty (i.e. no missing data). The ICCs were 0.959 for the OKS, 0.956 for the APQ for total scores, and >0.7 for each item. Cronbach’s α was greater than 0.7, and the corrected item-total correlation was greater than 0.4 for each item of both questionnaires. The OKS and APQ showed better correlations with questions from the pain and function domains than with those from the mental status domains of the SF-36 and EQ-5D. No floor or ceiling effect was identified in either questionnaire. Conclusions: The Chinese versions of the OKS and APQ are easy to understand and complete and showed good reliability and validity. They can be used to assess patient-reported outcomes after undergoing knee replacement in mainland China.

The Dutch Version of the Oxford Knee Score – Activity and Participation Questionnaire: A Validation Study

“…The pattern of oor and ceiling effects in the present study were comparable to the original study however, no oor or ceiling effects were observed in the Chinese version which was validated in a preoperative sample (5).…”

“…Our Dutch population was on average 5 years older compared to the English population in the study by Dawson et al(4). However, the results of measurement properties in the present study are comparable to those of the original English version(4) and the Chinese version (5). With a good internal consistency (Cronbach's alpha: 0.85 and 0.90 respectively), test-retest reliability (ICC of 0.79 (or 0.92 when one outlier was excluded) and 0.96 respectively) and supported construct validity (r > 0.5 with the OKS, American Knee Society Scores (AKSS) and SF-36 PCS)(4).…”

“…sports, dancing, and participation in activities with friends and family) that t activity patterns of younger or more active patients (4). Besides the original English version of the OKS-APQ and a Chinese version (5), the questionnaire has not been translated and validated in other languages including Dutch. The original OKS-APQ has shown to be a valuable complement to the OKS, particularly where further detail regarding the levels of activity and participation are required (4).…”

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

“…In general, the patterns of observed floor and ceiling effects of the Dutch OKS-APQ for the summary score and at item level were consistent with the original OKS-APQ and the Chinese version of the OKS-APQ [ 5 , 10 ]. The floor effects found in the preoperative sample might be explained by the fact that these patients were awaiting a TKA and therefore report severe complaints/functional limitations.…”

“…timing and adjustments of activities) [ 5 ]. Besides the original English version of the OKS-APQ and a Chinese version [ 10 ], the questionnaire has not been translated and validated in other languages including Dutch. The original OKS-APQ has shown to be a valuable complement to the OKS, particularly where further detail regarding the levels of activity and participation are required [ 5 ].…”