Knee Injury and Osteoarthritis Outcome Score Patellofemoral Questionnaire: Psychometric Properties among Females of Kingdom of Saudi Arabia

Abstract

Patellofemoral joint osteoarthritis (PFJ-OA), being a subset of knee osteoarthritis (KOA), is evident in adults, and its prevalence is greater in women in Saudi Arabia too. To assess its disease dimensions, the ‘Knee Injury and Osteoarthritis Outcome Score Patellofemoral’ questionnaire (KOOS-PF) is frequently used to measure symptoms and function among the people with PFJ-OA. Cross-cultural validation is ongoing in several languages, and it needed to be validated among females in Arabic. Therefore, aiming to translate, cross-culturally adapt and validate its psychometric properties, a cross-sectional study was designed where the Ar-KOOS-PF-F was administered among 105 females. The demographic characteristics of recruited females were 51.62 (8.49) years and 30.12 (3.70) kg/m2. For internal consistency, the questionnaire was re-administered after 48 h to estimate the test-retest reliability (92 females, 87.61% compliance rate). Concurrent validity was also established with a visual analog scale (VAS). Factorial validity was established by principal component analysis (PCA). The psychometric properties were: excellent internal consistency of Cronbach’s alpha (α) = 0.930, intraclass correlation coefficient (ICC) for intra-ratter reliability = 0.960 (0.915–0.999), test–retest reliability, ICC = 0.893 (0.889–0.970), standard error of measurement (SEM) = 2.46, relative standard deviation/ (RSD/CV) = 29.9%, minimal detectable change (MDC%) = 22.96% and good concurrent validity with VAS (r = −0.783; p = 0.023). The best-fit four-factor model for confirming overall item communalities ranged from 0.529 to 0.867, which indicates moderate to high communalities, and confirms the homogeneity of Ar-KOOS-PF-F using PCA. The floor (0.9%) and ceiling effects (13.6%) were also within the limits. This scale can be used among females, as it has acceptable psychometric properties of scale validation.

A Systematic Review of Psychometric Properties of Knee-Related Outcome Measures Translated, Cross-Culturally Adapted, and Validated in Arabic Language

“…A total of 20 articles were selected for this review; out of which 12 articles were from Saudi Arabia [ 1 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], two each from Morocco [ 36 , 37 ], Egypt [ 38 , 39 ], and Jordan [ 40 , 41 ], and one each from Tunisia [ 14 ], and Kuwait [ 42 ]. A total of 10 knee-related outcome measures were cross-culturally adapted, and their psychometric measurement properties were evaluated in the Arabic language.…”

“…A total of 10 knee-related outcome measures were cross-culturally adapted, and their psychometric measurement properties were evaluated in the Arabic language. They were Western Ontario and McMaster universities osteoarthritis index (WOMAC) [ 1 , 14 , 37 ], knee injury and osteoarthritis outcome score (KOOS) [ 33 , 34 , 35 , 38 , 39 , 43 ] knee outcome survey- activities of daily living scale (KOS-ADLS) [ 30 , 42 ]. Oxford knee score [ 1 ], anterior knee pain scale [ 31 ], osteoarthritis of knee and hip health-related quality of life (OAKHQoL) scale [ 37 ], Kujala patellofemoral pain scoring system [ 40 , 41 ], intermittent and constant osteoarthritis pain questionnaire (ICOAP) [ 25 ], short version of anterior cruciate ligament-return to sport after injury scale (ACL-RSI) [ 26 ], and Tegner activity scale (TAS) [ 27 ].…”

“…All PROMs have at least two subscales, except one, i.e., Oxford knee score (OKS) [ 29 , 34 , 38 ]. OAKHQoL has a maximum of six subscales [ 36 ], followed by KOOS (five subscales) [ 33 , 35 , 39 , 43 ], WOMAC (two to three subscales) [ 14 , 28 , 37 ], and KOS-ADLS [ 30 , 42 ], anterior knee pain scale (two subscales each) [ 31 , 40 ]. The function subscale was present in all PROMs, followed by pain and symptom subscales (three PROMs each).…”

“…The function subscale was present in all PROMs, followed by pain and symptom subscales (three PROMs each). Most of these tools were evaluated on knee osteoarthritis patients [ 14 , 28 , 29 , 35 , 36 , 37 , 38 , 43 ], apart from three on patellofemoral pain syndrome [ 31 , 40 , 41 ], anterior cruciate ligament/ligamentous injury, and meniscal injury [ 26 , 27 , 38 , 39 ]. Two studies used the population of various knee-related conditions to evaluate their tools [ 30 , 42 ] ( Table 1 ).…”

“…OAKHQoL, Kujala PFPSS, LKS, and IKDC were not validated in the Saudi Arabian population ( Table 1 ). Four studies included only males [ 26 , 27 , 29 , 33 ], while one study included only females [ 35 ], and in another two studies, the majority (~90%) of the patients were females. Eight studies [ 14 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] were from countries other than Saudi Arabia, using local dialects in their PROM.…”