Translation and Psychometric Analysis of the Indonesian Versions of the Lysholm and Tegner Scores for Patients With Anterior Cruciate Ligament Injuries

Abstract

Background: The Lysholm knee score and Tegner activity scale are frequently used patient-reported outcome measures in patients with anterior cruciate ligament (ACL) injuries because of their excellent psychometric properties. These questionnaires were originally developed in the English language. Purpose: To translate and cross-culturally adapt these measures into the Indonesian language and study their validity and reliability so that they can be used in the Indonesian-speaking population with ACL injuries. Study Design: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. Methods: After a forward-backward translation procedure and cross-cultural adaptation, validity and reliability were investigated. A total of 253 patients with an ACL injury were sent 4 questionnaires (36-Item Short Form Health Survey, Kujala anterior knee pain scale, Indonesian Lysholm knee score [I-LK], and Indonesian Tegner activity scale [I-TS]). The responses of those patients were analyzed. Following COSMIN guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement errors were determined. The Bland-Altman method was used to explore absolute agreement. Results: A total of 106 patients (42% response rate) were included in this study. Construct validity was considered to be good, as more than 75% of the predefined hypotheses on correlations between the I-LK, I-TS, and other measures were confirmed. Reliability proved excellent, with a high test-retest correlation for both questionnaires (intraclass correlation coefficient = 0.99). Bland-Altman analysis showed no systematic bias between testing and retesting. The internal consistency of the I-LK was good (Cronbach alpha = 0.73). For the I-LK and I-TS, floor and ceiling effects were less than 15% (floor: 0% and 4.7%, respectively; ceiling: 12.3% and 3.8%, respectively); the standard error of measurement was 1.8 and 0.9, respectively; the minimal detectable change at the individual level was 5.1 and 0.6, respectively; and the minimal detectable change at the group level was 2.4 and 0.5, respectively. Conclusion: Both the I-LK and I-TS appear to be good evaluation tools for Indonesian-speaking patients with an ACL injury.

Responsiveness of the Indonesian Versions of the Anterior Cruciate Ligament-Return to Sport After Injury Score, the International Knee Documentation Committee Subjective Knee Form, and the Lysholm Score in Patients With ACL Injury

“…2,3 Standard error of measurement and minimal detectable change (MDC) were retrieved from previous validity studies. [4][5][6] The dichotomized GRC score was the external criterion for confidence in both sports resumption and knee function to evaluate whether the change in score was perceived as important by the patient and to determine the minimal clinically important difference (MCID). Univariate logistic regression analyses were performed for all 3 PROMs evaluated.…”

“…We used the valid and reliable Indonesian version of ACL-RSI. 6 The IKDC measures symptoms, function, and sports activity in patients with various knee conditions and has 18 questions. The scale is scored by summing the scores for the individual items and then transforming the score to a scale ranging from 0 to 100, with 100 indicating absence of symptoms and higher levels of functioning.…”

“…16 The valid and reliable Indonesian version of the Lysholm scale was used. 4 The Tegner scale assesses activity levels based on work and sports activities. It consists of a numerical range from 0 to 10; each value indicates the ability to perform specific activities, with the highest value indicating the best score.…”

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

“…Most Italian versions of the selected questionnaires did not calculate SEM or MDC, except FreKAQ (32) HAAS (29) Pedi-FABS (38) and Pedi-IKDC (38). However, it was calculated in other versions such as in the Persian FreKAQ (88) as well as ACL-RSI Dutch (96) version, Indonesian Lysholm Score (91) and German IKDC versions (97). Spanish Lysholm Score version (90) reported only the MCD value, and the Norwegian ACL-RSI (84) version said only the SEM value.…”

“…Finally, the Arabic version (80) needs to report the Construction validity method. SF-36 were the most used questionnaire to evaluate the Construct validity of the Lysholm Score and IKDC speci cally in the Lysholm Score Spanish (90), Turkish (82) and Indonesian version (91) and for IKDC, in the Italian (34), Thai (92) and Chinese (93) versions. Finally Only three of the published versions of KOOS made the study of validity criterion (30,94,95), but the heterogeneity of the tools used limits the possibility of being able to compare the results between the Italian (30), Urdu (94) and Brazilian -Portuguese (95) versions.…”