The 12-item Oxford Knee Score: cross-cultural adaptation into German and assessment of its psychometric properties in patients with osteoarthritis of the knee

SummaryObjectiveTo cross-culturally adapt and validate the Oxford Knee Score (OKS) for use in German-speaking patients with osteoarthritis of the knee.MethodsAfter the cross-cultural adaptation (OKS-D), the following metric properties of the questionnaire were assessed in 100 consecutive patients (mean age 66.5 years, 61 women) undergoing total knee replacement: feasibility (percentage of fully completed questionnaires), reliability (Intraclass Correlation Coefficients [ICC] and Bland and Altman's limits of agreement), and construct validity (correlation with the Western Ontario and McMaster Universities Index [WOMAC], Knee Society Score [KSS], Activities of Daily Living Scale [ADLS], and Short Form 12 [SF-12]), floor and ceiling effects, and internal consistency (Cronbach's Alpha, CA).ResultsWe received 91.9% fully completed questionnaires. Reliability of the OKS-D was excellent (ICC 0.91). Bland and Altman's limits of agreement revealed no significant bias (−0.2) and a random error of 6.2. Correlation coefficients with the other questionnaires ranged from −0.22 (SF-12 Mental Component Scale [MCS]) to −0.77 (ADLS). We observed no floor or ceiling effects. The CA was 0.83.ConclusionsThe German version of the OKS is a reliable and valid measure for the self-assessment of pain and function in German-speaking patients with osteoarthritis of the knee

2D vs. 3D pain visualization: User preferences in a spinal cord injury cohort

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2011 Springer VerlagResearch on pain experienced after Spinal Cord Injury (SCI) has revealed that not only are there several types of pain present in the same individual with this kind of trauma, but also that people who suffer such an injury can describe the characteristics of the same type of pain in different ways. Making it possible, therefore, to more precisely describe pain experience could prove to be vital for an increased quality of life. Accordingly, fifteen individuals with pain after SCI were asked to describe their pain experience using a 3 Dimensional (3D) model of the human body that could be used as an aid in communicating their pain. The results of this study suggest that the consensus of the participants approved the ability of the 3D model to more accurately describe their pain, an encouraging outcome towards the use of 3D technology in support of post SCI pain rehabilitation

Limiting factors to high intensity exercise The role of intramuscular pH and skeletal muscle buffering

SIGLEAvailable from British Library Document Supply Centre- DSC:D95837 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Factor analysis of the North American Spine Society outcome assessment instrument: a study based on a spine registry of patients treated with lumbar and cervical disc arthroplasty.

BACKGROUND CONTEXT: Studies involving factor analysis (FA) of the items in the North American Spine Society (NASS) outcome assessment instrument have revealed inconsistent factor structures for the individual items. PURPOSE: This study examined whether the factor structure of the NASS varied in relation to the severity of the back/neck problem and differed from that originally recommended by the developers of the questionnaire, by analyzing data before and after surgery in a large series of patients undergoing lumbar or cervical disc arthroplasty. STUDY DESIGN/SETTING: Prospective multicenter observational case series. PATIENT SAMPLE: Three hundred ninety-one patients with low back pain and 553 patients with neck pain completed questionnaires preoperatively and again at 3 to 6 and 12 months follow-ups (FUs), in connection with the SWISSspine disc arthroplasty registry. OUTCOME MEASURES: North American Spine Society outcome assessment instrument. METHODS: First, an exploratory FA without a priori assumptions and subsequently a confirmatory FA were performed on the 17 items of the NASS-lumbar and 19 items of the NASS-cervical collected at each assessment time point. The item-loading invariance was tested in the German version of the questionnaire for baseline and FU. RESULTS: Both NASS-lumbar and NASS-cervical factor structures differed between baseline and postoperative data sets. The confirmatory analysis and item-loading invariance showed better fit for a three-factor (3F) structure for NASS-lumbar, containing items on "disability," "back pain," and "radiating pain, numbness, and weakness (leg/foot)" and for a 5F structure for NASS-cervical including disability, "neck pain," "radiating pain and numbness (arm/hand)," "weakness (arm/hand)," and "motor deficit (legs)." CONCLUSIONS: The best-fitting factor structure at both baseline and FU was selected for both the lumbar- and cervical-NASS questionnaires. It differed from that proposed by the originators of the NASS instruments. Although the NASS questionnaire represents a valid outcome measure for degenerative spine diseases, it is able to distinguish among all major symptom domains (factors) in patients undergoing lumbar and cervical disc arthroplasty; overall, the item structure could be improved. Any potential revision of the NASS should consider its factorial structure; factorial invariance over time should be aimed for, to allow for more precise interpretations of treatment success

Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement

SummaryObjectiveThe aim of this study was to explore the role of expectations in relation to patient-rated global treatment outcome in patients undergoing hip preservation surgery for femoroacetabular impingement (FAI).MethodPre-operatively, 86 patients completed the Oxford Hip Score (OHS), a question about the motivation for undergoing surgery, and Likert-scales rating the improvement expected in various domains (pain, general function, sport, walking capacity, independence, social function, mental well-being). 12-months post-operatively, they rated the actual perceived improvement in each domain and the global outcome of surgery (GTO, 5-point Likert-scale: operation “helped a lot” through to “made things worse”), and completed the OHS again.ResultsThe most frequent “top reason” for surgery was “alleviation of pain”, being indicated by 33% patients; 20% patients chose “fear of worsening”, 16% “improvement in everyday activities”, 11% “other therapies failed”, 10% “improvement in sporting activities” and 10% other. The 12-month data revealed prior expectations had been overly optimistic in more than 50% patients for hip pain, sport, and general physical capacity, and in 33–45% patients for independence, mental well-being, and walking capacity. Multiple regression revealed significant (P<0.05) unique associations between GTO and “fulfilled expectations” for pain and sport (explaining 47% and 12% variance, respectively).ConclusionExpectations of surgery were overly optimistic. Having one’s expectations fulfilled, especially in relation to pain, was important for a good outcome. The results emphasise the benefit of assessing patient-orientated outcome in routine practice and the factors that might influence it, such that realistic expectations can be established for patients prior to surgery

The German Hip Outcome Score: validation in patients undergoing surgical treatment for femoroacetabular impingement.

To cross-culturally adapt and validate the Hip Outcome Score (HOS) for use in German-speaking patients undergoing surgical treatment for femoroacetabular impingement.After cross-cultural adaptation (German-language version of the HOS [HOS-D]), the following metric properties of the questionnaire were assessed in 85 consecutive patients (mean age, 33.4 years; 36 women) undergoing hip arthroscopy or surgical hip dislocation: feasibility, reliability, internal consistency, and construct validity (correlation with Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, Short Form 12, and University of California, Los Angeles activity scale). We calculated floor and ceiling effects taking the minimal detectable change into account.The activities of daily living subscale of the HOS-D could be scored in all cases and the sport subscale in all but one. The HOS-D scores were highly reproducible with intraclass correlation coefficients of 0.94 for the activities of daily living subscale and 0.89 for the sport subscale. Internal consistency was confirmed by Cronbach \u3b1 values >0.90 for both subscales. Correlation coefficients with the other measures ranged from -0.08 (Mental Component Scale of Short Form 12) to -0.90 (Western Ontario and McMaster Universities Arthritis Index function subscale).The HOS-D is a reliable and valid self-assessment tool for patients undergoing surgical femoroacetabular impingement treatment. By use of the HOS, comparisons between studies and treatment regimens involving either German- or English-speaking patients are now possible.Level I, testing of previously developed diagnostic criteria in a series of consecutive patients with universally applied gold standard

Comparison of the reliability, responsiveness, and construct validity of 4 different questionnaires for evaluating outcomes after total knee arthroplasty.

The study aimed to compare the reliability, responsiveness and construct convergent validity of four questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index, Activities of Daily Living of the Knee Outcome Survey, Oxford Knee Score, and the 12-item Short Form Health Survey) in total knee arthroplasty patients. Seventy-nine patients completed the questionnaires before surgery and 6 months later. The reliability was high for all instruments with intraclass correlation coefficients from 0.81 to 0.96 and SEMs from 6.6\% to 28.3\% of mean scores. The score changes after surgery were three- to five-fold the instruments' measurement error. The responsiveness was large for all instruments. In conclusion most of the selected instruments were reliable and responsive. It was not possible to clearly identify a "best" or "better" tool and hence all can be considered useful, with the reported psychometric properties serving to guide the choice of instrument for a given purpose

Reliability and validity of the cross-culturally adapted Italian version of the Core Outcome Measures Index

Patient-orientated outcome questionnaires are essential for the assessment of treatment success in spine care. Standardisation of the instruments used is necessary for comparison across studies and in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders and is the recommended outcome instrument in the Spine Society of Europe Spine Tango Registry; currently, no validated Italian version exists. A cross-cultural adaptation of the COMI into Italian was carried out using established guidelines. 96 outpatients with chronic back problems (&gt;3&nbsp;months) were recruited from five practices in Switzerland and Italy. They completed the newly translated COMI, the Roland Morris disability (RM), adjectival pain rating, WHO Quality of Life (WHOQoL), EuroQoL-5D, and EuroQoL-VAS scales. Reproducibility was assessed in a subgroup of 63 patients who returned a second questionnaire within 1&nbsp;month and indicated no change in back status on a 5-point Likert-scale transition question. The COMI scores displayed no floor or ceiling effects. On re-test, the responses for each individual domain of the COMI were within one category in 100% patients for "function", 92% for "symptom-specific well-being", 100% for "general quality of life", 90% for "social disability", and 98% for "work disability". The intraclass correlation coefficients (ICC(2,1)) for the COMI back and leg pain items were 0.78 and 0.82, respectively, and for the COMI summary index, 0.92 (95% CI 0.86-0.95); this compared well with 0.84 for RM, 0.87 for WHOQoL, 0.79 for EQ-5D, and 0.77 for EQ-VAS. The standard error of measurement (SEM) for COMI was 0.54 points, giving a ''minimum detectable change'' for the COMI of 1.5 points. The scores for most of the individual COMI domains and the COMI summary index correlated to the expected extent (0.4-0.8) with the corresponding full-length reference questionnaires (r&nbsp;=&nbsp;0.45-0.72). The reproducibility of the Italian version of the COMI was comparable to that published for the German and Spanish versions. The COMI scores correlated in the expected manner with existing but considerably longer questionnaires suggesting adequate convergent validity for the COMI. The Italian COMI represents a practical, reliable, and valid tool for use with Italian-speaking patients and will be of value for international studies and surgical registries