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da Silva-Júnior FB, Dibai-Filho AV, Barros DCC, Dos Reis-Júnior JR, Gonçalves MBS, Soares AR, Cabido CET, Pontes-Silva A, Fidelis-de-Paula-Gomes CA, Pires FDO. Anterior Knee Pain Scale (AKPS): structural and criterion validity in Brazilian population with patellofemoral pain. BMC Musculoskelet Disord 2024; 25:39. [PMID: 38191375 PMCID: PMC10773022 DOI: 10.1186/s12891-024-07164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024] Open
Abstract
PURPOSE To identify the best internal structure of the Brazilian version of the Anterior Knee Pain Scale (AKPS), comparing different instrument structures (structural validity) and correlating the scores of the versions (criterion validity). METHODS We included Brazilian volunteers, aged ≥ 18 years, with patellofemoral pain (PFP) for at least 3 months. We used the confirmatory factor analysis and considered the following fit indices: chi-square/degrees of freedom (DF), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA). We considered the structure with the lowest values of the Akaike information criterion (AIC), sample size adjusted Bayesian information criterion (SABIC), and assessed criterion validity using Pearson correlation coefficient (r) to correlate the long and short versions. RESULTS The study included 101 participants, mostly women (65.3%), young adults (~ 31 years old), overweight (BMI > 25 kg/m2), incomplete higher education (37.6%), and physically active (64.4%). The original 1-domain, 13-item structure showed adequate fit indices (chi-square/GL < 3.00, TLI and CFI > 0.90, and RMSEA < 0, 08). However, items 11 and 12 had a factorial load of less than 0.23. Therefore, we excluded items 11 and 12 and found adequate fit indices (chi-square/GL < 3.00, TLI and CFI > 0.90, and RMSEA < 0, 08) and lower AIC and SABIC values. We observed a correlation coefficient above the acceptable cutoff of 0.70 (r = 0.966, p-value < 0.001) between the versions. CONCLUSION The 11-item AKPS (without items 11 and 12) is the version with the most adequate internal structure and correlates satisfactorily with the long version of the instrument.
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Affiliation(s)
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Universidade Federal Do Maranhão, São Luís, Brazil
- Department of Physical Education, Universidade Federal Do Maranhão, São Luís, Brazil
| | | | | | | | | | - Christian Emmanuel Torres Cabido
- Postgraduate Program in Physical Education, Universidade Federal Do Maranhão, São Luís, Brazil
- Department of Physical Education, Universidade Federal Do Maranhão, São Luís, Brazil
| | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal De São Carlos, São Carlos, Brazil.
| | | | - Flavio de Oliveira Pires
- Postgraduate Program in Physical Education, Universidade Federal Do Maranhão, São Luís, Brazil
- Department of Physical Education, Universidade Federal Do Maranhão, São Luís, Brazil
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Hoglund LT, Scalzitti DA, Jayaseelan DJ, Bolgla LA, Wainwright SF. Patient-Reported Outcome Measures for Adults and Adolescents With Patellofemoral Pain: A Systematic Review of Construct Validity, Reliability, Responsiveness, and Interpretability Using the COSMIN Methodology. J Orthop Sports Phys Ther 2023; 53:460–479. [PMID: 37339377 DOI: 10.2519/jospt.2023.11730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE: We aimed to appraise the construct validity, reliability, responsiveness, and interpretability of patient-reported outcome measures (PROMs) used to assess function and pain in adults and adolescents with patellofemoral pain (PFP). DESIGN: Systematic review of measurement properties LITERATURE SEARCH: We searched the PubMed, CINAHL, Scopus, SPORTDiscus, and Cochrane Library databases from inception to January 6, 2022. STUDY SELECTION CRITERIA: We included studies that assessed the measurement properties of English-language PROMs for PFP and their cultural adaptations and translations. DATA SYNTHESIS: Using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, we determined overall ratings and quality of evidence for construct validity, internal consistency, reliability, measurement error, and responsiveness. We extracted data related to interpretability for clinical use. RESULTS: After screening 7066 titles, 61 studies for 33 PROMs were included. Only 2 PROMs had evidence of "sufficient" or "indeterminate" quality for all measurement properties. The Knee injury and Osteoarthritis Outcome Score patellofemoral subscale (KOOS-PF) had "low" to "high" quality evidence for a rating of "sufficient" for 4 measurement properties. The Lower Extremity Functional Scale (LEFS) had very low-quality evidence for a "sufficient" rating for 4 measurement properties. The KOOS-PF and LEFS were rated "indeterminate" for structural validity and internal consistency. The KOOS-PF had the best interpretability with reported minimal important change and 0% ceiling and floor effects. No studies examined cross-cultural validity. CONCLUSION: The KOOS-PF and LEFS had the strongest measurement properties among PROMs used for PFP. More research is needed, particularly regarding structural validity and interpretability of PROMs. J Orthop Sports Phys Ther 2023;53(8):1-20. Epub: 20 June 2023. doi:10.2519/jospt.2023.11730.
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Zhang Y, Ren J, Zang Y, Guo W, Disantis A, Martin RL. Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity. Int J Sports Phys Ther 2023; V18:653-686. [PMID: 37425110 PMCID: PMC10324371 DOI: 10.26603/001c.74528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. Purpose The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Study design Literature Review. Methods PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Results Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Conclusion Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. Level of evidence 3a.
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Affiliation(s)
- Yongni Zhang
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Jiayi Ren
- Shuguang Hospital of Shanghai University of Traditional Chinese Medicine
| | - Yaning Zang
- Department of Kinesiology Shanghai University of Sport
| | - Wenhao Guo
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Ashley Disantis
- Department of Physical Therapy Duquesne University
- UPMC Children's Hospital of Pittsburgh
| | - Robroy L Martin
- Department of Physical Therapy Duquesne University
- UPMC Center for Sports Medicine
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Hoglund LT, Scalzitti DA, Bolgla LA, Jayaseelan DJ, Wainwright SF. Patient-Reported Outcome Measures for Adults and Adolescents with Patellofemoral Pain: A Systematic Review of Content Validity and Feasibility Using the COSMIN Methodology. J Orthop Sports Phys Ther 2023; 53:23-39. [PMID: 36251651 DOI: 10.2519/jospt.2022.11317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To assess the content validity and feasibility of patient-reported outcome measures (PROMs) used to assess pain and function in adults and adolescents with patellofemoral pain (PFP). DESIGN: Systematic review. LITERATURE SEARCH: We searched the databases PubMed, CINAHL, Scopus, SPORTDiscus, and the Cochrane Library from inception to January 6, 2022. STUDY SELECTION CRITERIA: We included studies that described the development or evaluation of the content validity of English-language PROMs for PFP, as well as their translations and cultural adaptations to different languages. DATA SYNTHESIS: Using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, we determined overall ratings and quality of evidence for the relevance, comprehensiveness, and comprehensibility of PROMs. We extracted data related to feasibility for clinical use (eg, administration time and scoring ease). RESULTS: Forty-three studies for 33 PROMs were included. The overall quality of most studies was "inadequate" due to failure to engage stakeholders and/or ensure adherence to rigorous qualitative research procedures. Of all PROMs evaluated, the Knee injury and Osteoarthritis Outcome Score-Patellofemoral subscale (KOOS-PF), was the only PROM with sufficient content validity components. Quality of evidence for content validity of the KOOS-PF was low. Most PROMs were rated feasible for clinical and research purposes. CONCLUSION: Most PROMs used to measure pain and function in patients with PFP have inadequate content validity. The KOOS-PF had the highest overall content validity. We recommend the KOOS-PF for evaluating pain and function (in research and clinical practice) in adults and adolescents with PFP. J Orthop Sports Phys Ther 2023;53(1):23-39. Epub: 18 October 2022. doi:10.2519/jospt.2022.11317.
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Van Cant J, Declève P, Garnier A, Roy JS. Influence of symptom frequency and severity on hip abductor strength and endurance in individuals with patellofemoral pain. Phys Ther Sport 2021; 49:83-89. [PMID: 33631707 DOI: 10.1016/j.ptsp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare clinical measures of hip abductor strength and endurance of individuals with patellofemoral pain with more severe symptoms to those with less severe symptoms. DESIGN Cross-sectional. SETTINGS Laboratory. PARTICIPANTS Sixty participants with patellofemoral pain were divided three times into 2 groups according to three symptomatology criteria: functional capacity, pain frequency and pain severity. MAIN OUTCOME MEASURES Isometric strength evaluated using a hand-held dynamometer, endurance using maximum number of repetitions and maximum holding time, functional capacity using the Anterior Knee Pain Scale, pain frequency using a 2-category scale ("Less frequent" = 1-2 times a week; "More frequent" = >3 times a week) and pain severity using Numeric Pain Rating Scales. RESULTS Participants with more frequent symptoms and with more severe pain were significantly weaker (10%, p = 0.04 and 16%, p = 0.001, respectively), and had less isometric (17%, p = 0.02 and 24%, p = 0.002, respectively) and dynamic (13%, p = 0.02 and 23%, p = 0.007, respectively) endurance compared to those with less pronounced symptoms. CONCLUSION Our study highlighted that hip abductor strength and endurance deficits are more pronounced in individuals with more severe and frequent pain.
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Affiliation(s)
- J Van Cant
- Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Department of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200, Brussels, Belgium.
| | - P Declève
- Department of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200, Brussels, Belgium
| | - A Garnier
- Department of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200, Brussels, Belgium
| | - J S Roy
- Département de réadaptation, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
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Hott A, Liavaag S, Juel NG, Brox JI, Ekeberg OM. The reliability, validity, interpretability, and responsiveness of the Norwegian version of the Anterior Knee Pain Scale in patellofemoral pain. Disabil Rehabil 2019; 43:1605-1614. [PMID: 31583918 DOI: 10.1080/09638288.2019.1671499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the reliability, validity, responsiveness, and interpretability of the Norwegian Anterior Knee Pain Scale (AKPS) in patients with patellofemoral pain (PFP). METHODS The AKPS was translated into Norwegian. One hundred and twelve patients with PFP participated in a randomized controlled trial. Fifty stable patients completed the AKPS at a one-week interval for test-retest reliability. Smallest detectable change (SDC) and floor/ceiling effects were evaluated. Validity and responsiveness were assessed using hypothesis testing for correlations with other scores and known-group validity. Minimal important change (MIC) and responsiveness were evaluated at three months. RESULTS Intraclass correlation coefficient (ICCagreement) for sum score was 0.83. Smallest detectable change was 13. No floor/ceiling effects were found for total score, but ceiling effects were found on eight of 13 individual items. Hypothesis testing for construct validity and responsiveness was largely confirmed but correlations were moderate to low. The MIC was 11. Area under receiver operating characteristic curve was 0.66 (95% CI 0.56-0.77) indicating moderate responsiveness. CONCLUSIONS The Norwegian AKPS had comparable measurement properties to other versions, with acceptable reliability and construct validity. We found moderate responsiveness which may be related to ceiling effects on several items.Implications for rehabilitationThe Anterior Knee Pain Scale (AKPS) is a commonly used outcome measure in patellofemoral pain, having acceptable reliability and moderate responsiveness.A change in AKPS total score of 11 points would be considered important by the patient, although changes up to 13 points may be due to measurement error.The AKPS has limitations including ceiling effects on most individual items in this patient population, and low correlation between pain and AKPS that questions the validity of the score. A revision of the score should be considered.
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Affiliation(s)
- Alexandra Hott
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Sigurd Liavaag
- Department of Orthopedic Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ole Marius Ekeberg
- Department of Research & Innovation, Helse Fonna, Haugesund, Norway.,Department for Physical Medicine and Rehabilitation, Helse Fonna, Haugesund, Norway
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Abstract
Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running). Symptoms can restrict participation in physical activity, sports, and work, as well as recur and persist for years. This clinical practice guideline will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.
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Hiemstra LA, Page JL, Kerslake S. Patient-Reported Outcome Measures for Patellofemoral Instability: a Critical Review. Curr Rev Musculoskelet Med 2019; 12:124-137. [PMID: 30835079 PMCID: PMC6542883 DOI: 10.1007/s12178-019-09537-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper was to review the current psychometric properties of patient-reported outcome measures that are commonly used for patients with patellofemoral instability. This review provides evidence to guide the selection of subjective outcome measures for assessing outcomes in clinical care and research studies. RECENT FINDINGS At the present time, there are two patient-reported outcome measures that have been designed for, and tested on, large cohorts of patellofemoral instability patients, the Banff Patella Instability Instrument (BPII) and the Norwich Patellar Instability Score (NPI). The BPII is a wholistic quality of life outcome measure and the NPI is a symptom score. The use of disease-specific outcome measures such as the BPII and NPI, in combination with generic knee, functional activity, and/or psychological outcome measures that have been proven to be valid and reliable for the patellofemoral instability population, is most likely to provide a well-rounded evaluation of treatment outcomes.
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Affiliation(s)
- Laurie Anne Hiemstra
- Banff Sport Medicine, PO Box 1300, Banff, Alberta, T1L 1B3, Canada.
- Department of Surgery, University of Calgary, Calgary, Canada.
| | - Jessica L Page
- Banff Sport Medicine, PO Box 1300, Banff, Alberta, T1L 1B3, Canada
| | - Sarah Kerslake
- Banff Sport Medicine, PO Box 1300, Banff, Alberta, T1L 1B3, Canada
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