Skip to main content
SpringerLink
Log in

Using WOMAC Index scores and personal characteristics to estimate Assessment of Quality of Life utility scores in people with hip and knee joint disease

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

To determine whether Assessment of Quality of Life (AQoL) utility scores can be reliably estimated from Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in people with hip and knee joint disease (arthritis or osteoarthritis).

Methods

WOMAC and AQoL data were analysed from 219 people recruited for a national population-based study. Generalised linear models were used to estimate AQoL utility scores based on WOMAC total and subscale scores and personal characteristics. Goodness of fit was assessed for each model, and plots of prediction errors versus actual AQoL utility scores were used to gauge bias.

Results

Each model closely predicted the average AQoL utility score for the overall sample (actual mean AQoL 0.64, range of predicted means 0.63–0.64; actual median AQoL 0.71, range of predicted medians 0.68–0.69). No clear preferred model was identified, and overall, the models predicted 40–46 % of the variance in AQoL utility scores. The WOMAC function subscale model performed similarly to the total score model. The models functioned best at the mid-range of AQoL scores, with greater bias observed for extreme scores. Inaccuracies in individual-level estimates and low/high health-related quality of life (HRQoL) subgroup estimates were evident.

Conclusion

Reliable overall group-level estimates were produced, supporting the application of these techniques at a population level. Using WOMAC scores to predict individual AQoL utility scores is not recommended, and the models may produce inaccurate estimates in studies targeting patients with low/high HRQoL. Where pain and stiffness data are unavailable, the WOMAC function subscale can be used to generate a reasonable utility estimate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Australian Orthopaedic Association National Joint Replacement Registry. (2013). Annual report. Adelaide: Australian Orthopaedic Association.

    Google Scholar 

  2. Ackerman, I. N., & Osborne, R. H. (2012). Obesity and increased burden of hip and knee joint disease in Australia: Results from a national survey. BMC Musculoskeletal Disorders, 13, 254.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Ackerman, I. N., Ademi, Z., Osborne, R. H., & Liew, D. (2013). Comparison of Health-Related Quality of Life, work status and health care utilization and costs according to hip and knee joint disease severity: Results from a national Australian study. Physical Therapy, 93(7), 889–899.

    Article  PubMed  Google Scholar 

  4. McConnell, S., Kolopack, P., & Davis, A. M. (2001). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): A review of its utility and measurement properties. Arthritis Care & Research, 45(5), 453–461.

    Article  CAS  Google Scholar 

  5. Ackerman, I. N., Graves, S. E., Bennell, K. L., & Osborne, R. H. (2006). Evaluating quality of life in hip and knee replacement: Psychometric properties of the WHOQOL-BREF instrument. Arthritis Care & Research, 55(4), 583–590.

    Article  Google Scholar 

  6. Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., & Roos, E. M. (2011). Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care & Research, 63(S11), S208–S228.

    Article  Google Scholar 

  7. Hawthorne, G., & Osborne, R. H. (2005). Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure. Australian and New Zealand Journal of Public Health, 29(2), 136–142.

    Article  PubMed  Google Scholar 

  8. Dakin, H. (2013). Review of studies mapping from quality of life or clinical measures to EQ-5D: An online database. Health and Quality of Life Outcomes, 11(1), 151.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Australian Government Department of Health. (2014). Appendix 6: Utility valuation of health outcomes. http://www.pbs.gov.au/info/industry/listing/elements/pbac-guidelines/e-appendixes/f-appendix-6. Accessed 8 January 2014.

  10. National Institute for Health and Care Excellence (NICE). (2014). Published technology appraisals. http://guidance.nice.org.uk/TA/Published. Accessed 8 January 2014.

  11. Barton, G., Sach, T., Jenkinson, C., Avery, A., Doherty, M., & Muir, K. (2008). Do estimates of cost-utility based on the EQ-5D differ from those based on the mapping of utility scores? Health and Quality of Life Outcomes, 6(1), 51.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Xie, F., Pullenayegum, E. M., Li, S.-C., Hopkins, R., Thumboo, J., & Lo, N.-N. (2010). Use of a disease-specific instrument in economic evaluations: Mapping WOMAC onto the EQ-5D utility index. Value in Health, 13(8), 873–878.

    Article  PubMed  Google Scholar 

  13. Grootendorst, P., Marshall, D., Pericak, D., Bellamy, N., Feeny, D., & Torrance, G. W. (2007). A model to estimate Health Utilities Index Mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the knee. Journal of Rheumatology, 34(3), 534–542.

    PubMed  Google Scholar 

  14. Marshall, D., Pericak, D., Grootendorst, P., Gooch, K., Faris, P., Frank, C., et al. (2008). Validation of a prediction model to estimate Health Utilities Index Mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the hip. Value in Health, 11(3), 470–477.

    Article  PubMed  Google Scholar 

  15. Pinedo-Villanueva, R. A., Turner, D., Judge, A., Raftery, J. P., & Arden, N. K. (2013). Mapping the Oxford hip score onto the EQ-5D utility index. Quality of Life Research, 22(3), 665–675.

    Article  PubMed  Google Scholar 

  16. Dakin, H., Gray, A., & Murray, D. (2013). Mapping analyses to estimate EQ-5D utilities and responses based on Oxford Knee Score. Quality of Life Research, 22(3), 683–694.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Busija, L., Pausenberger, E., Haines, T. P., Haymes, S., Buchbinder, R., & Osborne, R. H. (2011). Adult measures of general health and health-related quality of life. Arthritis Care & Research, 63, S383–S412.

    Article  Google Scholar 

  18. Ackerman, I. N., Busija, L., Tacey, M. A., Bohensky, M. A., Ademi, Z., Brand, C. A., & Liew, D. (in press). Performance of the Assessment of Quality of Life measure in people with hip and knee joint disease and implications for research and clinical use. Arthritis Care & Research.

  19. World Health Organization. (2000). Obesity: Preventing and managing the global epidemic. Geneva: World Health Organization.

    Google Scholar 

  20. Australian Electoral Commission. (2013). Current federal electoral divisions. http://www.aec.gov.au/profiles/. Accessed 17 December 2013.

  21. Australian Bureau of Statistics. (2014). 2033.0.55.001—Census of population and housing: Socio-economic indexes for areas (SEIFA), Australia—Data only, 2006. http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/356A4186CCDDC4D1CA257B3B001AC22C?opendocument. Accessed 8 January 2014.

  22. Bellamy, N. (2009). WOMAC osteoarthritis index. User guide IX. Brisbane: Australia.

    Google Scholar 

  23. Hawthorne, G., Richardson, J., Day, N., & McNeil, H. (2000). Construction and utility scaling of the Assessment of Quality of Life (AQoL) instrument. Melbourne: Monash University.

    Google Scholar 

  24. Chen, A., Gupte, C., Akhtar, K., Smith, P., & Cobb, J. (2012). The global economic cost of osteoarthritis: How the UK compares. Arthritis. doi:10.1155/2012/698709.

  25. Hiligsmann, M., Cooper, C., Arden, N., Boers, M., Branco, J., Luisa Brandi, M., Bruyère, O., Guillemin, F., Hochberg, M., Hunter, D., Kanis, J., Kvien, T., Laslop, A., Pelletier, J., Pinto, D., Reiter-Niesert, S., Rizzoli, R., Rovati, L., Severens, J., Silverman, S., Tsouderos, Y., Tugwell, P., & Reginster, J. (2013). Health economics in the field of osteoarthritis: An expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism. doi:10.1016/j.semarthrit.2013.07.003.

  26. Ackerman, I. N., Graves, S. E., Wicks, I. P., Bennell, K. L., & Osborne, R. H. (2005). Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery. Arthritis Care & Research, 53(5), 653–658.

    Article  Google Scholar 

  27. Bellamy, N., Wilson, C., & Hendrikz, J. (2010). Population-based normative values for the Western Ontario and McMaster Osteoarthritis Index and the Australian/Canadian (AUSCAN) Hand Osteoarthritis Index functional subscales. Inflammopharmacology, 18(1), 1–8.

    Article  PubMed  Google Scholar 

  28. Grotle, M., Hagen, K., Natvig, B., Dahl, F., & Kvien, T. (2008). Prevalence and burden of osteoarthritis: Results from a population survey in Norway. Journal of Rheumatology, 35(4), 677–684.

    PubMed  Google Scholar 

  29. Australian Bureau of Statistics. (2014). 2007–2008 National health survey users’ guide—electronic. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CC0FB5A08570984ECA25762E0017CF2B/$File/4363055001_2007-08.pdf. Accessed 8 January 2014.

Download references

Acknowledgments

We gratefully acknowledge the assistance of Alexandra Gorelik (Senior Statistician, Melbourne EpiCentre) for her statistical advice and constructive feedback. This research was supported in part by a Physiotherapy Research Foundation and United Pacific Industries Thermoskin Research Grant (#T09-THE003). Dr. Ackerman is supported by a National Health and Medical Research Council of Australia Public Health (Australian) Early Career Fellowship (#520004).

Conflict of interest

There are no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Melbourne EpiCentre, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne and Melbourne Health, Parkville, VIC, 3050, Australia

    Ilana N. Ackerman, Mark A. Tacey, Zanfina Ademi, Megan A. Bohensky, Danny Liew & Caroline A. Brand

  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Zanfina Ademi

Authors
  1. Ilana N. Ackerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark A. Tacey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zanfina Ademi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Megan A. Bohensky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Danny Liew
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caroline A. Brand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilana N. Ackerman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ackerman, I.N., Tacey, M.A., Ademi, Z. et al. Using WOMAC Index scores and personal characteristics to estimate Assessment of Quality of Life utility scores in people with hip and knee joint disease. Qual Life Res 23, 2365–2374 (2014). https://doi.org/10.1007/s11136-014-0667-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-014-0667-y

Keywords

Search

Navigation