Rheumatology International

, Volume 38, Issue 8, pp 1547–1555 | Cite as

Cross-cultural adaptation and validation of the Saudi Arabic version of the Knee Injury and Osteoarthritis Outcome Score (KOOS)

  • Saud A. Alfadhel
  • Vishal Vennu
  • Ali H. Alnahdi
  • Mohammed T. Omar
  • Saeed H. Alasmari
  • Zahra AlJafri
  • Saad M. BindawasEmail author
Validation Studies


The Knee Injury Osteoarthritis Outcome Score (KOOS) is a widely used joint-specific measure employed to evaluate pain, symptoms, activities of daily living, recreational activities, and quality of life in patients with knee osteoarthritis (OA). Although the original KOOS has been translated into many languages, a Saudi Arabic version is not available. This study aimed to culturally adapt and evaluate the psychometric properties of the Saudi Arabic version of the KOOS in patients with knee OA. The original KOOS was translated and adapted into Saudi Arabic version over six stages according to the guidelines suggested by Beaton and recommended by the American Association of Orthopedic Surgeons Outcome Committee. Patients diagnosed with knee OA (n = 136) were recruited to examine the psychometric properties, such as internal consistency that was tested using Cronbach’s alpha, test–retest reliability that was analyzed using the intra-class correlation coefficient (ICC2,1), and construct validity that examined by testing the correlations between the new version subscales, Form 36 Health Survey subscales, and the Visual Analog Scale, Spearman’s correlation coefficient (rs) was used to measure the correlations. A total of 122 (89.7%) of the 136 participants with knee OA completed the second re-test of new Saudi Arabic version. Excellent internal consistency (Cronbach’s alpha = 0.87–0.92) was detected in the subscales of the adapted version, as well as excellent test–retest reliability (ICC2,1 = 0.92–0.94). The pattern of correlation between the subscales of the Saudi Arabic version of the KOOS, SF-36 domains and the Visual Analog Scale for pain supported the construct validity of the adapted version. The Saudi Arabic version of the KOOS was well accepted and exhibited excellent reliability, internal consistency, and construct validity in Saudi patients with knee OA.


Osteoarthritis Knee Reliability Validity Psychometric 



The authors extend their appreciations to the Deanship of Scientific Research at King Saud University and editing service provided by the external body for this work.

Author contributions

Alfadhel SA and Bindawas SM designed and directed the project. Alfadhel SA, Alasmari SH, and AlJafri Z organized, managed and preformed data collection. Alfadhel SA, Vennu V, Alnahdi AH, Omar MT, and Bindawas SM, analyzed the data, and drafted the paper. Alfadhel SA, Bindawas SM, Alnahdi AH, Omar MT, and Alasmari SH critically commented to the manuscript and contributed the interpretation of the results. All authors read and approved the final manuscript.


We thank the Deanship of Scientific Research at King Saud University for funding this work through Research Group No. RG-1438-085. The funding body played no role in study design, the writing of the manuscript or the decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

Alfadhel SA, Vennu V, Alnahdi AH, Omar MT, Alasmari SH, AlJafri Z, Bindawas SM declared that they have no conflict of interest.

Ethical approval

The Research Ethics Committee and Institutional Review Board at the following institutions authorized this study: College of Applied Medical Sciences (No: 098-36/37), King Saud University Medical City (No: 16/0169/IRB), and King Saud Medical City (No: H-01-R-053). All patients involved in the present study had thoroughly read and signed the informed consent.

Supplementary material

296_2018_4072_MOESM1_ESM.docx (475 kb)
Supplementary material 1 (DOCX 475 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Rehabilitation Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
  2. 2.Physical Therapy DepartmentGeneral Directorate of Medical ServicesRiyadhSaudi Arabia
  3. 3.Department of Physical TherapyKing Saud Medical CityRiyadhSaudi Arabia
  4. 4.Department of Physical TherapyKing Khalid University HospitalRiyadhSaudi Arabia

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