Rheumatology International

, Volume 40, Issue 2, pp 233–242 | Cite as

Measurement properties of Portuguese–Brazil Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for the assessment of knee complaints in Brazilian adults: ELSA-Brasil Musculoskeletal cohort

  • Poliane T. S. Lage
  • Luciana A. C. Machado
  • Sandhi M. Barreto
  • Roberta C. de Figueiredo
  • Rosa W. TellesEmail author
Cohort Studies


Information on measurement properties of translated versions of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index is still limited. This study investigated the internal consistency, test–retest reliability/agreement, construct validity, and floor and ceiling effects of Portuguese–Brazil WOMAC applied to civil servants at baseline of ELSA-Brasil Musculoskeletal cohort. Each measurement property was evaluated in the overall sample, in the subgroup reporting knee symptoms, and across different sociodemographic strata (except factorial analyses). Separate analyses were performed for pain, stiffness and function dimensions, considering the knee with the worst score (or right knee if same score in both knees). A total of 1740 participants were included (319 completed WOMAC on 2 occasions), mean age 56.0 (standard deviation = 8.9) years, 46.8% male, 42.1% had knee symptoms. In the overall sample, the range of results for WOMAC’s dimensions were: internal consistency = cronbach alpha 0.92–0.98; test–retest reliability = intraclass correlation coefficient 0.85–0.97; standard error of measurement (SEM) = 1.38–5.86; smallest detectable change (SDC) = 3.84–16.25; lowest possible score = 38.8%-61.1% (floor effect present); highest possible score = 0.2%-0.9% (ceiling effect absent). Construct validity was confirmed by hypothesis testing and factorial analysis. Results were similar in the symptomatic group, except for higher SEM and SDC, and the absence of floor effects in pain and function dimensions. Portuguese–Brazil WOMAC showed good overall quality in a nonclinical setting. Variability in measurement properties across different strata of the population should be taken into consideration for the design of future studies using WOMAC.


WOMAC Measurement properties Patient-reported outcome measurements Knee 


Author contributions

PTSL: contributed to the design of the study, data acquisition, analysis and interpretation, drafted the manuscript, approved the version to be published and agreed with all aspects of the work. LACM: conceived and designed the study, contributed to data analysis and interpretation, performed a critical revision of the manuscript for important intellectual content, approved the version to be published and agreed with all aspects of the work. SMB: conceived and designed the study, contributed to data interpretation, performed a critical revision of the manuscript for important intellectual content, approved the version to be published and agreed with all aspects of the work. RCF: contributed to the design of the study, data analysis and interpretation, performed a critical revision of the manuscript for important intellectual content, approved the version to be published and agreed with all aspects of the work. RWT: conceived and designed the study, contributed to data analysis and interpretation, performed a critical revision of the manuscript for important intellectual content, approved the version to be published and agreed with all aspects of the work.


ELSA-Brasil was supported by Ministério da Saúde Brasil (BR), Secretaria de Ciência Tecnologia e Insumos Estratégicos (BR), Ministério da Ciência e Tecnologia (BR), Departamento de Ciência e Tecnologia (Decit-BR), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq-BR), grant 01 06 0278.00 and 01 10 0746 00 (MG), and Financiadora de Estudos e Projetos (FINEP-BR). ELSA-Brasil Musculoskeletal was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-BR-pós-doc/SUS 054/2010). Dr. Sandhi M. Barreto is a research fellow of CNPq-BR and State of Minas Gerais Agency for Research and Technology (FAPEMIG). The investigation was carried out while Dr. Luciana A.C. Machado was a Postdoctoral Fellow supported by CAPES-BR.

Supplementary material

296_2019_4496_MOESM1_ESM.docx (44 kb)
Supplementary file1 (DOCX 45 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of MedicineUniversidade Federal de Minas Gerais (UFMG)Belo HorizonteBrazil
  2. 2.Hospital das Clínicas, UFMGBelo HorizonteBrazil
  3. 3.Universidade Federal de São João Del-ReiSão João del-ReiBrazil

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