Abstract
Purpose
The Knee Injury Osteoarthritis Outcome Score (KOOS)-Child questionnaire is one of the frequently child-friendly measures used in pediatric studies. The aim of this study was to transculturally adapt the Greek version of KOOS-Child and evaluate its clinimetric properties in children with knee disorders.
Methods
Children visiting the Outpatients Orthopaedic Clinic of a Greek Paediatric General Hospital were considered eligible if they were aged 8–14 years, had a knee soft tissue injury and associated physical limitations. The transcultural adaptation was based on a multistage backward translation approach. Participants completed the KOOS-Child at their first visit to the orthopedic specialist (baseline), 2 weeks and 3 months after baseline. Content validity of the KOOS-Child was evaluated using general QoL measures (KIDSCREEN and Kid-KINDL) and construct validity was explored by correlating relevant items. Responsiveness was evaluated according to the children’s response on the given orthopeadic treatment.
Results
Sample consisted of 59 children (30 males), aged: 11 ± 1.8 years. The KOOS-Child showed high internal consistency (Cronbach’s a: 0.80–0.96). Adequate convergent validity with > 75% relevant a priori hypotheses was confirmed. Construct validity was moderate to strong (Pearson’s r correlations between related KOOS and Kid-KINDL subdimensions: 0.54–0.62). KOOS and KIDSCREEN subdimensions correlations were fair (Pearson’s r correlations: 0.32–0.65). KOOS-Child’s diagnostic accuracy was high. Factor analysis extracted height factors accounting for 76.15% of the total variance, confirmed by the scree plot. Responsiveness was moderate to high with Cohen’s d from 0.6 to 1.4.
Conclusion
The Greek version of the KOOS-Child demonstrated excellent internal consistency, good construct validity, diagnostic accuracy and interpretability as well as good responsiveness. The measure could be used across Greek children with orthopaedic knee problems. Generalisability of findings is limited due to the relatively limited cohort.
Level of evidence
II.
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Abbreviations
- ACL:
-
Anterior cruciate ligament
- KOOS:
-
Knee Injury and Osteoarthritis Outcome Score
- QoL:
-
Quality of life
- ADL:
-
Activities of Daily living
- PROMs:
-
Patient-reported outcome measures
- COSMIN:
-
COnsensus-based Standards for the selection of health Measurement INstruments
- ES:
-
Effect size
- EQ-5D:
-
EuroQol 5D indices
- SD:
-
Standard deviation
- ROC:
-
Receiver-operating characteristic
- AUC:
-
Area under the curve
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Acknowledgements
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics and specifically the research team of Prof. Dr. Ulrike Ravens-Sieberer, for granting permission to use the QoL questionnaires.
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MM contribution: study design, performed manuscript preparation, data analysis. PT contribution: study design, performed measurements, TB contribution: study design, data analysis, EB: study design manuscript preparation. MR contribution: study design, performed measurements, manuscript preparation. All authors read and approved the final manuscript.
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Ethical approval was granted from the Scientific Committee of Karamandaneion Paediatric General Hospital of Patras (Greece).
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Moutzouri, M., Tsoumpos, P., Bania, T. et al. “Greek KOOS-Child: a valid, disease specific, diagnostically accurate and responsive PROM in children with knee-related pathology”. Knee Surg Sports Traumatol Arthrosc 29, 1841–1849 (2021). https://doi.org/10.1007/s00167-020-06237-5
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DOI: https://doi.org/10.1007/s00167-020-06237-5