Clinical Rheumatology

, Volume 31, Issue 7, pp 1097–1102 | Cite as

Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index

  • Haidar Nadrian
  • Nasrin Moghimi
  • Elham Nadrian
  • Rahmatollah Moradzadeh
  • Kaveh Bahmanpour
  • Abedin Iranpour
  • Nicholas Bellamy
Original Article


The WOMAC Osteoarthritis Index and Lequesne Algofunctional Index have not been translated and validated for Iranian patients with osteoarthritis (OA) of the knee or hip. The aim of this study was to validate the Persian form of WOMAC OA Index and Lequesne Algofunctional Index and to assess their test–retest reliability and convergent validity. Forward/backward translations and consensus panels were conducted to obtain the Persian versions of WOMAC OA Index and Lequesne Algofunctional Index. A non-probability sample of 116 patients with knee/hip osteoarthritis was asked to complete the WOMAC OA Index and Lequesne Algofunctional Index as well as Medical Outcomes Study—20-Item Short Form (SF-20) questionnaires, a visual analogue scales (VAS) of pain and demographic information form. Internal consistency (using Cronbach’s alpha) and convergent validity (by examining the Pearson’s correlation coefficients) were evaluated to determine the psychometric properties of the questionnaires. In order to evaluate test–retest reliability, 20 randomly selected patients completed the questionnaires, on a second occasion, 7–10 days later. Cronbach’s alpha coefficients and intraclass correlation coefficients for the WOMAC OA Index and Algofunctional Index subscales ranged from 0.63 to 0.94 and from 0.53 to 0.96, respectively. Statistically significant correlations were found between WOMAC OA Index, Algofunctional Index and SF-20 subscales and VAS for pain. The Persian version of WOMAC demonstrated a more acceptable validity, internal consistency and reliability compared with the Lequesne Algofunctional Index. However, both indices are valid and reliable instruments for evaluating the OA severity of knee/hip in Iran.


Health status Lequesne Algofunctional Index Medical Outcomes Study—20-Item Short Form (SF-20) Osteoarthritis WOMAC Osteoarthritis Index 



We thank all OA patients who participated in the study.


Prof. Nicholas Bellamy is the registered copyright and trademark holder of the WOMAC Index.


  1. 1.
    Goncalvesyz RS, Cabriy J, Pinheirox JP, Ferreirak PL (2009) Cross-cultural adaptation and validation of the Portuguese version of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Osteoarthr Cartil 17:1156–1162CrossRefGoogle Scholar
  2. 2.
    Arden N, Cooper C (2006) Osteoarthritis handbook. Taylor & Francis, LondonGoogle Scholar
  3. 3.
    Lawrence RC, Hochberg MC, Kelsey JL et al (1989) Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol 16:427–441PubMedGoogle Scholar
  4. 4.
    Basaran S, Guzel R, Seydaoglu G, Guler-Uysal F (2010) Validity, reliability, and comparison of the WOMAC Osteoarthritis Index and Lequesne Algofunctional Index in Turkish patients with hip or knee osteoarthritis. Clin Rheumatol 29:749–756PubMedCrossRefGoogle Scholar
  5. 5.
    Lequesne M (1991) Indices of severity and disease activity for osteoarthritis. Semin Arthritis Rheum 20(6 Suppl 2):48–54PubMedCrossRefGoogle Scholar
  6. 6.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840PubMedGoogle Scholar
  7. 7.
    Meenan RF, Gertman PM, Mason JH (1980) Measuring health status in arthritis. The Arthritis Impact Measurement Scales. Arthritis Rheum 23:146–152PubMedCrossRefGoogle Scholar
  8. 8.
    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedGoogle Scholar
  9. 9.
    Escobar A, Quintana JM, Bilbao A et al (2002) Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Clin Rheumatol 21:466–471PubMedCrossRefGoogle Scholar
  10. 10.
    Bellamy N (2008) Principles of outcome assessment. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology, 4th edn. Mosby Elsevier, Spain, pp 12–20Google Scholar
  11. 11.
    Lequesne MG, Mery C, Samson M, Gerard P (1987) Indexes of severity for osteoarthritis of the hip and knee. Scand J Rheumatol 65(Suppl):85–89CrossRefGoogle Scholar
  12. 12.
    Bellamy N. WOMAC Osteoarthritis Index. Available at: Access date: 2/11/2011
  13. 13.
    Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049PubMedCrossRefGoogle Scholar
  14. 14.
    Brazier JE, Harper R, Munro J (1999) Generic and condition specific outcome measures for people with OA of the knee. Rheumatology 38:870–877PubMedCrossRefGoogle Scholar
  15. 15.
    Bellamy N (2003) WOMAC Osteoarthritis Index user guide IX. Brisbane, AustraliaGoogle Scholar
  16. 16.
    Lequesne MG (1997) The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 24:779–781PubMedGoogle Scholar
  17. 17.
    Jones EG, Kay M (1992) Instrumentation in cross-cultural research. Nurs Res 41:186–188PubMedGoogle Scholar
  18. 18.
    Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46:1417–1432PubMedCrossRefGoogle Scholar
  19. 19.
    Stewart AL, Hays RD, Ware JE (1988) The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care 26:724–735PubMedCrossRefGoogle Scholar
  20. 20.
    Stewart AL, Sherbourne CD, Hays RD et al (1992) Developing and testing the MOS 20-Item Short-Form Survey: a general population application in measuring functioning and wellbeing. In: Stewart AL, Ware JE Jr (eds) The medical outcome study approach. Dule University Press, DurhamGoogle Scholar
  21. 21.
    Stewart AL, Ware JE, Brook RH (1982) Construction and scoring of aggregate functional status measures, vol 1. Rand Corp, Santa Monica, Publication no. R2551-I-HHSGoogle Scholar
  22. 22.
    Robb JC, Young LT, Cooke RG, Joffe RT (1998) Gender differences in patients with bipolar disorder influence outcome in the Medical Outcomes Survey (SF-20) subscale scores. J Affect Disord 49:189–193PubMedCrossRefGoogle Scholar
  23. 23.
    Aalto AM, Aro S, Ohinmma A, Aro AR, Mähönen M (1997) The validation of the SF-20 instrument for health related quality of life in the Finnish general population. STAKES, National Research and Development Centre for Welfare and Health. 37/1997, Helsinki, FinlandGoogle Scholar
  24. 24.
    Hanninen J, Takala J, Keinanen-Kiukaanniemi S (1998) Quality of life in NIDDM patients assessed with the SF-20 questionnaire. Diabetes Res Clin Pract 42:17–27Google Scholar
  25. 25.
    Scharloo M, Kaptein AA, Weinman J, Hazes JM, Willems LNA, Bergman W, Rooijmans HGM (1998) Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. J Psychosom Res 44:573–585PubMedCrossRefGoogle Scholar
  26. 26.
    Smith MY, Feldman J, Kelly P, DeHovitz JA, Chirgwin K, Minkoff H (1996) Health-related quality of life of HIV-infected women: evidence for the reliability, validity and responsiveness of the Medical Outcomes Study Short-Form 20. Qual Life Res 5:47–55PubMedCrossRefGoogle Scholar
  27. 27.
    Kempen GI, Ormel J, Brilman EI, Relyveld J (1997) Adaptive responses among Dutch elderly: the impact of eight chronic medical conditions on health-related quality of life. Am J Publ Health 87:38–44CrossRefGoogle Scholar
  28. 28.
    Flandry F, Hunt JP, Terry GC, Hughston JC (1991) Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 19:112–118PubMedCrossRefGoogle Scholar
  29. 29.
    Guermazi M, Poiraudeau S, Yahia M, Mezganni M, Fermanian J, Elleuch MH, Revel M (2004) Translation, adaptation and validation of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for an Arab population: the Sfax modified WOMAC. Osteoarthr Cartil 12:459–468PubMedCrossRefGoogle Scholar
  30. 30.
    Stucki G, Sangha O, Stucki S, Michel BA, Tyndall A, Dick W, Theiler R (1998) Comparison of the WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index and a self-report format of the self-administered Lequesne-Algofunctional Index in patients with knee and hip osteoarthritis. Osteoarthr Cartil 6:79–86PubMedCrossRefGoogle Scholar
  31. 31.
    Kuptniratsaikul V, Rattanachaiyanont M (2007) Validation of a modified Thai version of the Western Ontario and McMaster (WOMAC) Osteoarthritis Index for knee osteoarthritis. Clin Rheumatol 26:1641–1645PubMedCrossRefGoogle Scholar
  32. 32.
    Bae SC, Lee HS, Yun HR, Kim TH, Yoo DH, Kim SY (2001) Cross-cultural adaptation and validation of Korean Western Ontario and McMaster Universities (WOMAC) and Lequesne osteoarthritis indices for clinical research. Osteoarthr Cartil 9:746–750PubMedCrossRefGoogle Scholar
  33. 33.
    Tuzun EH, Eker L, Aytar A, Daskapan A, Bayramoglu M (2005) Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC Osteoarthritis Index. Osteoarthr Cartil 13:28–33PubMedCrossRefGoogle Scholar
  34. 34.
    Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L (2003) Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthr Cartil 11:551–560PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Haidar Nadrian
    • 1
  • Nasrin Moghimi
    • 2
  • Elham Nadrian
    • 3
  • Rahmatollah Moradzadeh
    • 1
  • Kaveh Bahmanpour
    • 1
  • Abedin Iranpour
    • 4
  • Nicholas Bellamy
    • 5
  1. 1.School of NursingIslamic Azad University-Sanandaj BranchSanandajIran
  2. 2.Tohid HospitalKurdistan University of Medical SciencesSanandajIran
  3. 3.School of Psychology and Training SciencesPayam-e-Noor University-Sanandaj BranchSanandajIran
  4. 4.School of Health and Health Research InstituteTehran University of Medical SciencesTehranIran
  5. 5.Centre of National Research on Disability and Rehabilitation Medicine (CONROD)University of QueenslandBrisbaneAustralia

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