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

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

In Japan, only few cross-culturally adapted, internationally used orthopaedic patient self-assessed outcome scores are available. In addition, the high incidence of knee osteoarthritis (OA) suggests the need for validated outcome measures such as the widely used Knee Injury and Osteoarthritis Outcome Score (KOOS) for Japanese populations. The purpose of this study was to provide a cross-culturally adapted and validated KOOS questionnaire for further use in national and international clinical projects involving Japanese patients.

Methods

The Japanese KOOS was developed according to the standard cross-cultural adaptation guidelines. For validation, the KOOS was tested on 58 patients diagnosed with OA. Reliability was tested using the intraclass correlation coefficient (ICC). Internal consistency or homogeneity was assessed using Cronbach’s alpha. Construct validity was evaluated by quantifying the correlation between the KOOS and the Japanese OKS and SF-36 questionnaires with Spearmann’s correlation coefficients.

Results

No major difficulties were encountered during the translation and pre-testing stages. All five KOOS subscales showed adequate reproducibility with ICC values greater than 0.85, high internal consistency with Cronbach’s alpha values around 0.90, and high Spearmann’s coefficients over 0.50 signifying good correlation between the KOOS subscales and the OKS as well as the majority of the established subscales of the SF-36. No floor and ceiling effects were observed for the five subscales.

Conclusions

Our validated Japanese KOOS is a reliable and stable outcomes measure that provides a valuable basis for national and international clinical projects focusing on patient-based assessments in knee OA.

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Acknowledgments

The authors would like to acknowledge Toshinao Sawai and Naohiko Banno from Synthes K.K. for their administrative support, and Dr. Laurent Audigé from AO Clinical Investigation and Documentation for his statistical advice.

Conflict of interest

The work of the study was supported by the AO Foundation and Synthes Japan. The authors did not receive any benefits from any commercial party related directly or indirectly to the subject of this article.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Science, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka, 530-0043, Japan

    Norimasa Nakamura

  2. Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Ryohei Takeuchi, Hiroyuki Ishikawa & Tomoyuki Saito

  3. Department of Orthopaedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1, Imaizumi-Hokubu, Toyama, 939-8511, Japan

    Takeshi Sawaguchi

  4. AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland

    Sabine Goldhahn

Authors
  1. Norimasa Nakamura
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  2. Ryohei Takeuchi
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  3. Takeshi Sawaguchi
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  4. Hiroyuki Ishikawa
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  5. Tomoyuki Saito
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  6. Sabine Goldhahn
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Corresponding author

Correspondence to Sabine Goldhahn.

Additional information

The Japanese version of the KOOS will be published with a Japanese version of the abstract in the Journal of the Japanese Orthopaedic Association.

Electronic supplementary material

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Supplementary material (PDF 305 kb)

Appendix

Appendix

See Table 3

Table 3 Reliability data for the individual 42 items of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire
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Nakamura, N., Takeuchi, R., Sawaguchi, T. et al. Cross-cultural adaptation and validation of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sci 16, 516–523 (2011). https://doi.org/10.1007/s00776-011-0112-9

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  • DOI: https://doi.org/10.1007/s00776-011-0112-9

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