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“Greek KOOS-Child: a valid, disease specific, diagnostically accurate and responsive PROM in children with knee-related pathology”

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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

References

  1. Baldwin JN, McKay MJ, Simic M et al (2017) Self-reported knee pain and disability among healthy individuals: reference data and factors associated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and KOOS-Child. Osteoarthr Cartil 25(8):1282–1290

    Article  CAS  Google Scholar 

  2. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25(24):3186–3191

    Article  CAS  Google Scholar 

  3. Bullinger M, Levke A (2008) Michael Erhart Ravens-Sieberer U and the BELLA study group psychometric properties of the KINDL-R questionnaire: results of the BELLA study. Eur Child Adolesc Psychiatry 17:125–132

    Article  Google Scholar 

  4. Bullinger M (1997) Entwicklung und Anwendung von Instrumenten zur Erfassung der Lebensqualitat. In: Bullinger M (ed) Lebensqualita¨tsforschungBedeutungAnforderungAkzeptanz. Stuttgart New York, Schattauer

    Google Scholar 

  5. Cohen J (1988) Statistical power analysis for the behavioral sciences. Routledge Academic, New York, NY

    Google Scholar 

  6. Hajian-Tilaki K (2013) Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med 4(2):627–635

    PubMed  PubMed Central  Google Scholar 

  7. https://www.cosmin.nl/wp-content/uploads/COSMIN-methodology-for-content-validity-user-manual-v1.pdf (2018). (Accessed Mar 2018).

  8. https://www.kidscreen.org/english/project/ (2004) (Accessed Janu 2018).

  9. https://www.kidscreen.org/english/questionnaires/ (2004) file:///C:/Users/panther/Downloads/KIDSCREEN%2520instruments_description_English.pdf. (Accessed Janu 2018).

  10. https://www.kindl.org/english/information/ (1994) (Accessed Janu 2018).

  11. Kerssemakers SP, Fotiadou AN, de Jonge MC, Karantanas AH, Maas M (2009) Sport injuries in the paediatric and adolescent patient: a growing problem. Pediatr Radiol 39(5):471–484

    Article  Google Scholar 

  12. kooschildusersguide. pdf website (2013). https://www.koos.nu/kooschildusersguide.pdf. (Accessed Jul 2019)

  13. Mokking LB, Terwee CB, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HCW (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19(4):539–549

    Article  Google Scholar 

  14. Momayyezi M, Fallahzadeh H, Farzaneh F, Momayyezi M, Bazm S (2018) Design, validity and reliability of the cancer-related fatigue questionnaire in children with cancer aged 4–18 years. J Compr Ped 9(4):e66245

    Google Scholar 

  15. Nunnally JC, Bernstein IH (1994) The assessment of reliability. Psychometr Theory 3:248–292

    Google Scholar 

  16. Örtqvist M, Iversen MD, Janarv P-M, Broström EW, Roos EM (2014) Psychometric properties of the Knee injury and osteoarthritis outcome score for children (KOOS-Child) in children with knee disorders. BJ Sport Med 48:1437–1446

    Article  Google Scholar 

  17. Örtqvist M, Roos EM, Brostrom EW, Janarv P-M, Iversen MD (2012) Development of the knee injury and osteoarthritis outcome score for children (KOOS-Child): comprehensibility and content validity. Acta Orthop 83(6):666–673. https://doi.org/10.3109/17453674.2012.747921

    Article  PubMed  PubMed Central  Google Scholar 

  18. Portney LG, Watkins MP (2009) Foundations of clinical research: applications to practice. Pearson/Prentice Hall, Upper Saddle River, NJ

    Google Scholar 

  19. Ravens-Sieberer et al, 2005, Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, Auquier P, Power M, Abel T, Czemy L, Mazur J, Czimbalmos A, Tountas Y, Hagquist C, Kilroe J, and the European KIDSCREEN Group (2005) European KIDSCREEN Group KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoeconomics Outcomes Res 5:353–364

    Article  Google Scholar 

  20. Ravens-Sieberer U, Kurth B-M, KiGGS study group, BELLA Study Group (2008) The mental health module (BELLA study) within the German Health Interview and Examination Survey of Children and Adolescents (KiGGS): study design and methods. Eur Child Adolesc Psychiatry 17(Suppl1):10–21

    Google Scholar 

  21. Ravens-Sieberer U, Görtler E, Bullinger M (2000) Subjektive Gesundheit und Ge-sundheitsverhalten von Kindern und Jugendli-chen-Eine Befragung Hamburger Schüler im Rahmen der schulärztlichen Untersuchung. Gesundheitswesen 62:148–155

    Article  CAS  Google Scholar 

  22. Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation of a Swedish version. Scand J Med Sci Sport 8:439–448

    Article  CAS  Google Scholar 

  23. Roos EM, Toksvig-Larsen S (2003) Knee injury and osteoarthritis outcome score (KOOS) -validation and comparison to the WOMAC in total knee replacement. Health Q Life Outcomes 1:45

    Article  Google Scholar 

  24. Trottier RE, Beauséjour M, Lamer S, Glava P, Grimard G, NaultM L (2019) Validation of the French version of the KOOS-child questionnaire. Knee Surg Sports Traumatol Arthrosc. 27(7):2361–2367

    Article  Google Scholar 

  25. Tzavara C, Tzonou A, Zervas I, Ravens-Sieberer U, Dimitrakaki C, Tountas Y (2012) Reliability and validity of the KIDSCREEN-52 health-related quality of life questionnaire in a Greek adolescent population. Ann Gen Psychiatry 11:3

    Article  Google Scholar 

  26. Unal I (2017) Defining an optimal cut-point value in ROC analysis: an alternative approach. Comput Mathemat Methods Med 1:14

    Google Scholar 

  27. van der Velden CA, van der Steen MC, van Florens JL, Douveren RJ, Reijman PAM (2019) Pedi-IKDC or KOOS-child: which questionnaire should be used in children with knee disorders? BMC Musculoskelet Disord 20:240. https://doi.org/10.1186/s12891-019-2600-6

    Article  PubMed  PubMed Central  Google Scholar 

  28. van Doorn RK, Winkler LMZ, Mearin KH, Koopman ML (2008) CDDUX: a disease-specific health-related quality-of-life questionnaire for children with celiac disease. J Pediatr Gastroenterol Nutr 47(2):147–152

    Article  Google Scholar 

  29. Vidali E, Vidalis A, Ravens-Sieberer U, Bullinger M (2001) The Greek Edition of the KINDL-R questionnaire. Hippocrateia J 5(3):124–135

    Google Scholar 

  30. Wee HL, Ravens-Sieberer U, Erhart M, Li SC (2007) Factor structure ofthe Singapore English version of the KINDL children quality of life questionnaire. Health Qual Life Outc 5:4

    Article  Google Scholar 

  31. Wolfler A, Giannini A, Finistrella M, Salvo I, Calderini E, Frasson G, Dall'Oglio I, Di Furia M, Iuzzolino R, Musicco M, Latour JM (2017) Empowerment of parents in the intensive care questionnaire: translation and validation in Italian PICUs. Pediatr Crit Care Med 18(2):e77–e85

    Article  Google Scholar 

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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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There is no funding source.

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Authors and Affiliations

  1. University of West Attica, 5 Spirou Papaspirou, Peania, 19002, Patras, Greece

    Maria Moutzouri

  2. Karamandaneion Paediatric General Hospital of Patras, Patras, Greece

    Pantelis Tsoumpos

  3. University of Patras, Patras, Greece

    Theofani Bania & Evdokia Billis

  4. University Hospital of Rion, Patras, Greece

    John Gliatis

Authors
  1. Maria Moutzouri
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  2. Pantelis Tsoumpos
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  3. Theofani Bania
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  4. Evdokia Billis
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  5. John Gliatis
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Contributions

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.

Corresponding author

Correspondence to Maria Moutzouri.

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The authors declare that they have no conflict of interest.

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Ethical approval was granted from the Scientific Committee of Karamandaneion Paediatric General Hospital of Patras (Greece).

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It was given from children and their parents.

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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

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