A. Almangoush*, L. Herrington*, I. Attia, R. Jones*, A. Aldawoudy, A. Abdul Aziz, A. Waley

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1 Published in: Osteoarthritis and Cartilage 21 (2013) Cross-cultural adaptation, reliability, internal consistency and validation of the Arabic version of the Knee injury and Osteoarthritis Outcome Score (KOOS) for Egyptian people with knee injuries A. Almangoush*, L. Herrington*, I. Attia, R. Jones*, A. Aldawoudy, A. Abdul Aziz, A. Waley *College of Health, Sport and Rehabilitation Sciences, University of Salford, Salford M6 6PU, United Kingdom Alexandria Knee Centre, 5 Mohamed Fawzy Moaz St., Smoha, Alexandria, Egypt Faculty of Medicine, Cairo University, Cairo, Egypt Faculty of Medicine, Alexandria University, Alexandria, Egypt Summary Objective: The objective of this study was to cross-culturally adapt and validate the Arabic version of the Knee injury and Osteoarthritis Outcome Score (KOOS) among a sample from Egyptian populace. Methods: This version was obtained with forward/backward translations and pre-testing. The Arabic KOOS, the RAND-36-Item Health Survey (RAND-36) questionnaire, visual analogue scales (VAS) of pain and a form for patient characteristics were used. Testeretest reliability and internal consistency were assessed, using Intraclass Correlation Coefficient (ICC) and Cronbach s alpha, respectively. The dimensionality was assessed, by factor analysis and construct validity by using a priori hypothesized correlations with the RAND-36. Ceiling/floor effects and measurement error were tested as well. Results: No major difficulties were encountered during the translation and pre-testing stages. Reliability was acceptable with Cronbach s alpha coefficients between 0.80 and 0.95, and ICCs ranging from 0.88 to 0.96 for the KOOS subscales. Factor analysis was performed on the whole study population and the results indicated that all items of the Arabic KOOS loaded on one factor, which ranged from 0.34 to Construct validity was supported by the confirmation of all priori hypotheses by the presence of higher correlations between similar constructs than between dissimilar constructs of the KOOS subscales, RAND-36 subscales and VAS. Floor/ceiling effects were considered not to be present. Conclusion: The Arabic KOOS is a reliable and valid instrument that can be self-administered to Egyptian patients and provides a valuable basis for research and clinical projects focussing on patient-based assessments in anterior cruciate ligament (ACL), meniscus and combined injures of knee. Further studies to validate the Arabic version of the KOOS using females and elderly population with different knee problems and various educational levels in other Arabic counties are highly recommended. For information regarding the Arabic (Egypt) version of KOOS, please contact Adel Almangoush 102 Norton Street Manchester M16 7GU Tel: 0044 (161) Mob: A.A.Almangoush@edu.salford.ac.uk

2 إستبيان لتقييم الحالة الصحية للركبة SOOK( ) تاريخ اليوم:.../.../... تاريخ الميالد:.../.../... األسم... هذه المعلومات سوف تساعدنا لمعرفة كيف تشعر بركبتك و كذالك كيف ستكون قادر علي إنجاز نشاطاتك اإلعتيادةة. أجب كل سؤال بوضععالمة ( ) واحدةعلي اإلجابة المناسبة أمام كل سؤال, وإذا كنت غير متأكد من اإلجابة الرجاء إختيار أقرب إجابة ممكنة. أعراض المرض ةنبغي اإلجابة علي هذه األسئلة المتعلقة باألعراض المصاحبة لركبتك خالل األسبوع الماضي. صعوبة فرد الركبة عند إستيقاضك في الصباح ما هي شدة K 1 ما هي شدة صعوبة فرد الركبة بعد وضع الجلوس التمدد أو اإلسترخاء في وقت الحق من نفس اليوم K 2 هل يوجد تورم في ركبتك K 3 داةما هل تشعر بأي خشخشة أوسماع فرقعة أو أي نوع آخر من األصوات عندما تحرك ركبتك K 4 داةما هل ركبتك تقفش فجأة أو بتعلق عندما تقوم بالحركة K 5 داةما التيبس األسئلة التالية تتعلق بدرجة تيبس )تصلب( مفصل الركبة الذي أحسست به خالل األسبوع الماضي. التيبس هو الشعور بالتقييد أو البطئ في سهولة حركة مفصل الركبة. هل يمكنك فرد ركبتك بالكامل )علي اآلخر ( K 6 ماحصلش نادرا أحيانا غالبا دايما هل يمكنك ثني ركبتك بشكل كامل )علي اآلخر ( K 7 ماحصلش نادرا أحيانا غالبا دايما 1

3 األلم )الوجع ) P 1 كم مرة تحس بوجع في ركبتك عادة داةما كل يوم كل أسبوع كل شهر ماحصلش ماهي شدة الوجع التي قد تكون شعرت بها ألسبوع الماضيخالل آدائك للنشاطات اآلتية... اللف و اإلستناد )اإلرتكاز( علي الركبة المصابة P 2 P 3 فرد الركبة بالكامل ثني الركبة بالكامل )وضع الجلوس في الصالة مثال...( P 4 المشي على األرض المستوية P 5 شديد معتدل خفيف الشئ P 6 طلوع أو نزول الساللم في الليل أثناء وجودك في السرير للنوم P 7 وضع الجلوس أو وضع النوم )اإلستلقاء( P 8 عند وقوفك في الوضع الطبيعي P 9 أنشطة الحياة اليومية ما الصعوبات التي قابلتها في الركبةاألسبوعالماضي... في نزول الساللم A 1 2

4 في صعود )طلوع( الساللم A 2 القيام من وضع الجلوس A 3 الوقوف A 4 إنحناء الجسم أو توطى إللتقاط األشياء )الحاجات( من علي األرض A 5 المشي على أرض مستوية A 6 الصعود و النزول من السيارة )العربية( A 7 الذهاب للتسوق A 8 لبس الشرابات القصيرة أو الطويلة A 9 القيام )النهوض( من السرير A 11 خلع الشرابات القصيرة أو الطويلة A 11 النوم في السرير )التقلب علي أحد الجانيبين أوالحفاظ على وضع ثابث للركبة( A 12 عند قيامك باإلستحمام A 13 وضع الجلوس A 14 عند قيامك بقضاء الحاجة )قياما و قعودا من علي التواليت ) A 15 3

5 األعمال المنزلية المجهدة )تحريك و نقل الصناديق الثقيلة, شطف البالط... ا خ(ل A 16 األعمال المنزلية الخفيفة )الطبخ و مسح الغبار... ا خ(ل A 17 النشاط الرياضي و المهارات الالزمة لممارسة الهوايات ما الصعوبات التي قابلتها في الركبة االسبوعالماضي ثني الركبتين من وضع الوقوف KP 1 KP 2 الجري القفز)النط( KP 3 اللف و اإلستناد )اإلرتكاز( علي الركبة المصابة KP 4 النزول و اإلرتكاز علي الركبتين )كالنزول للسجود في الصالة مثال...( KP 5 الركبة المصابة و عالقتها بنمط الحياة Q1 Q3 إلي أي مدي تشغلك مشاكل ركبتك أو تمثل مساحة من ذهنك أو تفكيرك داةما يوميا أسبوعيا شهريا ماحصلش هل قمت بتعديل أسلوب حياتك لتجنب األنشطة التي قد تسبب تلفا في ركبتك Q2 كليا بشدة بإعتدال قليال ماحصلش ما مدي قلقك من عدم ثقتك بكفأة آداء ركبتك بشدة كبيرة بشدة معتدل قليال ماحصلش بشكل عام ما مدى الصعوبات التي تقابلها عند ممارسة حياتك الطبيعية بسبب مشاكل ركبتك Q 4 شكرا جزيال إلجابتك علي كل األسئلة في هذا اإلستبيان 4

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