Kim Seok Jin, Basur Mohnish Singh, Park Chang Kyu, Chong Suri, Kang Yeon Gwi, Kim Moon Ju, Jeong Jeong Seong, Kim Tae Kyun
Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Korea.
Department of Orthopaedic Surgery, Al Raha Hospital, AbeerGroup, Abu Dhabi, UAE.
Clin Orthop Relat Res. 2017 Jun;475(6):1629-1639. doi: 10.1007/s11999-017-5307-8. Epub 2017 Mar 6.
The 2011 Knee Society Score (2011 KS Score) is used to characterize the expectations, symptoms, physical activity, and satisfaction of patients who undergo TKA and is widely used to assess the outcome of TKA. However, it has not been adapted or validated for use in Korea.
QUESTIONS/PURPOSES: We developed a Korean version of the 2011 KS Score and evaluated the (1) test-retest reliability, (2) convergent validity, and (3) responsiveness of the Korean version.
The Korean version of the 2011 KS Score was derived by using a well-established translational procedure based on international guidelines, which include translation, synthesis, back-translation, expert committee review, pretesting, and submission for appraisal. A total of 123 patients with knee osteoarthritis who were scheduled to undergo TKA were recruited for the study. Ninety percent of the patients (111 of 123) were women, which is an exact representation of the Korean population having TKAs. To evaluate reliability, the patients were evaluated twice during a 4-week interval using the questionnaire. Reliability was assessed by using intraclass correlation coefficients (ICCs) and internal consistency by using Cronbach's alpha to determine the validity of the Korean version of the 2011 KS Score. The patients were evaluated by using the validated Korean versions of the WOMAC and SF-36 questionnaires. Spearman's correlation coefficient was used for validation. Responsiveness was determined by calculating the standardized response mean from the preoperative and postoperative test scores in the Korean version of the 2011 KS Score. To address the gender disparity in our study we identified 53 males who underwent TKA for osteoarthritis after completion of this study and generated age-matched controlled groups to evaluate construct validity and responsiveness in Korean males.
The reliability proved good to excellent with an ICC between 0.69 and 0.85, depending on the clinical properties tested, which included the following: symptoms, satisfaction, expectation, and total functional activity consisting of functional activity, standard activity, advanced activity, and discretionary activity. All subscales showed good to excellent internal consistency indicated by Chronbach's alpha (range, 0.83-0.92). For validity, three of the four domains (the exception was expectation) of the 2011 KS Score, correlated either strongly or moderately with the Korean WOMAC score (r ≥ 0.35). When compared with the SF-36, the satisfaction domain showed a weak positive correlation with all the subscales of the SF-36 except general health (r < 0.35). The activity domain showed a strong positive correlation with physical function (r = 0.62) and physical component summary (r = 0.52), moderate with physical role (r = 0.46), and weak with bodily pain (r = 0.26) and social function (r = 0.31). The symptom domain also exhibited a similar moderate positive correlation with physical function (r = 0.41) and weak positive correlation with bodily pain, social function, and physical component summary (r = 0.22, 0.20, and 0.26, respectively). For responsiveness, all the domains of Korean version of the 2011 KS Score, except for expectation, showed large changes (> 0.8), calculated as standardized response mean. The total amount of the Korean version of the 2011 KS Score (2.03, p < 0.001) showed higher responsiveness when compared with the WOMAC total (1.88, p < 0.001) and SF-36 physical and mental component summaries (1.14, p < 0.001; and 0.68, p < 0.001, respectively).
The Korean version of the 2011 KS Score was successfully developed using a process of crosscultural adaptation for the Korean-speaking population who had undergone TKA for osteoarthritis of the knee. The Korean version of the 2011 KS Score was shown to be a reliable, valid, and responsive tool and can be used to assess functional outcomes and expectations of Korean patients who undergo TKA. The demographic features of TKA in the Korean population should be taken into account with additional studies recommended to further investigate these psychometric properties in Korean men.
Level II, diagnostic study.
2011年膝关节协会评分（2011 KS评分）用于描述接受全膝关节置换术（TKA）患者的期望、症状、身体活动及满意度，被广泛用于评估TKA的疗效。然而，该评分在韩国尚未进行调整或验证。
问题/目的：我们开发了2011 KS评分的韩文版，并评估了其（1）重测信度、（2）收敛效度和（3）反应度。
2011 KS评分的韩文版是根据国际指南采用成熟的翻译程序得出的，该程序包括翻译、综合、回译、专家委员会审查、预测试和提交评估。本研究共招募了123例计划接受TKA的膝关节骨关节炎患者。90%的患者（123例中的111例）为女性，这准确反映了接受TKA的韩国人群情况。为评估信度，使用该问卷在4周间隔内对患者进行了两次评估。通过组内相关系数（ICC）评估信度，使用Cronbach's α评估内部一致性，以确定2011 KS评分韩文版的效度。使用经过验证的韩文版WOMAC和SF - 36问卷对患者进行评估。采用Spearman相关系数进行验证。通过计算2011 KS评分韩文版术前和术后测试分数的标准化反应均值来确定反应度。为解决本研究中的性别差异问题，在本研究完成后，我们确定了53例因骨关节炎接受TKA的男性患者，并生成年龄匹配的对照组，以评估韩文版在韩国男性中的结构效度和反应度。
根据所测试的临床特性，包括症状、满意度、期望以及由功能活动、标准活动、高级活动和自主活动组成的总功能活动，信度良好至优秀，ICC在0.69至0.85之间。所有子量表均显示出良好至优秀的内部一致性，Cronbach's α值范围为0.83 - 0.92。对于效度，2011 KS评分的四个领域中的三个（期望除外）与韩文版WOMAC评分呈强或中度相关（r≥0.35）。与SF - 36相比，满意度领域与SF - 36的所有子量表（一般健康除外）呈弱正相关（r < 0.35）。活动领域与身体功能（r = 0.62）和身体成分总结（r = 0.52）呈强正相关，与身体角色呈中度相关（r = 0.46），与身体疼痛（r = 0.26）和社会功能（r = 0.31）呈弱相关。症状领域与身体功能也表现出类似的中度正相关（r = 0.41），与身体疼痛、社会功能和身体成分总结呈弱正相关（分别为r = 0.22、0.20和0.26）。对于反应度，2011 KS评分韩文版的所有领域（期望除外），以标准化反应均值计算显示出较大变化（> 0.8）。2011 KS评分韩文版的总量表（2.03，p < 0.001）与WOMAC总量表（1.88，p < 0.001）以及SF - 36身体和心理成分总结（分别为1.14，p < 0.001；和0.68，p < 0.001）相比，显示出更高的反应度。
通过跨文化适应过程，成功开发了2011 KS评分的韩文版，适用于因膝关节骨关节炎接受TKA的韩国人群。2011 KS评分韩文版被证明是一种可靠、有效且具有反应度的工具，可用于评估接受TKA的韩国患者的功能结局和期望。韩国人群TKA的人口统计学特征应予以考虑，建议进行更多研究以进一步调查韩文版在韩国男性中的这些心理测量特性。
II级，诊断性研究。
