Department of Research, Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.
Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
BMC Musculoskelet Disord. 2021 Aug 17;22(1):700. doi: 10.1186/s12891-021-04521-0.
Patients undergoing total knee arthroplasty (TKA) tend to be younger and tend to receive TKA at an earlier stage compared to 20 years ago. The Oxford Knee Score - Activity and Participation (OKS-APQ) questionnaire evaluates higher levels of activity and participation, reflecting activity patterns of younger or more active people. The purpose of this study was to translate the OKS-APQ questionnaire into Dutch, and to evaluate its measurement properties in pre- and postoperative TKA patients.
The OKS-APQ was translated and adapted according to the forward-backward translation multi step approach and tested for clinimetric quality. Floor and ceiling effects, structural validity, construct validity, internal consistency and test-retest reliability were evaluated using COSMIN quality criteria. The OKS-APQ, the Oxford Knee Score (OKS), the Short Form-36 (SF-36), a Visual Analogue Scale (VAS) for pain and the Forgotten Joint Score (FJS) were assessed in 131 patients (72 preoperative and 59 postoperative TKA patients), and the OKS-APQ was administered twice in 50 patients (12 preoperative and 38 postoperative TKA patients), after an interval of minimal 2 weeks.
Floor effects were observed in preoperative patients. Confirmatory factor analyses (CFA) indicated a good fit of a 1-factor model by the following indices: (Comparative Fit Index (CFI): 0.97, Tucker-Lewis Index (TLI): 0.96 and Standardized Root Mean Square Residual (SRMR): 0.03). Construct validity was supported as > 75% of the hypotheses were confirmed. Internal consistency (Cronbach α's from 0.81 to 0.95) was good in the pooled and separate pre- and postoperative samples and test-retest reliability (Intraclass Correlation Coefficients (ICCs) from 0.63 - 0.85) were good in postoperative patients and moderate in preoperative patients. The standard Error of Measurements (SEMs) ranged from 8.5 - 12.2 and the Smallest Detectable Changes in individuals (SDC) ranged from 23.5 - 34.0 (on a scale from 0 to 100).
Preliminary findings suggest that the Dutch version of the OKS-APQ is reliable and valid for a Dutch postoperative TKA patient sample. However, in a preoperative TKA sample, the OKS-APQ seems less suitable, because of floor effects and lower test-retest reliability. The Dutch version of the OKS-APQ can be used alongside the OKS to discriminate among levels of activity and participation in postoperative patients.
与 20 年前相比，接受全膝关节置换术（TKA）的患者往往更年轻，并且在更早的阶段接受 TKA。牛津膝关节评分-活动和参与（OKS-APQ）问卷评估更高水平的活动和参与度，反映了更年轻或更活跃人群的活动模式。本研究的目的是将 OKS-APQ 问卷翻译成荷兰语，并评估其在 TKA 术前和术后患者中的测量特性。
OKS-APQ 按照正向-反向翻译的多步方法进行翻译和改编，并根据临床测量质量标准进行测试。使用 COSMIN 质量标准评估地板和天花板效应、结构有效性、构建有效性、内部一致性和测试-重测信度。在 131 名患者（72 名术前和 59 名术后 TKA 患者）中评估了 OKS-APQ、牛津膝关节评分（OKS）、简短表格-36（SF-36）、疼痛视觉模拟量表（VAS）和遗忘关节评分（FJS），并在 50 名患者（12 名术前和 38 名术后 TKA 患者）中进行了两次 OKS-APQ 评估，间隔至少 2 周。
术前患者出现地板效应。验证性因子分析（CFA）表明，通过以下指标，1 因素模型拟合良好：（比较拟合指数（CFI）：0.97，塔克-刘易斯指数（TLI）：0.96 和标准化根均方残差（SRMR）：0.03）。结构有效性得到支持，因为>75%的假设得到了证实。在合并和单独的术前和术后样本中，内部一致性（Cronbach α 值为 0.81 至 0.95）良好，术后患者的测试-重测信度（组内相关系数（ICC）为 0.63 至 0.85）良好，术前患者的测试-重测信度为中度。测量误差的标准误差（SEM）范围为 8.5-12.2，个体的最小可检测变化（SDC）范围为 23.5-34.0（在 0 到 100 的量表上）。
初步研究结果表明，荷兰语版的 OKS-APQ 对荷兰语术后 TKA 患者样本具有可靠性和有效性。然而，在 TKA 术前患者中，由于地板效应和较低的测试-重测信度，OKS-APQ 似乎不太适用。荷兰语版的 OKS-APQ 可与 OKS 一起用于区分术后患者的活动和参与水平。
