Section of Sports Traumatology M51, Bispebjerg and Frederiksberg Copenhagen University Hospital, Copenhagen, Denmark.
Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Copenhagen University Hospital, Copenhagen, Denmark.
Scand J Med Sci Sports. 2023 Sep;33(9):1831-1840. doi: 10.1111/sms.14413. Epub 2023 May 29.
Pedi-IKDC is commonly used to evaluate anterior cruciate ligament (ACL) deficiency in children. However, its construct validity has not been thoroughly assessed. The aim was to examine the measurement properties of the Pediatric International Knee Documentation Committee (Pedi-IKDC) by modern test theory (MTT) models, confirmatory factor analysis (CFA), and item response theory (IRT).
The cohort consisted of all children and adolescents in Denmark (n = 535, age 9-16) treated with physeal-sparing ACL reconstruction 2011-2020. Patient-reported outcome measure (PROM) data were collected before surgery and at 1 year follow-up. Structural validity of Pedi-IKDC was assessed with MTT models. Reliability was reported as McDonalds coefficient omega. Responsiveness was evaluated with standardized response means.
Sufficient PROM data were available for 372 patients. The original unidimensional construct did not fit CFA model expectations neither before surgery (χ = 462.0, df = 163, p < 0.0001; RMSEA: 0.109, CFI: 0.910, TFI: 0.895) nor at follow-up. Neither did a two-factor CFA model with "Symptoms" and "Sports activities" as individual subscales (χ = 455.6, df = 162, p < 0.0001) nor a bifactor model (χ = 338.9, df = 143, p < 0.0001), although fit indices improved with the latter (RMSEA: 0.094, CFI: 0.941, TFI: 0.922). The IRT models confirmed this pattern. The scale was responsive (SRM 1.66 (95% CI: 1.46-1.88)). Coefficient omega values were 0.866 before surgery and 0.919 at follow-up.
The Pedi-IKDC exhibited inadequate structural validity. Neither the original construct, a two-factor model, nor bifactor models fitted data well. We advise that data obtained by Pedi-IKDC are interpreted with caution.
Pedi-IKDC 常用于评估儿童前交叉韧带（ACL）缺失。然而，其结构效度尚未得到充分评估。本研究旨在通过现代测试理论（MTT）模型、验证性因子分析（CFA）和项目反应理论（IRT）来检验小儿国际膝关节文献委员会（Pedi-IKDC）的测量特性。
该队列包括丹麦所有（n=535，年龄 9-16 岁）2011 年至 2020 年接受骺板保留 ACL 重建术的儿童和青少年。在手术前和 1 年随访时收集患者报告的结局测量（PROM）数据。通过 MTT 模型评估 Pedi-IKDC 的结构效度。信度以 McDonalds 系数 ω 报告。反应性用标准化反应均值进行评估。
372 例患者有足够的 PROM 数据。原始的单维结构在手术前（χ²=462.0，df=163，p<0.0001；RMSEA：0.109，CFI：0.910，TFI：0.895）和随访时（χ²=455.6，df=162，p<0.0001）均不符合 CFA 模型预期。“症状”和“运动活动”作为单独分量表的两因素 CFA 模型（χ²=455.6，df=162，p<0.0001）或双因素模型（χ²=338.9，df=143，p<0.0001）也不符合，尽管后者的拟合指数有所改善（RMSEA：0.094，CFI：0.941，TFI：0.922）。IRT 模型证实了这一模式。该量表具有反应性（SRM 1.66（95%CI：1.46-1.88））。手术前的 ω 值为 0.866，随访时为 0.919。
Pedi-IKDC 表现出结构效度不足。原始结构、两因素模型或双因素模型都不能很好地拟合数据。我们建议谨慎解释 Pedi-IKDC 获得的数据。
