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Validation of Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients scheduled for total knee replacement

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Abstract

Objective

Our aim was to cross-culturally validate Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients with knee osteoarthritis (OA) scheduled for total knee replacement in Singapore.

Methods

Chinese WOMAC was translated from the original English version following standard guidelines. Patients were asked to complete a questionnaire containing the WOMAC (twice within 6 days), the Short Form 36 (SF-36), and the EuroQoL EQ-5D. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC), dimensionality using item-to-domain correlations and factor analyses. Convergent and discriminant construct validity was assessed using six each a priori hypotheses.

Results

Chinese WOMAC was well accepted by the patients in the pilot test. The Chinese and English versions were therefore administered to a consecutive sample of 131 Chinese- and 127 English-speaking subjects, respectively, with knee OA. Cronbach’s alpha exceeded 0.7 for all domains except for Chinese pain domain, whereas the ICC exceeded 0.7 for all domains. Hypothesized item-to-domain correlations were observed for all items except for four items in Chinese physical function domain. The factor analyses yielded seven and five factors with eigenvalues of more than 1.0 in the Chinese and English versions, respectively. A total of 10/12 a priori construct validity hypotheses were satisfied for the Chinese version. Weak correlations between WOMAC pain and SF-36 bodily pain and moderate correlation between WOMAC pain and EQ-5D anxiety/depression were observed.

Conclusions

Chinese WOMAC was well accepted and demonstrated acceptable psychometric properties in Singaporean patients with severe knee OA.

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Acknowledgements

We thank Mr. William Yeo, Ms. Hwee-Chi Chong, Li Wei, and Dorothy Tai from the Orthopaedic Diagnostic Center for their assistance in recruiting study subjects. This project was funded by an Academic Research Grant from the National University of Singapore, No. R-148-000-059-112.

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Authors and Affiliations

  1. Programs for Assessment of Technology in Health (PATH), Department of Clinical Epidemiology and Biostatistics, McMaster University, 25 Main Street West, Suite 2000, Hamilton, ON, Canada, L8P 1H1

    Feng Xie, Ron Goeree, Jean-Eric Tarride & Daria O’Reilly

  2. Department of Experimental Pharmacology & Pharmacy, University of Newcastle, Australia, Newcastle, NSW, Australia

    Shu-Chuen Li

  3. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore

    Ngai-Nung Lo, Seng-Jin Yeo & Kuang-Ying Yang

  4. Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore

    Julian Thumboo

  5. Department of Medicine, National University of Singapore, Singapore, Singapore

    Julian Thumboo

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  1. Feng Xie
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  2. Shu-Chuen Li
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  3. Ron Goeree
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  4. Jean-Eric Tarride
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  5. Daria O’Reilly
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  6. Ngai-Nung Lo
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  7. Seng-Jin Yeo
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  8. Kuang-Ying Yang
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  9. Julian Thumboo
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Correspondence to Feng Xie.

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Xie, F., Li, SC., Goeree, R. et al. Validation of Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients scheduled for total knee replacement. Qual Life Res 17, 595–601 (2008). https://doi.org/10.1007/s11136-008-9340-7

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  • DOI: https://doi.org/10.1007/s11136-008-9340-7

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