Cross-cultural validation of Hindi version Knee Injury and Osteoarthritis Outcome Score (KOOS) in osteoarthritis knee

Purpose To assess the reliability, validity and responsiveness of the Hindi version of the Knee Injury and Osteoarthritis Outcome Score (H-KOOS) in osteoarthritic knee. Methods Two hundred and fourteen patients of osteoarthritis knee (OA) between 40 and 80 years of age were evaluated with H-KOOS, Short form health survey (SF12v2) and the WHOQOL-BREF questionnaire. The H-KOOS was re-evaluated after 48 h in 125 patients to assess the test–retest reliability. For responsiveness, 40 patients were treated with the intra-articular hyaluronic acid injection, and the effect was assessed after 6 weeks. Results Most of the domains in H-KOOS did not show a ceiling effect. The floor values were observed in 3.75% of patients in sports/recreation function and 2.75% of patients in Quality of life (QoL). The test–retest reliability was excellent with the Intraclass-Correlation-Coefficient (ICC) ranging from 0.89 to 0.94. Internal consistency as assessed using Cronbach‘s alpha coefficient was acceptable for pain, activities of daily living (ADL) and sport/recreation function (range 0.86–0.93); however, symptoms and QoL had weak internal consistency. There were moderate to strong correlations ( r = 0.35 to 0.6) between domains measuring similar constructs in H-KOOS, SF12v2 and WHOQOL-BREF indicating good convergent construct validity. The responsiveness as measured by the effect size (ES) and standardized response mean (SRM) was large for pain (ES 0.9, SRM 0.8), moderate for Sport/Rec (ES 0.66, SRM 0.2) and small for ADL, QoL and Symptoms subscales. Conclusion The Hindi version KOOS is a valid, reliable and responsive measure to evaluate osteoarthritis knee with minimal ceiling and floor effects. Level of evidence Prospective cohort study, level II.