Are the Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score Measures Validated for Common Non-English Languages and Associated Cultures in the United States? A Systematic Review

Abstract

Background: Versions of the Hip Disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) measures are widely used. However, inadequate translation and validation can lead to inaccurate information for non-English-speaking patients, exacerbating disparities. This systematic review examined the translation quality and measurement properties of non-English HOOS and KOOS versions.

Methods: We systematically reviewed peer-reviewed articles on linguistic or cultural adaptation and/or psychometric validation of HOOS or KOOS versions in adult hip or knee patients, focusing on the top five non-English languages spoken in the United States (Spanish, Chinese, Tagalog, Vietnamese, and Arabic). Translation quality and measurement properties were evaluated.

Results: There were 18 articles included: HOOS (one Chinese), KOOS (two Arabic, seven Chinese, two Spanish, and one Tagalog), KOOS-12 (one Spanish), KOOS for Joint Replacement (one Spanish), and KOOS-Patellofemoral subscale (PF; two Arabic and one Spanish). Of the 14 studies describing translation, six were rated as at least adequate on ≥ 80% of translation criteria. While nine studies specifically described cultural adaptation, none quantitatively assessed cross-cultural validity (i.e., measurement invariance) across language or culture. Only the Spanish KOOS-12 had high-quality evidence of sufficient structural validity and internal consistency. There was very low-quality to moderate-quality evidence of sufficient reliability for most measures and limited information about measurement error. There was sufficient construct validity for Spanish KOOS for Joint Replacement (high-quality evidence) and Spanish KOOS-PF (low-quality evidence), but moderate-quality to high-quality evidence of insufficient construct validity for several measures. There was sufficient responsiveness for most subscales of the Chinese KOOS (high-quality evidence), Spanish KOOS and KOOS-12 (moderate-quality evidence), and Chinese HOOS and Spanish KOOS-PF (low-quality evidence).

Conclusions: Potential limitations were found in the quality of available HOOS and KOOS translations. Until high-quality, validated translations are available, cautious use is necessary to prevent biased estimates of health status, which can lead to inappropriate treatment decisions and exacerbate health care disparities.

Keywords: limited English proficiency; measurement invariance; outcome assessment; psychometrics; total hip arthroplasty; total knee arthroplasty.