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. 2025 Jul 4;26(1):620.
doi: 10.1186/s12891-025-08870-y.

Cross-cultural adaption of the Knee injury and Osteoarthritis Outcome Score (KOOS) into Punjabi for knee injury and osteoarthritis patients in Canada

Nitya Suryaprakash  1   2 , Jackie L Whittaker  3   4 , Marie Westby  3   5 , Richard Sawatzky  6   7 , Stirling Bryan  8   9 , Kusum Soni  1 , Kamaljit Sidhu  10 , Santosh Powar  11 , Laurie J Goldsmith  12
Affiliations

Cross-cultural adaption of the Knee injury and Osteoarthritis Outcome Score (KOOS) into Punjabi for knee injury and osteoarthritis patients in Canada

Nitya Suryaprakash et al. BMC Musculoskelet Disord. .

Abstract

Background: The Knee injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific patient-reported outcome that is used to assess knee-related symptoms, function and quality of life across a variety of knee conditions in patient populations. Currently there is no Punjabi version of the tool available. This study aims to cross-culturally adapt the KOOS tool from the source English language to the target Punjabi language for use in the Canadian health context.

Methods: We followed standard guidelines including: 1) creation of a concept definition document 2) forward translation 3) reconciliation 4) back translation 5) expert committee review 6) creation of pilot version for cognitive interviews 7) cognitive interviews 8) final review and proof reading.

Results: Thirty people identifying as South Asian with lived experiences of various knee conditions took part in cognitive interviews (70% women, mean age 61 years) to provide insights into equivalence in conceptual, semantic, and content between the source English language and the target Punjabi language KOOS. Cognitive interviews identified comprehension and interpretation, structural, conceptual, cultural, and other issues in the preliminary Punjabi KOOS. These issues were addressed considering the Punjabi audience and culture in Canada, and the purpose of the tool to arrive at a cross-culturally adapted Punjabi KOOS.

Conclusion: A cross-culturally Punjabi version of the KOOS is available to assess knee related outcomes of SA Punjabi patients in Canada. Future validation of the tool is required with SA Punjabi patients in Canada to ensure that the "target Punjabi instrument" has the same properties as the "original English KOOS instrument".

Keywords: Cross-cultural adaptation; KOOS; Knee injuries; Osteoarthritis; Punjabi.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Harmonised Ethics Board through British Columbia Provincial Research Ethics Platform (PREP) (#H23-03004)]. The authors certify that the study was performed in accordance with the ethical standards detailed in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Competing interests: JLW is a Senior Editor with the Journal of Orthopaedic and Sport Physical Therapy, Associate Editor with the British Journal of Sports Medicine, Arthritis Society (Canada) Integrated Scientific and Medical Advisory Committee member and Data Safety and Monitoring Committee member for the PIKASO trial.

Figures

Fig. 1
Fig. 1
Pictorial flow chart of the translation of the original KOOS English instruments to Punjabi (Canadian)
See this image and copyright information in PMC

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References

    1. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96. - PubMed
    1. Roos EM, Lohmander LS. The knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. - PMC - PubMed
    1. Svantesson E, Hamrin Senorski E, Webster KE, Karlsson J, Diermeier T, Rothrauff BB, et al. Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. Orthop J Sports Med. 2020;8(7):2325967120934751. - PMC - PubMed
    1. Rodriguez-Merchan EC. Knee instruments and rating scales designed to measure outcomes. J Orthop Traumatol. 2012;13(1):1–6. - PMC - PubMed
    1. Roos EM. 30 years with the Knee injury and Osteoarthritis Outcome Score (KOOS). Osteoarthritis Cartilage. 2024;32(4):421–9. - PubMed

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