Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee

Fausto Salaffi, G. Leardini, B. Canesi, A. Mannoni, A. Fioravanti, R. Caporali, G. Lapadula, L. Punzi, R. Bucci, M. A. Cimmino, A. Ciocci, F. Colombo, L. Frizziero, V. Grattagliano, M. Magaro, M. T. Mascia, G. Minisola, V. Modena, M. Muratore, A. NervettiI. Olivieri, G. Perpignano, S. Rossi, L. Sabadini, P. Sarzi Puttini, F. Schiavon, A. Spano, A. Stancati, S. Stisi, F. Telese, G. Tirri

Research output: Contribution to journalArticle

127 Citations (Scopus)

Abstract

Objective: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. Methods: Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey-MOS SF-36). A sample of 258 patients was readministered the WOMAC 7-10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal-Wallis test. Results: All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test-retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. Conclusion: The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

Original languageEnglish
Pages (from-to)551-560
Number of pages10
JournalOsteoarthritis and Cartilage
Volume11
Issue number8
DOIs
Publication statusPublished - Aug 1 2003

Fingerprint

Knee Osteoarthritis
Ontario
Reproducibility of Results
Osteoarthritis
Stiffness
Nonparametric Statistics
Pain
Education
Health
Hip Osteoarthritis
Ambulatory Care Facilities
Health Surveys
Italy
Health Status
Comorbidity
Knee
Language
Demography
Outcome Assessment (Health Care)
Interviews

Keywords

  • Health status
  • Osteoarthritis of the knee
  • Trial methodology
  • Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. / Salaffi, Fausto; Leardini, G.; Canesi, B.; Mannoni, A.; Fioravanti, A.; Caporali, R.; Lapadula, G.; Punzi, L.; Bucci, R.; Cimmino, M. A.; Ciocci, A.; Colombo, F.; Frizziero, L.; Grattagliano, V.; Magaro, M.; Mascia, M. T.; Minisola, G.; Modena, V.; Muratore, M.; Nervetti, A.; Olivieri, I.; Perpignano, G.; Rossi, S.; Sabadini, L.; Sarzi Puttini, P.; Schiavon, F.; Spano, A.; Stancati, A.; Stisi, S.; Telese, F.; Tirri, G.

In: Osteoarthritis and Cartilage, Vol. 11, No. 8, 01.08.2003, p. 551-560.

Research output: Contribution to journalArticle

Salaffi, F, Leardini, G, Canesi, B, Mannoni, A, Fioravanti, A, Caporali, R, Lapadula, G, Punzi, L, Bucci, R, Cimmino, MA, Ciocci, A, Colombo, F, Frizziero, L, Grattagliano, V, Magaro, M, Mascia, MT, Minisola, G, Modena, V, Muratore, M, Nervetti, A, Olivieri, I, Perpignano, G, Rossi, S, Sabadini, L, Sarzi Puttini, P, Schiavon, F, Spano, A, Stancati, A, Stisi, S, Telese, F & Tirri, G 2003, 'Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee', Osteoarthritis and Cartilage, vol. 11, no. 8, pp. 551-560. https://doi.org/10.1016/S1063-4584(03)00089-X
Salaffi, Fausto ; Leardini, G. ; Canesi, B. ; Mannoni, A. ; Fioravanti, A. ; Caporali, R. ; Lapadula, G. ; Punzi, L. ; Bucci, R. ; Cimmino, M. A. ; Ciocci, A. ; Colombo, F. ; Frizziero, L. ; Grattagliano, V. ; Magaro, M. ; Mascia, M. T. ; Minisola, G. ; Modena, V. ; Muratore, M. ; Nervetti, A. ; Olivieri, I. ; Perpignano, G. ; Rossi, S. ; Sabadini, L. ; Sarzi Puttini, P. ; Schiavon, F. ; Spano, A. ; Stancati, A. ; Stisi, S. ; Telese, F. ; Tirri, G. / Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. In: Osteoarthritis and Cartilage. 2003 ; Vol. 11, No. 8. pp. 551-560.
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TY - JOUR

T1 - Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee

AU - Salaffi, Fausto

AU - Leardini, G.

AU - Canesi, B.

AU - Mannoni, A.

AU - Fioravanti, A.

AU - Caporali, R.

AU - Lapadula, G.

AU - Punzi, L.

AU - Bucci, R.

AU - Cimmino, M. A.

AU - Ciocci, A.

AU - Colombo, F.

AU - Frizziero, L.

AU - Grattagliano, V.

AU - Magaro, M.

AU - Mascia, M. T.

AU - Minisola, G.

AU - Modena, V.

AU - Muratore, M.

AU - Nervetti, A.

AU - Olivieri, I.

AU - Perpignano, G.

AU - Rossi, S.

AU - Sabadini, L.

AU - Sarzi Puttini, P.

AU - Schiavon, F.

AU - Spano, A.

AU - Stancati, A.

AU - Stisi, S.

AU - Telese, F.

AU - Tirri, G.

PY - 2003/8/1

Y1 - 2003/8/1

N2 - Objective: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. Methods: Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey-MOS SF-36). A sample of 258 patients was readministered the WOMAC 7-10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal-Wallis test. Results: All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test-retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. Conclusion: The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

AB - Objective: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. Methods: Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey-MOS SF-36). A sample of 258 patients was readministered the WOMAC 7-10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal-Wallis test. Results: All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test-retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. Conclusion: The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

KW - Health status

KW - Osteoarthritis of the knee

KW - Trial methodology

KW - Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index

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