Chinese versions of the Oxford knee score OKS: Their reliability and validity

Anup Kumar Pandey, Amity University Kolkata

Assessment of knee arthritis is done by the different Chinese versions of the Oxford Knee Score. They are Malaysian, Singaporean and Hong Kong Chinese versions that differ slightly in wordings and use of Cantonese in the Hong Kong version.

194 patients from mainland China participated in the study. Each of them was diagnosed with knee osteoarthritis. The patients were put into Group A that completed Malaysian OKS, Group B that completed Singaporean OKS, and Group C that completed Hong Kong OKS. 36-item Short Form Survey (SF-36) was also completed by the participants. The patients received the questionnaires through smart devices. Patients were asked to point out if they faced any difficulty in the language in the comprehension of questions of the score during the form completion. The patients were sent OKS questionnaires through WeChat® platform for reliability analysis.

For the assessment, testing, and retesting reliability, patient responses of first and second OKS were compared. Initial studies used a 1-14 days time frame between the score completion. During this period, the patient’s clinical status would not experience any major change in the absence of intervention. By using the intraclass correlation coefficient, the test-retest reliability was calculated to evaluate reproducibility. To measure internal consistency, Cronbach’s α coefficient was used. By calculating the Spearman’s rank correlation coefficients (ρ), the OKS scores were compared to the domains of SF-36. The SF-36 assesses health under Physical Component Summary (PCS) and Mental Component Summary (MCS). PCS includes Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), and General Health (GH). The MCS includes Vitality (VT), Social Functioning (SF), Role Emotional (RE), and Mental Health (MH). Using SPSS® Version 20.0 software package, the statistical analysis was performed. 

The test-retest reliability that was calculated with ICC in all three groups was 0.917, 0.921, and 0.824 respectively. The Cronbach’s α coefficient of three groups was 0.912, 0.896, and 0.846 respectively. Group A showed strong negative correlations with related domains of SF-36, bodily pain (ρ = -0.724), and physical functioning (ρ = -0.538). Group B showed moderate correlations with related domains of the SF-36 bodily pain (ρ = −0.495), physical functioning (p = −0.406), while Group C exhibited strong negative correlations with physical functioning (ρ = −0.655), bodily pain (ρ = −0.565) but weak negative correlations with unrelated domains. 

Currently, there are four validated versions of Chinese OKS. Several Chinese versions of OKS were found to be reliable and valid in mainland samples of patients with knee osteoarthritis. 

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References 

• Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–9 http://10.1302/0301-620x.80b1.7859.
• Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007;89-B:1010–4http://10.1302/0301-620X.89B8.19424

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