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J Bone Joint Surg Am. 2015 May 6;97(9):751-7. doi: 10.2106/JBJS.N.00542.

Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture.

Collaborators (903)

Bhandari M, Devereaux PJ, Guyatt GH, Einhorn TA, Thabane L, Schemitsch EH, Koval KJ, Frihagen F, Poolman RW, Tetsworth K, Guerra-Farfan E, Walter SD, Sprague S, Swinton M, Scott T, McKay P, Madden K, Heels-Ansdell D, Buckingham L, Duraikannan A, Silva H, Heetveld MJ, Poolman RW, Van Lieshout EM, Burgers TP, Bhandari M, Zura RD, Schemitsch EH, Avram V, Manjoo A, Williams D, Antoniou J, Ramsay T, Bogoch ER, Trentholm A, Lyman S, Mazumdar M, Bozic KJ, Luborsky M, Goodman S, Murray S, Korley R, Buckley R, Duffy P, Puloski S, Carcary K, Lorenzo M, Schemitsch EH, McKee MD, Hall JA, Nauth A, Whelan D, Daniels TR, Bogoch ER, Waddell JP, Ahn H, Vicente MR, Hidy JT, MacNevin MT, Kreder H, Axelrod T, Jenkinson R, Nousiainen M, Stephen D, Wadey V, Kunz M, Milner K, Cagaanan R, MacNevin M, O'Brien PJ, Blachut PA, Broekhuyse HM, Guy P, Lefaivre KA, Slobogean GP, Johal R, Leung I, Coles C, Leighton R, Richardson CG, Biddulph M, Gross M, Dunbar M, Amirault JD, Alexander D, Coady C, Glazebrook M, Johnston D, Oxner W, Reardon G, Wong I, Trask K, MacDonald S, Furey A, Stone C, Parsons M, Stone T, Zomar M, McCormack R, Apostle K, Boyer D, Moola F, Perey B, Viskontas D, Moon K, Moon R, Laflamme Y, Benoit B, Ranger P, Malo M, Fernandes J, Tardif K, Fournier J, Vendittoli PA, Massé V, Roy AG, Lavigne M, Lusignan D, Davis C, Stull P, Weinerman S, Weingarten P, Lindenbaum S, Hewitt M, Danielwicz R, Baker J, Mont M, Deloanois DE, Kapadia B, Issa K, Mullen M, Sems A, Foreman B, Parvizi J, Morrison T, Lewis C, Caminiti S, Einhorn TA, Tornetta P 3rd, Creevy WR, Silva H, Lespasio MJ, Carlisle H, Marcantonio A, Kain M, Specht L, Tilzey J, Garfi J, Mehta S, Esterhai JL Jr, Ahn J, Donegan D, Horan A, McGinnis K, Roberson J, Bradbury T, Erens G, Webb K, Mullis B, Shively K, Parr A, Ertl J, Worman R, Webster M, Cummings J, Frizzell V, Moore M, Jones CB, Ringler JR, Sietsema DL, Walker JE, Kanlic E, Abdelgawad A, Shunia J, DePaolo C, Sutherland S, Alosky R, Zura R, Manson M, Strathy G, Peter K, Johnson P, Morton M, Shaer J, Schrickel T, Hileman B, Hanes M, Chance E, Heinrich EM, Dodgin D, LaBadie M, Zamorano D, Tynan M, Schwarzkopf R, Scolaro JA, Gupta R, Bederman S, Bhatia N, Hoang B, Kiester D, Jones N, Rafijah G, Alavekios D, Lee J, Mehta A, Schroder S, Chao T, Colin V, Dang PP, Heng SK, Lopez G, Galle S, Pahlavan S, Phan DL, Tapadia M, Bui C, Jain N, Moore T, Moroski N, Pourmand D, Kubiak EN, Gililland J, Rothberg D, Peters C, Pelt C, Stuart AR, Corbey K, Shuler FD, Day J, Garabekyan T, Cheung F, Oliashirzai A, Salava J, Morgan L, Wilson-Byrne T, Cordle MB, Elmans LH, van den Hout JA, Joosten AJ, van Beurden AF, Bolder SB, Eygendaal D, Moonen AF, van Geenen RC, Hoebink EA, Wagenmakers R, van Helden W, van Jonbergen HP, Roerdink H, Reuver JM, Barnaart AF, Flikweert ER, Krips R, Mullers JB, Schüller H, Falke ML, Kurek FJ, Slingerland AC, van Dijk JP, van Helden WH, Bolhuis HW, Bullens PH, Hogervorst M, de Kroon KE, Jansen RH, Steenstra F, Raven EE, Fontiijne WP, Wiersma SC, Boetes B, ten Holder EJ, van der Heide HJ, Nagels J, van der Linden-van der Zwaag EH, Keizer SB, Swen JW, den Hollander PH, Thomassen BJ, Poolman RW, Molekamp WJ, de Meulemeester FR, Kleipool AE, Haverlag R, Simons MP, Mutsaerts EL, Kooijman R, Postema RR, Bleker RJ, Lampe HI, Schuman L, Cheung J, van Bommel F, Winia WP, Haverkamp D, van der vis H, Nolte PA, van den Bekerom MP, de Jong T, van Noort A, Vergroesen DA, Schutte BG, van der vis HM, Beimers L, de Vries J, Zurcher AW, Albers GH, Rademakers M, Breugem S, van der Haven I, Damen PJ, Bulstra GH, Campo MM, Somford MP, Haverkamp D, Liew S, Bedi H, Carr A, Cscongvay S, Donohue C, Doig S, Edwards E, Esser M, Freeman R, Gong A, Li D, Miller R, Ton L, Wang O, Young I, Dowrick A, Murdoch Z, Sage C, Page R, Bainbridge D, Angliss R, Miller B, Thomson A, Brown G, Williams S, Eng K, Bowyer D, Skelley J, Goyal C, Beattie S, Guerado E, Cruz E, Cano JR, Froufe MA, Marull Serra L, Al-dirra S, Martinez C, Tarazona Santabalbina FJ, Guerra-Farfan E, Teixidor Serra J, Hernandez JT, Garcia MA, Garcia VM, Barrera S, Garrido M, Frihagen F, Nordsletten L, Clarke-Jenssen J, Hjorthaug G, Brekke AC, Vesterhaus EB, Skaugrud I, Tripathi P, Katiyar S, Shukla P, Bhandari M, Swiontkowski M, Devereaux PJ, Guyatt G, Heetveld MJ, Jeray K, Liew S, Schemitsch EH, Thabane L, Walter S, Bhandari M, Sprague S, Viveiros H, McKay P, Scott T, Swinton M, Truong V, Koo K, Heels-Ansdell D, Zhou Q, Buckingham L, Duraikannan A, Maddock D, Simunovic N, Swiontkowski M, Agel J, Heetveld MJ, Van Lieshout EM, Zielinski SM, Rangan A, Hanusch BC, Kottam L, Clarkson R, Della Rocca GJ, Haverlag R, Liew S, Slobogean G, Katz J, Gillespie B, Greendale GA, Guy P, Hartman C, Rubin C, Waddell J, McCormack R, Apostle K, Boyer D, Moola F, Perey B, Stone T, Viskontas D, Lemke HM, Zomar M, Moon K, Moon R, Oatt A, Buckley RE, Duffy P, Korley R, Puloski S, Johnston K, Powell J, Carcary K, Sanders D, Lawendy A, Tieszer C, Stephen D, Kreder H, Jenkinson R, Nousiainen M, Axelrod T, Murnaghan J, Nam D, Wadey V, Yee A, Milner K, Kunz M, Schemitsch EH, Ahn H, Hall JA, McKee MD, Whelan DB, Nauth A, Vicente MR, Wild LM, Khan RM, Hidy JT, Coles C, Leighton R, Biddulph M, Johnston D, Glazebrook M, Alexander D, Coady C, Dunbar M, Amirault D, Gross M, Oxner W, Reardon G, Richardson G, Trenholm A, Wong I, Trask K, MacDonald S, Dobbin G, Bicknell R, Yach J, Bardana D, Wood G, Harrison M, Yen D, Lambert S, Howells F, Ward A, Zalzal P, Brien H, Naumetz V, Weening B, Simunovic N, Wai EK, Papp S, Gofton WT, Liew A, Kingwell SP, Johnson G, O'Neil J, Roffey DM, Borsella V, Avram V, Oliver TM, Jones V, Jones CB, Ringler JR, Endres TJ, Agnew SG, Sietsema DL, Walker JE, Jeray KJ, Broderick JS, Goetz DR, Pace TB, Schaller TM, Porter SE, Tanner SL, Snider RG, Nastoff LA, Bielby SA, Switzer JA, Cole PA, Anderson SA, Lafferty PM, Li M, Ly TV, Marston SB, Foley AL, Vang S, Wright DM, Marfcantonio AJ, Kain MS, Iorio R, Specht LM, Tilzey JF, Lobo MJ, Garfi JS, Vallier HA, Dolenc A, Robinson C, Prayson MJ, Laughlin R, Rubino LJ, May J, Rieser GR, Dulaney-Cripe L, Gayton C, Shaer J, Schrickel T, Hileman B, Gorcyca JT, Gross JM, Humphrey CA, Kates S, Noble K, McIntyre AW, Pecorella K, Davis CA, Weinerman S, Weingarten P, Stull P, Lindenbaum S, Hewitt M, Schwappach J, Baker JK, Rutherford T, Newman H, Lieberman S, Finn E, Robbins K, Hurley M, Lyle L, Mitchell K, Browner K, Whatley E, Payton K, Reeves C, Cannada LK, Karges D, Hill L, Mehta S, Esterhai J, Ahn J, Horan AD, McGinnis K, Kaminski CA, Kowalski BN, Keeve JP, Anderson CG, McDonald MD, Hoffman JM, Tarkin I, Siska P, Gruen G, Evans A, Farrell DJ, Irrgang J, Luther A, Cross WW 3rd, Cass JR, Sems SA, Torchia ME, Scrabeck T, Jenkins M, Dumais J, Romero AW, Sagebien CA, Butler MS, Monica JT, Seuffert P, Hsu JR, Ficke J, Charlton M, Napierala M, Fan M, Tornetta P 3rd, Tannoury C, Carlisle H, Silva H, Archdeacon M, Finnan R, Le T, Wyick J, Hess S, Brennan ML, Probe R, Kile E, Mills K, Clippper L, Yu M, Erwin K, Horwitz D, Strohecker K, Swenson TK, Schmidt AH, Westberg JR, Aurang K, Zohman G, Peterson B, Huff RB, McBeth J, Shively K, Ertl JP, Mullis B, Parr JA, Worman R, Frizzell V, Moore MM, Tobias E, Thomas E, DePaolo CJ, Alosky R, Shell LE, Hampton L, Shepard S, Nanney T, Cuento C, Hammerberg EM, Stahel P, Hak D, Maurffrey C, Gibula D, Gissel H, Henderson C, Zamorano DP, Tynan MC, Pourmand D, Lawson D, Della Rocca GJ, Crist BD, Murtha YM, Anderson LK, Linehan C, Pilling L, Lewis CG, Caminiti S, Sullivan RJ, Roper E, Obremskey W, Kregor P, Richards JE, Stringfellow K, Dohm MP, Zellar A, Segers MJ, Zijl JA, Verhoeven B, Smits AB, de Vries JP, Fioole B, van der Hoeven H, Theunissen EB, de Vries Reilingh TS, Govaert L, Wittich P, de Brauw M, Wille J, Go PM, Ritchie ED, Wessel RN, Hammacher ER, Heetveld MJ, Visser GA, Stockmann H, Silvas R, Snellen JP, Rijbroek B, Scheepers JG, Vermeulen EG, Siroen MP, Vuylsteke R, Brom HL, Rijna H, de Rijcke PA, Koppert CL, Buijk SE, Groenendijk RP, Dawson I, Tetteroo GW, Bruijninckx MM, Doornebsoch PG, de Graaf EJ, van der Elst M, van der Pol CC, van't Riet M, Karsten TM, de Vries MR, Stassen LP, Schep NW, Schmidt GB, Hoffman WH, Poolman RW, Simons MP, van der Heijden FH, Willems WJ, de Meulemeester FR, van der Hart CP, Turckan K, Festen S, de Nies F, Haverlag R, Out NJ, Bosma J, van Kampen A, Biert J, van Vugt AB, Edwards MJ, Blokhuis TJ, Frölke JP, Geeraedts LM, Gardeniers JW, Tan ET, Poelhekke LM, de Waal Malefijt MC, Schreurs B, Roukema GR, Josaputra HA, Keller P, de Rooij PD, Kuiken H, Boxma H, Cleffken BI, Liem R, Rhemrev SJ, Bosman CH, de Mol van Otterloo A, Hoogendoorn J, de Vries AC, Meylaerts SA, Verhofstad MH, Meijer J, van Egmond T, van der Heijden FH, van der Brand I, Patka P, Eversdijk MG, Peters R, Hartog DD, Van Waes OJ, Oprel P, van der Vis HM, Campo M, Verhagen R, Albers GH, Zurcher AW, Simmermacher RK, van Mulken J, van Wessem K, Blokhuis TJ, van Gaalen SM, Leenen LP, Bronkhorst MW, Guicherit OR, Goslings JC, Haverlag R, Ponsen KJ, Bhatia M, Arora V, Tyagi V, Gupta A, Jain N, Khan F, Sharma A, Sanghavi A, Trivedi M, Rai A, Subash, Rai K, Yadav V, Singh S, Rai K, Prasad AS, Mishra V, Sundaresh DC, Khanna A, Cherian JJ, Olakkengil DJ, Sharma G, Dadi A, Palla N, Ganguly U, Rai BS, Rajakumar J, Hull P, Lewis S, Evans S, Nanda R, Logishetty R, Anand S, Bowler C, Jennings A, Chuter G, Rose G, Horner G, Clark C, Eke K, Reed M, Herriott C, Dobb C, Liew S, Bedi H, Carr A, Curry H, Chia A, Csongvay S, Donohue C, Doig S, Edwards E, Etherington G, Esser M, Gong A, Jain A, Li D, Miller R, Moaveni A, Russ M, Ton L, Wang O, Dowrick A, Murdoch Z, Sage C, Tetsworth K, Donald G, Weinrauch P, Pincus P, Yang S, Halliday B, Gervais T, Holt M, Flynn A, Pirpiris M, Love D, Bucknill A, Farrugia RJ, Frihagen F, Clarke-Jenssen J, Hjorthaug G, Ianssen T, Amundsen A, Brattgierd JE, Borch T, Bøe B, Flatøy B, Hasselund S, Haug KJ, Hemlock K, Hoseth TM, Jomaas G, Kibsgård T, Lona T, Moatshe G, Müller O, Molund M, Nicolaisen T, Nilsen F, Rydinge J, Smedsrud M, Stødle A, Trommer A, Ugland S, Karlsten A, Ekås G, Vesterhus EB, Brekke AC, Pape HC, Knobe M, Pfeifer R.

Abstract

BACKGROUND:

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture.

METHODS:

Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older.

RESULTS:

The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%).

CONCLUSIONS:

The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations.

CLINICAL RELEVANCE:

The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.

PMID:
25948522
DOI:
10.2106/JBJS.N.00542
[Indexed for MEDLINE]

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