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 elderlypatients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitablefor use in future clinical studies in these populations.
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 elderlypatients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitablefor use in future clinical studies in these populations.
Original language | English |
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Pages (from-to) | 751-757 |
Number of pages | 7 |
Journal | Journal of Bone and Joint Surgery-American Volume |
Volume | 97A |
Issue number | 9 |
DOIs | |
Publication status | Published - 6 May 2015 |
Bibliographical note
Source of Funding:Research grants for the FAITH Trial were received from the Canadian Institutes of
Health Research (M. Bhandari); Stichting NutsOhra (the Netherlands; M.J. Heetveld);
the Netherlands Organization for Health Research and Development (the Netherlands; E.M.M. Van Lieshout); and Physician Services (M. Bhandari). Funding for the
pilot phase of FAITH was supported, in part, by Stryker. Dr. Bhandari was also
funded, in part, by a Canada Research Chair in Musculoskeletal Trauma (McMaster
University, Hamilton, Ontario, Canada), which is unrelated to the present study.
We also acknowledge the support of The County Durham & Tess Valley Comprehensive Local Research Network, which operates as part of the National Institute for
Health Research Comprehensive Clinical Research Network in England. These
funding sources had no role in the study design; collection, management, analysis, or
interpretation of the data; or the preparation, review, or approval of the manuscript.
Research grants for the HEALTH Trial were received from the Canadian
Institutes of Health Research (M. Bhandari and G.H. Guyatt), National Institutes
of Health (T.A. Einhorn), The Netherlands Organization for Health Research and
Development (E.M.M. Van Lieshout), Sophies Minde Foundation for Orthopaedic Research (L. Nordsletten and F. Frihagen), and McMaster Surgical Associates (M. Bhandari). Dr. Bhandari was also funded, in part, by a Canada
Research Chair in Musculoskeletal Trauma (McMaster University), which is
unrelated to the present study. The funding sources had no role in the design or
conduct of the study; the collection, management, analysis, or interpretation of
the data; or the preparation, review, or approval of the manuscript.
Research programs
- EMC MUSC-01-47-01
- EMC MUSC-01-48-01