Background & Aims

With a notable prevalence, particularly among the elderly, hip osteoarthritis emerges as a progressively significant concern due to its direct impact on functionality and quality of life. This study takes a proactive stance in this challenging scenario, aiming to translate, cross-culturally adapt, and validate the questionnaire ICOAP/hip into Brazilian Portuguese for individuals with hip osteoarthritis. In addition to addressing the growing demand for validated instruments in this context, the study tackles fundamental gaps in understanding the reliability and validity of the ICOAP construct, outlining ways to enhance its potential clinical utility. Identifying the characteristics associated with chronic pain in hip osteoarthritis is crucial for guiding more assertive assessments and therapies. This study offers a valuable contribution to managing hip osteoarthritis and promoting functional independence in a population increasingly affected by this globally prevalent condition.

Methods

This involves carrying out a study of translation, cross-cultural adaptation, and validity of instruments, carried out by the Guidelines for the Process of Cross-cultural Adaptation of Self-Report Measures and Consensus-based Standards for the Selection of Health Measurement Instruments. The study consisted of three phases: translation of the questionnaire, testing the pre-final version of the translated version of the ICOAP hip into Brazilian Portuguese, and validation of the final version of the ICOAP hip. Thus, 130 individuals participated in the study. Thirty in the first two phases and 100 in the last. Individuals of both genders participated in the survey, over 40 years old, with a medical diagnosis defined as hip osteoarthritis, complaints of pain and/or changes in hip function lasting 12 weeks or more, morning stiffness, pain intensity greater than or equal to 3 and those whose mother tongue is Brazilian Portuguese, literate, able to read and write in Brazilian Portuguese.

Results

Fifty individuals diagnosed with hip osteoarthritis were included for validity analyses, and a subsample of 50 patients was used for test-retest reliability. For structural validity, the original structure of the Portuguese hip ICOAP presented all adequate fit indices: chi-square/GL = 1.05; CFI = 1.00; TLI = 1.00; RMSEA (90% CI) = 0.024 (0.000 to 0.073); SRMR = 0.031. The reliability analysis presents excellent test-retest reliability and internal consistency values, with an ICC value = 0.99 and Cronbach’s alpha = 0.997 for the constant pain domain. And ICC = 0.99 and Cronbach’s alpha = 0.996 for the intermittent pain domain. For the total score, adequate reliability and internal consistency were observed, with intraclass correlation coefficient (ICC) values ? 0.99, standard error of measurement (SEM) ? 8.60%, and Cronbach’s alpha ? 0.997. Regarding construct validity, constant pain, and correlations greater than 0.50 were observed for the items ICOAP hip and HOOS, SF-36, and END.

Conclusions

The Brazilian Portuguese version of the ICOAP hip, with two domains and 11 items, presents adequate psychometric properties. However, the constant pain domain showed a greater magnitude of proper correlation with the reference instruments to assess pain intensity, functionality, and quality of life in individuals with hip osteoarthritis.

References

1. PEREIRAY, D.; PELETEIROYZ, B.; ARAU?JOYZ, J.; BRANCOX, J.; SANTOSK, R.A.; RAMOSYZ, E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011 Nov; 19(11):1270-85. doi: 10.1016/j.joca.2011.08.009.
2. DEVEZA, L.A.; MELO, L.; YAMATO, T.P.; MILLS, K.; RAVI, V.; HUNTER, D.J. Knee osteoarthritis phenotypes and their relevance for outcomes: a systematic review. Osteoarthritis Cartilage. 2017 Dec;25(12):1926-1941. doi: 10.1016/j.joca.2017.08.009.
3. BIJLSMA, J.W.; BERENBAUM, F.; LAFEBER, F.P. Osteoarthritis: an update with relevance for clinical practice. Lancet 2011; 377:2115.26.
4. MATHERS, C.D.; LONCAR, D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.
5. ROEMER, F.W.; KWOH, C.K.; HANNON, M.J. et. al. Can structural joint damage measured with MR imaging be used to predict knee replacement in the following year? Radiology 2015;274:810.20.
6. WOOLF, A.D.; PFLEGER, B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003;81:646.56.
7. HERRERO-BEAUMONT, G.; ROMAN-BLAS, J.A.; BRUYE?RE, O.; COOPER, C.; KANIS, J.; MAGGI, S.; RIZZOLI, R.; REGINSTER, J.Y. Clinical settings in knee osteoarthritis: Pathophysiology guides treatment. Maturitas. 2017 Feb;96:54-57. doi: 10.1016/j.maturitas.2016.11.013.
8. DELL’ISOLA, A.; PIHL, K.; TURKIEWICZ, A.; HUGHES, V.; ZHANG, W.; BIERMA-ZEINSTRA, S.; PRIETO-ALHAMBRA, D.; ENGLUND, M. Risk of comorbidities following physician-diagnosed knee or hip osteoarthritis: a register-based cohort study. Arthritis Care Res (Hoboken). 2021 Jun 4. Doi: 10.1002/acr.24717. Epub ahead of print. PMID: 34086422.
9. FAWOLE, H.O.; IDOWU, O.A.; ABARAOGU, U.O.; DELL’ISOLA, A.; RISKOWSKI, J.L.; OKE, K.I.; ADENIYI, A.F.; MBADA, C.E.; STEULTJENS, M.P.; CHASTIN, S.F.M. Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis. Rheumatol Adv Pract. 2021 Feb 26;5(1):rkab013. doi: 10.1093/rap/rkab013. PMID: 33928211; PMCID: PMC8068317.
10. NEOGI, T. The epidemiology and impact of pain in osteo-arthritis. Osteoarthritis Cartilage 2013;21:1145.53.
11. FU, K.; ROBBINS, S.R.; MCDOUGALL, J.J. Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2018, May 1;57 (suppl_4): iv43-iv50. doi: 10.1093 /rheumatology/ kex419. PMID: 29267879.
12. MAILLEFERT, J.F.; KLOPPENBURG, M.; FERNANDES, L.; PUNZI, L.; GÜNTHER, K.P.; MARTIN MOLA, E.; LOHMANDER, L.S.; PAVELKA, K.; LOPEZ-OLIVO, M.A.; DOUGADOS, M.; HAWKER, G.A. Multi-language translation and cross-cultural adaptation of the OARSI/OMERACT measure of intermittent and constant osteoarthritis pain (ICOAP). Osteoarthritis Cartilage. 2009 Oct;17(10):1293-6. doi: 10.1016/j.joca.2009.04.003. Epub 2009 Apr 17. PMID: 19410033.
13. HAWKER, G.A.; STEWART, L.; FRENCH, M.R.; CIBERE, J.; JORDAN, J.M.; MARCH, L. et. al. Understanding the pain experience in hip and knee osteoarthritis. An OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008;16: 415e22.
14. HAWKER, G.A.; DAVIS, A.M.; FRENCH, M.R.; CIBERE, J.; JORDAN, J.M.; MARCH, L.; et. al. Development and preliminary psychometric testing of a new OA pain measure. An OARSI / OMERACT initiative. Osteoarthritis Cartilage 2008; 16:409e14.
15. OARSI. OARSI initiatives: pain indexes, https://oarsi.org/research/outcome-measures.
16. WRIGHT, T.; GOLDRING, S. Reaching consensus and highlighting future directions for research: the osteoarthritis summit breakout sessions. HSS J 2012; 8:80e3.
17. EREL, S.; SIMSSEK, I?.E.; O?ZKAN, H. Analysis of the reliability and validity of the Turkish version of the intermittent and constant osteoarthritis pain questionnaire. Acta Orthop Traumatol Turc, 2015;49:508-12.
18. GONC?ALVES, R.S.; CABRI, J.; PINHEIRO, J.P. et. al. Cross-cultural adaptation and validation of the Portuguese version of the intermittent and constant osteoarthritis pain (ICOAP) measure for the knee. Osteoarthritis Cartilage 2010;18:1058–61.
19. KESSLER, S.; GRAMMOZIS, A.; GU?NTHER, K.P. et. al. The intermittent and constant pain score (ICOAP) – a questionnaire to assess pain in patients with gonarthritis. Z Orthop Unfall 2011;149:22-6.
20. MANOLARAKIS, G.E.; KONTODIMOPOULOS, N.; SIFAKI-PISTOLLA, D. et. al. Establishing the psychometric properties of the icoap questionnaire through intra-articular treatment of osteoarthritic pain: implementation for the greek version. Arthritis 2016;2016:1-11.
21. SIT, R.W.S.; CHAN, D.C.C.; WONG, W. et. al. Translation, cross-cultural adaptation and validation of the traditional Chinese intermittent and constant osteoarthritis pain (ICOAP)questionnaire for knee osteoarthritis. BMJ Open 2019;9:e026006. doi:10.1136/ bmjopen-2018-026006.
22. METSAVAHT, LEONARDO et. al. Qual o melhor questionário para avaliar os aspectos físicos de pacientes com osteoartrite no joelho na população brasileira? Revista Brasileira de Ortopedia (online). 2011, v. 46, n. 3. Acesso: 14/jun/2021, pp. 256-261. Disponível em: https://doi.org/10.1590/S0102-36162011000300004.Epub08/ set/2011. ISSN 1982-4378.
23. FERNANDES, M.I. Traduc?a?o e Validação do Questiona?rio de Qualidade de Vida Específico Para Osteoartrose WOMAC (Western Ontario And McMaster Universities) para a Li?ngua Portuguesa (dissertation). Sa?o Paulo: Universidade Federal de Sa?o Paulo; 2002. Available from: https:// repositorio.unifesp.br/handle/11600/19401. Accessed in 2020 (Mar 4).
24. FERREIRA, C.S.B.; DIBAI-FILHO, A.V.; ALMEIDA, D.O.D.S.; BASSI-DIBAI, D.; BARRETO. F.S.; OLIVEIRA, A.R.; FIDELIS-DE-PAULA-GOMES, C.A. Structural validity of the Brazilian version of the Western Ontario and McMaster Universities Osteoarthritis Index among patients with knee osteoarthritis. São Paulo Med J. 2020 Sep-Oct;138(5):400-406. doi: 10.1590/1516-3180.2020.0046.R1.26062020. PMID: 33084741.
25. METSAVAHT, L.; LEPORACE, G.; RIBERTO, M.; DE MELLO SPOSITO, M.M.; BATISTA, L.A. Translation and cross-cultural adaptation of the Brazilian version of the International Knee Documentation Committee Subjective Knee Form: validity and reproducibility. Am J Sports Med. 2010 Sep; 38(9): 1894-9. doi: 10.1177 /0363546510365314. Epub 2010 May 14. PMID: 20472755.
26. BEATON, D. E. et. al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, v. 25, n. 24, p. 3186-3191, 2019.
27. MOKKINK, L.B.; TERWEE, C.B.; PATRICK, D.L.; ALONSO J.; STRATFORD, P.W.; KNOL, D.L.; BOUTER, L.M.; VET, H.C.W. de. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of clinical epidemiology. v. 63, n. 7, p. 737-745, 2010.
28. MURDEN, R.A.; MCRAE, T.D.; KANER, S.; BUCKNAM, M.E. Mini-mental state exam scores vary with education in blacks and whites. J Am Geriatr Soc. 1991;39: 149-55.
29. RODRIGUES, E.K. DA S.; FONSECA, M. DE C.R.; MACDERMID, J.C. Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): Cross-cultural adaptation, internal consistency, test-retest reliability and construct validity. Journal of Hand Therapy, v. 28, n. 1, p. 69-76, 2015.
30. HAWKER, G.A.; MIAN, S.; KENDZERSKA, T.; FRENCH, M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of. Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:240-52.
31. FERREIRA-VALENTE, M.A.; PAIS-RIBEIRO, J.L.; JENSEN, M.P. Validity of four pain intensity rating scales. Pain 2011;152: 2399-2404.
32. IRRGANG, J.J.; ANDERSON, A.F.; BOLAND, A.L.; HARNER, C.D.; KUROSAKA, M.; NEYRET, P. et. al. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2001; 29:600-13.
33. HAVERKAMP, D.; SIEREVELT, I.N.; BREUGEM, S.J.; LOHUIS, K.; BLANKEVOORT, L.; VAN DIJK, C.N. Translation and validation of the Dutch version of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2006;34:1680-1684.
34. LERTWANICH, P.; PRAPHRUETKIT, T.; KEYURAPAN, E.; LAMSAM, C.; KULTHANAN, T. Validity and reliability of Thai version of the International Knee Docu- mentation Committee Subjective Knee Form. J Med Assoc Thai. 2008;91:1218-1225.
35. PADUA, R.; BONDI, R.; CECCARELLI, E. et. al. Italian version of the Inter- national Knee Documentation Committee Subjective Knee Form: cross-cultural adaptation and validation. Arthroscopy. 2004;20: 819-823.
36. CICONELLI, R.M. et. al. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36) Revista Brasileira De Reumatologia, 1999.
37. ETHGEN, O.; KAHLER, K.H.; KONG, S.X.; REGINSTER, J.Y.; WOLFE, F. The effect of health related quality of life on reported use of health care resources in patients with osteoarthritis and rheumatoid arthritis: a longitudinal analysis. J Rheumatol 2002;29:1147-1155.
38. TERWEE, C.B. et. al. Rating the methodological quality in systematic reviews of studies on measurement properties: A scoring system for the COSMIN checklist. Quality of Life Research, v. 21, n. 4, p. 651–657, 2012.
39. FLEISS, J.L. The design and analysis of clinical experiments. New York: Wiley, 1986.
40.SCHERMELLEH-ENGEL, K; MOOSBRUGGER, H; MU?LLER, H. Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of- Fit Measures. Methods of Psychological Research Online. v. 8, n. 1 p. 23–74, 2003.
41.BROWN, T. A. Confirmatory factor analysis for applied research. 2. ed. New York: Guilford Publications; 2006.
42. PRINSEN, C.A.C.; MOKKINK, L.B.; BOUTER, L.M.; ALONSO, J.; PATRICK, D.L.; de VET, H.C.W. et. al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Quality of Life Research. 2018;27(5):1147–57.
43. VAN BERKEL, A.C.; RINGELENBERG, R.; BINDELS, P.J.E.; BIERMA-ZEINSTRA, S.M.A.; SCHIPHOF, D. Nocturnal pain, is the pain different compared with pain during the day? An exploratory cross-sectional study in patients with hip and knee osteoarthritis. Fam Pract. 2022 Jul 18:cmac074.

Presenting Author

Aron Charles Barbosa da Silva

Poster Authors

Aron Charles barbosa da Silva

Ph.D. Candidate in Rehab.

Nove de Julho University

Lead Author

E-mail

Gabriela Nascimento Santana

Ph.D. Candidate in Rehab.

Nove de Julho University

Lead Author

E-mail

Patricia Santos

Msc student of Rehab. Sciences

Nove de Julho University

Lead Author

E-mail

Inaê Silva Santos

Msc student of Rehab. Sciences

Nove de Julho University

Lead Author

E-mail

Topics

  • Assessment and Diagnosis