ObjectivesKnee injury and Osteoarthritis Outcome Score (KOOS)-Child is a modification of the adult KOOS aiming to evaluate knee injury, including ACL deficiency. However, the measurement properties of KOOS-Child have not been assessed in a cohort of children with ACL deficiency. We aimed to study the structure of KOOS-Child using modern test theory models (Rasch analysis and confirmatory factor analysis (CFA)).MethodsData were collected prospectively in a cohort of children with ACL deficiency at three time points: before-and-after ACL surgery, and at 1-year follow-up. For each subscale, structural validity through the fit of a CFA model was evaluated for 153 respondents. Modification indices were examined to find the model of best fit, confirmed using Rasch analysis. Responsiveness was reported for each subscale. Reliability was calculated for each item. Floor and ceiling effects, and Person-item distribution were reported.ResultsAll subscales showed inadequate fit to a unidimensional CFA model. Rasch analysis confirmed these results. Adjusting the subscales improved model fit, although this was still quite poor, except for the quality of life subscale. With one exception, all items demonstrated ceiling effects. Person-item distribution confirmed this. Due to lack of fit, reliability was not reported. All subscales were able to detect change from baseline to 1-year follow-up.ConclusionsKOOS-Child exhibits inadequate measurement properties in its current form for children with ACL deficiency. Suggestions to make the subscales fit the models better and improve accuracy of KOOS-Child are presented. However, the large ceiling effects observed may reduce sensitivity and induce type 2 errors.
BackgroundPedi‐IKDC is commonly used to evaluate anterior cruciate ligament (ACL) deficiency in children. However, its construct validity has not been thoroughly assessed. The aim was to examine the measurement properties of the Pediatric International Knee Documentation Committee (Pedi‐IKDC) by modern test theory (MTT) models, confirmatory factor analysis (CFA), and item response theory (IRT).MethodsThe cohort consisted of all children and adolescents in Denmark (n = 535, age 9–16) treated with physeal‐sparing ACL reconstruction 2011–2020. Patient‐reported outcome measure (PROM) data were collected before surgery and at 1 year follow‐up. Structural validity of Pedi‐IKDC was assessed with MTT models. Reliability was reported as McDonalds coefficient omega. Responsiveness was evaluated with standardized response means.ResultsSufficient PROM data were available for 372 patients. The original unidimensional construct did not fit CFA model expectations neither before surgery (χ2 = 462.0, df = 163, p < 0.0001; RMSEA: 0.109, CFI: 0.910, TFI: 0.895) nor at follow‐up. Neither did a two‐factor CFA model with “Symptoms” and “Sports activities” as individual subscales (χ2 = 455.6, df = 162, p < 0.0001) nor a bifactor model (χ2 = 338.9, df = 143, p < 0.0001), although fit indices improved with the latter (RMSEA: 0.094, CFI: 0.941, TFI: 0.922). The IRT models confirmed this pattern. The scale was responsive (SRM 1.66 (95% CI: 1.46–1.88)). Coefficient omega values were 0.866 before surgery and 0.919 at follow‐up.ConclusionsThe Pedi‐IKDC exhibited inadequate structural validity. Neither the original construct, a two‐factor model, nor bifactor models fitted data well. We advise that data obtained by Pedi‐IKDC are interpreted with caution.
baseline. Patients were followed for 12 months and assessed for the presence of mechanical symptoms at 3, 6 and 12 months. Results In total, 63/121 patients reported mechanical symptoms at baseline (surgery, n=33 and exercise, n=30), while 9/ 26 in the surgery group and 20/29 in the exercise group reported mechanical symptoms at 12-month (missing data on 8 patients). During follow-up 8 patients crossed over from the exercise group to use the opportunity for later surgery.At 12-month the risk difference was 34.4% (95% CI 9.5-59.2) and the relative risk was 1.99 (95%CI, 1.11-3.57) in favour of the surgery group. Similarly, a larger proportion of patients in the exercise group reported mechanical symptoms at 3 and 6 months. Conclusion Our results suggest that meniscal surgery may be superior in alleviating mechanical symptoms compared with exercise therapy and patient education with the option of later surgery in young patients with meniscal tears and self-reported mechanical symptoms.
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