Translation, Cross-Cultural Adaptation and Validation of the Chinese Version of the High Activity Arthroplasty Score

Dongping Wan; Shihang Cao; Xinrui Li; Qiang Zan; Shuxin Yao; Jianbing Ma; Lei Shang; Chao Xu

doi:10.2147/PROM.S451710

Translation, Cross-Cultural Adaptation and Validation of the Chinese Version of the High Activity Arthroplasty Score

Patient Relat Outcome Meas. 2024 Apr 29:15:121-130. doi: 10.2147/PROM.S451710. eCollection 2024.

Authors

Dongping Wan^#^{1

2}, Shihang Cao^#^{1

2}, Xinrui Li^#^{3

4}, Qiang Zan², Shuxin Yao¹, Jianbing Ma¹, Lei Shang^{1

3}, Chao Xu^{1

3}

Affiliations

¹ Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China.
² The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China.
³ Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi'an, People's Republic of China.
⁴ School of Medicine, Northwest University, Xi'an, People's Republic of China.

^# Contributed equally.

Abstract

Background: The High Activity Arthroplasty Score (HAAS) is a validated score that assesses functional outcomes after lower limb arthroplasty, with fewer ceiling effects than other scores. The aim is to translate and cross-culturally adapt the HAAS into a Chinese version (HAAS-C) and to evaluate the psychometric properties of HAAS-C in patients after primary total knee arthroplasty (TKA).

Methods: A total of 104 patients diagnosed with knee osteoarthritis who had undergone TKA at least 12 months prior were recruited. A forward and backward translation procedure was performed for developing a culturally acceptable HAAS-C. Internal consistency was assessed using Cronbach's α, and test-retest reliability was measured using the intraclass correlation coefficient (ICC) within a 10-day interval. Construct validity was assessed by examining the correlations between HAAS-C and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQoL Group's five-dimension questionnaire (EQ-5D-5L), and Oxford knee score (OKS).

Results: HAAS-C demonstrated adequate Internal consistency reliability, as indicated by Cronbach's α coefficient of 0.75. Test-retest reliability yielded excellent results, with an ICC value of 0.98. Content validity indices were high, with a scale-level validity index of 0.9 and item-level validity indices greater than or equal to 0.8. HAAS-C showed a strong correlation with WOMAC (r = 0.69), a moderate correlation with EQ-5D-5L (r = 0.43), and OKS (r = 0.53) while exhibiting no floor or ceiling effects.

Conclusion: The validated HAAS-C questionnaire is a valid instrument for assessing patients undergoing TKA in mainland China.

Keywords: Chinese validation; high activity arthroplasty score; reliability; total knee arthroplasty; validity.

Grants and funding

This work was supported by Key Research and Development Program of Shaanxi Province (Grant No. 2023-YBSF-464); General Research Plan of Xi’an Health Commission (Grant No. 2023yb30); the National Natural Science Foundation of China (Grant No. 82173627).