Jennifer L Hunnicutt1, Brittany N Hand2, Chris M Gregory3,4, Harris S Slone5, Michelle M McLeod6, Brian Pietrosimone7, Christopher Kuenze8, Craig A Velozo4,9. 1. Department of Orthopaedics, School of Medicine, Emory University, Atlanta, Georgia. 2. School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio. 3. Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina. 4. Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina. 5. Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina. 6. Department Health and Human Performance, College of Charleston, Charleston, South Carolina. 7. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 8. Department of Kinesiology, Michigan State University, East Lansing, Michigan. 9. Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
Abstract
BACKGROUND: Measurement properties of the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR) are not established in individuals after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine the extent to which the KOOS-JR measures the construct of knee health in individuals post-ACLR using Rasch analysis. HYPOTHESIS: The KOOS-JR will fit the Rasch model, but significant ceiling effects will be present. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Rasch analysis of the KOOS-JR from 166 individuals 10 months post-ACLR was conducted. Unidimensionality, a key criterion of the Rasch model, was evaluated using confirmatory factor analysis. Model fit of the rating scale, items, and persons were evaluated. Mean square fit statistics ≥1.6 and standardized z-scores ≥2.0 were indicative of person or item misfit. Additionally, reliability indicators including person reliability and separation indices were examined. RESULTS: The KOOS-JR fit the criteria of unidimensionality. All items demonstrated model fit; however, ceiling effects were noted (n = 36; 22%). Person reliability was low (0.47). Calculation of person strata revealed that the KOOS-JR did not separate participants into more than 1 stratum. The mean person measure was 3.56 logits higher than the mean item measure, indicating that this sample is skewed toward increased knee health. CONCLUSION: Although the KOOS-JR represented a unidimensional construct with items and persons fitting the Rasch model, several limitations were noted: ceiling effects, low person reliability, and poor person differentiation. Ceiling effects indicate that many individuals in this sample experienced better knee health than the KOOS-JR items were able to measure. CLINICAL RELEVANCE: Evaluating the measurement properties of the KOOS-JR is necessary to determine its clinical value in sports medicine. In later stages after ACLR recovery, administration of the KOOS-JR may not be adequate.
BACKGROUND: Measurement properties of the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR) are not established in individuals after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine the extent to which the KOOS-JR measures the construct of knee health in individuals post-ACLR using Rasch analysis. HYPOTHESIS: The KOOS-JR will fit the Rasch model, but significant ceiling effects will be present. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Rasch analysis of the KOOS-JR from 166 individuals 10 months post-ACLR was conducted. Unidimensionality, a key criterion of the Rasch model, was evaluated using confirmatory factor analysis. Model fit of the rating scale, items, and persons were evaluated. Mean square fit statistics ≥1.6 and standardized z-scores ≥2.0 were indicative of person or item misfit. Additionally, reliability indicators including person reliability and separation indices were examined. RESULTS: The KOOS-JR fit the criteria of unidimensionality. All items demonstrated model fit; however, ceiling effects were noted (n = 36; 22%). Person reliability was low (0.47). Calculation of person strata revealed that the KOOS-JR did not separate participants into more than 1 stratum. The mean person measure was 3.56 logits higher than the mean item measure, indicating that this sample is skewed toward increased knee health. CONCLUSION: Although the KOOS-JR represented a unidimensional construct with items and persons fitting the Rasch model, several limitations were noted: ceiling effects, low person reliability, and poor person differentiation. Ceiling effects indicate that many individuals in this sample experienced better knee health than the KOOS-JR items were able to measure. CLINICAL RELEVANCE: Evaluating the measurement properties of the KOOS-JR is necessary to determine its clinical value in sports medicine. In later stages after ACLR recovery, administration of the KOOS-JR may not be adequate.
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