title: Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty.
abstract: BACKGROUND
  Cross cultural validity is of vital importance for international comparisons.
  
  
  OBJECTIVE
  To investigate the validity of international Dutch-English comparisons when using the Dutch translation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC).
  
  
  METHODS
  The dimensionality, reliability, construct validity, and cross cultural equivalence of the Dutch WOMAC in Dutch and Canadian patients waiting for primary total hip arthroplasty was investigated. Unidimensionality and cross cultural equivalence was quantified by principal component and Rasch analysis. Intratest reliability was quantified with Cronbach's alpha, and test-retest reliability with the intraclass correlation coefficient. Construct validity was quantified by correlating sum scores of the Dutch WOMAC, Arthritis Impact Measurement Scales (Dutch AIMS2), Health Assessment Questionnaire (Dutch HAQ), and Harris Hip Score (Dutch HHS).
  
  
  RESULTS
  The WOMAC was completed by 180 Dutch and 244 English speaking Canadian patients. Unidimensionality of the Dutch WOMAC was confirmed by principal component and Rasch analysis (good fit for 20/22 items). The intratest reliability of the Dutch WOMAC for pain and physical functioning was 0.88 and 0.96, whereas the test-retest reliability was 0.77 and 0.92, respectively. Dutch WOMAC pain sum score correlated 0.69 with Dutch HAQ pain, and 0.39 with Dutch HHS pain. Dutch WOMAC physical functioning sum score correlated 0.46 with Dutch AIMS2 mobility, 0.62 with Dutch AIMS2 walking and bending, 0.67 with Dutch HAQ disability, and 0.49 with Dutch HHS function. Differential item functioning (DIF) was shown for 6/22 Dutch items.
  
  
  CONCLUSIONS
  The Dutch WOMAC permits valid international Dutch-English comparisons after correction for DIF.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands. ld.roorda@vumc.nl
authors.forename: L D
authors.initials: LD
authors.lastname: Roorda
authors.forename: C A
authors.initials: CA
authors.lastname: Jones
authors.forename: M
authors.initials: M
authors.lastname: Waltz
authors.forename: G J
authors.initials: GJ
authors.lastname: Lankhorst
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: J W
authors.initials: JW
authors.lastname: van der Eijken
authors.forename: W J
authors.initials: WJ
authors.lastname: Willems
authors.forename: I C
authors.initials: IC
authors.lastname: Heyligers
authors.forename: D C
authors.initials: DC
authors.lastname: Voaklander
authors.forename: K D
authors.initials: KD
authors.lastname: Kelly
authors.forename: M E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D003431:Cross-Cultural Comparison; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D025341:Principal Component Analysis; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014177:Translations