title: The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study.
abstract: BACKGROUND
  The WOMAC is the most widely used self-report measure to evaluate physical functioning in hip or knee osteoarthritis, however its ability to discriminate pain and physical functioning (i.e. discriminate validity) has repeatedly been questioned. Little to no data is available on the discriminant validity of alternative questionnaires that measure the same construct, for instance the Hip and Knee Osteoarthritis Outcome Score (HOOS and KOOS, respectively) and the Lower Extremity Function Scale (LEFS). Therefore, we translated the LEFS to Dutch and studied its psychometric properties (i.e. validity, reliability and responsiveness). In addition, we assessed the discriminate validity of the LEFS, HOOS and KOOS.
  
  
  METHODS
  After translation with a forward/backward protocol, 401 individuals with hip or knee osteoarthritis completed the LEFS, HOOS/KOOS, SF-36, Hospital Anxiety and Depression Scale and Checklist Individual Strength questionnaires. To assess reliability and responsiveness, a sample of 106 and 108 patients completed a comparable set of questionnaires within 3 weeks and 3 months, respectively. Feasibility, validity, reliability and responsiveness were evaluated. Discriminant validity of the LEFS, HOOS and KOOS was examined by contrasting the scales' correlations with the physical functioning subscale of the SF-36 with the scales' correlations with the bodily pain subscale of the SF-36.
  
  
  RESULTS
  The Dutch version of the LEFS was feasible, had good internal consistency (0.96), good reliability (ICC = 0.86), good construct and discriminant validity, and showed no floor or ceiling effects. The minimal detectable change (MDC90) was ten points. Area under the receiver operating characteristic curve (AUC) analyses revealed good (AUC = 0.76) and fair (AUC = 0.63) responsiveness for the LEFS in improved and worsened patients, respectively. Discriminant validity for pain was apparent for the LEFS (p < 0.01), but not for the HOOS and KOOS (p = 0.21 and p = 0.20, respectively).
  
  
  CONCLUSIONS
  Considering the LEFS' good psychometric qualities and ability to discriminate between pain and functioning, we recommend the LEFS as the outcome measure of choice to assess self-reported physical functioning in individuals with hip or knee osteoarthritis.
authors: Department of Rheumatology, Sint Maartenskliniek, PO Box 9011, Nijmegen, 6500 GM, The Netherlands. t.hoogeboom@maartenskliniek.nl
authors: Thomas J
authors: TJ
authors: Hoogeboom
authors: Rob A
authors: RA
authors: de Bie
authors: Alfons A
authors: AA
authors: den Broeder
authors: Cornelia H M
authors: CH
authors: van den Ende
mesh_terms: D018771:Arthralgia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003431:Cross-Cultural Comparison; D004185:Disability Evaluation; D005260:Female; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function; D015203:Reproducibility of Results; D012647:Self-Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome