Zeynep HAZAR KANIK, Uğur SÖZLÜ, Sevim Beyza ÖLMEZ, Selda BAŞAR, Ulunay KANATLI

Cross-cultural adaptation, and validation of the Turkish version of the Nonarthritic Hip Score

Objective: The aim of this study was to translate and cross-culturally adapt the Nonarthritic Hip Score (NAHS) into Turkish and determine the validity and reliability of the translated version in physically active patients with hip pain. Methods: Sixty young to middle-aged and physically active patients (34 women and 26 men; mean age=35 years; age range: 18-40 years) with hip pain were included in the study. The original version of the NAHS was first translated into Turkish and back-translated into English by two bilingual translators each. The back-translated version was compared with the initial English version by a committee of the four translators. The Turkish version was then tested with 15 patients with hip pain and 15 healthy individuals. The participants were asked whether they had difficulties in understanding the questions. Subsequently, the questionnaire was accepted for use in the study population. Test–retest reliability and internal consistency were assessed using Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha, respectively. The construct validity was determined via the Pearson correlation coefficient between the NAHS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Short Form-12 (SF-12). Floor and ceiling effects were analyzed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to test construct validity. Results: An ICC of 0.994 and Cronbach’s alpha value of 0.908 were obtained; thus, the Turkish version of the NAHS was reliable. Neither floor nor ceiling effects (15%) were found in the sub-parameters (8.3-1.7%) and the total score (1.7%) of the NAHS. The EFA test showed that this questionnaire had four factors. Model fit indices in CFA were χ2/df=2.23, Tucker– Lewis index=0.90, comparative fit index=0.91, goodness of fit index=0.63, root mean square error of approximation=0.14 (90% CI: 0.12-0.16). The NAHS total score showed an excellent correlation with WOMAC (r=-0.909), mHHS (r=0.850), and SF-12 (r=0.811) scores. Conclusion: The Turkish version of the NAHS is a valid and reliable questionnaire for young and physically active patients with hip pain

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1. Diaz-Ledezma C, Lichstein PM, Maltenfort M, Restrepo C, Parvizi J. Pattern of impact of femoroacetabular impingement upon health-related quality of life: The determinant role of extra-articular factors. Qual Life Res 2013; 22: 2323-230. [Crossref]

2. Freke MD, Kemp J, Svege I, Risberg MA, Semciw A, Crossley KM. Physical impairments in symptomatic femoroacetabular impingement: A systematic review of the evidence. Br J Sports Med 2016; 50: 1180. doi: 10.1136/bjsports-2016-096152. Epub 2016 Jun 14. [Crossref]

3. Picavet HS, Hoeymans N. Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheu Dis. 2004; 63: 723-9. [Crossref]

4. Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: A systematic review. Arthroscopy 2015; 31: 1199- 204. [Crossref]

5. Hack K, Di Primio G, Rakhra K, Beaulé PE. Prevalence of camtype femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 2010; 92: 2436-44. [Crossref]

6. Laborie LB, Lehmann TG, Engesæter IØ, Eastwood DM, Engesæter LB, Rosendahl K. Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults. Radiology 2011; 260: 494-502. [Crossref]

7. Blankenbaker DG, De Smet AA. Hip injuries in athletes. Radiol Clin North Am. 2010; 48(6): 1155-1178. [Crossref]

8. Frank JS, Gambacorta PL, Eisner EA. Hip pathology in the adolescent athlete. J Am Acad Orthop Surg 2013; 21: 665-74. [Crossref]

9. Giordano BD. Assessment and treatment of hip pain in the adolescent athlete. Pediatr Clin North Am 2016; 61: 1137-54. [Crossref]

10. Ward D, Parvizi J. Management of hip pain in young adults. Orthop Clin North Am 2016; 47: 485-96. [Crossref]

11. Patrick DL, Burke LB, Powers JH, et al. Patient‐reported outcomes to support medical product labeling claims: FDA perspective. Value Health 2007; 10: 125-37. [Crossref]

12. Baumann F, Weber J, Zeman F, et al. Validation of a German version of the International Hip Outcome Tool (G-iHOT33) according to the COSMIN checklist: How much improvement is clinically relevant? Arch Orthop Trauma Surg 2016; 136: 83- 91. [Crossref]

13. Tijssen M, van Cingel R, van Melick N, de Visser E. Patient-Reported Outcome questionnaires for hip arthroscopy: A systematic review of the psychometric evidence. BMC Musculoskeletal Disord 2011; 12: 117. doi: 10.1186/1471-2474-12-117. [Crossref]

14. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15: 1833-40.

15. Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 1996; 78: 185-190. [Crossref]

16. Tugay BU, Tugay N, Guney H, Hazar Z, Yuksel I, Atılla B. Cross-cultural adaptation and validation of the Turkish version of Oxford Hip Score. Arch Orthop Trauma Surg 2015; 135: 879-89. [Crossref]

17. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty: An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737-55. [Crossref]

18. Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM. Hip Disability and Osteoarthritis Outcome Score (HOOS)-validity and responsiveness in total hip replacement. BMC Musculoskeletal Disord 2003; 4: 10. doi: 10.1186/1471-2474-4-10. Epub 2003 May 30. [Crossref]

19. Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC. The Nonarthritic Hip Score: Reliable and validated. Clin Orthop Relat Res 2003; 406: 75-83. [Crossref]

20. Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the Hip Outcome Score. Arthroscopy 2006; 22: 1304-11. [Crossref]

21. Mohtadi NG, Griffin DR, Pedersen ME, et al. The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: The International Hip Outcome Tool (iHOT-33). Arthroscopy 2012; 28: 595-610. [Crossref]

22. Thorborg K, Hölmich P, Christensen R, Petersen J, Roos EM. The Copenhagen Hip and Groin Outcome Score (HAGOS): Development and validation according to the COSMIN checklist. Br J Sports Med 2011; 45: 478-91. [Crossref]

23. Polat G, Celik D, Cil H, Erdil M, Asik M. Evidence for reliability, validity and responsiveness of Turkish version of Hip Outcome Score. Acta Orthop Traumatol Turc 2017; 51: 319-24. [Crossref]

24. Martin RL, Philippon MJ. Evidence of validity for the Hip Outcome Score in hip arthroscopy. Arthroscopy 2007; 23: 822-6. [Crossref]

25. Sim Y, Horner NS, de Sa D, Simunovic N, Karlsson J, Ayeni OR. Reporting of non-hip score outcomes following femoroacetabular impingement surgery: A systematic review. J Hip Preserv Surg 2015; 2: 224-41. [Crossref]

26. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine J 2000; 25: 3186-91. [Crossref]

27. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005; 13: 28-33. [Crossref]

28. Celik D, Can C, Aslan Y, Ceylan HH, Bilsel K, Razak Özdincler A. Translation, cross-cultural adaptation, and validation of the Turkish version of the Harris Hip Score. Hip Int 2014; 24: 473- 9. [Crossref]

29. Kocyigit H, Aydemir Ö, Fisek G, Olmez N, Memis A. Validity and reliability of Turkish version of Short form 36: a study of a patients with romatoid disorder. J Drug Ther 1999; 12: 102-6.

30. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220-33. [Crossref]

31. Weir JP. Quantifying test-retest reliability using the Intraclass Correlation Coefficient and the SEM. J Strength Cond Res 2005; 19: 231-40. [Crossref]

32. Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34-42. [Crossref]

33. Feise RJ, Michael Menke J. Functional rating index: A new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine J 2001; 26: 78-86. [Crossref]

34. HaHazar Kanik Z, Gunaydin G, Pala OO, et al. Translation, cultural adaptation, reliability, and validity of the Turkish version of the Penn Shoulder Score. Disabil Rehabil 2018; 40: 1214-9. [Crossref]

35. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999; 6: 1-55. [Crossref]

36. Del Castillo LN, Leporace G, Cardinot TM, Levy RA, Oliveira LP. Translation, cross-cultural adaptation and validation of the Brazilian version of the Nonarthritic Hip Score. Sao Paulo Med J 2013; 131: 244-51. [Crossref]

37. Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol 2003; 56: 730-5. [Crossref]

38. Allen MJ, Yen WM. Introduction to measurement theory. Long Grove, IL: Waveland Press.