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Dimensionality of the Knee Numeric-Entity Evaluation Score (KNEES-ACL): a condition-specific questionnaire
J D Comins1, M R Krogsgaard, S Kreiner
1Section for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark; Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
The Knee Numeric-Entity Evaluation Score (KNEES-ACL) is the first patient-reported outcome measure validated using Rasch analysis for anterior cruciate ligament (ACL) deficiency and reconstruction. This validated tool ensures reliable assessment of patient outcomes following ACL treatment.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Biostatistics
Background:
- Patient-reported outcome measures (PROMs) are crucial for evaluating anterior cruciate ligament (ACL) reconstruction benefits, but their validity is often questioned.
- Psychometric validation, particularly using Rasch analysis, is essential for reliable interpretation of PROM data in orthopedic research.
- Existing PROMs for ACL reconstruction lack validation through Rasch analysis, limiting the confidence in reported patient outcomes.
Purpose of the Study:
- To validate the psychometric properties of the newly developed Knee Numeric-Entity Evaluation Score (KNEES-ACL) using Rasch analysis.
- To confirm the suitability of the KNEES-ACL as a condition-specific PROM for patients with ACL deficiency and post-reconstruction.
Main Methods:
- Rasch analysis was employed to evaluate the psychometric properties of the KNEES-ACL pilot instrument.
- Two hundred forty-two patients undergoing ACL reconstruction completed the KNEES-ACL pre- and post-operatively.
- Key psychometric properties assessed included unidimensionality, local response dependency, and differential item functioning.
Main Results:
- Forty-one items across seven constructs measuring impairment, functional limitations, and psychosocial consequences demonstrated fit to Rasch models.
- Fourteen items were removed due to statistical lack of fit or inadequate face validity, with identified issues of local response dependency and differential item functioning being addressed.
- The KNEES-ACL was confirmed as a unidimensional instrument suitable for assessing patient outcomes in ACL deficiency and reconstruction.
Conclusions:
- The KNEES-ACL is the first condition-specific PROM for ACL deficiency and reconstruction patients to undergo Rasch validation.
- This rigorous validation confirms the KNEES-ACL's psychometric integrity, enabling reliable within- and between-group outcome comparisons.
- The KNEES-ACL provides a robust tool for assessing patient-reported outcomes in the context of ACL injury and surgical management.
