Cited by 331Musculoskeletal pain and rehabilitationOsteoarthritis Treatment and MechanismsTotal Knee Arthroplasty Outcomes

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Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee

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Salaffi, F, Leardini, G, Canesi, B, Mannoni, A, Fioravanti, A, Caporali, R, Lapadula, G, Punzi, L·2003·Osteoarthritis and Cartilage

DOI 10.1016/s1063-4584(03)00089-x

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Abstract

Objective The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee.Methods Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey-MOS SF-36). A sample of 258 patients was readministered the WOMAC 7-10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal-Wallis test.Results All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test-retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity.Conclusion The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

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Method
17-Italian Foot Function Index with numerical rating scale: Development, reliability, and validity of a modified version of the original Foot Function Index
Venditto, T., Tognolo, L., Rizzo, R. S., Iannuccelli, C., Sante, L. D., Trevisan, M., Maggiolini, F. R., Santilli, V., & Ioppolo, F. (2014) · The Foot · doi:10.1016/j.foot.2014.09.004 · Cited by 46
Assessment of physical function following total hip arthroplasty: Inertial sensor based gait analysis is supplementary to patient-reported outcome measures
Bolink, S. A. A. N., Lenguerrand, E., Brunton, L. R., Wylde, V., Gooberman‐Hill, R., Heyligers, I. C., Blom, A. W., & Grimm, B. P. (2015) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2015.11.014 · Cited by 45
Ultrasound-Guided Aspiration and Corticosteroid Injection of Baker's Cysts in Knee Osteoarthritis
Sante, L. D., Paoloni, M., Ioppolo, F., Dimaggio, M., Renzo, S. D., & Santilli, V. (2010) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3181fc7da2 · Cited by 44
Mud‐Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial
Ciani, O., Pascarelli, N. A., Giannitti, C., Galeazzi, M., Meregaglia, M., Fattore, G., & Fioravanti, A. (2016) · Arthritis Care & Research · doi:10.1002/acr.23116 · Cited by 44
Reliability and validity of the Italian version of the Chronic Pain Grade questionnaire in patients with musculoskeletal disorders
Salaffi, F., Stancati, A., & Grassi, W. (2006) · Clinical Rheumatology · doi:10.1007/s10067-005-0140-y · Cited by 44
Measuring functional disability in early rheumatoid arthritis: the validity, reliability and responsiveness of the Recent-Onset Arthritis Disability (ROAD) index.
Salaffi, F., Stancati, A., Neri, R., Grassi, W., & Bombardieri, S. (2005) · PubMed · Cited by 42
Two-year outcomes comparing Embosphere® microspheres versus Imipenem Cilastatin for genicular artery embolization in patients with moderate to severe knee osteoarthritis
Bhatia, S. S., Jalaeian, H., Kumar, J., Acharya, V., Shibuya, M., Bhatia, A. M., & Okuno, Y. (2023) · The Knee · doi:10.1016/j.knee.2022.12.008 · Cited by 44
Relationship between magnetic resonance imaging findings, radiological grading, psychological distress and pain in patients with symptomatic knee osteoarthritis
Carotti, M., Salaffi, F., Carlo, M. D., & Giovagnoni, A. (2017) · La radiologia medica · doi:10.1007/s11547-017-0799-6 · Cited by 43
Effects of capacitive and resistive electric transfer therapy in patients with knee osteoarthritis: a randomized controlled trial
Coccetta, C. A., Sale, P., Ferrara, P. E., Specchia, A., Maccauro, G., Ferriero, G., & Ronconi, G. (2018) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000324 · Cited by 42
Radiographic findings of femoroacetabular impingement in capoeira players
Mariconda, M., Cozzolino, A., Pietto, F. D., Ribas, M., Bellotti, V., & Soldati, A. (2014) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-014-2850-7 · Cited by 41
“The WOMAC score [32] was also obtained to assess hip functionality.”
Method
The efficacy and tolerability of glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial
Giordano, N. G., Fioravanti, A., Papakostas, P., Montella, A., Giorgi, G., & Nuti, R. (2009) · Current Therapeutic Research · doi:10.1016/j.curtheres.2009.05.004 · Cited by 41
Can balneotherapy modify microRNA expression levels in osteoarthritis? A comparative study in patients with knee osteoarthritis
Giannitti, C., Palma, A. D., Pascarelli, N. A., Cheleschi, S., Giordano, N. G., Galeazzi, M., & Fioravanti, A. (2017) · International Journal of Biometeorology · doi:10.1007/s00484-017-1420-3 · Cited by 41
“The primary efficacy outcomes were the global pain score evaluated by a 0–100 mm visual analog scale (VAS) and the physical function by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscore (WTPFS) (Bellamy et al. 1988; Salaffi et al. 2003).”
Method
RETRACTED: How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial
Monticone, M., Ambrosini, E., Brunati, R., Capone, A., Pagliari, G., Secci, C., Zatti, G., & Ferrante, S. (2017) · Clinical Rehabilitation · doi:10.1177/0269215517724851 · Cited by 41
Retracted
Cognitive behavioural therapy and pain coping skills training for osteoarthritis knee pain management: a systematic review
Ismail, A., Moore, C., Alshishani, N., Yaseen, K. M., & Alshehri, M. A. (2017) · Journal of Physical Therapy Science · doi:10.1589/jpts.29.2228 · Cited by 42
Frailty prevalence according to the Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) definition, and its variables associated, in patients with symptomatic knee osteoarthritis: findings from a cross-sectional study
Salaffi, F., Carlo, M. D., Carotti, M., Farah, S., & Giovagnoni, A. (2020) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01667-0 · Cited by 40
Psychological complications in patients with acromegaly: relationships with sex, arthropathy, and quality of life
Cangiano, B., Giusti, E. M., Premoli, C., Soranna, D., Vitale, G., Grottoli, S., Cambria, V., Mantovani, G., Mungari, R., Maffei, P., et al. (2022) · Endocrine · doi:10.1007/s12020-022-03106-8 · Cited by 39
“Each patient was administered three validated questionnaires: the AcroQoL (a quality of life continuous scale) [14–16]; Western Ontario and McMaster universities Osteoarthritis Index (WOMAC) [17, 18], composed of three scales evaluating articular pain, stiffness and functionality; and the Arthritis Impact Measurement…”
MethodInfluential
How to measure chronic pain: New concepts
Salaffi, F., Sarzi‐Puttini, P., & Atzeni, F. (2015) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2015.04.023 · Cited by 43
Reliability and validity of Persian version of Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis
Eftekharsadat, B., Niknejad-Hosseyni, S. H., Babaei-Ghazani, A., Toopchizadeh, V., & Sadeghi, H. (2015) · Journal of Analytical Research in Clinical Medicine · doi:10.15171/jarcm.2015.027 · Cited by 39
Arthropathy in acromegaly: a questionnaire-based estimation of motor disability and its relation with quality of life and work productivity
The Study Group on Motor Disability in Acromegaly of the Italian Society of Endocrinology, Fatti, L. M., Cangiano, B., Vitale, G., Persani, L., Mantovani, L. G., Sala, E., Arosio, M., Maffei, P., Dassie, F., et al. (2019) · Pituitary · doi:10.1007/s11102-019-00966-8 · Cited by 38
Effectiveness of gait retraining interventions in individuals with hip or knee osteoarthritis: A systematic review and meta-analysis
Rynne, R., Tong, G. L., Cheung, R. T. H., & Constantinou, M. (2022) · Gait & Posture · doi:10.1016/j.gaitpost.2022.04.013 · Cited by 38
The relationship of radiographic findings with pain, function, and quality of life in patients with knee osteoarthritis
Özden, F., Karaman, Ö., Tuğay, N., Kilinç, C. Y., Kılınç, R. M., & Tuğay, B. U. (2020) · Journal of Clinical Orthopaedics and Trauma · doi:10.1016/j.jcot.2020.04.006 · Cited by 38
Liposomal Bupivacaine in Adductor Canal Blocks Before Total Knee Arthroplasty Leads to Improved Postoperative Outcomes: A Randomized Controlled Trial
Malige, A., Ng-Pellegrino, A., Kunkle, K., Konopitski, A. P., Brogle, P. J., & Nwachuku, C. O. (2022) · The Journal of Arthroplasty · doi:10.1016/j.arth.2022.03.073 · Cited by 38
International Classification of Functioning, Disability and Health (ICF) core sets for osteoarthritis. A useful tool in the follow-up of patients after joint arthroplasty.
Pisoni, C., Giardini, A., Majani, G., & Maini, M. (2008) · PubMed · Cited by 38
Comparison of two different molecular weight intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis.
Gigis, I., Fotiadis, E., Nenopoulos, A., Tsitas, K., & Hatzokos, I. (2016) · PubMed Central · Cited by 37
Cross-cultural adaptation and validation of the Italian version of the Hip disability and Osteoarthritis Outcome Score (HOOS)
Torre, M., Luzi, I., Mirabella, F., Manso, M. D., Zanoli, G. A., Tucci, G., & Romanini, E. (2018) · Health and Quality of Life Outcomes · doi:10.1186/s12955-018-0935-6 · Cited by 37
Gait Parameters and Functional Outcomes After Total Knee Arthroplasty Using Persona Knee System With Cruciate Retaining and Ultracongruent Knee Inserts
Rajgopal, A., Aggarwal, K., Khurana, A., Rao, A., Vasdev, A., & Pandit, H. G. (2016) · The Journal of Arthroplasty · doi:10.1016/j.arth.2016.06.012 · Cited by 36
Effects of hyaluronic acid combined with anti-inflammatory drugs compared with hyaluronic acid alone, in clinical trials and experiments in osteoarthritis: a systematic review and meta-analysis
Euppayo, T., Punyapornwithaya, V., Chomdej, S., Ongchai, S., & Nganvongpanit, K. (2017) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-017-1743-6 · Cited by 36
Evaluation of a Photographic Chondropathy Score (PCS) for pathological samples in a study of inflammation in tibiofemoral osteoarthritis
Walsh, D. A., Yousef, A., McWilliams, D. F., Hill, R., Hargin, E., & Wilson, D. (2008) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2008.07.016 · Cited by 35
Randomized Placebo-Controlled Trial of 60-Day Percutaneous Peripheral Nerve Stimulation Treatment Indicates Relief of Persistent Postoperative Pain, and Improved Function After Knee Replacement
Goree, J. H., Grant, S. A., Dickerson, D. M., Ilfeld, B. M., Eshraghi, Y., Vaid, S., Valimahomed, A. K., Shah, J., Smith, G. L., Finneran, J. J., et al. (2024) · Neuromodulation Technology at the Neural Interface · doi:10.1016/j.neurom.2024.03.001 · Cited by 34
Localized hyperthermia induced by microwave diathermy in osteoarthritis of the knee: a randomized placebo‐controlled double‐blind clinical trial
Giombini, A., Cesare, A. D., Cesare, M. D., Ripani, M., & Maffulli, N. (2010) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-010-1350-7 · Cited by 34
Diverse Exercises Similarly Reduce Older Adults’ Mobility Limitations
Tollár, J., Nagy, F., Moizs, M., TÓTH, B. E., Sanders, L. M. J., & Hortobágyi, T. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002001 · Cited by 33
“These outcomes are reliable, valid, and sensitive to changes induced by exercise intervention (21,24,25).”
Background
Hip scores: A current concept review
Longo, U. G., Ciuffreda, M., Candela, V., Berton, A., Maffulli, N., & Denaro, V. (2019) · British Medical Bulletin · doi:10.1093/bmb/ldz026 · Cited by 32
RETRACTED: Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial
Monticone, M., Ambrosini, E., Rocca, B., Lorenzon, C., Ferrante, S., & Zatti, G. (2014) · Clinical Rehabilitation · doi:10.1177/0269215513519342 · Cited by 32
Retracted
Responsiveness of the Intermittent and Constant Osteoarthritis Pain (ICOAP) scale in a trial of duloxetine for treatment of osteoarthritis knee pain
Risser, R. C., Hochberg, M. C., Gaynor, P. J., D’Souza, D. N., & Frakes, E. P. (2013) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2013.02.007 · Cited by 31
Efficacy of intra-articular hyaluronic acid injections and exercise-based rehabilitation programme, administered as isolated or integrated therapeutic regimens for the treatment of knee osteoarthritis
Saccomanno, M. F., Donati, F., Careri, S., Bartoli, M., Severini, G., & Milano, G. (2015) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-015-3917-9 · Cited by 30
Measures of Hip Function and Symptoms
Weick, J. W., Bullard, J., Green, J. H., & Gagnier, J. J. (2020) · Arthritis Care & Research · doi:10.1002/acr.24231 · Cited by 29
Comparative validation of the WOMAC osteoarthritis and Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis
Konstantinidis, G. A., Aletras, V. H., Kanakari, K.-A., Natsis, K. S., Bellamy, N., & Niakas, D. A. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0490-x · Cited by 29
“The validation of psychometric properties of these two questionnaires is necessary to ensure that different translated versions are equally applicable to the original questionnaire in different populations [5, 25].”
Background
Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study
Benedetti, M. G., Boccia, G., Cavazzuti, L., Magnani, E., Mariani, E., Rainoldi, A., & Casale, R. (2017) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000242 · Cited by 29
Effectiveness of hip abductor strengthening on health status, strength, endurance and six minute walk test in participants with medial compartment symptomatic knee osteoarthritis
Singh, S., Pattnaik, M., Mohanty, P., & Ganesh, G. S. (2016) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-150599 · Cited by 28

Authors: Salaffi, F., Leardini, G., Canesi, B., Mannoni, A., Fioravanti, A., Caporali, R., Lapadula, G., & Punzi, L.
Affiliations: Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
Azienda Sanitaria di Firenze (IT)
University of Siena (IT)
University of Pavia (IT)
Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT)
University of Padua (IT)
Corresponding author: Salaffi, F
ORCID: Salaffi, F
Fioravanti, A
Caporali, R
Lapadula, G
Punzi, L
Venue: Osteoarthritis and Cartilage
Publisher: Elsevier BV
Published: 2003-08
Volume: 11
Issue: 8
Pages: 551-560
ISSN: 1063-4584 (ISSN-L)
DOI: 10.1016/s1063-4584(03)00089-x
OpenAlex: W2087139148
Cited by: 331
References: 71
Citations by year: 2026: 22 · 2025: 33 · 2024: 28 · 2023: 33 · 2022: 25 · 2021: 16 · 2020: 23 · 2019: 13 · 2018: 18 · 2017: 16 · 2016: 10 · 2015: 12 · 2014: 16 · 2013: 6 · 2012: 11
FWCI: 3.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3853 d)
Locations: Osteoarthritis and Cartilage (publishedVersion)
PubMed (publishedVersion)
Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
Keywords: knee osteoarthritis, questionnaire reliability, construct validity, test-retest reliability, SF-36, Lequesne algofunctional index, pain, stiffness, physical function, radiographic severity, educational attainment, health status, comorbidities, patient-reported outcomes, cross-cultural adaptation, Italy, North America
MeSH terms: Aged, Aged, 80 and over, Cross-Sectional Studies, Disability Evaluation, Female, Humans, Italy, Male, Middle Aged, Pain, Surveys and Questionnaires, Reproducibility of Results, Cohort Studies, Comorbidity, Muscle, Skeletal, Osteoarthritis, Knee

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Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee

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