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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Background
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Investigation of C1q-binding circulating immune complex correlates in osteoarthritis of the knee: a single-center retrospective study
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Longitudinal MRI identifies associations between cognitive decline, inflammatory markers, and hippocampal subregion volumes in individuals with knee osteoarthritis
Wang, Y., Cai, G., Li, M., Chen, R., Zeng, P., Zhao, B., Tao, J., & Liu, J. (2025) · Communications Medicine · doi:10.1038/s43856-025-01104-1 · Cited by 1
Comparative efficacy of high intensity laser therapy (Class IV) and ibuprofen gel phonophoresis in the treatment of knee osteoarthritis among people living in hilly terrain: A randomized controlled study
Sharma, D., Saini, V., Srivastav, A. K., & Samuel, A. J. (2025) · Lasers in Medical Science · doi:10.1007/s10103-025-04613-6 · Cited by 3
Postoperative education for patients after hip/knee arthroplasty: a systematic review with meta-analysis of randomized controlled trials
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Retained articulating spacers (1.5 stage) in chronic knee periprosthetic joint infections: an analysis of associate factors and outcomes in a single center cohort of patients
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Safety and efficacy of allogeneic umbilical cord-derived mesenchymal stem cell infusion for frailty: a phase 2, single-centre, randomised, open-label controlled trial
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“Knee pain, stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 34 a validated 24-item questionnaire comprising three subscales: pain (5 items), stiffness (2 items), and physical function (17 items).”
Comparison of three therapeutic methods of transcutaneous electrical nerve stimulation, embedding acupuncture, and drug therapy on interleukin-6 and pain levels in patients with knee osteoarthritis
Nematshahi, M., mirhamidi, M., Farkhani, E. M., Farahmand, S. K., Solati, S., Tehrani, M. V., & Bahrami-Taghanaki, H. (2026) · Clinical Rheumatology · doi:10.1007/s10067-026-08197-6 · Cited by 1
Can we accurately predict outcome after hip and knee replacement?
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ERKEN EVRE DİZ OSTEOARTRİTLİ HASTALARDA POSTÜRAL STABİLİTENİN SAĞLIKLI BİREYLER İLE KARŞILAŞTIRILMASI
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IMPROVING FUNCTION IN KNEE OSTEOARTHRITIS WITH PLATELET-RICH PLASMA THERAPY: A FUNCTIONAL OUTCOME EVALUATION
Babu, P. A., SEKHAR, A. C., & SUJIN, S. (2023) · International Journal of Pharmacy and Pharmaceutical Sciences · doi:10.22159/ijpps.2023v15i6.48005 · Cited by 1
Effectiveness of combined therapy in physical therapy for the management of musculoskeletal pain: a systematic review and meta-analysis
Ortiz, H. A. D. L. B., Leiva, C. A., Lillo, C. A., Álvarez, D. C., & Pizarro, B. C. (2024) · Physiotherapy Quarterly · doi:10.5114/pq/163383 · Cited by 1
Comparative Effects of Isometric Quadriceps Training, Glucosamine and Chondroitin Sulphate Iontophoresis on Pain Intensity and Physical Functions of Patients with Knee Osteoarthritis
Lasisi, K., Onigbinde, A. T., Ayinla, S. C., Ayeni, O. E., Kekere, T. F., Awotipe, A., Borode, A. O., Ayodeji, A. O., Adeyemi, T., Adewuni, A. S., et al. (2024) · European Journal of Medical and Health Research · doi:10.59324/ejmhr.2024.2(4).25 · Cited by 1
The impact of blood flow restriction training combined with low-load resistance training on the risk of falls in patients with knee osteoarthritis in China: a single-centre, two-arm, single-blind, parallel randomised controlled trial protocol
Lin, Q., Yu, D., Lu, T., Zhang, Y., Chen, X., Qin, J., & Wu, F. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-092689 · Cited by 1
Italian Version of the Risk Assessment and Prediction Tool: Properties and Usefulness of a Decision-Making Tool for Subjects’ Discharge after Total Hip and Knee Arthroplasty
Monticone, M., Frigau, L., Sconza, C., Foti, C., Molà, F., & Respizzi, S. (2019) · International Journal of Statistics in Medical Research · doi:10.6000/1929-6029.2019.08.02 · Cited by 1
Microfracture and Hydrogel Scaffolds for the Treatment of Osteochondral Injuries of the Knee: Clinical Results at 4 Years Follow-Up
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“Clinical evaluation was performed using the VAS (Visual Analogue Scale) and the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) questionnaires consisting of 3 subscales: Pain, Stiffness, and Physical Function [9,10].”
Method
Effect of biomechanical correction of tibia on medial joint space loading, varus deformity and functional tasks in patients with medial tibiofemoral joint osteoarthritis: a two-group pre-test, post-test randomized clinical trial study protocol
Saini, S., Goyal, M., & Samuel, A. J. (2021) · Revista Pesquisa em Fisioterapia · doi:10.17267/2238-2704rpf.v11i2.3578 · Cited by 1
Efficacy of Maitland Mobilization and Myofascial Trigger Point Release in Patients of Osteoarthritis of Knee
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“Hence, Group A shows significant improvement in pain reduction than Group B. Table 2: Comparison of mean difference in Goniometer for ROM score in two groups Student’s unpaired t test: Group N Mean Std. Deviation Std. Error Mean t-value Group A 36 16.38 8.34 1.39 2.32 P=0.023, SGroup B 36 12.25 6.64 1.10 Table 2 shows…”
BackgroundInfluential
Management of a rare intra-articular fracture of the lateral femoral condyle: case report.
Compagnoni, R., Ricci, M., Pedrini, F. A., Ferrua, P., Menon, A., & Randelli, P. S. (2021) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v92is1.11094 · Cited by 1
“it included the Numeric Rating Scale (NRS) for pain (11), the International Knee Documentation Committee (IKDC) subjective score (12) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (13).”
Method
Combine Approach of Proximal Fibula Osteotomy (PFO) Followed by Intra-Articular Dextrose Prolotherapy in Severe Medial Knee Osteoarthritis
Rahman, A. N., Herman, H., Kriswanto, E., Faried, A., & Nasser, M. K. (2022) · Journal of Pain Research · doi:10.2147/jpr.s357284 · Cited by 1
“result points were divided into four groups based on the severity: mild (0–24 points), moderate (25–48 points), severe (49–72 points), and very severe (73–96 points).(12)”
Background
Correlation between Toe Grip Strength and Knee Function in Patients with Knee Osteoarthritis-Protocol for a Cross-Sectional Study
Joseph, D. C. (2023) · Annals of Physiotherapy & Occupational Therapy · doi:10.23880/aphot-16000251 · Cited by 1
Impatto sulla qualità della vita delle fratture vertebrali in donne in età postmenopausale affette da osteoporosi. Validità della versione italiana del mini-Osteoporosis Quality of Life Questionnaire The impact of vertebral fractures on quality of life in postmenopausal women with osteoporosis. Validity of the Italian version of mini-Osteoporosis Quality of Life Questionnaire
Salaffi, F., Stancati, A., Carotti, M., Lorenzetti, R., & Grassi, W. (2005) · Cited by 1
Comment on Alayat et al. The Effectiveness of Photobiomodulation Therapy on Pain and Function in Patients with Patellofemoral Pain Syndrome—A Systematic Review and Meta-Analysis. J. Clin. Med. 2026, 15, 20
Ortiz, H. A. D. L. B., & Chamorro-Lange, C. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15176635 · Cited by 1
“These scales capture different constructs—AKPS assesses function related to anterior knee pain, where higher scores indicate better function, and WOMAC assesses disability, where improvements are reflected by lower scores [25,26]—and their combination may increase heterogeneity and indirectness.”
OSTEOARTRITIS - EPIDEMIOLOGIJA, EKONOMSKI ASPEKTI I KVALITETA ŽIVOTA OSTEOARTHRITIS - EPIDEMIOLOGY, ECONOMICS AND QUALITY OF LIFE
Grazio, S. (2005)
Patient-reported Outcome Measures—Framework, Psychometrics, and Uses
Davis, D. R. (2016) · Orthopaedic Section, APTA, Inc. eBooks · doi:10.17832/isc.2016.26.1.1
The relationship between Medical Outcomes Study Short Form-36 (SF-36) and conventional objective outcome scales in patients with postoperative tibial plateau fractures
Taşdemir, Z., & GÜZEL, Ş. E. (2019) · Balıkesir Medical Journal · doi:10.33716/bmedj.519418
A Study of Efficacy and Tolerability of Rosehip Extract (Gopo) vs. Ibuprofen (a nsaid) in Treatment of Osteoarthritis in Weight Bearing Joints
Lal, H., Singh, H., Sandhu, K. S., & Sehgal, V. K. (2019) · International Journal of Medical and Dental Sciences · doi:10.18311/ijmds/2019/23417
“[12] Other studies have also shown that pain was significantly reduced in patient taking ibuprofen.[13,14] Warlhom in 2003 conducted a double blind randomized clinical trial between rosehip and placebo in 100 patients.”
Background
Functional Outcome of Early Knee Osteoarthritis Treated with Platelet Rich Plasma
Kumar, V., Vishal, R., & Pillai, V. R. (2020) · International Journal of Contemporary Medical Research [IJCMR] · doi:10.21276/ijcmr.2020.7.1.2
The Effect of Symmetrical Involvement of the Knee Joints in Moderate Osteoarthritis on Individuals’ Report of Pain and Function (Part One of a Preliminary Study): Intermittent and Constant Osteoarthritis Pain Measure
Melyanian, B., Niki, Z., & Rezaeian, Z. S. (2016) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.22122/jrrs.v11i6.2552
Managing an essential public health menace - Osteoarthritis of knee, through janu basti procedure of traditional Indian medicine - A pilot study
Mishra, A., & Shrivastava, V. (2020) · Journal of Medical and Scientific Research · doi:10.17727/jmsr.2020/8-20
“The WOMAC consists of 24 items, rated on a five point Likert scale, and divided into 3 sub-scales [10, 11]: Pain (5 items), stiffness (2 items), and physical function (17 items).”
BackgroundMethod
Fatigue and Pain Measurements in Systemic Lupus Erythematosus
Ajrawat, P., Strand, V., Matsos, M. P., Simon, L. S., & Touma, Z. (2021) · Springer eBooks · doi:10.1007/978-3-030-73303-2_15
Effects of COVID-19 Quarantine on patients affect of hip osteoarthritis in list for joint replacement
Grassi, M., Larghi, M. M., Placenza, E., Faugno, L., Rampulla, C., & Manzotti, A. (2020) · Hong Kong Journal of Orthopaedic Research · doi:10.37515/ortho.8231.3302
Measures of Knee Osteoarthritis: Condition Specific Outcome Measure Scales and their Availability in Bengali Language
Baidya, O. (2018) · Orthopedics and Rheumatology Open Access Journal · doi:10.19080/oroaj.2018.10.555799
“All the scales (WOMAC, ICOAP, KOOS, KOOS-PS, SF-36, SF-12 and Lysholm scale) reviewed in this study are having satisfactory reliability and validity for the original English version [8,13,15,20].”
BackgroundMethod
Qualidade de vida relacionada à saúde de idosos com osteoartrite de joelhos
Alves, R. A. E. (2011) · doi:10.47749/t/unicamp.2011.841238
2003 Volume Contents, Author and Keyword Indexes
(2003) · Osteoarthritis and Cartilage · doi:10.1016/s1063-4584(03)00283-8
A single systems research design to examine the effectiveness of osteopathic treatment for people with osteoarthritis of the hip
Howat, T. (2013) · Unitec Research Bank (Unitec Institute of Technology)
Impact of Functional Task Training on Gait Parameter of OA Knee
Kirupa, K., Paul, J., Harikrishnan, N., & Manoj Abraham, M. (2023) · International journal of human movement and sports sciences · doi:10.13189/saj.2023.110203
Psychometric Analysis of the questionnaires for the assessment of lower limbs available in Italian version: a systematic reviewPreprint
Barni, L., Carrasco-Vega, E., Martín‐Martín, J., Galli, M., Freddolini, M., Merchán-Baeza, J. A., & González‐Sánchez, M. (2023) · Research Square · doi:10.21203/rs.3.rs-3078112/v1
Comparative Effect of Faradic and Russian Currents on the Quadriceps Muscle in Patients with Knee Osteoarthritis
Rani, N., Verma, S., Das, K., Pramanick, P., & Chauhan, K. (2023) · International Journal for Research in Applied Science and Engineering Technology · doi:10.22214/ijraset.2023.55301
ปจจยทสมพนธกบขอจำกดในการทำกจกรรมของผสงอายหลงผาตดเปลยนขอเขาเทยม
คําวะรัตน์, พ., & สาสัตย์, ศ. (2017) · doi:10.58837/chula.the.2017.1102
Tuina on knee pain and physical function for patients with mild-moderate knee osteoarthritis in Shanghai: protocol for a multicenter, assessor-blinded, randomized controlled trialPreprint
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Evaluation of the effect of low-intensity pulsed ultrasound in pain and dysfunction for knee osteoarthritis: a double-blind, randomized controlled trial protocolPreprint
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Effectiveness of Träbert current in a physiotherapy program for the management of musculoskeletal pain: a systematic review and meta-analysis
Ortiz, H. A. D. L. B., Muñoz, S. C., Lagos, E. A., Guajardo, K. D., & Villa, V. J. (2024) · Physiotherapy Quarterly · doi:10.5114/pq.2024.135417

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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