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A functional difficulty and functional pain instrument for hip and knee osteoarthritis

Alan M Jette1*, Christine M McDonough12, Pengsheng Ni1, Stephen M Haley1, Ronald K Hambleton3, Sippy Olarsch1, David J Hunter4, Young-jo Kim56 and David T Felson7

Author Affiliations

1 Health & Disability Research Institute, Boston University School of Public Health, Boston University, 715 Albany Street – T5W, Boston, MA 02118, USA

2 The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 35 Centerra Parkway, Lebanon, NH 03766, USA

3 Center for Educational Assessment, Department of Educational Policy, Research, and Administration, School of Education, University of Massachusetts, 813 North Pleasant Street, Amherst, MA 01003, USA

4 Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA

5 Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA 02115, USA

6 The Department of Orthopedic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA

7 Boston University School of Medicine, Boston University, 715 Albany Street R-304, Boston, MA 02118-2526, USA

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Arthritis Research & Therapy 2009, 11:R107  doi:10.1186/ar2760

Published: 9 July 2009



The objectives of this study were to develop a functional outcome instrument for hip and knee osteoarthritis research (OA-FUNCTION-CAT) using item response theory (IRT) and computer adaptive test (CAT) methods and to assess its psychometric performance compared to the current standard in the field.


We conducted an extensive literature review, focus groups, and cognitive testing to guide the construction of an item bank consisting of 125 functional activities commonly affected by hip and knee osteoarthritis. We recruited a convenience sample of 328 adults with confirmed hip and/or knee osteoarthritis. Subjects reported their degree of functional difficulty and functional pain in performing each activity in the item bank and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Confirmatory factor analyses were conducted to assess scale uni-dimensionality, and IRT methods were used to calibrate the items and examine the fit of the data. We assessed the performance of OA-FUNCTION-CATs of different lengths relative to the full item bank and WOMAC using CAT simulation analyses.


Confirmatory factor analyses revealed distinct functional difficulty and functional pain domains. Descriptive statistics for scores from 5-, 10-, and 15-item CATs were similar to those for the full item bank. The 10-item OA-FUNCTION-CAT scales demonstrated a high degree of accuracy compared with the item bank (r = 0.96 and 0.89, respectively). Compared to the WOMAC, both scales covered a broader score range and demonstrated a higher degree of precision at the ceiling and reliability across the range of scores.


The OA-FUNCTION-CAT provided superior reliability throughout the score range and improved breadth and precision at the ceiling compared with the WOMAC. Further research is needed to assess whether these improvements carry over into superior ability to measure change.