Development of a questionnaire for identification of the risk factors for osteoarthritis of the knees in developing countries. A pilot study in Iran and Bangladesh. An ILAR-COPCORD phase III study

Background: Knee osteoarthritis (OA) is one of the most prevalent rheumatic disorders in the Asia-Pacific region. Identification of modifiable risk factors is important for development of strategies for primary and secondary prevention of knee OA. Objective: Developing a core questionnaire for identification of risk factors of knee OA at the community level. Methods: Steps performed: (1) item generation from literature, existing knee OA questionnaires and patient focus group discussions; (2) development of a preliminary APLAR-COPCORD English questionnaire; (3) translation into target language, back translation and development of a pre-final target language version; (4) adaptation of the pre-final target language version through tests of comprehensibility, content validity, test-retest reliability; and (5) finalization of the English questionnaire. Investigators in Bangladesh, Iran, China, Philippines and Indonesia participated in steps 1 and 2. Subsequent steps were carried out by Bangladeshi and Iranian investigators. Results: Fifty-three items were generated. Fourteen were obtainable from physical examination and placed in an examination sheet. Two radiological items were not included. A preliminary English questionnaire comprising the remaining 37 items was constructed and translated into Bengali and Persian. The preliminary Bengali and Persian versions were adapted as a result of tests of comprehensibility, content validity and test-retest reliability. The English questionnaire was adapted through repeated exchange of ideas and experiences among participating investigators. A 35-item English core questionnaire was finally developed. Conclusion: The questionnaires may be used to identify risk factors of knee OA in Asia-Pacific communities after validation and further adaptation. From these data strategies for primary and secondary prevention of knee OA can be developed.