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IJSPT
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Zhang Y, Ren J, Zang Y, Guo W, Disantis A, Martin RL. Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity. IJSPT. 2023;18(3):653-686. doi:10.26603/​001c.74528
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  • Figure 1. PRISMA Search Diagram
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  • Figure 2. Number of Language Versions Available for Recommended Patient Reported Outcome Measures
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  • Figure 3. Number of Language Versions Available for Recommended Cross-culturally Adapted Patient Reported Outcome Measures
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Abstract

Background

A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown.

Purpose

The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization.

Study design

Literature Review

Methods

PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data.

Results

Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use.

Conclusion

Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use.

Level of evidence

3a

INTRODUCTION

Patient reported outcome measures (PROMs) are widely used in orthopaedic settings.1–5 The decision regarding which PROM to use should be based on the available psychometric evidence. Although a large number of PROMs have been developed in the English language for various lower extremity orthopaedic pathologies, the psychometric evidence supporting their use is highly variable.6–10 An umbrella review by Zhang et al.11 assessed 19 systematic reviews and found that 20 different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown.

The usefulness of a PROM can be defined by the instrument’s psychometric properties, including evidence for reliability, validity, and responsiveness. Test-retest reliability defines the stability of a score over time for patients who have not changed.1,2,12 A useful value for clinicians related to test-retest reliability is minimal detectable change (MDC) which is the change in score outside of measurement error. This reflects a true change in the patient.1,2,12 Validity refers to the degree to which the instrument measures the construct it was intended to measure.2,12 PROMs commonly offer evidence for concurrent validity which is the degree to which the scores of a PROM relate to scores on other instruments that measure the same or similar construct.1,2,12 Responsiveness is the ability of an instrument to detect a meaningful change in patient status over time. It can be defined with a value for minimal clinically important difference (MCID).1,2,12,13 A PROM may be more useful to clinicians and researchers when there is evidence for the three psychometric properties of reliability, validity, and responsiveness.

Cross-cultural adaptation studies are needed to translate PROMs into a variety of languages that will allow for more international implementation.14 Cross-cultural adaption studies ensure that the items and responses for the translated PROMs have the same meaning as the original language version.15 Clinicians and researchers need to not only be aware of recommended PROMs for specific lower extremity pathologies, but also be aware of which versions are cross-culturally adapted. The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization.

METHOD

The current study utilized the results of a previous umbrella review to identify which of the 20 recommended PROMs have been translated and cross-culturally adapted.11 (Table 1) A literature review was conducted on PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus Search from database inception to May 2022. The search strategy and terms are listed in Table 2. Studies were included if a non-English language version of one of the 20 recommended PROMs was cross-culturally adapted into another language while providing evidence of one psychometric property (reliability, validity and responsiveness) to support its use. Studies on individuals less than age 18 were excluded. Two authors independently evaluated the studies for inclusion and independently completed data extraction. Any conflicts were resolved by a third author. Cross-culturally adapted language versions for each of the 20 recommended PROMs were identified and recorded. The supporting psychometric properties for reliability, validity, and responsiveness for each version were extracted and recorded on a data collection spreadsheet for tabulation.

Table 1.Recommended Patient Reported Outcome Measures
Systematic review recommended PROMs Pathology/ Surgical Procedure
ACL-RSI Anterior cruciate ligament injury
A-FORM Recovery after Ankle Fractures
ATRS Achilles’ tendon rupture
AKPS Patellofemoral pain syndrome
FAAM Chronic Ankle instability
FADI Chronic Ankle instability
HAGOS Groin pain
Hip Arthroscopy for labral pathology
Non-arthritic hip joint pain, femoroacetabular impingement, Hip labral pathology
HOS Hip Arthroscopy for labral pathology
Non-arthritic hip joint pain, femoroacetabular impingement, Hip labral pathology
HOS combined with NAHS Hip Arthroscopy
HOOS Hip osteoarthritis
Total Hip Arthroplasty for osteoarthritis
iHOT-12 Hip Arthroscopy for labral pathology
Non-arthritic hip joint pain, femoroacetabular impingement, hip labral pathology
iHOT-33 Hip Arthroscopy for labral pathology
Non-arthritic hip joint pain, femoroacetabular impingement, Hip labral pathology
KOOS Total Knee Arthroplasty for osteoarthritis
KOS-ADLS Patellofemoral pain syndrome
MOXFQ Foot or ankle diseases
Surgery for hallux valgus
OHS Total Hip Arthroplasty for osteoarthritis
OKS Total Knee Arthroplasty for osteoarthritis
SEFAS Surgery for hallux valgus
Rheumatoid arthritis in the foot and ankle
WOMAC Knee osteoarthritis
Total Hip Arthroplasty for osteoarthritis
Total Knee Arthroplasty for osteoarthritis
WORQ Total Knee Arthroplasty for osteoarthritis

Abbreviations: ACL-RSI, ACL-Return to Sport after Injury Scale; A-FORM, Ankle-fracture outcome of rehabilitation measure; AKPS, Anterior Knee Pain Scale; ATRS, Achilles tendon Total Rupture Score; FAAM, Functional Ankle Ability Measure; FADI, Foot and Ankle Disability Index; HAGOS, The Copenhagen Hip and Groin Outcome Score; HOS, Hip Outcome Score; HOOS, Hip dysfunction and Osteoarthritis Outcome Score; IHOT, International Hip Outcome Tool; KOOS, Knee Injury and Osteoarthritis Outcome Score; KOS-ADLS, Knee Outcome Survey of Daily Living Scale; MOXFQ, The Manchester-Oxford Foot Questionnaire; NAHS, Non-Arthritic Hip Score; OHS, Oxford hip score; OKS, Oxford Knee Score; SEFAS, Self-Reported Foot and Ankle Score; WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index; WORQ, The Work Osteoarthritis or joint replacement questionnaire

Table 2.Search Strategy
(Reliability) OR (validity) OR (responsiveness) OR (“psychometric properties”) OR (“cross-cultural adaptation”) AND ACL-Return to Sport after Injury Scale (ACL-RSI)
Ankle-fracture outcome of Rehabilitation Measure (A-FORM)
Anterior Knee Pain Scale (AKPS)
Achilles tendon Total Rupture Score (ATRS)
Functional Ankle Ability Measure (FAAM)
Foot and Ankle Disability Index (FADI)
The Copenhagen Hip and Groin Outcome Score (HAGOS)
Hip Outcome Score (HOS)
Hip dysfunction and Osteoarthritis Outcome Score (HOOS)
International Hip Outcome Tool (IHOT)
Knee Injury and Osteoarthritis Outcome Score (KOOS)
Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS)
The Manchester-Oxford Foot Questionnaire (MOXFQ)
Non-Arthritic Hip Score (NAHS)
Oxford Hip Score (OHS)
Oxford Knee Score (OKS)
Self-Reported Foot and Ankle Score (SEFAS)
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
The Work Osteoarthritis or Joint Replacement Questionnaire (WORQ)

RESULTS

The search identified 9064 articles. 312 met the inclusion criteria. (Figure 1) Of the 20 recommended PROMs, 19 were cross-culturally adapted into languages other than English (Table 3 and Figure 1). The Knee Injury and Osteoarthritis Outcome Score (KOOS), The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), ACL-Return to Sport after Injury Scale (ACL-RSL), Functional Ankle Ability Measure (FAAM), Achilles tendon Total Rupture Score (ATRS), Hip dysfunction and Osteoarthritis Outcome Score (HOOS), Oxford hip score (OHS), The Manchester-Oxford Foot Questionnaire (MOXFQ) and Oxford hip score (OKS) were available in over 10 different language versions. (Figure 2) A breakdown of the PROMs available in languages other than English are presented in Figure 3. Turkish, Dutch, German, Chinese, and French were the most common languages. Each of these versions had more than 10 PROMs with psychometric properties supporting their use.

Table 3.Available Language Versions for Recommended Patient Reported Outcome Measures
PROMs Language versions
ACL-RSL Arabic16; Brazilian17; Chinese18,19; Dutch20,21; French22; German23; Italian24–26; Japanese27; Korean28; Lithuanian29; Norwegian30; Spanish31; Swedish32; Turkish33
ATRS Chinese34; Danish35; Dutch36,37; French38; Greek39; Italian40; Korean41; Norwegian42; Persian43; Portuguese44; Polish45; Swedish46; Turkish47
AKPS Arabic48; Brazilian49; Dutch50,51; French52; Greek53; Norwegian54; Spanish55
A-FORM N/A
FAAM Brazilian56; Chinese57; Danish58; Dutch59; Finnish60; French61; German62; Italian63; Japanese64; Persian65; Spanish66,67; Thai68; Turkish69–71
FADI Italian72
HAGOS Brazilian73; Chinese74; Danish75,76; Dutch77–79; Italian80; Norwegian76; Swedish81
HOOS Chinese82; Dutch83; French84; German85,86; Italian87; Japanese88; Korean89; Persian90; Polish91,92; Portuguese93,94; Romanian95; Thai96; Turkish97
HOS Brazilian98; German99,100; Korean101; Portuguese102; Romanian103; Spanish104; Turkish105
IHOT-12 Dutch106; French107; German108; Greek109; Japanese110; Swedish111; Turkish112
IHOT-33 Chinese113; Dutch114; French115; German116; Spanish117; Thai118
KOOS Arabic119–122; Chinese123–127; Danish128; Dutch129–131; Finnish132; French133,134; Filipino135; German136; Greek137; Hindi138; Icelandic139; India140; Indonesian141; Italian142,143; Japanese144–147; Malay148; Norwegian128; Persian149–154; Polish155,156; Portuguese157–159; Spanish160–162; Swedish171-173; Turkish163,164；Urdu165
KOS-ADLS Arabic166,167; Chinese168; French169; German170; Greek171; Persian152; Polish172; Portuguese173; Turkish174
MOXFQ Chinese175; Dutch176; Finnish177; French178; German179,180; Italian181; Korean182; Persian183; Spanish184,185; Turkish186,187;
NHS Portuguese188; Turkish189
OHS Chinese190; Danish191,192; Dutch193; French194; German195–197; Indonesian198; Italian199; Japanese200; Korean201; Persian202,203; Romanian103; Spanish204,205; Turkish206
OKS Arabic207–209; Chinese210–218; Dutch219; Estonian220; Finish221; French222,223; German224,225; Greek226; Japanese146,227; Korean228; Persian229; Portuguese230; Slovenia231; Spanish205,232; Thai233; Turkish234
SEFAS Danish235; German236; Spanish- French237; Swedish238–242; Thai243; Turkish244
WORQ Korean245
WOMAC Arabic246,247; Bengali248; Brazilian249–251; Chinese252–256; Dutch131,257–259; Finnish260–262; French263; French-Canadian264,265; German266–272; Greek273,274; Hebrew275; Italian276,277; Japanese278,279; Korean280,281; Malay282; Marathi283; Moroccan284; Nepali285; Persian286,287; Spanish288–295; Swedish296–298; Thai299,300; Turkish301–303

Abbreviations: ACL-RSI,ACL-Return to Sport after Injury Scale; A-FORM, Ankle-fracture outcome of rehabilitation measure; AKPS, Anterior Knee Pain Scale; ATRS, Achilles tendon Total Rupture Score; FAAM, Functional Ankle Ability Measure; FADI, Foot and Ankle Disability Index; HAGOS, The Copenhagen Hip and Groin Outcome Score; HOS, Hip Outcome Score; HOOS, Hip dysfunction and Osteoarthritis Outcome Score; IHOT, International Hip Outcome Tool; KOOS, Knee Injury and Osteoarthritis Outcome Score; KOS-ADLS, Knee Outcome Survey of Daily Living Scale; MOXFQ, The Manchester-Oxford Foot Questionnaire; NAHS, Non-Arthritic Hip Score; OHS, Oxford hip score; OKS, Oxford Knee Score; SEFAS, Self-Reported Foot and Ankle Score; WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index; WORQ, The Work Osteoarthritis or joint replacement questionnaire

Figure 1
Figure 1.PRISMA Search Diagram
Figure 2
Figure 2.Number of Language Versions Available for Recommended Patient Reported Outcome Measures

Abbreviations: ACL-RSI,ACL-Return to Sport after Injury Scale; ADLS, Activities of Daily Living Scale; A-FORM, Ankle-fracture outcome of rehabilitation measure; AKPS, Anterior Knee Pain Scale; ATRS, Achilles tendon Total Rupture Score; FAAM, Functional Ankle Ability Measure; FADI, Foot and Ankle Disability Index; HAGOS, The Copenhagen Hip and Groin Outcome Score; HOS, Hip Outcome Score; HOOS, Hip dysfunction and Osteoarthritis Outcome Score; IHOT, International Hip Outcome Tool; KOOS, Knee Injury and Osteoarthritis Outcome Score; MOXFQ, The Manchester-Oxford Foot Questionnaire; NAHS, Non-Arthritic Hip Score; OHS, Oxford hip score; OKS, Oxford Knee Score; SEFAS, Self-Reported Foot and Ankle Score; WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index; WORQ, The Work Osteoarthritis or joint replacement questionnaire

Figure 3
Figure 3.Number of Language Versions Available for Recommended Cross-culturally Adapted Patient Reported Outcome Measures

The cross-culturally adapted translated PROMs with all three psychometric properties for reliability, validity and responsiveness are listed in Tables 4, 5, and 6. They corresponded to the hip, knee, and foot and ankle, respectively. Cross-culturally adapted PROMs that do not have all three psychometric properties are listed in the Appendix. In addition, the number of research studies supporting each of the psychometric properties of reliability, validity, and responsiveness for the hip, knee, and foot and ankle are also shown in Tables 4, 5, and 6, respectively.

The WOMAC and the KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. The HOOS and OHS were both available in seven languages having all three psychometric elements of reliability, validity and responsiveness supporting their use. The most well studied PROMs were the German-WOMAC, Spanish-WOMAC, Swedish-KOOS and Swedish-SEFAS. (Tables 4-6) There were 124 cross-culturally adapted PROMs that had only studies providing evidence for reliability and/or validity. (Appendix)

Table 4.The Cross-culturally Adapted Translated Hip Patient Reported Outcome Measures with all three Psychometric Properties
Hip PROM
(Number of Language Versions)		 Language Version Reliability Validity Responsiveness
HAGOS Chinese 174 174 174
HOOS French 184 184 184
German 186 285,86 186
Italian 187 187 187
Japanese 188 188 188
Korean 189 189 189
Polish 291,92 291,92 192
Chinese 182 182 182
HOS German 299 299,100 1100
Korean 1101 1101 1101
Turkish 1105 1105 1105
IHOT-12 French 1107 1107 1107
German 1108 1108 1108
Greek 1109 1109 1109
Japanese 1110 1110 1110
Swedish 1111 1111 1111
IHOT-33 Chinese 1113 1113 1113
German 1116 1116 1116
OHS Chinese 1190 1190 1190
German 1195 3195–197 2196,197
Indonesian 1198 1198 1198
Italian 1199 1199 1199
Japanese 1200 1200 1200
Korean 1201 1201 1201
Spanish 2204,205 2204,205 1204
WOMAC
 Chinese 3252–254 5252–256 2254,256
Dutch 4131,257–259 4131,257–259 1259
Finnish 2260,261 3260–262 1260
German 3266,267,272 4266,267,269,270,272 3268,269,271
Italian 1276 1276 1277
Korean 1280 2280,281 1280
Spanish 4289,292,295 5288,289,292–294 4290–293
Swedish 3296–298 3296–298 1297
Thai 2299,300 2299,300 1299
Turkish 3301–303 3301–303 1301

Abbreviations: HAGOS, The Copenhagen Hip and Groin Outcome Score; HOS, Hip Outcome Score; HOOS, Hip dysfunction and Osteoarthritis Outcome Score; IHOT, International Hip Outcome Tool; OHS, Oxford hip score; WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index

Table 5.The Cross-culturally Adapted Translated Knee Patient Reported Outcome Measures with all three Psychometric Properties
Knee
(Number of Language Versions)		 Language Version Reliability Validity Responsiveness
ACL-RSL Dutch 120 120 121
AKPS Brazilian 149 149 149
KOOS




 Chinese 5123–127 5123–127 2125,127
French 2133,134 2133,134 2133,134
Hindi 1138 1138 1138
Japanese 1144 3144,145,147 1146
Persian 4149–152 2149–152 1154
Portuguese 3157–159 3157–159 2157–159
Spanish 2160,162 3160–162 3160–162
Swedish 3304–306 3304–306 3304–306
Turkish 1163 1163 1164
Dutch 2129,130 2129,130 1130
KOS-ADLS
Arabic 2166,167 2166,167 1167
Chinese 1168 1168 1168
Persian 1152 1152 1152
Polish 1172 1172 1172
Portuguese 1173 1173 1173
OKS Arabic 3207–209 3207–209 1209
Finish 1221 1221 1221
German 2224,225 2224,225 1225
Japanese 1227 1227 1146

Abbreviations: ACL-RSI, ACL-Return to Sport after Injury Scale; AKPS, Anterior Knee Pain Scale; KOOS, Knee Injury and Osteoarthritis Outcome Score; KOS-ADLS, Knee Outcome Survey of Daily Living Scale OKS, Oxford Knee Score

Table 6.The Cross-culturally Adapted Translated Foot and Ankle Patient Reported Outcome Measures with all three Psychometric Properties
Foot and Ankle
(Number of Language Versions)		 Language Version Reliability Validity Responsiveness
ATRS Chinese 134 134 134
Dutch 137 137 136
MOXFQ German 2179,180 2179,180 2179,180
Italian 1181 1181 1181
Spanish 2184,185 2184,185 2184,185
SEFAS Danish 1235 1235 1235
German 1236 1236 1236
Swedish 3238–240 4238–240,242 4238–241

Abbreviations: ATRS, Achilles tendon Total Rupture Score; MOXFQ, The Manchester-Oxford Foot Questionnaire; SEFAS, Self-Reported Foot and Ankle Score

DISCUSSION

Of the 20 PROMs with appropriate psychometric properties that were previously identified by Zhang et al.,11 19 have been cross-culturally adapted into language versions other than English. The KOOS and WOMAC were found to be available in 24 and 23 different languages, respectively. The most commonly culturally adapted language was Turkish, with 14 PROMs. There were 64 cross-culturally adapted translated PROMs with all three psychometric properties for reliability, validity, and responsiveness. To the authors’ knowledge, this is the first review that summarizes the availability of cross-culturally adapted PROMs for either lower or upper extremity pathologies. The result of this study can be a useful resource for international clinicians and researchers when choosing a PROM to use based on the evidence available in their languages of interest.

While there are a variety of reasons PROMs may be cross-culturally adapted, pathology prevalence and length of time the PROM has been in use may be important factors. The authors’ identified nine PROMs that were cross-culturally adapted into 10 different languages, while 11 PROMs were cross-culturally adapted into less than 10. The most common cross-culturally adapted PROMs, the KOOS and WOMAC, were developed for use in knee osteoarthritis. Similarly, the HOOS and OHS, available in 13 different languages, were originally developed for use in hip osteoarthritis. Osteoarthritis in a prevalent pathology worldwide,307 which may explain the high frequency in which these PROMs were cross-culturally adapted into a language other than English.

The KOOS and the WOMAC, were developed in 1988 and 1998, respectively.308,309 These instruments may be cross-culturally adapted at a higher frequency because of the length of time these instruments have been available. However, PROMs developed more recently, such as the ACL-RSL, FAAM, and ATRS, have also been cross-culturally adapted into 14, 13, and 13 different languages, respectively. (Figure 2) Anterior cruciate ligament tears, Achilles tendon ruptures, and ankle instability are common pathologies. This may help to explain why a larger number of language versions for these instruments exist, despite being developed more recently.

In addition to the pathology prevalence and length of time the PROM has been in use, the frequency at which PROMs are cited in published research studies may also influence whether the instrument has been cross-culturally adapted into languages other than English. The umbrella review by Zhang et al.11 found the WOMAC, HOOS, KOOS, ATRS, and FAAM were the most commonly cited instruments. These PROMs were also found to be the most frequently cross-culturally adapted. When specifically looking at these PROMs, the WOMAC consists of 24 items divided into three subscales: pain (5 items), stiffness (2 items) and physical function (17 items).310 The HOOS consists of 40 items311 while the KOOS consists of 42 items, with each PROM being divided into five subscales: 1) pain, 2) symptoms, 3) activities of daily living, 4) sport and recreation function, and 5) knee-related quality of life.312 ATRS consists of 10 items313 and the FAAM consists of a 29-item questionnaire divided into two subscales: activities of daily living (21item) and sports (8 times).314

According to the results of this study, there are 64 cross-culturally adapted language PROMs supported by all three properties of reliability, validity, and responsiveness. (Tables 4-6) Studies that cross-culturally adapt PROMs commonly offer evidence for reliability and validity with evidence for responsiveness being infrequently studied. (Appendix) This may be due to the fact that responsiveness studies require a more challenging longitudinal study design.

Limitations

A limitation of this study is that this review does not include a comprehensive search of all PROMs. Only cross-culturally adapted PROMs that were recommended in other systematic reviews were included in this review. Additionally, this review focused solely on musculoskeletal lower extremity pathologies. Regional and global PROMs, as well as those that pertain to the spine and upper extremity were not included in this current review. The study did not present the details regarding specific values that define reliability, validity and responsiveness for each PROM.

CONCLUSION

Of the 20 recommended PROMs identified in a previous review by Zhang et al.,11 19 were cross-culturally adapted into languages other than English. The PROMs most frequently cross-culturally adapted were the KOOS and WOMAC with 23 and 24 languages available, respectively. PROMs were most frequently cross-culturally adapted into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use.

Conflicts of Interest

The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article

Funding

There is no financial support for the research.

Submitted: October 20, 2022 CDT

Accepted: March 08, 2023 CDT

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Appendix. Cross-culturally adapted PROMs psychometric properties. Number of the supporting psychometric properties for reliability, validity, and responsiveness for each PROMs language version are listed. PROMs language versions supported by evidence of reliability, validity, and responsiveness are highlighted in bold.
PROMs Language Reliability Validity Responsiveness
ACL-RSL Arabic 1 1 0
Brazilian 1 1 0
Chinese 2 2 0
Dutch 1 1 1
French 0 1 0
German 1 1 0
Italian 3 3 0
Japanese 1 1 0
Korean 1 1 0
Lithuanian 1 1 0
Norwegian 1 1 0
Spanish 1 1 0
Swedish 1 1 0
Turkish 1 1 0
ATRS Chinese 1 1 1
Danish 1 1 0
Dutch 1 1 1
French 1 1 0
Greek 1 1 0
Italian 1 1 0
Korean 1 1 0
Norwegian 1 1 0
Persian 1 1 0
Portuguese 1 1 0
Polish 1 1 0
Swedish 1 1 0
Turkish 1 1 0
AKPS Arabic 1 1 0
Brazilian 1 1 1
Dutch 2 1 0
French 1 1 0
Greek 1 1 0
Norwegian 1 1 0
Spanish 1 1 0
FAAM Brazilian 1 1 0
Chinese 1 1 0
Danish 0 1 0
Dutch 1 1 0
Finnish 0 1 0
French 1 1 0
German 1 1 0
Italian 1 1 0
Japanese 1 1 0
Persian 1 1 0
Spanish 1 0 0
Thai 1 1 0
Turkish 1 1 0
FADI Italian 1 1 0
HAGOS Brazilian 1 1 0
Chinese 1 1 1
Danish 1 2 0
Dutch 3 3 0
Italian 1 1 0
Norwegian 0 1 0
Swedish 1 1 0
HOOS Chinese 1 1 1
Dutch 1 1 0
French 1 1 1
German 1 2 1
Italian 1 1 1
Japanese 1 1 1
Korean 1 1 1
Persian 1 1 0
Polish 2 2 1
Portuguese 2 2 0
Romanian 1 1 0
Thai 1 1 0
Turkish 1 1 0
HOS Brazilian 1 1 0
German 2 2 1
Korean 1 1 1
Portuguese 0 1 0
Romanian 1 1 0
Spanish 1 1 0
Turkish 1 1 1
IHOT-12 Dutch 1 1 0
French 1 1 1
German 1 1 1
Greek 1 1 1
Japanese 1 1 1
Swedish 1 1 1
Turkish 1 1 0
IHOT-33 Chinese 1 1 1
Dutch 1 1 0
French 1 1 0
German 1 1 1
Spanish 1 1 0
Thai 1 1 0
KOOS Arabic 4 4 0
Chinese 5 5 2
Danish 1 1 0
Dutch 2 2 1
Finnish 1 1 0
French 2 2 2
Filipino 1 1 0
German 1 1 0
Greek 1 1 0
Hindi 1 1 1
Icelandic 1 1 0
India 1 1 0
Indonesian 1 1 0
Italian 2 2 0
Japanese 1 3 1
Malay 1 1 0
Norwegian 0 1 0
Persian 4 4 1
Polish 2 0 2
Portuguese 3 3 2
Spanish 2 3 3
Swedish 3 3 3
Turkish 1 1 1
Urdu 1 1 0
KOS-ADLS Arabic 2 2 2
Chinese 1 1 1
French 1 0 1
German 1 1 0
Greek 1 1 0
Persian 1 1 1
Polish 1 1 1
Portuguese 1 1 1
Turkish 1 1 0
MOXFQ Chinese 1 0 1
Dutch 1 1 0
Finnish 0 1 0
French 1 1 0
German 2 2 2
Italian 1 1 1
Korean 1 1 0
Persian 1 1 0
Spanish 2 2 2
Turkish 2 2 0
NHS Portuguese 0 1 0
Turkish 1 1 0
OHS Chinese 1 1 1
Danish 1 2 0
Dutch 0 1 0
French 0 1 0
German 1 3 2
Indonesian 1 1 1
Italian 1 1 1
Japanese 0 1 1
Korean 1 1 1
Persian 2 2 0
Romanian 0 1 0
Spanish 2 2 1
Turkish 0 1 0
OKS Arabic 3 3 1
Chinese 6 9 0
Dutch 1 1 0
Estonian 1 1 0
Finish 1 1 1
French 1 1 0
German 2 2 1
Greek 1 1 0
Japanese 1 1 1
Korean 1 1 0
Persian 1 1 0
Portuguese 1 1 0
Slovenia 1 1 0
Spanish 1 1 0
Thai 1 1 0
Turkish 1 1 0
SEFAS Danish 1 1 1
German 1 1 1
Spanish-French 0 1 0
Swedish 3 4 4
Thai 1 1 0
Turkish 1 1 0
WORQ Korean 1 1 0
WOMAC Arabic 2 2 0
Bengali 1 1 0
Brazilian 2 3 0
Chinese 2 5 2
Dutch 4 4 1
Finnish 2 3 1
French 0 0 1
French-Canadian 2 2 0
German 3 4 3
Greek 2 2 0
Hebrew 1 1 0
Italian 1 1 1
Japanese 1 2 0
Korean 1 2 1
Malay 1 1 0
Marathi 0 1 0
Moroccan 1 1 0
Nepali 1 1 0
Persian 2 2 0
Spanish 4 5 4
Swedish 3 3 1
Thai 2 2 1
Tturkish 3 3 1