La versione italiana del Anterior Cruciate Ligament Quality of Life (ACL-QoL): adattamento cross-culturale, validità e affidabilità

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The Italian version of the Anterior Cruciate Ligament Quality of Life (ACL-QoL): cross-cultural adaptation, validity and reliability

Autori

Pavan Nicolò (Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy; Physiotherapy Study Kinè, San Vendemiano, Italy; Kinè s.r.l, Treviso, Italy)

Segat Francesco (Physiotherapy Study Kinè, San Vendemiano, Italy; Kinè s.r.l, Treviso, Italy)

Pellicciari Leonardo (IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy)

Piai Andrea (Physiotherapy Study Kinè, San Vendemiano, Italy)

Brindisino Fabrizio (Department of Medicine and Health Science “Vincenzo Tiberio,” University of Molise, Campobasso, Italy)

Venturin Davide (Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy; Physiotherapy Study Kinè, San Vendemiano, Italy; Kinè s.r.l, Treviso, Italy; Department of Medicine and Health Science “Vincenzo Tiberio,” University of Molise, Campobasso, Italy)

Background and aims

The Anterior Cruciate Ligament Quality of Life (ACL-QoL) questionnaire assesses the quality of life (QoL) among patients with anterior cruciate ligament (ACL) injury. This instrument stands out as the unique knee-related QoL measure tailored explicitly for individuals with ACL injuries.(1) The ACL-QoL is available in different languages, but nowadays no Italian version is available. The study aim was to translate and cross-culturally adapt the ACL-QoL into the Italian language and evaluate its measurement properties in individuals with surgical and non-surgical ACL injury.

Methods

113 subjects (mean±SD age: 28.3±8.4 years, 87 male) presenting at least one episode of ACL injury were included in three Italian private physiotherapy clinics. The ACL-QoL was translated into Italian following international guidelines.(2) According to the COSMIN guideline, feasibility (ceiling and floor effects), structural validity (confirmatory factor analysis [CFA]), internal consistency (Cronbach’s alpha), test-retest reliability (intraclass correlation coefficient [ICC], measurement error (minimal detectable change [MDC]) and construct validity (hypothesis testing).(3)

Results

The cross-cultural adaptation was carried out without any problems. Floor and ceiling effects were not detected except for a minor floor effect in “Work-Related Concerns” subscale.  The final CFA revealed partially fit to the five-factor model (CFI=0.931; TLI=0.918; RMSEA=0.077; SRMSR=0.058). Each subscale demonstrated adequate internal consistency (Cronbach’s alpha ≥ 0.70). Test-retest reliability was also good to excellent (ICC>0.80 for all subscales), indicating that these subscales are suitable for individual level measurement (except for the “Symptoms and Physical Complaints” subscale). The MCD ranged from 18.8% to 32.1% of the total score of each subscale. Over 75% of a-priori hypothesis was met, underscoring the satisfactory construct validity.

Conclusion

The Italian version of the ACL-QoL is a reliable and valid tool for assessing knee-related QoL in individuals who have experienced an ACL injury and is applicable at various recovery stages. The Italian version of the ACL-QoL demonstrates adequate internal consistency, test-retest reliability and construct validity, making it suitable for both surgical and non-surgical management. However, the factorial structure of the ACL-QoL could be improved, and the MCD of some subscales may indicate that the measurement error may be a little high.

REFERENCES

  1. Mohtadi N. Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency. Am J Sports Med. 1998 May-Jun;26(3):350-9. doi: 10.1177/03635465980260030201.
  2. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91. doi: 10.1097/00007632-200012150-00014.
  3. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010 Jul;63(7):737-45. doi: 10.1016/j.jclinepi.2010.02.006.

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