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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Reliability of the Kannada Version of the Knee Injury and Osteoarthritis Outcome Score: A Cross-sectional Study
Correspondence Address :
Nityal Kumar Alagingi,
Assistant Professor, Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Mangalore-575018, Karnataka, India.
E-mail: nityal86@gmail.com
Introduction: The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a valid and reliable tool for assessing knee injury and osteoarthritis (OA). It has been cross-culturally adapted into several Indian languages. However, the reliability of the Kannada translation of the KOOS scale has not been established.
Aim: The aim of this study was to confirm the reliability of the Kannada translation of the KOOS scale and to assess the inter-rater and test-retest reliability of the culturally adapted KOOS outcome measure.
Materials and Methods: A cross-sectional study was conducted involving 74 patients diagnosed with OA. All patients were asked to complete the KOOS questionnaire. To test inter-rater reliability, two raters completed the questionnaire, while for test-retest reliability, one rater was involved. The procedure was repeated after a week. The scores of both questionnaires were then compared to check the inter-rater and test-retest reliability of the cross-culturally adapted KOOS outcome measure. Cronbach’s Alpha and the Intraclass Correlation Coefficient (ICC) were utilised to determine the scale’s reliability.
Results: The entire scale demonstrated high reliability, with an ICC ranging from 0.96 to 0.98 for all subscales. The domain-wise and overall Cronbach’s Alpha values were >0.70. There was agreement between the raters (p<0.01) and test-retest data (p<0.01) for pain and activities of daily living items. Highly significant correlations were also observed between test-retest data for all items related to sport and recreation function and knee-related quality of life (p<0.001).
Conclusion: The Cronbach’s Alpha values obtained for all domains of the scale were >0.70, indicating the scale’s reliability. Additionally, the scale demonstrated consistency as the ICC was determined to be substantial.
Activities of daily living, Knee pain, Measurement properties, Patient-reported outcome measure
OA is a multi-cause disease associated with genetic, hormonal, aging, mechanical, and metabolic factors (1). It alters focal areas and leads to the loss of articular cartilage within synovial joints, which is correlated with bone hypertrophy and capsule thickness (1). It is one of the leading causes of disability worldwide, and its prevalence could rise in response to rising life expectancies, rising rates of obesity, and decreased mobility among the population as a whole (1).
In India, the prevalence of OA with clinical symptoms affects 10% of men and 20% of women who are 45 years of age or older, while the prevalence of OA as seen on radiographs rises between 27% and 80%. Compared to rural areas, urban areas have a higher prevalence of OA (2).
When there is an increase in the prevalence of OA, it is necessary to have a Patient-Reported Outcome Measure (PROM) that reflects the impact of the condition on individuals, hence can be used to measure the effectiveness and outcome of healthcare (3),(4). This makes it important for the patient to have a reliable self-reported outcome measure to have a better understanding of the severity of their condition [3,4].
To evaluate both short- and long-term symptoms and function in patients with knee OA and ligament damage, Roos and Lohmander developed the KOOS, an independent questionnaire as an extension of the WOMAC (5). There are 42 items in it. It evaluates five factors: knee-related quality of life, pain, symptoms, activities of daily living, sports, and recreational function (6),(7).
KOOS has proven to be a valid and reliable self-reported outcome measure that can be used for short-term as well as long-term outcome measures of knee OA (8).
Due to the increase in large multicentre international studies and the requirement for globally meaningful epidemiologic and/or therapeutic study results, there is a need for cross-cultural adaptation of health status outcome measures to use the outcome measure in the patient-specific language. It will help in better understanding the outcome measure and provide accurate results (9),(10).
However, in order to cross a culturally adapted scale to be deemed reliable, its reliability needs to be tested. The previous cross-culturally adapted KOOS scale in the Kannada language has not undergone any psychometric property testing to demonstrate its reliability. This makes the usage of the scale difficult in clinical practice. Therefore, a study is proposed to test the reliability of the cross-culturally adapted KOOS (11).
The cross-sectional study was conducted from March 2022 to February 2023 at the Department of Physiotherapy of KS Hegde Charitable Hospital. This study was approved by the Ethics Committee of NITTE Institute of Physiotherapy, NITTE (Deemed-to-be University), Mangalore, Karnataka (NIPT/IEC/Min/07/2021-2022).
Inclusion criteria: Individuals suffering from knee OA (Kellgren Lawrence grading 0-4) (12) and able to read and write the Kannada language were included in the study.
Exclusion criteria: Patients who cannot read and write the Kannada language and those with psychiatric and/or communication disorders were excluded from the study.
Sample size calculation: The sample reliability was considered at 0.75 with a population reliability of 0.5 (9). Considering a power of 95% and an alpha error of 5%, the total sample size came out to be 74.
Procedure
Patients diagnosed with knee OA (Kellgren and Lawrence Grade 0-4) were recruited from KS Hegde Hospital after obtaining ethical clearance from the Institutional Ethical Committee. The study included only patients who were fluent in Kannada and could read and write in the language. These patients were provided with a consent form before participating in the study. Upon completion, they were asked to fill out a cross-culturally adapted version of the KOOS questionnaire in Kannada. Neither the patients nor the therapists were given any prior instructions on how to fill out the questionnaire, ensuring unbiased and accurate responses.
Outcome measure: KOOS is a PROM that evaluates pain, symptoms, Activities of Daily Living (ADL) function, sport and recreation function, and quality of life. It is designed for both research and clinical purposes and is openly available. KOOS has been shown to be a valid, reliable, and responsive outcome measure in various patient populations with knee injuries, knee OA, and total knee replacement. It is currently offered in 50 different languages, and each question has five possible answers with scores ranging from 0 (none) to 4 (significant issues). Scores are transformed to a scale of 0-100, with 0 signifying no knee issues and 100 signifying serious knee issues (13).
Reliability: To assess reliability, the KOOS questionnaires were evaluated using the guidelines provided by the Guidelines for Reporting Reliability and Agreement Studies (GRRAS). Inter-rater and test-retest reliability were checked according to these guidelines (14).
Test-retest reliability: Once the patient gave their consent, they were asked to fill out the KOOS outcome measure for their knee OA. To ensure test-retest reliability, the questionnaires were given twice—once on the first day and then again at least seven days later to reduce memory recall. Afterwards, the therapist scored the scale.
Inter-rater reliability: When assessing inter-rater reliability, two raters, Rater A and B, each rated the questionnaire. For the initial round of questionnaire administration, one rater assessed the scale. Seven days later, the other rater assessed the same scale to ensure consistency in the outcome measure between both raters. The scale was then returned to the therapist for scoring.
Statistical Analysis
The data were analysed using Statistical Package for the Social Sciences (SPSS) software, version 26.0 (SPSS Inc.; Chicago, IL). The collected data were summarised using descriptive statistics, such as frequency, percentage, mean, and Standard Deviation (SD). To assess the reliability of the scales, Cronbach’s Alpha and the Intraclass Correlation Coefficient (ICC) were used. Kappa Statistic was employed to determine the level of agreement between the raters. Pearson’s correlation coefficient was used to analyse the test-retest data. A p-value of 0.05 or below was considered significant.
In this study, 74 patients with knee OA were included. The patients had a mean age of 65.1±4.0 years for males and 62.12±3.4 years for female participants, as shown in (Table/Fig 1). The mean overall score for the KOOS questionnaire was similar for both raters, with scores of 101.3±33.1 for rater 1 and 99.7±32.9 for rater 2, respectively, as shown in (Table/Fig 2).
(Table/Fig 3) depicts the reliability analysis for the domains. The full domain of the scale obtained a Cronbach’s Alpha of >0.70 (15), indicating its reliability. Moreover, the ICCs for all the domains were >0.94, indicating high reliability..
There was agreement between the raters (p<0.05) as well as test-retests (p<0.01) for all the items of symptoms. The Kappa value ranged from 0.246 to 0.501 for all the items, as shown in (Table/Fig 4). For all the items of pain, there was agreement between the raters (p<0.01) as well as test-retests (p<0.01), as shown in (Table/Fig 5). Similarly, there was agreement between the raters (p<0.05) as well as test-retests (p<0.01) for all the items of activities of daily living, as shown in (Table/Fig 6). Highly significant correlations were also observed between test-retest data for all the items of Sport and recreation function and knee-related quality of life (p<0.001), as shown in (Table/Fig 6),(Table/Fig 7).
After analysing the reliability of the Kannada version of KOOS, this study found significant results in all subscales. The p-values for all subscales were less than 0.001, indicating a high level of reliability between the raters.
The Kannada version of the KOOS subscales demonstrates a remarkable internal consistency, as evidenced by Cronbach’s α-values exceeding 0.70 (ranging from 0.86 to 0.98). Although concerns have been raised about cross-cultural adaptation and the requirement for patients to be bilingual (16), cross-culturally adapted outcome measures hold significant value in clinical settings. For instance, the Kannada version’s values are comparable to the Finnish version (Cronbach α-range: 0.79-0.96), where the subscale Cronbach values are as follows: Pain (0.94), Symptoms (0.84), Activities of Daily Living (0.97), Sports and Recreational Activities (0.96), and Knee-Related Quality of Life (0.86) (9), as well as the Malaysian version (Cronbach α range: 0.78-0.95), where the subscale Cronbach values are as follows: Pain (0.87), Symptoms (0.77), Activities of Daily Living (0.94), Sports and Recreational Activities (0.93), and Knee-Related Quality of Life (0.90) (17). Furthermore, the test-retest reliability analysis confirms that the Kannada version of KOOS is highly reliable, with ICC values exceeding 0.90 (ranging from 0.95 to 0.98), and remarkable subscale Cronbach values: Pain (0.91), Symptoms (0.91), Activities of Daily Living (0.96), Sports and Recreational Activities (0.88), and Knee-Related Quality of Life (0.86).
This study observed lower test-retest reliability scores of 0.97 to 0.971 and Cronbach values ranging from 0.72 to 0.91 compared to the Urdu version of KOOS, suggesting translation and adaptation issues (18). Similar results were also seen in the Hindi version of KOOS (19).
It is essential to adapt KOOS to ensure that the instrument maintains conceptual, linguistic, and measurement equivalence when translated into Kannada. This adaptation process involves ensuring that the translated version conveys the same meaning as the original and is culturally appropriate for the target population. Failure to achieve these goals can lead to measurement errors, compromising the instrument’s validity and reliability.
This study identified that a seven-day washout period is sufficient to assess test-retest reliability compared to the previous study, which used a 21-day washout period and reported similar ICC and Cronbach’s values (14).
Limitation(s)
The validity of this tool was not assessed in this study.
The Kannada version of the KOOS exhibits adequate internal consistency and excellent test-retest reliability. It is a reliable tool that can be used as a self-report and disease-specific questionnaire for patients with knee OA. Future studies can be conducted to validate the Kannada version of KOOS.
DOI: 10.7860/JCDR/2023/65605.18458
Date of Submission: May 25, 2023
Date of Peer Review: Jul 22, 2023
Date of Acceptance: Aug 21, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 25, 2023
• Manual Googling: Jul 12, 2023
• iThenticate Software: Aug 18, 2023 (13%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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