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  • Validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory across different cultures and languages: a cross-sectional study of 452 male athletes with groin pain

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Original research
Validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory across different cultures and languages: a cross-sectional study of 452 male athletes with groin pain
  1. Karl Bang Christensen1,
  2. Mikkel Bek Clausen2,3,
  3. Enda King4,
  4. Andrew Franklyn-Miller5,6,
  5. Joar Harøy7,8,
  6. Thor Einar Andersen7,8,
  7. Per Hölmich9,
  8. Kristian Thorborg9
  1. 1 Department of Public Health, Section of Biostatistics, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
  2. 2 School of Physiotherapy, Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Kobenhavn, Denmark
  3. 3 School of Physiotherapy, University College Copenhagen, Copenhagen
  4. 4 Sports Medicine, Sports Surgery Clinic, Dublin, Ireland
  5. 5 Sports Surgery Clinic, Dublin, Ireland
  6. 6 CHESM, University of Melbourne, Melbourne, Victoria, Australia
  7. 7 Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
  8. 8 The Norwegian FA Sports Medicine Clinic, Oslo, Norway
  9. 9 Department of Orthopaedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Amager-Hvidovre Hospital, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
  1. Correspondence to Karl Bang Christensen, Department of Public Health, Section of Biostatistics, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark; kach{at}sund.ku.dk

Abstract

Bkground No studies have tested the validity of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory, across different cultures and languages.

Objective To validate the Danish, English and Norwegian versions of HAGOS and its six subscales (Symptoms (S, Item 1–7), Pain (P, Item 1–10), activities of daily living (Item 1–5), Sport and recreation (Sport/rec, Item 1–8), Participation in physical activity (item 1–2) and quality of life (item 1–5)) by evaluating differential item functioning (DIF) and measurement invariance across the three language versions in male multidirectional team athletes with groin pain. Second, to modify subscales depending on goodness-of-fit to the item response theory models and calculate conversion tables if language DIF was observed.

Methods We included individual responses to the Danish (n=157), English (n=146) and Norwegian (n=149) language versions of HAGOS from 452 athletes (median age 24 years old, range 20–28) with groin pain. Overall fit, model fit, individual item fit, local response dependence and measurement invariance was examined using confirmatory factor analysis and graphical Rasch models.

Results The removal of seven misfitting items (S2, P1, P2, A4, SP1, SP5, Q3) resulted in 6 HAGOS subscales with acceptable psychometric properties. For the Symptoms, Pain and Sports subscales evidence of DIF was disclosed between the three different language-versions of HAGOS and conversion tables were created.

Conclusions A revised HAGOS derived using modern test theory provides valid measurements for male multidirectional athletes with groin pain across different cultures and languages. Conversion tables must be applied to compare HAGOS scores from Danish, Norwegian and English language versions.

  • hip
  • sports medicine
  • surveys and questionnaires
  • groin

Data availability statement

Data are available on reasonable request. Statistical code and dataset are available from the corresponding author on reasonable request.

https://doi.org/10.1136/bjsports-2021-104412

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    Data availability statement

    Data are available on reasonable request. Statistical code and dataset are available from the corresponding author on reasonable request.

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    Footnotes

    • Twitter @mikkelbek, @enda_king, @JHaroey

    • Contributors KBC, MBC and KT all participated in the conception and design of the study. KT and MBC were responsible for acquisition of data. KBC did the statistical analysis, and all authors took part in the interpretation of the data. KBC and KT drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version of the manuscript. KBC and KT are the guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests KT is the developer of HAGOS.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.