Cross-Cultural Adaptation and Psychometric Validation of the Persian High-Activity Arthroplasty Score in Patients Following Total Knee Arthroplasty Publisher Pubmed



Vosoughi F ; Vahedi P ; Yazdanmehr A ; Poursalehian M ; Koolinia F ; Menbari Oskouie I
Source: Journal of ISAKOS Published:2026

Abstract

Background: Indications for total knee arthroplasty (TKA) are expanding to include younger and more active patients. The High-Activity Arthroplasty Score (HAAS) was developed to assess higher-level function; however, a validated Persian version has not been available. Methods: The HAAS was translated and culturally adapted into Persian through a standard forward–backward method with expert review and pilot testing. Persian-speaking patients who underwent primary TKA for osteoarthritis (OA) completed the Persian HAAS (P-HAAS), the Oxford Knee Score (OKS), and the Forgotten Joint Score (FJS). Internal consistency was evaluated using Cronbach's alpha, and test–retest reliability over 2 weeks was assessed with intraclass correlation coefficients (ICC). Measurement error was quantified using the standard error of measurement (SEM) and minimal detectable change at 95% confidence (MDC95). Construct validity was tested via prespecified hypotheses using Spearman correlations with OKS and FJS. Floor and ceiling effects were examined at ≥15%. Results: A total of 101 participants were included. Internal consistency of the P-HAAS total score was good (Cronbach's alpha = 0.817). Test–retest reliability was excellent for the total score (ICC = 0.935) and good-to-excellent for individual items (ICC = 0.823–0.911). Measurement error was low (SEM = 0.88; MDC95 = 2.44). Construct validity was supported by strong correlations with OKS (r = 0.717) and FJS (r = 0.819). Total-score floor (3%) and ceiling (0%) effects were below threshold, although item-level effects were present (HAAS-2 floor 57%; HAAS-3 ceiling 32%). Conclusion: The P-HAAS demonstrated good reliability and construct validity after TKA, with low measurement error and no floor or ceiling effects at the total-score level. It offers a practical option for evaluating higher-level activities; responsiveness and clinically important change thresholds warrant further study. Level of evidence: IV, Prospective Cross-Cultural Adaptation and Validation Study. © 2026 The Author(s). Published by Elsevier Inc. on behalf of International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/