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

Vosoughi, Fardis; Vahedi, Pooya; Yazdanmehr, Amirali; Poursalehian, Mohammad; Koolinia, Faryar; Menbari Oskouie, Iman · J ISAKOS · 2026

cross_sectional · Level IV

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Abstract

Indications for total knee arthroplasty (TKA) are expanding to include younger and active patients. The High-Activity Arthroplasty Score (HAAS) was developed to assess higher-level function; however, a validated Persian version has not been available. 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%. 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%). 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. IV, Prospective Cross-Cultural Adaptation and Validation Study.