# Cross-Cultural Adaptation and Psychometric Properties of the Chinese Version of the Knee Osteoarthritis Fears and Beliefs Questionnaire

## TL;DR

This study adapted and validated a questionnaire to assess fears and beliefs in Chinese patients with knee osteoarthritis, showing it is reliable and valid for use in this population.

## Contribution

The study provides a validated Chinese version of the KOFBeQ with strong psychometric properties for assessing fear-avoidance behaviors in knee osteoarthritis patients.

## Key findings

- The adapted questionnaire has three subscales with strong internal consistency (Cronbach’s α = 0.86).
- Confirmatory factor analysis confirmed a good model fit and high test–retest reliability (ICC = 0.93).
- The tool is effective for assessing fears and beliefs in Chinese knee osteoarthritis patients.

## Abstract

This study aimed to adapt and validate the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ) for Chinese patients, thereby advancing the understanding of fear-avoidance behaviors. Adopting a cross-sectional design, data were collected for 241 subjects (78.8% women; mean age 68.0 ± 7.8 years) across various healthcare settings in Hong Kong. Exploratory factor analysis resulted in an 11-item questionnaire with three distinct subscales, covering fears and beliefs related to physicians and disease (six items), daily living activities (three items), and sports and leisure activities (two items). The overall Cronbach’s
α
coefficient was 0.86, indicating strong internal consistency. The questionnaire exhibited favorable convergent validity. Confirmatory factor analyses confirmed a good model fit. Test–retest reliability analysis indicated a high intraclass correlation coefficient of 0.93 (95% confidence interval: 0.88, 0.96), and a Bland–Altman plot revealed a slight bias in two measurements (0.97 [0.19]) without a systematic trend. The adapted Chinese version of the KOFBeQ demonstrated robust psychometric properties in terms of validity and reliability, providing an effective tool for surveying Chinese patients with knee osteoarthritis. These findings offer valuable insights for clinicians and patients, aiding in informed decision-making and improved rehabilitation strategies.