High recall bias in retrospective assessment of the pediatric International Knee Documentation Committee Questionnaire (Pedi-IKDC) in children with knee pathologies

Luca Macchiarola; Massimo Pirone; Alberto Grassi; Nicola Pizza; Giovanni Trisolino; Stefano Stilli; Stefano Zaffagnini

doi:10.1007/s00167-022-06922-7

High recall bias in retrospective assessment of the pediatric International Knee Documentation Committee Questionnaire (Pedi-IKDC) in children with knee pathologies

Knee Surg Sports Traumatol Arthrosc. 2022 Oct;30(10):3361-3366. doi: 10.1007/s00167-022-06922-7. Epub 2022 Feb 26.

Authors

Luca Macchiarola^{1

2}, Massimo Pirone³, Alberto Grassi³, Nicola Pizza³, Giovanni Trisolino⁴, Stefano Stilli⁴, Stefano Zaffagnini³

Affiliations

¹ Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy. luca.macchiarola@hotmail.it.
² Dipartimento Di Medicina Clinica E Sperimentale, Università Degli Studi Di Foggia, Foggia, FG, Italy. luca.macchiarola@hotmail.it.
³ Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy.
⁴ U.O. Ortopedia Pediatrica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy.

PMID: 35218375
DOI: 10.1007/s00167-022-06922-7

Abstract

Purpose: The increasing incidence of knee injuries among children is well known by sports physicians. Papers dealing with this topic have often collected patient-reported outcomes measures (PROMs) in a retrospective manner; this limitation could lead to a misinterpretation of the results, because pediatric patients might not remember their preoperative conditions adequately. This study aims to evaluate the reliability and the reproducibility of the IKDC pediatric score when administered retrospectively at a 12-month follow-up.

Methods: From September 2018 and June 2019, all patients aged 7-18 scheduled for surgery due to different knee pathologies in a single center were considered eligible. Parents were contacted by phone for consent. An open-source platform was implemented to collect the responses: two surveys were created (Q1, Q2). They included general information and the Pedi-IKDC score. Q1 was completed prospectively, while Q2 was completed 12 months after surgery. The two questionnaires were identical, and patients were carefully advised to complete Q2 recalling their health status before surgery. ICC and the concordance correlation coefficient (ρ_c) were used to assess the reproducibility between the prospective and recalled scores.

Results: Sixty-six patients responded to Q1 and Q2, and the mean age was 12.9 ± 2.2 years at Q1 and 14.1 ± 2.2 years at Q2. The mean time between Q1 and Q2 was 14.1 ± 2.1 months. Between prospective-IKDC and recall-IKDC, the ICC coefficient was "poor" at 0.32 (CI 0.09 to 0.5) and the ρ_c was "poor" at 0.4 (CI 0.29 to 0.51). Mean prospective-IKDC was 76.8 ± 23.52 mean recalled-IKDC was 60.4 ± 11.5 (P < 0.0001), while mean difference was -16.3 ± 2.09. Simple linear regression models showed that Δ-IKDC is independently associated with age at Q1 (R² = 0.2676; P0.0001) and prospective-IKDC (R² = 0.653; P < 0.0001).

Conclusions: Retrospective collection of the Pedi-IKDC score is not reliable and has high recall bias. This should be avoided in children with knee conditions.

Level of evidence: III.

Keywords: Pedi-IKDC; Pediatric ACL; Pediatric PROMs; Recall-bias.

MeSH terms

Adolescent
Anterior Cruciate Ligament Injuries*
Child
Documentation*
Humans
Prospective Studies
Reproducibility of Results
Retrospective Studies
Surveys and Questionnaires