Cross-cultural adaptation and psychometric assessment of the Chinese version of the University of Wisconsin Running Injury and Recovery Index in runners

Abstract

The University of Wisconsin Running Injury and Recovery Index (UWRI) is a nine-item patient-reported outcome measure assessing self-perceived running ability following running-related injury (RRI). This study aimed to translate and cross-culturally adapt the UWRI into Chinese and evaluate its internal consistency, test–retest reliability, measurement error, construct validity, responsiveness, and floor and ceiling effects, as well as obtain a preliminary anchor-based estimate of the minimal clinically important difference (MCID). The UWRI was translated and cross-culturally adapted using a standardized five-stage process. A total of 235 Chinese-speaking runners with self-reported RRI completed the baseline assessment. Of these, 50 participants who reported no substantial change in their injury-related condition and running ability completed a retest after 7–14 days, and 100 completed a 6-week follow-up. Internal consistency was explored for the two conceptual item groups. Test–retest reliability was evaluated using a two-way random-effects, absolute-agreement, single-measure intraclass correlation coefficient (ICC(2,1)), and measurement error was quantified using the standard error of measurement (SEM) and minimal detectable change at the 95% confidence level (MDC95). Construct validity was evaluated using three predefined convergent validity hypotheses. Responsiveness was examined across the five original Global Rating of Change (GROC) categories. A preliminary anchor-based MCID was estimated as the mean UWRI-CN change score among participants reporting “slightly improved” on the GROC. Cronbach’s alpha was 0.861 for the running progression item group and 0.754 for the symptom surveillance item group; these estimates were considered exploratory because structural validity was not assessed. Test–retest reliability was excellent (ICC(2,1) = 0.966; 95% CI: 0.942–0.981), with an SEM of 1.18 points and an MDC95 of 3.28 points. Two of the three predefined convergent validity hypotheses were met. The UWRI-CN showed a strong positive correlation with the Lower Extremity Functional Scale (Spearman’s ρ = 0.534) and a strong negative correlation with the Numerical Pain Rating Scale (ρ = −0.641). The correlation with the EQ-5D-5 L index was positive but strong rather than moderate as hypothesized (ρ = 0.531), while the moderate positive correlation with the EQ-5D VAS was exploratory (ρ = 0.391). UWRI-CN change scores followed the expected gradient across GROC categories, and the GROC anchor was strongly correlated with the UWRI-CN change score (ρ = −0.800, p < 0.001; opposite coding directions). The preliminary anchor-based MCID estimate was 5.14 points and exceeded the MDC95. No floor or ceiling effects were observed for the UWRI-CN total score. In Chinese-speaking runners with self-reported RRI, the UWRI-CN demonstrated excellent test–retest reliability, low measurement error, responsiveness, and partial support for construct validity. The preliminary MCID estimate may provide an initial reference for interpreting score changes but should not be treated as a fixed clinical decision threshold. Further studies should evaluate structural validity and confirm these findings in more diverse and clinically diagnosed populations.