Assessing symptom clusters in post-total knee arthroplasty patients: development and validation of a new scale

BACKGROUND: Patients undergoing total knee arthroplasty (TKA) often face various symptoms, but existing assessment tools mainly target functional recovery and efficacy, missing a comprehensive symptom cluster evaluation. This study seeks to create a symptom cluster assessment scale for TKA patients and assess its reliability and validity. METHODS: Using the Symptom Experience Model as the theoretical framework, a clinical test version of the scale was developed through literature review, semi-structured interviews, two rounds of Delphi expert consultations, and a pre-survey. Using convenience sampling, 476 TKA patients who visited orthopedic departments at three tertiary general hospitals in Hebei Province between January and June 2025 were selected for the formal survey. Following data collection, assessments of the scale's reliability and validity were performed. RESULTS: The formal version of the Symptom Cluster Assessment Scale for Total Knee Arthroplasty Patients comprises 5 dimensions and 22 items, demonstrating adequate internal consistency reliability (Cronbach's α coefficient of 0.907, split-half reliability of 0.868). Content validity results indicate an I-CVI ranging from 0.824 to 1.000 and an S-CVI/Ave of 0.948. Exploratory factor analysis extracted five common factors, accounting for 68.176% of cumulative variance. Confirmatory factor analysis results indicated that all model fit indices met corresponding criteria, demonstrating good model fit. Internal consistency testing revealed strong correlations between each dimension and the total scale. Convergent validity and discriminant validity both met established standards. CONCLUSION: This study effectively developed and validated a specialized scale for assessing symptom clusters in patients following TKA. This scale provides healthcare professionals with a systematic and practical assessment tool to facilitate the implementation of individualized rehabilitation interventions. Additionally, previously underrecognized symptom clusters specific to TKA have been identified.