Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways

Abstract

ObjectivesCurrent musculoskeletal outcome tools are fragmented across different healthcare settings and conditions. Our objectives were to develop and validate a single musculoskeletal outcome measure for use throughout the pathway and patients with different musculoskeletal conditions: the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ).SettingA consensus workshop with stakeholders from across the musculoskeletal community, workshops and individual interviews with a broad mix of musculoskeletal patients identified and prioritised outcomes for MSK-HQ inclusion. Initial psychometric validation was conducted in four cohorts from community physiotherapy, and secondary care orthopaedic hip, knee and shoulder clinics.ParticipantsStakeholders (n=29) included primary care, physiotherapy, orthopaedic and rheumatology patients (n=8); general practitioners, physiotherapists, orthopaedists, rheumatologists and pain specialists (n=7), patient and professional national body representatives (n=10), and researchers (n=4). The four validation cohorts included 570 participants (n=210 physiotherapy, n=150 hip, n=150 knee, n=60 shoulder patients).Outcome measuresOutcomes included the MSK-HQ's acceptability, feasibility, comprehension, readability and responder burden. The validation cohort outcomes were the MSK-HQ's completion rate, test–retest reliability and convergent validity with reference standards (EQ-5D-5L, Oxford Hip, Knee, Shoulder Scores, and the Keele MSK-PROM).ResultsMusculoskeletal domains prioritised were pain severity, physical function, work interference, social interference, sleep, fatigue, emotional health, physical activity, independence, understanding, confidence to self-manage and overall impact. Patients reported MSK-HQ items to be ‘highly relevant’ and ‘easy to understand’. Completion rates were high (94.2%), with scores normally distributed, and no floor/ceiling effects. Test–retest reliability was excellent, and convergent validity was strong (correlations 0.81–0.88).ConclusionsA new musculoskeletal outcome measure has been developed through a coproduction process with patients to capture prioritised outcomes for use throughout the pathway and with different musculoskeletal conditions. Four validation cohorts found that the MSK-HQ had high completion rates, excellent test–retest reliability and strong convergent validity with reference standards. Further validation studies are ongoing, including a cohort with rheumatoid/inflammatory arthritis.

Stratified primary care versus non-stratified care for musculoskeletal pain: findings from the STarT MSK feasibility and pilot cluster randomized controlled trial

“…included self-reported measures for average pain intensity over the last 2 weeks (identical wording and responses to the trial identification template), physical function measures for each of the MSK pain sites (filtered according to GP designation) including the back specific Roland-Morris Disability Questionnaire (RMDQ) [50], the Neck Disability Index (NDI) [51,52] the Shoulder Pain And Disability Index (SPADI) [53], the Knee Injury and Osteoarthritis Outcome Score Physical Function Short-form (KOOS-PS) [54] and for multi-site pain, the Short Form 12 (v2) Physical Component Scale [55]. Other outcomes were MSK risk status using the development version of the Keele STarT MSK tool [38], overall MSK health status using the Musculoskeletal Health Questionnaire [56], fear avoidance beliefs using the 11-item Tampa Scale of Kinesiophobia [57], patient perceived reassurance (from their GP) using the Effective Consultation and Reassurance Questionnaire (ECRQ) [58] (which has four subscales: information gathering, relationship building, generic reassurance and cognitive reassurance), health-related quality of life using the EuroQol five-dimension, five-level version (EQ-5D-5 L) [59], single items each capturing satisfaction with care received, whether participants had received written education material from their GP about their MSK problem (yes/ no), and overall rating of global change (− 5 to + 5 numerical response scale) since their index GP visit (the one in which the trial EMR screen was activated and they were invited to participate in the study data collection) [60], whether they were in paid employment and had taken any work absence due to their MSK pain, and an item asking how their productivity at work is affected (0-10 NRS). Patient population descriptors (captured at baseline alone) included; the Single Item Health Literacy Screener (SILS) [61] and pain episode duration by asking "how long is it since you had a whole month without [insert pain site e.g.…”

Patient-reported quality indicators to evaluate physiotherapy care for hip and/or knee osteoarthritis- development and evaluation of the QUIPA tool

“…The QUIPA tool was projected onto a presentation screen to allow the research assistant to alter the wording of the QIs in real time during the group session. Participants were also asked to comment on the appropriateness of the tool response scale and its overall format and layout [22,32]. The research team revised and reworded the QUIPA tool following each focus group session before presenting the revised version to the subsequent group.…”

Proof of Concept trial of diagnostic ultrasound in the orthopaedic triage setting.

“…There was no significant correlation between MSK-HQ scores and amount of physical activity measured as a component of the MSK-HQ questionnaire. The Mean daily Physical Activity level of the measured population was 1.67 days which is less than the recommended weekly physical activity recommendations recommended by the World Health Organisation [7]. However, the standard deviation of the population measured was 12 which is indicative of a varied spread of physical activity within the population.…”

“…pain severity, physical function, work, fatigue, emotional health, physical activity, independence, understanding, confidence to self manage and overall impact. The highest possible outcome score for MSK-HQ is 56, the least outcome being 0 [7].…”