Measurement properties of the musculoskeletal health questionnaire (MSK-HQ): a between country comparison

Abstract

Background: The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages. Objective: The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain. Methods: MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n = 153) and UK (n = 166) cohorts. Results: The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients' own judgment at 12 weeks exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8-10 points and 26% for the DK cohort and 6-8 points and 29% for the UK cohort. Conclusions: The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.

Validity and reliability of the Norwegian version of the Musculoskeletal Health Questionnaire in people on sick leave

“…In this study, the total score showed no floor and ceiling effects, which is consistent with former studies assessing the MSK-HQ [ 5 , 7 , 9 ]. Although, when assessing floor and ceiling effects at single items in this population, item 3 (gait) and item 4 (washing/dressing) demonstrated floor effects and item 9 (sleep) showed a ceiling effect.…”

“…The Norwegian population with different MSK disorders achieved a mean total score of 27.7, while the British populations scored a mean total score of 28.6 [ 5 ] and 26.6 [ 7 ]. The Danish population with MSK disorders, similar to our study, reached a higher mean score in both MSK-HQ (32.3) and EQ-5D-5L (0.69) [ 9 ]. One difference that might explain some of the differences is that only 7% of the Danish population was on sick leave and were possibly less affected of their MSK disorders [ 9 ].…”

“…The Danish population with MSK disorders, similar to our study, reached a higher mean score in both MSK-HQ (32.3) and EQ-5D-5L (0.69) [ 9 ]. One difference that might explain some of the differences is that only 7% of the Danish population was on sick leave and were possibly less affected of their MSK disorders [ 9 ]. Even though there are some differences, the scores are within the measurement error of the MSK-HQ.…”

“…The Norwegian MSK-HQ demonstrated high internal consistency, although a somewhat lower value than previous studies [ 5 , 7 , 9 ]. The items of the scale seemed to have high interrelatedness despite the different domains.…”

“…The development of the MSK-HQ included a scoping exercise to identify domains important for MSK health and a qualitative evaluation of face and content validity [ 5 ]. Further on, assessment of construct validity, test–retest reliability and data quality have been conducted with acceptable results [ 5 , 7 , 9 ]. To expand the use of MSK-HQ to Norway, a translation process and assessment of its psychometric properties are essential.…”