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57. Development and Validation of a Musculoskeletal Patient Reported Outcome Measure

Hill, Jonathan C.; Thomas, Elaine; Hill, Susan; Foster, Nadine E.; Rimmer, Yvonne; Shufflebotham, Julie; Doyle, Carol; Larkin, Treena; van der Windt, Danielle

Authors

Elaine Thomas

Susan Hill

Nadine E. Foster

Yvonne Rimmer

Julie Shufflebotham

Carol Doyle

Treena Larkin



Abstract

Background: The UK government has called for clinical services to gather data from patients to evaluate quality of healthcare and monitor progress over time. However, practical, brief clinical tools for this purpose are lacking. We aimed to develop and validate a musculoskeletal patient reported outcome measure (MSK-PROM) suitable for evaluating care and also monitoring patient progress within community musculoskeletal services.

Methods: In Phase 1 we developed the MSK-PROM through two consensus workshops (to identify and prioritize the key domains for inclusion in the tool), an online consultation survey with relevant stakeholders, and two face validity workshops to test the readability and comprehension of the draft tool. In Phase 2 we tested the reliability and sensitivity to change of the draft tool with a prospective cohort of adults attending musculoskeletal physiotherapy services in the West Midlands region, and discussed acceptability and feasibility with samples of participating patients and clinicians.

Results: Eleven key domains were prioritized for inclusion in the MSK-PROM: independence, physical function, severity of the worst symptom, pain severity, work interference, difficulty with activities and roles, quality of life, understanding how to deal with symptoms, anxiety/depression, and overall impact. For five of the identified health domains (function, anxiety, mood, pain and quality of life) questions from the existing validated and recommended quality of life measure (EQ-5D-5L) were used to avoid duplication in clinical practice. The MSK-PROM therefore includes six new single items in addition to five from the EQ-5D-5L. 425 physiotherapy consulters with musculoskeletal problems completed the MSK-PROM at every treatment visit (88% had a completed MSK-PROM for at least 1 follow-up, and 225 (53%) responded to a three month follow-up questionnaire. Completion rates for the MSK-PROM items were high (>97%) with scores Normally distributed (mean = 28, S.D. = 6.5, 10 of the 11 items are scored giving a scale range 10–50, with the work item excluded as for over a third of patients this item was not applicable). Data from stable patients with unchanged symptoms at visit 2 confirmed the MSK-PROM’s reliability (ICC 0.98 (95% CI 0.96, 0.98) and demonstrated its superior sensitivity to change compared with the EQ-5D-5L weighted score (MSK-PROM: standardized response mean (SRM) = 0.66, AUC 0.81 vs EQ-5D-5L: SRM 0.44, AUC 0.74). The MSK-PROM was found to be acceptable and feasible to use in community physiotherapy services, with minor modifications to improve the wording of the tool.

Conclusion: A new patient reported outcome measure (MSK-PROM) has been developed using domains that matter the most to musculoskeletal patients, clinicians and service managers, and has been shown to be feasible, valid and reliable for use in clinical practice. The tool will be made freely available for clinical use.

Citation

Hill, J. C., Thomas, E., Hill, S., Foster, N. E., Rimmer, Y., Shufflebotham, J., …van der Windt, D. (2014). 57. Development and Validation of a Musculoskeletal Patient Reported Outcome Measure. Rheumatology, 53(suppl_1), i76-i77. https://doi.org/10.1093/rheumatology/keu098.012

Journal Article Type Conference Paper
Online Publication Date Apr 3, 2014
Publication Date 2014-04
Deposit Date Nov 7, 2023
Journal Rheumatology
Print ISSN 1462-0324
Electronic ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 53
Issue suppl_1
Pages i76-i77
DOI https://doi.org/10.1093/rheumatology/keu098.012
Keywords Pharmacology (medical); Rheumatology
Publisher URL https://academic.oup.com/rheumatology/article/53/suppl_1/i76/1795298