Patient involvement in questionnaire design: tackling response error and burden

Not all questions are created equal: the weight of the Oxford Knee Scores questions in a multicentric validation study

BACKGROUND

The Oxford Knee Score (OKS) has been designed for patients with knee osteoarthritis and has a widespread use. It has 12 questions, with each question having the same weight for the overall score. Some authors have observed a significant ceiling effect, especially when distinguishing slight postoperative differences. We hypothesized that each questions' weight will depend significantly on the patient's sociodemographic data and lifestyle.

METHODS

In this international multicentric prospective study, we included patients attending a specialist outpatient knee clinic. Each patient filled out 3 questionnaires: (a) demographic data and data pertaining to the OKS, (b) the standard OKS, and (c) the patient gave a mark on the weight of the importance of each question, using a 5-point Likert scale (G OKS). Linear regression models were used for the analysis.

RESULTS

In total 203 patients (106 female and 97 male) with a mean age of 64.5 (±12.7) years and a mean body mass index (BMI) of 29.34 (±5.45) kg/m2 were included. The most important questions for the patients were the questions for pain, washing, night pain, stability, and walking stairs with a median of 5. In the regression models, age, gender, and driving ability were the most important factors for the weight of each of the question.

CONCLUSION

The questions in the OKS differ significantly in weight for each patient, based on sociodemographic data, such as age, self-use of a car, and employment. With these differences, the Oxford Knee Score might be limited as an outcome measure. Adjustment of the OKS that incorporates the demographic differences into the final score might be useful if the ceiling effect is to be mitigated.

LEVEL OF EVIDENCE

Level II prospective prognostic study.

Methods for capturing patient experience and satisfaction in healthcare services

Patient experience in healthcare has long been recognised in the UK and internationally as a crucial benchmark for assessing quality of care in healthcare settings. It is increasingly becoming part of a nurse's role to conduct, analyse and present the findings of patient satisfaction audits and research projects, and to implement changes to services based on the data collected. To undertake these audits and projects effectively, nurses require knowledge of how to use various data collection methods and research tools, determine their validity and reliability, and minimise bias. This article provides information about these areas, with the aim of assisting nurses in designing and implementing patient satisfaction audits and research projects in their clinical area, which can subsequently be used to improve patient experience.

Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study

Background:

People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions.

Aim:

A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review.

Methods:

A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA).

Results:

Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication.

Conclusion:

A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens.

Development and validation of a self-report measure of practical barriers to medication adherence - the Medication Practical barriers to Adherence Questionnaire (MPRAQ)

AIM

This study reports the development and validation of a new self-report measure (MPRAQ) that assesses practical barriers to medication adherence.

METHODS

MPRAQ comprises fifteen statements describing practical barriers. Responses are scored on a 5-point Likert scale; higher scores indicate more practical barriers. Initial face validity was evaluated by cognitive testing with patients from a diabetes support group. Following refinement, internal reliability and construct validity were assessed in two samples: patients recruited via Amazon mTurk and the Nivel Dutch Healthcare Consumer Panel (COPA). Respondents completed the Beliefs about Medicines Questionnaire (BMQ - general and specific), and Medication Adherence Report Scale (MARS-5). The mTurk sample also completed the Perceived Sensitivity to Medicines questionnaire (PSM), and repeated MPRAQ two weeks later to assess test-retest reliability.

RESULTS

Face validity was evaluated in 15 patients (46% female; mean (SD) age 64(12) years). A total of 184 mTurk participants completed the questionnaire (in English) and 334 in COPA (in Dutch). Internal reliability was acceptable (mTurk α=0.89; COPA α=0.94). Construct validity was confirmed, with significant correlation between MPRAQ and BMQ-Specific Concerns (mTurk r=0.546, p<0.0001; COPA r=0.370, p<0.0001); BMQ-General Harm (mTurk r=0.504, p<0.0001; COPA r=0.219, p<0.0001); BMQ-General Overuse (mTurk, r=0.324, p<0.0001; COPA r=0.109, p=0.047), and PSM (mTurk only, r=0.463, p<0.0001), and a negative correlation with MARS-5 (mTurk r=-0.450, p<0.0001; COPA r=-0.260, p<0.0001). MPRAQ did not correlate with BMQ-Specific Necessity or BMQ-General Benefit. Correlation between MPRAQ baseline and 2-week follow-up scores confirmed test-retest reliability (r=0.745, p<0.0001; n=52).

CONCLUSION

MPRAQ is a reliable and valid self-report measure of practical adherence barriers.