Item development and pre-testing of an Osteoarthritis Conceptualisation Questionnaire to assess knowledge and beliefs in people with knee pain

Scale Development of the Osteoarthritis Conceptualisation Questionnaire: Phase 2 Construct Validity

An individual's knowledge, beliefs and/or expectations about their osteoarthritis can influence their engagement with physical activity and their treatment decisions surrounding recommended non-surgical management. Yet there is no widely accepted questionnaire to assess complex mental frameworks surrounding osteoarthritis. Therefore, this study aimed to develop an Osteoarthritis Conceptualisation Questionnaire (OACQ) to assess an individual's conceptual framework for osteoarthritis via psychometric evaluation of an established item-bank. The Osteoarthritis Conceptualisation Questionnaire item-bank, co-developed with pain experts and people with lived experience of knee pain, was administered online to people with painful knee osteoarthritis. Psychometric evaluation was undertaken using factor and exploratory graph analyses to create a data-driven model of the Osteoarthritis Conceptualisation Questionnaire which was then compared with the existing theoretical model (construct validity). Four hundred and fifty-four participants completed the survey (n=336 female; 64.52 ±9.21 years). Psychometric evaluation resulted in the Osteoarthritis Conceptualisation Questionnaire, consisting of 36 items across four domains: 'Expectations'; 'Context'; 'Physiology'; and 'Conceptual Change'. Data-driven models aligned with theoretical models, providing preliminary evidence of construct validity. The resultant Osteoarthritis Conceptualisation Questionnaire could be used to assess osteoarthritis conceptualisations in people with painful knee osteoarthritis. Further research to evaluate scale and item functioning and test-retest reliability is warranted. PERSPECTIVE: Classical and innovative psychometric methods were utilised to develop a novel assessment of conceptualisations of osteoarthritis. The combined use of these methods provided a rigorous evaluation of construct validity. The OACQ may be useful for evaluating the effectiveness of pain science education interventions.

Scale Development of the Osteoarthritis Conceptualisation Questionnaire: Phase 3 Convergent Validity and Test-retest Reliability

The Osteoarthritis Conceptualisation Questionnaire (OACQ) aims to evaluate people's understanding of osteoarthritis. This study aimed to evaluate construct validity and reliability among those with painful knee osteoarthritis. Using previously collected data (n=454, n=336 female; 64 ± 9yrs) and a second confirmatory sample (n=64, n= 47 female; 67 ± 8yrs), the scale properties of the four-dimensional (i.e., subscale) OACQ were evaluated. Both samples were compared to a Rasch model indicative of measurement to evaluate the targeting, category ordering, unidimensionality, local dependence, person fit, internal consistency, and differential item functioning (DIF). Convergent validity was evaluated in both samples, evaluating associations between the OACQ and related assessments. Test-retest reliability was evaluated in the second sample over a one-week period. Results showed that targeting was poor, although all OACQ subscales showed unidimensionality. Person fit was below the acceptable threshold for two subscales; however, sensitivity analysis revealed no specific cause for this misfit. Internal consistency was good for all subscales, and DIF was consistent with expected associations between measures. Rasch findings were supported in the confirmatory sample. The OACQ had correlations with related measures supportive of convergent validity and demonstrates good to excellent reliability (ICC = 0.89, 95%CI [0.80 to 0.94]). This study provides evidence supportive of validity and reliability of the OACQ as an assessment of how people understand knee osteoarthritis. It has utility as a tool for clinicians and researchers to understand how their patients/participants conceptualise knee osteoarthritis, its causes and consequences, contributors to pain, and optimal management approaches. PERSPECTIVE: The OACQ is a 36 item, four-domain questionnaire with evidence for construct, structural, and convergent validity, as well as reliability for people with knee osteoarthritis. The OACQ can be used to comprehensively evaluate the conceptual framework of painful knee osteoarthritis.

Making sense of osteoarthritis: A narrative review

People make sense of osteoarthritis (OA) by drawing on information, beliefs, and knowledge. This narrative review summarises diverse qualitative and quantitative research investigating beliefs and knowledge about OA and the impact these have on behaviour and outcomes. It synthesises evidence and highlights key actions clinicians can take to support people to make sense of OA in helpful ways. Beliefs about OA inform the behaviour of those living with OA and the behaviour of clinicians caring for people with OA. Beliefs about OA often focus on joint degradation and inevitable progression. These impairment-focused fatalistic beliefs can result in reduced offer of, or engagement in, active management strategies. Alternative views focus on health as part of a dynamic ecosystem where people are healthy when they can participate in activities they value. These beliefs are associated with increased engagement in self-management and lifestyle-based interventions. Clinician actions that support people to make sense of OA ways that align with helpful behaviours and support participation in valued activities represent key opportunities to improve health and well-being.

People with painful knee osteoarthritis hold negative implicit attitudes towards activity

ABSTRACT

Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report. We developed an implicit association test that explored associations between images of a person moving/twisting their knee (activity) or sitting/standing (rest), and perceived threat (safe vs dangerous). We hypothesised that people with KOA would have greater implicit threat-activity associations (vs pain-free and non-knee pain controls), with implicit attitudes only weakly correlating with self-reported measures (pain knowledge, osteoarthritis/pain/activity beliefs, fear of movement). Participants (n = 558) completed an online survey: 223 had painful KOA (n = 157 female, 64.5 ± 8.9 years); 207 were pain free (n = 157 female, 49.3 ± 15.3 years); and 99 had non-KOA lower limb pain (n = 74 female, 47.5 ± 15.04 years). An implicit association between "danger" and "activity" was present in those with and without limb pain (KOA: 0.36, 95% CI 0.28-0.44; pain free: 0.13, 95% CI 0.04-0.22; non-KOA lower limb pain 0.11, 95% CI -0.03 to 0.24) but was significantly greater in the KOA group than in the pain free ( P < 0.001) and non-KOA lower limb pain ( P = 0.004) groups. Correlations between implicit and self-reported measures were nonsignificant or weak (rho = -0.29 to 0.19, P < 0.001 to P = 0.767). People with painful KOA hold heightened implicit threat-activity associations, capturing information unique to that from self-report questionnaires. Evaluating links between implicit threat-activity associations and real-world behaviour, including physical activity levels, is warranted.