Validation of outcome measurement instruments used in a multidisciplinary rehabilitation intervention for patients with chronic inflammatory arthritis: Linking of the International Classification of Functioning, Disability and Health, construct validity and responsiveness to change

Providing evidence for content validity of the most frequently used hip specific recovery outcome measures in hip fracture studies: an International Classification of Functioning approach

PURPOSE

We established the most commonly used clinician and patient-reported hip fracture outcome measures as of 2022, assessed their content validity using an International Classification of Functioning, Disability and Health (ICF) framework, and operationalized these results to contribute to an updated hip fracture core set.

MATERIALS AND METHODS

A literature search was conducted to identify articles utilizing outcome measures related to hip fracture. A total of five outcome measures were identified, linked to the ICF, and assessed for content validity via bandwidth percent, content density, and content diversity.

RESULTS

Outcome measures were linked to 191 ICF codes, most of which were associated with Activities and Participation. Notably, no outcome measure contained concepts linked to Personal Factors and Environmental Factors were underrepresented across all outcome measures. The modified Harris Hip Score had the highest content diversity (0.67), the Hip Disability and Osteoarthritis Outcome Score had the highest bandwidth of ICF content coverage (2.48), and the Oxford Hip Score had the highest content density (2.92).

CONCLUSIONS

These results clarify the clinical applicability of outcome measures and guide development of hip fracture outcomes that allow providers to assess the complex role of social, environmental, and personal factors in patient rehabilitation.IMPLICATIONS FOR REHABILITATIONHip fracture is a complex and disabling pathology predominantly affecting older adults and represents a public health problem.There are a variety of outcome measures used to assess a patient's recovery following a hip fracture, each with distinctive objectives and modes of administration.Content validity metrics associated with the Harris Hip Score suggest it would be a suitable outcome measure during early-stage recovery, whereas the modified Harris Hip Score may be more suitable for tracking long-term recovery tracking.Choosing an outcome measure most appropriate for a hip fracture patient is an individualized decision that must consider aspects such as age, activity level, needs, and environmental factors.

Mapping a measure of physical ability for persons with long-term musculoskeletal pain to the ICF and ICF Core Sets

BACKGROUND

Test Instrument for Profile of Physical Ability (TIPPA) is used in the Swedish sickness certification process for patients with long-term musculoskeletal pain. The aim was to explore the content of TIPPA in the context of work-ability assessments.

METHODS

The full protocol of TIPPA was linked to the in relation to the International Classification of Functioning, Disability and Health (ICF) and evaluated in relation to the ICF Core Sets for Chronic Widespread Pain (CWP).

RESULTS

Twenty-two unique meaningful concepts were identified in TIPPA. Eighteen of those could be linked to ICF, yielding 27 third-level ICF-categories. Ten of these categories fitted the domains of 'body function', 16 were 'activity and participation', while one was related to 'environmental factors'. Perspective and aim varied between the parts of the test. When assessed against Brief ICF Core Set for CWP, TIPPA covered three of nine 'body function' categories and 2 out of 10 'activity and participation' categories. The coverage of the subgroup 'activity' was two out of five. TIPPA did not cover three categories, i.e. 'd175 solving problems', 'd230 carrying out daily routine' and 'd240 handling stress and other psychological demands', in the subgroup of 'activity'.

CONCLUSIONS

TIPPA could be a useful measure for the assessment of physical ability. However, additional condition-specific items/measures are required to obtain full coverage of core aspects of functioning and disability in a comprehensive work-ability assessment for patients with long-term musculoskeletal pain.

Can The EQ-5D Detect Meaningful Change? A Systematic Review

BACKGROUND

The EQ-5D is one of the most frequently used, generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required.

OBJECTIVE

This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations.

METHODS

We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions.

RESULTS

Of 1401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45 %) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48 %). Only four conditions (7 %) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive.

CONCLUSION

The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with five response levels.

Return to work after organ transplantation: a cross-sectional study on working ability evaluation and employment status

INTRODUCTION

Organ transplantation has increased in Italy over the last decade. Thus, an increasing number of workers may face the problem of returning to work. The aim of this study was to provide an assessment of working ability of transplant recipients in comparison with their actual employment status.

METHODS

This study was based on 150 patients who underwent transplantation since 1994 and who underwent periodic post-transplantation examination during 2012. Fifty patients who had undergone heart transplantation (HT), 50 liver transplantation (LT), and 50 kidney transplantation (KT) and survived at least 12 months after surgery were eligible for this study. All patients underwent the International Classification of Functioning, Disabilities and Health (ICF) questionnaire; ten questions were further applied to those who were employed at the time of the study. X(2) statistics were used to compare working ability evaluation and employment status and for internal comparison among different organ recipients.

RESULTS

The employment status was as follows: 92 (61%) patients were in paid employment, 6 (4%) were students or housewives, 36 (24%) were unemployed, and 17 (11%) were retired because of invalidity benefits. According to our fitness evaluation only 4% to 10% of the patients were unfit for any job. When we excluded retired subjects, the X(2) statistics for correlated observations showed a highly significant statistical difference (P < .0001) between unemployed and unfit. As a result of the ICF questionnaire administration, there was a marked difference, although not statistically significant, in the fitness for previously performed jobs between KT and LT recipients (62% and 58%, respectively) and HT recipients (42%).

DISCUSSION AND CONCLUSION

In this cross-sectional study we found a relatively high rate of unemployment as compared with the working ability evaluation by ICF questionnaire and other questions. This may be due to several factors including health status and the possibility of gaining an adequate job. The ICF questionnaire proved to be a useful framework that can be used for research but also by occupational physicians in their usual practice after specific training.

Health determining concepts important to people with Crohn's disease and their coverage by patient-reported outcomes of health and wellbeing

BACKGROUND AND AIMS

Busy clinical settings often restrict the possibility to focus on concepts that determine health in a positive way, commonly assessed by using patient-reported outcomes (PROs). We aimed to explore which determinants of health (DHs) are important to people with Crohn's disease (CD), to understand possible gender differences and to analyze whether these DHs are covered by PROs used in CD.

METHODS

Two systematic literature reviews were done to identify relevant DHs and clinically relevant PROs. We conducted a qualitative narrative biographical study and mapped the patients' experiences to concepts that determine health in a positive way. Experiences, DHs and the items of the PROs were compared by the WHO International Classification of Functioning, Disability and Health (ICF) as a common framework.

RESULTS

15 people with CD with a median age of 46 years (IQR 34-60) and median disease duration of 15 years (IQR 8-30) participated. Self-efficacy, social support, job satisfaction and occupational balance were mentioned most frequently. While participation appeared to have greater meaning to men, appreciation and resilience seemed to be more important for women. Of 18 PROs the Perceived Stress Questionnaire (PSQ), the Inflammatory Bowel disease - Self-efficacy scale (IBD-SES), the Life Orientation Test - Revised (LOT-R) and the Patient Activation Measure 13 (PAM-13) cover most DHs.

CONCLUSIONS

This is the first study elaborating the coverage of patient's perspective by commonly used PROs in CD. The findings could support health professionals to focus on DHs in people with CD in clinical practice and research.

Disabilities of importance for patients to improve--using a patient preference tool in rheumatoid arthritis

PURPOSE

To investigate, using the McMaster Toronto Arthritis patient preference disability questionnaire (MACTAR), disabilities most important to improve in Swedish patients with rheumatoid arthritis (RA) and to compare these with the pre-defined activities in the International Classification of Functioning (ICF) comprehensive core set for RA and the Stanford Health Assessment Questionnaire (HAQ). Also to categorize patient preference selected disabilities using the ICF, to correlate the MACTAR score to RA core set measures and to evaluate the MACTAR's test-retest reliability.

METHODS

45 patients with RA (median (md) age 59 years, diagnosis duration md 10 years) were included. Assessments included disease activity score (DAS28), timed-stands test (TST), shoulder function assessment (SFA), visual analogue scale for pain (VAS), HAQ, patients' global assessment of well-being (PGA) and the MACTAR.

RESULTS

58 disabilities were identified of which 17 were identified by at least 5 patients. 47% of them were represented in the Comprehensive ICF RA core set and 53% in the HAQ. 16/17 were categorized in the ICF activities and participation component. Correlations between the MACTAR and other measures were: DAS28 (rs -0.65), TST (rs -0.19), SFA (rs 0.38), VAS (rs -0.61), HAQ (rs -0.51) and PGA (rs -0.61). Weighted κ was 0.59.

CONCLUSIONS

Half of the disabilities patients with RA identified by use of the MACTAR are not evaluated in the Comprehensive ICF core set for RA or the HAQ. MACTAR has moderate test-retest reliability. MACTAR can be considered to be used in addition to traditional RA outcomes and may potentially improve clinical assessment of patients with RA.

IMPLICATIONS FOR REHABILITATION

RA has an impact on personal life areas. The MACTAR helps identify individual disease-related disabilities of importance to improve. The MACTAR provides an opportunity for individualized goal-setting in rehabilitation and can thus promote adherence in rehabilitation. MACTAR may potentially improve clinical assessment for patients with RA.

Cultural adaptation, validity, reliability and responsiveness of the Swedish version of the effective musculoskeletal consumer scale (EC-17)

BACKGROUND

Endorsed by the Outcome MEasures in Rheumatoid Arthritis in Clinical Trials (OMERACT) group, The Effective Consumer Scale (EC-17) was developed in English for patients with musculoskeletal diseases to assess the skills and perceptions important for participating in and managing health care. The objective of this study was culturally to adapt the questionnaire into Swedish and to study its psychometric properties.

METHODS

After translation of the questionnaire into Swedish, two different groups of outpatients from two specialist rheumatology departments participated in the study. Face validity was assessed, together with internal consistency, test-retest and responsiveness of the questionnaire. Construct validity was assessed using the Arthritis Self-Efficacy Scale (ASES), and responsiveness to a five day educational intervention was analysed using the standardized response mean (SRM).

RESULTS

Analyses were based on 124 patients with inflammatory rheumatic diseases, of whom 50 attended the intervention. Data quality met the requirements, with missing values <5%, and floor and ceiling effects <15%. Item total correlations were all >0.4, ranging from 0.49 to 0.88. Cronbach's alpha was 0.93 and 0.95 for the two groups. The test-retest correlation (ICC₂.₁) was 0.94, and there was a significant improvement as a result of the intervention, with an SRM of 0.43. However, the questionnaire had a higher construct validity with the ASES subscale 'other symptoms' than hypothesized a priori (r(s) 0.75).

CONCLUSION

The Swedish version of the EC-17 met the required recommendations for face validity, internal consistency, test-retest reliability and responsiveness. Its construct validity needs to be further established, and the questionnaire needs further testing in different groups of patients and in different interventions.