International Knee Documentation Committee Subjective Knee Form Latent Growth Model Analysis: Assessing Recovery Trajectories

Patient-Reported Outcome Measures (PROMs), such as the six-item International Knee Documentation Committee Subjective Knee Form (IKDC-6), play a crucial role in assessing health conditions and guiding clinical decisions. Latent Growth Modeling (LGM) can be employed to understand recovery trajectories in patients post-operatively. Therefore, the purpose of this study was to assess LGM properties of the IKDC-6 in patients with knee pathologies that require surgical intervention and to assess differences between subgroups (i.e., sex and age). A cross-sectional study was conducted using the Surgical Outcome System (SOS) database with patients who had undergone knee arthroscopy. Our results found that preoperative scores did not influence the rate of change overtime. Perceived knee health improved over time, with varying rates among individuals. The adolescent age subgroup and male subgroup exhibited faster recovery rates compared to the older age subgroup and female subgroup. While initial hypotheses suggested IKDC-6 could serve as a prognostic tool, results did not support this. However, results indicated favorable outcomes irrespective of preoperative perceived knee impairment levels. This study provides valuable insights into recovery dynamics following knee surgery, emphasizing the need for personalized rehabilitation strategies tailored to individual patient characteristics.

Assessing the Structural Validity of the Knee Injury and Osteoarthritis Outcome Score Scale

BACKGROUND

The Knee Injury and Osteoarthritis Outcome Score (KOOS) scale is used to assess patient perspectives on knee health. However, the structural validity of the KOOS has not been sufficiently tested; therefore, our objective was to assess the KOOS in a large, multi-site database of patient responses who were receiving care for knee pathology.

METHODS

A cross-sectional study was conducted using the Surgical Outcome System (SOS) database. A confirmatory factor analysis (CFA) was conducted to assess the proposed five-factor KOOS using a priori cut-off values. Because model fit indices were not met, a subsequent exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting four-factor structure (i.e., KOOS SF-12) was then assessed using CFA and subjected to multigroup invariance testing.

RESULTS

The original KOOS model did not meet rigorous CFA fit recommendations. The KOOS SF-12 did meet model fit recommendations and passed all invariance testing between intervention procedure, sex, and age groups.

CONCLUSION

The KOOS failed to meet model fit recommendations. The KOOS SF-12 met model fit recommendations, maintained a multi-factorial structure, and was invariant across all tested groups. The KOOS did not demonstrate sound structural validity. A refined KOOS SF-12 model that met recommended model fit indices and invariance testing criteria was identified. Our findings provide initial support for a multidimensional KOOS structure (i.e., KOOS SF-12) that is a more psychometrically sound instrument for measuring patient-reported knee health.

Longitudinal Invariance Testing Of The Knee Injury Osteoarthritis Outcome Score For Joint Replacement Scale (KOOS-JR)

Background

The Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) is a seven-item patient reported outcome measure used to assess perceived knee health. Though commonly used, the longitudinal psychometric properties of the KOOS-JR have not been established and further characterization of its structural validity and multi-group invariance properties is warranted.

Purpose

The purpose of this study was to evaluate psychometric properties of the KOOS-JR in a large sample of patients who received care for knee pathology.

Study Design

Original research.

Methods

Longitudinal data extracted from the Surgical Outcome System (SOS) database of 13,470 knee pathology patients who completed the KOOS-JR at baseline, three-months, six- months, and one-year. Scale structure was assessed with confirmatory factor analysis (CFA), while multi-group and longitudinal invariance properties were assessed with CFA-based procedures. Latent group means were compared with statistical significance set at α ≤ .05 and Cohen's d effect size as d = 0.2 (small), d = 0.5 (medium), and d = 0.8 (large).

Results

CFA results exceeded goodness-of-fit indices at all timepoints. Multi-group invariance properties passed test requirements. Longitudinal analysis identified a biased item resulting in removal of item #1; the retained six-item model (KOOS-JR-6) passed longitudinal invariance requirements. KOOS-JR-6 scores significantly changed over time (p ≤ .001, Mdiff = 1.08, Cohen's d = 0.57): the highest scores were at baseline examination and the lowest at 12-month assessment.

Conclusions

The KOOS-JR can be used to assess baseline differences between males and females, middle and older aged adults, and patients receiving total knee arthroplasty or non-operative care. Caution is warranted if the KOOS-JR is used longitudinally due to potential measurement error associated with item #1. The KOOS-JR-6 may be a more viable option to assess change over time; however, more research is warranted.

Level of Evidence

3© The Author(s).

Evaluating Psychometric Properties of the International Knee Documentation Committee Subjective Knee Form in a Heterogeneous Sample of Post-Operative Patients

Background

The International Knee Document Committee Subjective Knee Form (IKDC-SKF) is a patient-reported outcome measure used in orthopedics and sports medicine. Further psychometric assessment is necessary to confirm measurement properties in a large, heterogenous sample.

Purpose

The purpose of the study was to assess the psychometric properties of the IKDC-SKF in a large, heterogenous sample.

Study Design

Cross-Sectional Study.

Methods

An exploratory factor analysis (EFA) was conducted to identify a sound latent structure and to assess internal consistency in a large sample of patients who underwent knee arthroscopy. A confirmatory factor analysis (CFA) was conducted to confirm structural validity. Multi-group invariance was conducted to assess factorial stability across sex and age groups, while longitudinal invariance procedures were performed to assess stability over time.

Results

A 3-factor, 9-item IKDC-SKF short form was identified with EFA procedures. The model was confirmed with CFA (CFI = 0.983; TLI = 0.975; IFI = 0.983; RMSEA = 0.057), while a sound 2-factor, 6-item model was also identified (CFI = 1.0; TLI = 0.999; IFI = 1.0; RMSEA = 0.11). The 9-item IKDC-SKF short form was invariant across groups but not time; removal of a single item (i.e., 8-item IKDC-SKF short form) resulted in longitudinal invariance. The 6-item IKDC-SKF short form was invariant across groups and time.

Conclusion

The 6-item, 8-item, and 9-item short form versions of the IKDC-SKF exceed contemporary fit recommendations and present as plausible alternatives to the IKDC-SKF with improved measurement properties, reduced scale response burden, and evidence of multi-group and longitudinal invariance. Further, the 6- and 8-item IKDC-SKF short forms may be used to assess group differences or change across time.# Level of evidence hereLevel 3©The Author(s).

Psychometric Properties of a Modified Athlete Burnout Questionnaire in the Collegiate Athletics Setting

CONTEXT

Mental health is an important component of holistic care in athletic settings. Burnout is one of many factors associated with poor mental health, and clinicians should assess for these symptoms. The Athlete Burnout Questionnaire (ABQ) has been proposed as a measure of burnout in athletes; however, design concerns are prevalent within the scale, and psychometric analyses have resulted in inconsistent measurement properties, limiting the usefulness of the scale for accurate assessment of burnout in athletes. The objective of our study was to assess the factor structure of the Alternate Modified ABQ-15v2 using confirmatory factor analysis. If model fit was inadequate, a secondary purpose was to identify a psychometrically sound alternate ABQ model.

DESIGN

Observational study.

METHODS

Intercollegiate athletes and dancers pursuing a degree in dance (n = 614) were recruited from programs across the United States. Individuals had varied health statuses (eg, healthy, injured), scholarship support, and participated in a variety of intercollegiate sports. A confirmatory factor analysis was conducted on the modified 15-item ABQ (Alternate Modified ABQ-15v2). Exploratory factor analysis and covariance modeling of a proposed alternate 9-item scale (ABQ-9) was conducted and multigroup invariance analysis was assessed across athlete category, class standing, and student-athlete scholarship status to assess consistency of item interpretation across subgroups.

RESULTS

The Modified ABQ did not meet recommended model fit criteria. The ABQ-9 met all recommended model fit indices but was not invariant across athlete category.

CONCLUSIONS

The ABQ-9 may be a viable and efficient option for assessing burnout in the collegiate athletics setting. However, further research is needed to validate the ABQ-9 in a cross-validation study.

Evaluating a Project Extension for Community Health Outcomes Pediatric Behavioral Health Series in a Rural and Frontier State: An Exploratory Investigation

BACKGROUND

Idaho, a predominately rural state, has a high prevalence of mental illness with minimal access to care. Barriers in diagnosis and treatment of pediatric behavioral health disorders could be mitigated with an accessible and effective specialty training program.

METHODS

A 10-session Project Extension for Community Health Outcomes (ECHO) series was designed to expand provider knowledge about pediatric behavioral health conditions and improve perceived clinical practice skills. Pre- and postseries evaluation surveys and individual session evaluations were used to assess the program.

RESULTS

A total of 148 individuals attended at least 1 of the 10 sessions. Participants reported high satisfaction with individual sessions and indicated that attendance positively impacted their knowledge and competency. Participants also reported that the knowledge and skills gained from the series would benefit more than half of their patients or clients.

CONCLUSION

The short ECHO series appears to be a viable and valuable option to provide Idaho providers with effective specialty training that is well attended and well received.

Confirmatory Factor Analysis of the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Associated Sub-scales

Background

Hip Disability and Osteoarthritis Outcome Score (HOOS), HOOS-Joint Replacement (JR), HOOS Physical Function (PS), and HOOS-12 item scale have been suggested as reliable and valid instruments for assessing hip disability. However, factorial validity, invariance across subgroups, and repeated measures of the scale across different populations have not been well supported in the literature.

Purpose

The primary study objectives were to: (1) assess model fit and psychometric properties of the original 40-item HOOS scale, (2) assess model fit of the HOOS-JR, (3) assess model fit of the HOOS-PS, and (4) assess model fit of the HOOS-12. A secondary objective was to perform multigroup invariance testing across physical activity level and hip pathology subgroups for models that met recommended fit indices.

Study Design

Cross-Sectional Study.

Methods

Individual confirmatory factor analyses (CFAs) were conducted for the HOOS, HOOS-JR, HOOS-PS, and HOOS-12. Additionally, multigroup invariance testing (i.e., activity level, injury type) was conducted on the HOOS-JR and HOOS-PS.

Results

Model fit indices did not meet contemporary recommendations for the HOOS and the HOOS-12. Model fit indices for the HOOS-JR and the HOOS-PS met some, but not all, contemporary recommendations. Invariance criteria was met for the HOOS-JR and HOOS-PS.

Conclusion

The scale structure of the HOOS and HOOS-12 were not supported; however, preliminary evidence to support the scale structure of the HOOS-JR and HOOS-PS was found. Clinicians and researchers who utilize the scales should do so with caution due to their limitations and untested properties until further research establishes the full psychometric properties of these scales and recommendations for their continued use.

Many-faceted rasch calibration of the foot function index-revised short form

Background

The Foot Function Index Revised Short version (FFI-RS) is a foot- and ankle- patient-reported outcome measure (PROM), developed from the Foot Function Index (FFI). Previous studies, estimating item parameters and multidimensional properties, have limitations properly establishing the measurement properties of the FFI-RS. A multi-faceted Rasch analysis with a larger sample would allow for a more robust validation approach to improve the clinical interpretation of the FFI-RS using a multidimensional perspective. Therefore, the purpose of this study was to assess the psychometric properties of the FFI-RS as a PROM of foot function.

Method

A total of 2184 patients with foot pathology who completed the FFI-RS were included in the data. Data were extracted from the cloud-based orthopedic and sports medicine global registry Surgical Outcome System (SOS). The psychometric properties of the FFI-RS were assessed using a many-faceted Rasch analysis that included model-data fit, rating scale function, item-person map (distribution of item difficulty and person ability), and item difficulty of the subscale.

Results

Two misfit items were discovered and deleted; 32-items from the original FFI-RS were retained. The 4-item Likert scale functioned effectively and item difficulty (-0.58 to 1.48), subscale difficulty (-0.58 to 1.15), and person’s foot function (-6.62 to 6.24) had wide distributions.

Conclusions

Many-faceted Rasch analysis revealed the FFI-RS had sound psychometric properties using the many-faceted Ranch analysis and retained 32 of the original items. Clinicians and researchers should consider weaknesses identified with items in the ‘Difficulty” subscale and future work should be conducted to modify or develop items that will more accurately evaluate a wide range of foot function levels.

Stakeholder perceptions of the use of a rapidly deployed modified ECHO to train and prepare healthcare providers for COVID-19

Background:

Innovative approaches to deliver timely information to rural healthcare providers are necessary with the COVID-19 pandemic. Project Extension for Community Healthcare Outcomes (ECHO) is a telementoring program designed to provide practitioners in rural communities with opportunities to engage in specialty training. We examined participant perceptions of a rapidly deployed, single continuing education session to improve healthcare provider preparedness for COVID-19 in Idaho.

Methods:

A modified Project ECHO session was developed to inform providers about emergency preparedness, treatment, testing, and resources for COVID-19. A post-session survey examined session impact and barriers on clinical practice.

Results:

Respondents believed the modified ECHO session increased COVID-19 knowledge and would improve their clinical practice and preparedness. Respondents were satisfied with the session and identified content, interdisciplinary collaboration, and format as beneficial; perceived barriers for utilizing session information included a lack of relevance of content and clinical applicability, and time constraints.

Conclusions:

A rapidly deployed modified Project ECHO session was perceived as an effective mechanism to foster collaboration and relay information to promote best practices at the start of the COVID-19 pandemic. An established Project ECHO network may be useful to rapidly exchange knowledge and information during a health emergency.

Evaluation of an opioid and addiction treatment tele-education program for healthcare providers in a rural and frontier state

OBJECTIVE

To develop and evaluate a relevant and readily accessible post-professional opioid use disorder (OUD) education program for a rural and frontier state.

DESIGN

Observational study.

SETTING/PARTICIPANTS

Healthcare providers enrolled in Extension for Community Healthcare Outcomes (ECHO) Idaho Opioid, a tele-mentoring education program.

MAIN OUTCOME MEASURE

Participant-level demographics of those that attended the ECHO Idaho Opioid program and post-session and program evaluation -surveys.

RESULTS

A total of 273 individuals attended at least one ECHO Idaho Opioid session (per session average = 22.8); 183 post-session evaluations (per session average = 6.3) and 42 program evaluations were completed. The program was well received by providers in a rural and frontier state and may be a viable option to enhance patient care for OUD patients in these communities.

CONCLUSION

The Project ECHO model is successful at reaching providers across diverse geographic regions, overcoming barriers associated with attending advanced trainings or developing peer networks to improve patient care. The model can be used to develop educational content and delivery that participants believe is satisfactory, valuable, and applicable to their profession and practice.

Disablement in the Physically Active Scale Short Form-8: psychometric evaluation

Background

Patient-centered care and evidence-based practice (EBP) are core competencies for health care professionals. The importance of EBP has led to an increase in research involving clinical outcomes; current recommendations emphasize collecting patient focused measures, thus increasing the need for psychometrically sound patient reported outcome measures (PROMs) of health. Disablement has been identified as a valuable multi-dimensional construct for patient care. The Disablement in the Physically Active Scale Short Form-8 (DPA SF-8) has been proposed as a tool to be used in the physically active population that assesses a physical summary component of health and a quality of life component however, further analysis is necessary to ensure the instrument is psychometrically sound.

Methods

Confirmatory factor analyses (CFAs) were conducted on the DPA SF-8 at each time point to ensure factor structure. Reliability of the scale and internal consistency of the subscales were assessed, and a minimal detectable change (MDC) calculated. Additionally, a minimal clinically important difference (MCID) was also established, and invariance testing across three time points and groups was conducted.

Results

The CFAs at all three visits exceeded recommended model fit indices. The interclass correlation coefficient value (.924) calculated indicated excellent scale reliability and Cronbach’s alpha for subscales PHY and QOL were within recommend values. The MDC value calculated was 5.83 and the MCID for persistent injuries were 2 points and for acute injuries, 3 points. The DPA SF-8 was invariant across time and across subgroups.

Conclusions

The DPA SF-8 met CFA recommendations and criteria for multi-group and longitudinal invariance testing, which indicates the scale may be used to assess for differences between the groups or across time. Our overall analysis indicates the DPA SF-8 is a valid, reliable, and responsive instrument to assess patient improvement in the physically active population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00380-3.

Clinical Practice Patterns Among Health Care Professionals for Instrument-Assisted Soft Tissue Mobilization

CONTEXT

Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial intervention used by health care professionals.

OBJECTIVE

To document IASTM clinical practice patterns among health care professionals in the United States.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 853 members of the National Athletic Trainers' Association (n = 249) and the American Physical Therapy Association (n = 604).

MAIN OUTCOME MEASURE(S)

Responses to a 55-item electronic survey that assessed 4 areas, namely, IASTM training and experience, IASTM application, perception of IASTM in practice, and demographic information.

RESULTS

Most (n = 705, 83%) of the 853 respondents used IASTM in their practice, and they had an average of 15 years of work experience. Approximately 86% (n = 731) reported completing some type of formal training, and 61% (n = 518) had completed some type of informal training. Respondents used >34 different IASTM tools. Seventy-one percent (n = 606) indicated either not knowing how to quantify the amount of force applied by the tool during treatment or not trying to quantify. Fifteen percent (n = 128) estimated a force ranging from 100 to 500g. The treatment time for a specific lesion and location ranged from 1 to ≤5 minutes, with an average total treatment time of 14.46 ± 14.70 minutes. Respondents used 31 different interventions before or after IASTM. Approximately 66% (n = 564) reported following treatment recommendations, and 19% (n = 162) described rarely or never following recommendations learned during training. A total of 94% (n = 801) recounted using some type of clinical outcome measure to assess their treatment. Cluster analysis identified 3 distinct cluster groupings among professionals, with most (89%, n = 729/818) indicating that IASTM was an effective treatment.

CONCLUSIONS

This survey documented the IASTM practice patterns of health care professionals. Cluster profiles characterized group differences in IASTM training and clinical application. The gaps among research, clinical practice, and training need to be bridged to establish IASTM best practices.

Invariance Testing of the Disablement in the Physically Active Scale Short Form-10

INTRODUCTION

Psychometrically sound instruments are needed to accurately track treatment effectiveness and assess quality of patient care. The Disablement in Physically Active Scale Short Form-10 (DPAS-10) was developed as a more parsimonious version of the DPA Scale to assess disablement in the physically active. Psychometric assessment of the DPAS-10 has not been completed; specifically, scale properties must be assessed in a sample of individuals who only respond to the 10-item scale at multiple time points.

OBJECTIVES

To assess the psychometric properties of the DPAS-10 using confirmatory factor analysis (CFA) and invariance procedures across multiple time points.

METHODS

Confirmatory factor analyses and longitudinal invariance tests were conducted.

RESULTS

The DPAS-10 met contemporary fit index recommendations and demonstrated longitudinal invariance; however, localized fit issues suggest further modification is needed.

CONCLUSION

Adoption of the DPAS-10 into widespread clinical practice and research is not recommended until further psychometric testing and scale modification is performed.

Measuring psychological pain: psychometric analysis of the Orbach and Mikulincer Mental Pain Scale

Background

Suicide is a public health concern, with an estimated 1 million individuals dying each year worldwide. Individual psychological pain is believed to be a contributing motivating factor. Therefore, establishing a psychometrically sound tool to adequately measure psychological pain is important. The Orbach and Mikulincer Mental Pain Scale (OMMP) has been proposed; however, previous psychometric analysis on the OMMP has not yielded a consistent scale structure, and the internal consistency of the subscales has not met recommended values. Therefore, the primary purpose of this study was to assess the psychometric properties of the OMMP in a diverse sample.

Methods

A confirmatory factor analysis (CFA) on the 9-factor, 44-item OMMP was conducted on the full sample (n = 1151). Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted on a random subset of the data (n = 576) to identify a more parsimonious structure. The EFA structure was then tested in a covariance model in the remaining subset of participants (n = 575). Multigroup invariance testing was subsequently performed to examine psychometric properties of the refined scale.

Results

The CFA of the original 9-factor, 44-item OMMP did not meet recommended model fit recommendations. The EFA analysis results revealed a 3-factor, 9-item scale (i.e., OMMP-9). The covariance model of the OMMP-9 indicated further refinement was necessary. Multigroup invariance testing conducted on the final 3-factor, 8-item scale (i.e., OMMP-8) across mental health diagnoses, sex, injury status, age, activity level, and athlete classification met all criteria for invariance.

Conclusions

The 9-factor, 44-item OMMP does not meet recommended measurement criteria and should not be recommended for use in research and clinical practice in its current form. The refined OMMP-8 may be a more viable option to use; however, more research should be completed prior to adoption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42409-021-00025-8.

Invariance Testing of the Disablement in the Physically Active Scale

CONTEXT

The increased emphasis on implementing evidence-based practice has reinforced the need to more accurately assess patient improvement. Psychometrically sound, patient-reported outcome measures are essential for evaluating patient care. A patient-reported outcome instrument that may be useful for clinicians is the Disablement in the Physically Active Scale (DPAS). Before adopting this scale, however, researchers must evaluate its psychometric properties, particularly across subpopulations.

OBJECTIVE

To evaluate the psychometric properties of the DPAS in a large sample using confirmatory factor analysis procedures and assess structural invariance of the scale across sex, age, injury status, and athletic status groups.

DESIGN

Observational study.

SETTING

Twenty-two clinical sites.

PATIENTS OR OTHER PARTICIPANTS

Of 1445 physically active individuals recruited from multiple athletic training clinical sites, data from 1276 were included in the analysis. Respondents were either healthy or experiencing an acute, subacute, or persistent musculoskeletal injury.

MAIN OUTCOME MEASURE(S)

A confirmatory factor analysis was performed on the full sample, and multigroup invariance testing was conducted to assess differences across sex, age, injury status, and athletic status. Given the poor model fit, alternate model generation was used to identify a more parsimonious factor structure.

RESULTS

The DPAS did not meet contemporary fit index recommendations or the criteria to demonstrate structural invariance. We identified an 8-item model that met the model fit recommendations using alternate model generation.

CONCLUSIONS

The 16-item DPAS did not meet the model fit recommendations and may not be the most parsimonious or reliable measure for assessing disablement and quality of life. Use of the 16-item DPAS across subpopulations of interest is not recommended. More examination involving a true cross-validation sample should be completed on the 8-item DPAS before this scale is adopted in research and practice.

The Effectiveness of Standing on a Balance Board for Increasing Energy Expenditure

PURPOSE

This study aimed to investigate differences in energy expenditure (EE), heart rate (HR), productivity, fatigue, and pain while performing desk work while sitting (SIT), standing (STAND), and standing on a balance board (BOARD).

METHODS

Thirty healthy adults (60% female, age = 39.7 ± 11.8 yr, body mass index = 26.7 ± 5.0 kg·m) employed in sedentary-based jobs volunteered for this randomized crossover trial. Participants performed typing work in three different positions: SIT, STAND, and BOARD, each condition lasting 30 min. Oxygen consumption (V˙O2) was measured via indirect calorimetry, and EE was calculated using respiratory quotient and corresponding caloric equivalent values. Productivity was quantified by measuring words typed per minute, accuracy, and typing mistakes. Overall feelings of fatigue and pain were self-reported three times during each position using validated 10-cm visual analog scales. Repeated-measures ANOVA was used to assess differences in outcome variables across conditions.

RESULTS

V˙O2 was significantly different among all conditions regardless of current standing desk use (SIT = 3.35 ± 0.53, STAND = 3.77 ± 0.48, BOARD = 3.92 ± 0.54 mL·kg·min, P < 0.001). EE (kcal·min) also differed (P < 0.001) among SIT (1.27 ± 0.22), STAND (1.42 ± 0.26), and BOARD (1.48 ± 0.29). Compared with sitting (67 ± 9 bpm), HR was higher in STAND (76 ± 11 bpm) and BOARD (76 ± 11 bpm, P < 0.001). Measures of productivity were not different across conditions (P > 0.05). Fatigue progressively increased over each 30-min condition, whereas pain in SIT and BOARD increased from minute 10 to minute 20 and then leveled off between minutes 20 and 30. For STAND, pain continued to increase over time.

CONCLUSION

Compared with sitting, a balance board may be effective for increasing EE without interfering with productivity in an occupational setting.