Development and validation of the computer-administered animated activity questionnaire to measure physical functioning of patients with hip or knee osteoarthritis

Assessing the measurement properties of PROMIS Computer Adaptive Tests, short forms and legacy patient reported outcome measures in patients undergoing total hip arthroplasty

BACKGROUND

The commonly used ('legacy') PROMs evaluating outcomes of total hip arthroplasty (THA), have several limitations regarding their measurement properties and interpretation of scores. One innovation in PROMs is the use of Computerized Adaptive Testing (CAT). The Patient-Reported Outcomes Measurement Information System (PROMIS®) is a validated system of CATs. The aim of this study was to assess the measurement properties of PROMIS and legacy instruments in patients undergoing THA.

METHODOLOGY

Patients in this multicenter study filled out a questionnaire twice, including Dutch-Flemish PROMIS v1.2 Physical Function (PROMIS-PF) and v1.1 Pain Interference (PROMIS-PI) CATs and short forms, PROMIS v1.0 Pain Intensity, and legacy PROMs (Hip disability and Osteoarthritis Outcome Score (HOOS), HOOS-Physical function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), and two numeric rating scales measuring pain). The reliability, measurement precision (Standard Error of Measurement (SEM)), smallest detectable change (SDC), and burden of PROMIS instruments were presented head-to-head to legacy PROMs. Furthermore, construct validity was assessed.

RESULTS

208 patients were included. All instruments had a sufficient test-retest reliability (range ICC: 0.83-0.96). The SEM of PROMIS CATs and short forms ranged from 1.8 to 2.2 T-score points, the SEM of legacy instruments 2.6-11.1. The SDC of PROMIS instruments ranged from 2.1 to 7.3 T-score points, the SDC of legacy instruments 7.2-30.9. The construct validity of PROMIS CAT and short forms were found sufficient, except for the PROMIS-PI short form. The burden of PROMIS CATs was smaller than PROMIS short forms (range 4.8-5.2 versus 8-20 items, respectively). The burden of legacy instruments measuring physical functioning ranged from 5 to 40 items.

CONCLUSIONS

The PROMIS-PF is less burdensome, with high measurement precision, and almost no minimal or maximal scores, and an equal reliability compared to legacy instruments measuring physical functioning in patients undergoing THA. The PROMIS Pain Intensity 1a is comparable to the legacy pain instruments in terms of burden, reliability and SDC. Measuring the construct Pain Interference may not have additional value in this population because of its high correlation with instruments measuring physical functioning. The SDC values presented in this study can be used for individual patient monitoring.

Effect of Context Specificity on Response to the Shortened WOMAC Function Scale in Patients Undergoing Total Knee Arthroplasty

OBJECTIVE

To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (1) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures (ii) affected mean scale score, structural validity, reliability, and interpretability.

DESIGN

Secondary analysis of randomized clinical trial data.

SETTING

A tertiary teaching hospital.

PARTICIPANTS

Patients undergoing TKA (N=114).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, whereas the modified "level walking" item enquired about difficulty in walking 400 m. Before and 12 weeks after TKA, patients completed the WOMAC-F questionnaire, modified ShortMAC-F questionnaire, knee pain scale questionnaire, sit-to-stand test, fast gait speed test, and stair climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit estimates.

RESULTS

The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker-Lewis indices, >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach's α, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and substantial clinical benefit estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower).

CONCLUSIONS

The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA.

Cross-cultural adaptation, reliability and validity of the Turkish version of the modified Gait Efficacy Scale in community-dwelling older adults

BACKGROUND

There are no published studies on the cross-cultural adaptation of the modified Gait Efficacy Scale (mGES) to Turkish and investigated its reliability and validity.

PURPOSE

The aim of the study was to cross-culturally adapt the mGES to Turkish (T-mGES) and to prove its psychometric properties in community-dwelling older adults.

METHODS

International translation strategies and cultural adaptation procedures were used. A total of 103 community-dwelling older adults (73 women, 30 men) have participated in psychometric property analysis. Participants were assessed using the T-mGES, Activity Specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I). T-mGES was recompleted one week later.

RESULTS

The mean age of the individuals was 67.8 ± 4.8 years. The T-mGES had strong test-retest reliability (ICC: 0.835, CI 95%: 0.72-0.90). The T-mGES' overall score had strong internal consistency (Cronbach's α: 0.961). The SEM95 and MDC95 values for the total score were 6.62 and 18.34, respectively. T-mGES had a strong relationship with ABC and FES-I (r1: 0.899, r2: -0.707, p < .01), indicating a high (r > 0.50) construct validity. On the other hand, factor analysis results proved a one-dimensioned structure of the T-mGES.

CONCLUSION

T-mGES is a reliable and valid questionnaire for assessing gait efficacy in Turkish speaking community-dwelling older adults. T-mGES provides a straightforward measure due to its unidimensional form.

Virtual performance measure in osteoarthritis: An innovative transformation of patient care

Objectives

The purpose of this study was to develop and establish reliability and validity of a virtual performance measure (VPM) score that encompassed 10 videos in patients with osteoarthritis of the knee joint. Patients' experience and satisfaction were documented.

Design

Forty videos were chosen for 10 functional tasks, with four videos showing increasing difficulty for each task. Patients were requested to choose the video that best reflected their own situation. Clinical and radiological findings and self-report and performance measures were completed.

Results

Data of 100 patients, 70 (70%) females, mean age: 65 ​± ​9 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM score was 0.92. The intraclass correlation value of 0.82 was obtained for test-retest reliability. Factor analysis showed three distinct domains. There was moderate correlations between the VPM score and the self-report and actual performance measures ranging from r ​= ​0.46 to 0.66. The VPM summated score of 10 activities was able to differentiate between candidates and non-candidates for knee arthroplasty, with the area under the curve value of 0.90 indicating excellent predictive validity. The overall patient experience and satisfaction was positive with 67% of participants feeling that virtual care could have an impact on minimizing physical presence in the clinic or hospital.

Conclusions

The VPM is a reliable and valid outcome measure in patients with osteoarthritis of the knee joint. This digital tool has the potential to transform osteoarthritis care by providing a valid remote measurement of real-life functional limitations and reduce the burden of time consuming in-person tests.

Instrumented BASFI (iBASFI) Shows Promising Reliability and Validity in the Assessment of Activity Limitations in Axial Spondyloarthritis

OBJECTIVE

The Bath Ankylosing Spondylitis Functional Index (BASFI) is the most popular method to assess activity capacity in axial spondyloarthritis (axSpA), to our knowledge. It is endorsed by the Assessment of Spondyloarthritis international Society. But it may have recall bias or aberrant self-judgments in individual patients. Therefore, we aimed to (1) develop the instrumented BASFI (iBASFI) by adding a body-worn accelerometer with automated algorithms to performance-based measurements (PBM), (2) study the iBASFI's core psychometric properties, and (3) reduce the number of iBASFI items.

METHODS

Twenty-eight patients with axSpA wore a 2-axial accelerometer while completing 12 PBM derived from the BASFI. A chronometer and both manual and "automated algorithm-based" acceleration segmentation identified movement time. Test-retest trials and methods (algorithm vs manual segmentation/chronometer/BASFI) were compared with ICC, standard error of measurement [percentage of movement time (SEM%)], and Spearman ρ correlation coefficients. Linear regression identified the optimal set of reliable iBASFI PBM.

RESULTS

Good to excellent test-retest reliability was found for 8/12 iBASFI items (ICC range 0.812-0.997, SEM range 0.4-30.4%), typically with repeated and fast movements. Automated algorithms excellently mimicked manual segmentation (ICC range 0.900-0.998) and the chronometer (ICC range 0.878-0.998) for 10/12 iBASFI items. Construct validity compared with the BASFI was confirmed for 7/12 iBASFI items (δ range 0.504-0.755). Together, sit-to-stand speed test (stBeta 0.483), cervical rotation (stBeta -0.392), and height (stBeta -0.375) explained 59% of the variance in the BASFI (p < 0.01).

CONCLUSION

The proof-of-concept iBASFI showed promising reliability and validity in measuring activity capacity. The number of the iBASFI's PBM may be minimized, but further validation in larger axSpA cohorts is needed before its clinical use.

Patient-Reported Mobility: A Systematic Review

OBJECTIVES

To identify the self-administered instruments to assess mobility in adults with disability, to link the mobility assessed by these instruments to the International Classification of Functioning, Disability and Health (ICF), and to evaluate their methodological quality.

DATA SOURCES

Scopus, Science Direct, and Web of Science were systematically searched up to July 2015.

STUDY SELECTION

Studies on the development and validation of self-administered questionnaires in which at least half of the items were related to movement or mobility were included.

DATA EXTRACTION

The mobility assessed by the instruments was classified according to the ICF categories. The methodological quality was assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist.

DATA SYNTHESIS

Of 5791 articles, 34 studies were eligible for inclusion. Only 10 of the instruments contained items that exclusively assessed mobility. The most frequently linked ICF categories were "changing basic body position" (19.4%), "walking" (14.8%), and "moving around" (13.5%). Measurement properties evaluated included internal consistency (5 studies), reliability (5 studies), measurement error (1 study), content validity (9 studies), structural validity (4 studies), hypotheses testing (6 studies), and responsiveness (1 study). Only content validity obtained the highest quality, probably because the studies included in the review reported the development and initial validation of the instruments.

CONCLUSIONS

Self-administered mobility questionnaires published in the scientific literature assess mobility activities rather than functions related to movement, and do so from the perspective of disability, frequently including self-care and domestic life as domains for assessment. The instruments that presented the highest methodological quality were the Outpatient Physical Therapy Improvement in Movement Assessment Log, the Movement Ability Measure, and the Mobility Activities Measure for Inpatient Rehabilitation Settings.

Validation of the Animated Activity Questionnaire (AAQ) for patients with hip and knee osteoarthritis: comparison to home-recorded videos

A recently developed computerized Animated Activity Questionnaire (AAQ) uses video animations to measure limitations in basic daily activities in patients with hip or knee osteoarthritis (OA). The AAQ is less time and money consuming than performance-based tests and less burdensome for patients. Compared to patient-reported outcome measurements, the AAQ is less influenced by the perception of the patient. Previous validation studies of the AAQ showed promising results. Since the AAQ purports to measure activity limitations in real-life situations, this study aims to establish the construct validity of the AAQ by comparing the AAQ to home-recorded videos. Home-recorded videos of eleven basic activities performed by 22 OA patients were transformed into scores and subsequently correlated with the AAQ, the Hip disability and Knee injury Osteoarthritis Outcome Score (H/KOOS), and three performance-based tests (Stair Climbing Test, Timed Up and Go test, and the 30 s Chair Stand Test). The AAQ was expected to correlate highly with the home-recorded videos and the performance-based tests, and moderately with the H/KOOS. As hypothesized, the AAQ correlated highly with the home-recorded videos and performance-based tests (0.83 and, 0.73 respectively), but also unexpectedly highly with the H/KOOS (0.79). In conclusion, since the AAQ correlates highly with home-recorded videos, it seems to have potential as a measurement tool to assess limitations in activities close to the real-life situation, but this should be confirmed in a larger sample of patients.