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. 2016 Aug 5;6(8):e012331.
doi: 10.1136/bmjopen-2016-012331.

Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways

Jonathan C Hill  1 , Sujin Kang  2 , Elena Benedetto  2 , Helen Myers  1 , Steven Blackburn  1 , Stephanie Smith  2 , Kate M Dunn  1 , Elaine Hay  1 , Jonathan Rees  2 , David Beard  2 , Sion Glyn-Jones  2 , Karen Barker  2 , Benjamin Ellis  3 , Ray Fitzpatrick  4 , Andrew Price  2
Affiliations

Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways

Jonathan C Hill et al. BMJ Open. .

Abstract

Objectives: Current musculoskeletal outcome tools are fragmented across different healthcare settings and conditions. Our objectives were to develop and validate a single musculoskeletal outcome measure for use throughout the pathway and patients with different musculoskeletal conditions: the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ).

Setting: A consensus workshop with stakeholders from across the musculoskeletal community, workshops and individual interviews with a broad mix of musculoskeletal patients identified and prioritised outcomes for MSK-HQ inclusion. Initial psychometric validation was conducted in four cohorts from community physiotherapy, and secondary care orthopaedic hip, knee and shoulder clinics.

Participants: Stakeholders (n=29) included primary care, physiotherapy, orthopaedic and rheumatology patients (n=8); general practitioners, physiotherapists, orthopaedists, rheumatologists and pain specialists (n=7), patient and professional national body representatives (n=10), and researchers (n=4). The four validation cohorts included 570 participants (n=210 physiotherapy, n=150 hip, n=150 knee, n=60 shoulder patients).

Outcome measures: Outcomes included the MSK-HQ's acceptability, feasibility, comprehension, readability and responder burden. The validation cohort outcomes were the MSK-HQ's completion rate, test-retest reliability and convergent validity with reference standards (EQ-5D-5L, Oxford Hip, Knee, Shoulder Scores, and the Keele MSK-PROM).

Results: Musculoskeletal domains prioritised were pain severity, physical function, work interference, social interference, sleep, fatigue, emotional health, physical activity, independence, understanding, confidence to self-manage and overall impact. Patients reported MSK-HQ items to be 'highly relevant' and 'easy to understand'. Completion rates were high (94.2%), with scores normally distributed, and no floor/ceiling effects. Test-retest reliability was excellent, and convergent validity was strong (correlations 0.81-0.88).

Conclusions: A new musculoskeletal outcome measure has been developed through a coproduction process with patients to capture prioritised outcomes for use throughout the pathway and with different musculoskeletal conditions. Four validation cohorts found that the MSK-HQ had high completion rates, excellent test-retest reliability and strong convergent validity with reference standards. Further validation studies are ongoing, including a cohort with rheumatoid/inflammatory arthritis.

Keywords: Cohort studies; Outcome Assessment; Questionnaires; Validation studies.

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Figures

Figure 1
Figure 1
Example items from the MSK-HQ. MSK-HQ, Musculoskeletal Health Questionnaire.
Figure 2
Figure 2
A person–item map for the Rasch partial credit model presents item response difficulty.
See this image and copyright information in PMC

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