DEVELOPMENT AND VALIDATION OF SELF-ADMINISTERED QUESTIONNAIRE TO IDENTIFY THE SYMPTOMS OF EARLY PATELLOFEMORAL ARTHRITIS: A PSYCHOMETRIC TESTING IN INDIA

H. Patel¹, M. Balaganapathy¹

¹Ashok & Rita Patel Institute of Physiotherapy, Faculty of Medicine, CHARUSAT, Changa, India

Background: Knee osteoarthritis is one of the leading cause for increasing global burden in musculoskeletal disorders. It is proven that the knee osteoarthritis begins from the posterior surface of sesamoid bone and progresses to large condylar joint surface. Crepitus, anterior knee pain, stiffness and difficulty in functional activities are patient reported as initial symptoms of osteoarthritis in young age population >40-year age. e The prevalence rate of patellofemoral arthritis is 39% in South Asian population. The census for osteoarthritis recommends to focus on the pre-diagnostic stage. International patellofemoral osteoarthritis consortium 2018 also highlighted the need to develop and validate patient specific tool for this condition. However, none of the tool is available to screen the early symptoms of patellofemoral arthritis.

Purpose: We aim to develop and evaluate psychometric properties of Self-administered questionnaire to identify the symptoms of early patellofemoral arthritis.

Methods: The Self-administered questionnaire to identify the symptoms of early patellofemoral arthritis was developed using a mixed method stepwise approach. Patient plays key role in development of self-administers questionnaire. Early patellofemoral arthritis patients (n=48) interviewed in face-to-face interview and focused group discussions to collect the qualitative data and narrative review was conducted. The conceptual framework for questionnaire was prepared. Initial content validation was completed through Expert panel discussions (n=8). Total n=310 patients were recruited for psychometric validation of questionnaire from orthopedic outpatient units in India. Exploratory factor analysis conducted to assess the construct validity. Cronbach’s Alpha used to assess internal consistency, intra class correlation coefficient (ICC) for test retest reliability. The standard error, MDC and MCID calculated for the measurement error.

Results: Conceptual framework was developed from qualitative data obtained from patients and narrative review on reported symptoms of patellofemoral arthritis. It comprises of 43 items under 6 domains. After, two rounds of panel discussion and community consultations finalized the 4 domains and 12 contents version: Crepitus (2 items), Stiffness (2 items), Pain (2 items) and Difficulty in functional activity (6 items). Good internal consistency, α was 0.90; and acceptable level of item redundancy. The ICC value for the total scores for test and retest assessment was 0.936 (ICC 2,1; 95% CI = 0.880–0.936; p<0.000); the standard error of measurement was 1.95. The MDC was 5.39 and MCID was 3.29. Principal components analysis demonstrates FOUR-factor solution with 56.83% total variance. The initial Eigenvalues showed that the first factor explained 53.30% of the variance, the second factor 14.78% of the variance, a third factor 9.71 % of the variance, and a fourth factor 9.08% of the variance.

Conclusions: It is an acceptable, reliable and valid self-administered questionnaire that can potentially identify the early symptoms of Patellofemoral arthritis. The questionnaire provides good opportunity to patients for the self-analysis of the symptoms at community level. The symptoms monitoring track can be possible for individual use.

Implications: The newly developed self-administered questionnaire is simple, convenient to use, and valid measurement tool for detecting early symptoms of patellofemoral arthritis. It is cost-effective and can be utilize as guide at individual level for further consultation to orthopedic professionals.

Funding acknowledgements: No direct funding was received for this study. The CHARUSAT-Institutional fund was provided for gathering the qualitative data.​

Keywords:
self-administered questionnaire
early patellofemoral arthritis
Psychometric properties

Topics:
Musculoskeletal: lower limb
Research methodology, knowledge translation & implementation science
Orthopaedics

Did this work require ethics approval? Yes

Institution: CHARUSAT

Committee: Institutional Ethics Committee-CHARUSAT

Ethics number: CHA/IEC/ADM/20/07/622.2