DEVELOPMENT OF THE MUSCULOSKELETAL HEALTH QUESTIONNAIRE (MSK-HQ) FOR USE IN DIFFERENT CONDITIONS AND DIFFERENT HEALTHCARE PATHWAYS

Hill J.¹, Kang S.², Benedetto E.², Myers H.¹, Blackburn S.¹, Smith S.², Dunn K.¹, Hay E.M.¹, Rees J.², Beard D.², Barker K.², Ellis B.³, Fitzpatrick R.⁴, Price A.²

¹Keele University, Stoke on Trent, United Kingdom, ²University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, Oxford, United Kingdom, ³Arthritis Research UK, London, United Kingdom, ⁴University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom

Background: Musculoskeletal pain is the single greatest cause of years lived with disability. This can include osteoarthritis, inflammatory disorders and musculoskeletal disorders such as back, neck, shoulder, hip, and knee pain. Current musculoskeletal outcome tools are fragmented across different healthcare settings and conditions.

Purpose: The Arthritis UK Musculoskeletal Health Questionnaire (MSK-HQ) was developed as a generic, single musculoskeletal outcome measure that can be used throughout the healthcare pathway and with patients with different musculoskeletal conditions. In addition, we aimed for the MSK-HQ to capture key outcomes that are highly relevant to patients across a range of musculoskeletal conditions and settings.

Methods: The MSK-HQ was co-produced with patients and clinicians to identify aspects of MSK health that are important to both. A consensus workshop with stakeholders from across the musculoskeletal community 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. Analysis examined 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: Stakeholder workshop participants (n=29) included patients from primary care, physiotherapy, orthopaedic and rheumatology (n=8); general practitioners, physiotherapists, orthopaedists, rheumatologists and pain specialists (n=7), patient and professional national body representatives (n=10), and researchers (n=4). Participants in the four validation cohorts included 570 participants (n=210 physiotherapy, n=150 hip, n=150 knee, n=60 shoulder patients). The MSK-HQ was found to have good face and content validity through the workshops, and was psychometrically robust, showing good completion rates (94.2%), scores were normally distributed with no floor/ceiling effects, it had excellent test-retest reliability (total score agreement ICC was 0.84 with 95% CI 0.77 to 0.89, n=226), and strong convergent validity with reference standards (correlations 0.81–0.88). Key outcome domains prioritised by patients with MSK conditions and seen as important across the clinical pathway in rank order were; pain severity (during the day and night), physical function (walking and dressing), work interference, social interference, sleep, fatigue, emotional health, physical activity, independence, understanding, confidence to self-manage, and overall-impact.

Conclusion(s): The MSK-HQ is a single, generic measure of musculoskeletal conditions that has good psychometric properties of validity and reliability. It is acceptable to patients as relevant and easy to understand and has low levels of responder burden. Further work will encompass more validation studies, including factor structure and responsiveness, as well as cohort studies with patients with rheumatoid/inflammatory arthritis.

Implications: A new musculoskeletal health questionnaire (MSK-HQ) has been successfully developed through a co-production process with patients and was shown to have promising measurement properties in four different musculoskeletal cohorts. The MSK-HQ is available for use and captures key outcomes known to be highly relevant to patients across a range of musculoskeletal conditions and settings.

Funding acknowledgements: This project was funded by Arthritis Research UK (Ref. 20518).

Topic: Musculoskeletal

Ethics approval: Ethics came from the UK NHS Health Research Authority National Research Ethics Service Committee (approval reference: 15/YH/0167 and 15/WA/0040).

All authors, affiliations and abstracts have been published as submitted.