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Patient-reported quality indicators to evaluate physiotherapy care for hip and/or knee osteoarthritis- development and evaluation of the QUIPA tool
BMC Musculoskeletal Disorders ( IF 2.3 ) Pub Date : 2020-04-01 , DOI: 10.1186/s12891-020-03221-5
Pek Ling Teo , Rana S. Hinman , Thorlene Egerton , Krysia S. Dziedzic , Jessica Kasza , Kim L. Bennell

There is no physiotherapy-specific quality indicator tool available to evaluate physiotherapy care for people with hip and/or knee osteoarthritis (OA). This study aimed to develop a patient-reported quality indicator tool (QUIPA) for physiotherapy management of hip and knee OA and to assess its reliability and validity. To develop the QUIPA tool, quality indicators were initially developed based on clinical guideline recommendations most relevant to physiotherapy practice and those of an existing generic OA quality indicator tool. Draft items were then further refined using patient focus groups. Test-retest reliability, construct validity (hypothesis testing) and criterion validity were then evaluated. Sixty-five people with hip and/or knee OA attended a single physiotherapy consultation and completed the QUIPA tool one, twelve- and thirteen-weeks after. Physiotherapists (n = 9) completed the tool post-consultation. Patient test-retest reliability was assessed between weeks twelve and thirteen. Construct validity was assessed with three predefined hypotheses and criterion validity was based on agreement between physiotherapists and participants at week one. A draft list of 23 clinical guideline recommendations most relevant to physiotherapy was developed. Following feedback from three patient focus groups, the final QUIPA tool contained 18 items (three subscales) expressed in lay language. The test-retest reliability estimates (Cohen’s Kappa) for single items ranged from 0.30–0.83 with observed agreement of 64–94%. The intraclass correlation coefficient (ICC) and 95% confidence interval (CI) for the Assessment and Management Planning subscale was 0.70 (0.54, 0.81), Core Recommended Treatments subscale was 0.84 (0.75, 0.90), Adjunctive Treatments subscale was 0.70 (0.39, 0.87) and for the total QUIPA score was 0.80 (0.69, 0.88). All predefined hypotheses regarding construct validity were confirmed. However, agreement between physiotherapists and participants for single items showed large measurement error (Cohen’s Kappa estimates ranged from − 0.04-0.59) with the ICC (95% CI) for the total score being 0.11 (− 0.14, 0.34). The QUIPA tool showed acceptable test-retest reliability for subscales and total score but inadequate reliability for individual items. Construct validity was confirmed but criterion validity for individual items, subscales and the total score was inadequate. Further research is needed to refine the QUIPA tool to improve its clinimetric properties before implementation.

中文翻译:

患者报告的质量指标可评估髋关节和/或膝关节骨关节炎的理疗护理-QUIPA工具的开发和评估

没有可用的特定于物理疗法的质量指标工具来评估髋关节和/或膝盖骨关节炎(OA)患者的物理疗法护理。这项研究旨在开发一种患者报告的质量指标工具(QUIPA),用于髋和膝OA的物理治疗,并评估其可靠性和有效性。为了开发QUIPA工具,最初是根据与物理治疗实践最相关的临床指南建议以及现有的通用OA质量指标工具的建议制定质量指标。然后使用患者焦点小组进一步完善草稿项目。然后评估重测信度,构想效度(假设检验)和标准效度。65名髋关节和/或膝盖OA患者参加了一次物理治疗咨询,并完成了QUIPA工具,十二周和十三周之后 物理治疗师(n = 9)完成了咨询后的工具。在第12周到第13周之间评估了患者的重测信度。用三个预定假说评估构建体有效性,标准有效性基于第一周物理治疗师和参与者之间的共识。制定了与物理治疗最相关的23条临床指南建议的清单草案。在三个患者焦点小组的反馈意见之后,最终的QUIPA工具包含了18项(三个分量表)以通俗语言表达的项目。单个项目的重测信度估计(Cohen's Kappa)在0.30-0.83之间,观察到的一致性为64-94%。评估和管理计划子量表的类内相关系数(ICC)和95%置信区间(CI)为0.70(0.54,0。81),核心推荐治疗量表为0.84(0.75,0.90),辅助治疗量表为0.70(0.39,0.87),而QUIPA总分为0.80(0.69,0.88)。确认了所有关于构建体有效性的预定义假设。但是,物理治疗师与参与者之间就单个项目达成的协议显示出较大的测量误差(Cohen的Kappa估计范围为-0.04-0.59),ICC(95%CI)的总得分为0.11(-0.14,0.34)。QUIPA工具显示对子量表和总分的可接受的重测可靠性,但对单个项目的可靠性不足。确认了结构效度,但个别项目,分量表和总分的标准效度不足。在实施之前,需要进一步研究以完善QUIPA工具,以改善其斜度特性。核心推荐治疗子量表为0.84(0.75,0.90),辅助治疗子量表为0.70(0.39,0.87),而QUIPA总分为0.80(0.69,0.88)。确认了所有关于构建体有效性的预定义假设。但是,物理治疗师与参与者之间就单个项目达成的协议显示出较大的测量误差(Cohen的Kappa估计范围为-0.04-0.59),ICC(95%CI)的总得分为0.11(-0.14,0.34)。QUIPA工具显示对子量表和总分的可接受的重测可靠性,但对单个项目的可靠性不足。确认了结构效度,但个别项目,分量表和总分的标准效度不足。在实施之前,需要进一步研究以完善QUIPA工具,以改善其斜度特性。核心推荐治疗子量表为0.84(0.75,0.90),辅助治疗子量表为0.70(0.39,0.87),而QUIPA总分为0.80(0.69,0.88)。确认了所有关于构建体有效性的预定义假设。但是,物理治疗师与参与者之间就单个项目达成的协议显示出较大的测量误差(Cohen的Kappa估计范围为-0.04-0.59),ICC(95%CI)的总得分为0.11(-0.14,0.34)。QUIPA工具显示对子量表和总分的可接受的重测可靠性,但对单个项目的可靠性不足。确认了结构效度,但个别项目,分量表和总分的标准效度不足。在实施之前,需要进一步研究以完善QUIPA工具,以改善其斜度特性。
更新日期:2020-04-01
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