Oahksforum r Osborne

7/29/2019 Oahksforum r Osborne

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Origins and validity of the

Osteoarthritis Hip and Knee

Questionnaire

Professor Richard Osborne BSc, PhD

Chair in Public Health

Public Health Innovation@Deakin,Deakin University

Melbourne, Australia


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RMH OWL follow up study:

Quality of life of people waiting for JRS

-0.20 0.00 0.20 0.40 0.60 0.80 1.00

AQoL baseline

0

5

10

15

20

25

Frequency

Mean = 0.3885

Std. Dev. = 0.234

N = 307

Populationnorm

Ackerman IN,

Graves SE, Wicks

IP, Bennell KL,

Osborne RH.

Severely

compromised

quality of life inwomen and those

of lower

socioeconomic

status waiting for

joint replacement

surgery.Arthritis

Rheum

2005;53(5):653-8.


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An evidence-based prioritisationand management system is

required


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RHM OWL Prioritisation Proposal23 12 2003 Final.doc

2. Project OutlineThe aim of the project is to develop a system thatfacilitates the appropriate management of people whomay require JRS. This system will involve clinicalpathways to triage people with hip or knee

osteoarthritis, facilitate fast and slow tracking (ieprioritisation), and ultimately ensure a higherproportion of the most needy people receive timelyJoint Replacement Surgery.


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Sponsor: Victorian

Government, Department

of Human Services

Field Champions

Mr Richard de Steiger (RMH)Mr Stan OLoughlin (DH)

Mr Ian Critchley (GVH)

Mr Chris Haw (WH)

Mr Rob Pianta (WH)

Mr Graeme Brown (Geelong)

Miss Susan Liew (Austin)Mr Roger Westh (Austin)

Investigators

Prof Richard Osborne

Prof Stephen Graves

Prof Ian Wicks

A/Prof Caroline Brand

Consultants

Prof Peter Fayers

Prof Paul Dieppe

Prof Tony Scott

Project staff

RMH: Ms Kerry Haynes

Ms Peta Chubb

Ms Catherine JonesMs Tanja Farmer

Ms Debra RobbinsMs Melanie Hawkins

GVH: Dr Jennifer Critchley

WH: Dr Anjali Haikerwal

DH: Ms Rosie Molloy

Ms Barbara Newell

Phase I:

2.5 years (2004-5)

Development of amanagement andprioritisation system


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Sponsor: VictorianGovernment,Department of HumanServices

Pilot Hospitals

Geelong

Peninsula

Royal Melbourne

St Vincents

Investigators

Prof Richard Osborne

A/Prof Caroline Brand

ConsultantsMr Richard de Steiger

Prof Stephen Graves

Ms Jenni Livingston

Ms Fiona Landgren

Project staffMs Melanie Hawkins

Ms Catherine Jones

Ms Jo Slee

Phase II:

1.5 years (2006-7)

Development ofstatewideimplementation plan


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Development of a

Multi-Attribute Prioritisation Tool (MAPT)

State-of-the-art surgeon/patient/systemconsultation, psychometrics and clinimetrics

Concept Mapping workshops Groups facilitated to identify factors that should be

considered when determining priority for JRS 4 workshops with orthopaedic surgeons

4 workshops with patients

With the grounded consultations we aimed to:

Ensure that the questionnaire was: Clinically relevant, endorsed and owned by clinical groups

Implementable

Embedded into clinical practice

Appropriate across settings


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Prioritisation domains generated from

surgeons and patients

1. Pain1.1. Sleep disturbance1.2. Rest pain1.3. Pain related to movement

2. Limitations to dailyactivities

2.1. Impairment of mobility2.2. Ability to self-care2.3. Level of domestic support2.4. Carer roles

3. Psychosocial health

impact

3.1. Psychological effect of

disability

3.2. Social effect of disability

4. Economic impact

4.1. Interference with ability to

work

4.2. Financial provider for

others

5. Recent deterioration


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MAPT development

Pre-testing draft ~120 questions

Derived from what patients and surgeons saidin

workshops

Consultation with surgeons and other experts

Development of draft questions across 5 domains

Cultural and linguistic audit

Cognitive interviews with patientsField testing

60 draft items

Completed by 600+ patients +/- on OWL


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Questions

Guttman-like scales

Discrete health states in each response

option Verifiable through a clinical interview

Attribution to the hip or knee

Not Likert questions


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WOMAC indexWestern Ontario & McMaster Osteoarthritis Index

24 itemsThink about the difficulty you had in doing the following daily physical activities due to your

arthritis during the last 48 hours. By this we mean your ability to move around and look

after yourself.

QUESTION:What degree of difficulty do you have?

None Mild Moderate Severe Extreme

8. Descending (going down) stairs

9. Ascending (going up) stairs

10. Rising from sitting

11. Standing

12. Bending to the floor


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Weighting items

Some questions (indications for need for joint

replacement) are more important than others

Discrete Choice Experiments

Surgeons asked to apply clinical judgement to

patient vignettes

Helps to appropriately weight clinical red flags

96 Victorian orthopaedic surgeons participated

Simple score

0 (no need for surgery)

100 (highest need for surgery)

Victoria has

~140

arthroplasty

surgeons

Witt J, Scott A, Osborne RH. Designing Choice Experiments with Many Attributes. An Application to

Setting Priorities for Orthopaedic Waiting Lists. Health Economics 18: 681-96, 2009

Orthopaedic Waiting List Project


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Orthopaedic Waiting List ProjectDiscrete Choice Experiments

Please indicate whether you are a consultant or registrar:Consultant Registrar

1 (1.1)

Patient A Patient BI do not look after, or experience nodifficulty looking after, dependents.

It is moderately difficult looking afterdependents.

I have pain that stops me going to

sleep most of the time.

I have pain that stops me going to

sleep all of the time.It does not affect, or causes littleaffect to, my enjoyment of life.

It makes it moderately or verydifficult for me to enjoy my life.

I do not getenough help withlooking after myself.

I do not getenough help with lookingafter myself.

It makes it moderately difficult formy household to manage financially. It does not affect my householdfinances or it makes it slightlydifficult for my household to managefinancially.

Higher priority: Patient A Patient B1% 99%


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The need for surgery assessed

by the MAPT

MAPT WOMAC


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Validation

Administered to 1000+ patients Correlation with international standards

Oxford Hip / Knee

WOMAC

Quality of Life (AQoL)

SF36 EQ-5D

Hospital Anxiety and Depression Scale

Clinical veracity of the questionnaire Face validity

Construct validity Test re-test reliability

Practicality response rate (patient, health professional)

Gaming and stoicism


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Correlation R=0.80

Correlation R=0.84

Correlation between the MAPT and

other questionnaires


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Correlation between the MAPT and

other questionnaires

MAPT MAPT MAPT

Whole Sample Hips Only Knees Only

Oxford Hip - 0.8 -

Oxford Knee - - 0.75WOMAC

Pain 0.75 0.87 0.62

Stiffness 0.66 0.70 0.68

Physical Function 0.75 0.81 0.88

WOMAC Total 0.78 0.84 0.92

MAPT


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MAPTshowed

appropriate

correlationswith other

scales

MAPT

Whole Sample

AQoL

Independent Living -0.57

Social Relationships -0.47

Physical Senses -0.13Psychological Wellbeing -0.75

AQoL Total -0.71

EQ-5D (Euroqol) -0.77

HADS

Depression 0.62

Anxiety 0.58

SF-36

Physical Function -0.57

Role Physical -0.59

Bodily Pain -0.36

General Health -0.32Vitality -0.50

Social Function -0.60

Role Emotional -0.54

Mental Health -0.44

Physical Summary -0.46

Mental Summary -0.51


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Reliability

Internal consistency reliability

Very High

Cronbachs alpha coefficient 0.87 (n=854)

Test-retest reliability

High

Participants on the OWL (n=80).

Two-week interval retest ICC = 0.75

MDD = about 10 units on the 100 unit scale


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MAPT scores x time since surgery

Weeks Since Surgery N Mean SD

Currently on OWL 460 45.5 30.4

1 12 54 21.8 27.5

13 24 32 11.8 22.3

25 -104 118 6.8 15.4


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Coordinator vs patient score(ICC = 0.74)

Coordinator

marks higher

than patient

(stoic?)

Coordinator

marks lower

than patient

(gaming?)


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Key points:

MAPT contains the information a clinician needs for

making sound clinical (holistic) judgments

key information on a platter

Free of bias

Hip/knee, age, education, gender

Transparent

Supports equitable clinical care Developed and validated using state-of-the-art

techniques to prioritise care

The MAPT is a core element of bringing order into

what was a chaotic system


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Thank you

[email protected]
mailto:[email protected]:[email protected]

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