Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, 3010, Australia.
School of Primary Community and Social Care, Keele University, Staffordshire, UK.
BMC Musculoskelet Disord. 2020 Apr 1;21(1):202. doi: 10.1186/s12891-020-03221-5.
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.
目前尚无专门针对物理治疗的质量指标工具可用于评估髋膝关节骨关节炎（OA）患者的物理治疗护理。本研究旨在开发一种针对髋膝关节 OA 的物理治疗管理的患者报告质量指标工具（QUIPA），并评估其可靠性和有效性。
为了开发 QUIPA 工具，首先根据与物理治疗实践最相关的临床指南建议和现有的通用 OA 质量指标工具中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案项目。之后评估了测试-重测信度、结构有效性（假设检验）和标准有效性。65 名髋膝关节 OA 患者参加了单次物理治疗咨询，并在治疗后 1、12 和 13 周时完成了 QUIPA 工具。9 名物理治疗师（n=9）在咨询后完成了工具。在第 12 和 13 周之间评估了患者的测试-重测信度。结构有效性通过三个预设假设进行评估，标准有效性基于第 1 周时物理治疗师和参与者之间的一致性。
制定了一份与物理治疗最相关的 23 条临床指南建议草案清单。在收到三个患者焦点小组的反馈后，最终的 QUIPA 工具包含 18 个项目（三个子量表），用白话表达。单个项目的测试-重测可靠性估计值（Cohen's Kappa）范围为 0.30-0.83，观察一致性为 64-94%。评估和管理计划子量表的组内相关系数（ICC）和 95%置信区间（CI）为 0.70（0.54，0.81），核心推荐治疗子量表为 0.84（0.75，0.90），辅助治疗子量表为 0.70（0.39，0.87），QUIPA 总分为 0.80（0.69，0.88）。所有关于结构有效性的预设假设均得到确认。然而，物理治疗师和参与者对单个项目的一致性显示出较大的测量误差（Cohen's Kappa 估计值范围为 -0.04-0.59），总分的 ICC（95%CI）为 0.11（-0.14，0.34）。
QUIPA 工具在子量表和总分方面表现出可接受的测试-重测信度，但在单个项目方面的可靠性不足。结构有效性得到确认，但单个项目、子量表和总分的标准有效性不足。在实施之前，需要进一步研究来改进 QUIPA 工具，以提高其临床测量属性。
