Arumalla Nikita, Galloway James B, Ledingham Joanna, Garrood Toby, Norton Sam
Faculty of Life Sciences and Medicine, Academic Rheumatology, King's College London, London, UK.
Rheumatology, Queen Alexandra Hospital, Portsmouth, UK.
Rheumatol Adv Pract. 2025 Apr 11;9(2):rkaf041. doi: 10.1093/rap/rkaf041. eCollection 2025.
The Musculoskeletal Health Questionnaire (MSK-HQ) is a patient reported outcome measure (PROM) co-produced for use across musculoskeletal diseases. This study analyses the validity, reliability, sensitivity to change and measurement invariance of the MSK-HQ in inflammatory arthritis (IA).
A total of 5106 patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and March 2020 with a diagnosis of IA were included. Patients completed PROMs at baseline and 3 and 12 months alongside clinic visits. Convergent validity was assessed in relation to the HAQ-II, Patient Health Questionnaire 4 (PHQ-4) and 28-item DAS (DAS28). Construct validity was assessed using confirmatory factor analysis (CFA). Hierarchical tests for configural, metric and scalar invariance determined measurement invariance in item CFAs.
The MSK-HQ total score correlated well with the HAQ-II ( = -0.79) and PHQ-4 ( = -0.66) and moderately with the DAS28 ( = -0.42). A unidimensional structure for the MSK-HQ was confirmed only when two items relating to illness perception were excluded. The MSK-HQ total score demonstrated good sensitivity to change. Reliability was high (α = 0.93). The minimum clinically important difference was 4 points across the IA subtypes. Significance was noted in tests of DIF for a few MSK-HQ items, but the level of bias was small.
This study provides evidence for the validity and sensitivity to change of the MSK-HQ in patients with IA, with a change of >4 points likely to be clinically meaningful. The MSK-HQ has high convergent and construct validity and is sensitive to change, providing a valuable tool for clinical care and research studies.
肌肉骨骼健康问卷（MSK-HQ）是一种患者报告结局指标（PROM），是为跨肌肉骨骼疾病使用而共同制定的。本研究分析了MSK-HQ在炎性关节炎（IA）中的效度、信度、对变化的敏感性和测量不变性。
纳入2018年5月至2020年3月期间招募到国家早期炎性关节炎审计（NEIAA）中的5106例诊断为IA的患者。患者在基线、3个月和12个月时完成PROMs，并同时进行门诊就诊。与健康评估问卷-II（HAQ-II）、患者健康问卷4（PHQ-4）和28关节疾病活动评分（DAS28）相关评估收敛效度。使用验证性因子分析（CFA）评估结构效度。对项目CFA中的构型、度量和标量不变性进行分层测试以确定测量不变性。
MSK-HQ总分与HAQ-II（r = -0.79）和PHQ-4（r = -0.66）相关性良好，与DAS28（r = -0.42）中度相关。仅在排除与疾病认知相关的两个项目后，MSK-HQ的单维结构才得到确认。MSK-HQ总分对变化表现出良好的敏感性。信度较高（α = 0.93）。IA各亚型的最小临床重要差异为4分。在一些MSK-HQ项目的差异性项目功能（DIF）测试中发现有显著性，但偏差水平较小。
本研究为MSK-HQ在IA患者中的效度和对变化的敏感性提供了证据，变化>4分可能具有临床意义。MSK-HQ具有较高的收敛效度和结构效度，对变化敏感，为临床护理和研究提供了有价值的工具。
