Original article
Vol. 145 No. 4546 (2015)
Development of the knee osteoarthritis patient education questionnaire: a new measure for evaluating preoperative patient education programmes for patients undergoing total knee replacement
- Erika O Huber
- Caroline H Bastiaenen
- Heike A Bischoff-Ferrari
- André Meichtry
- Rob A de Bie
Summary
OBJECTIVE: The aim of this study was to develop a generic instrument for the use of patients, named the Knee Osteoarthrtis Patient Education Questionnaire (KOPEQ), to assess the validity of a preoperative educational intervention and to make a preliminary test of its psychometric properties.
METHODS: A patient-reported outcome instrument was designed, using the conceptual framework of Wilson and Cleary as a methodological guide. Likert items with a five-point scale were chosen for the scoring option. The feasibility and interpretability of administering the KOPEQ was tested through conducting interviews with targeted patients. Items of the KOPEQ were linked to the International Classification of Functioning, Disability and Health (ICF). Psychometric testing contained internal consistency for reliability, and factor analysis for validity properties.
RESULTS: A final list of 16 items was derived and linked to the ICF. Targeted patients confirmed in interviews, that all 16 questions were highly understandable and that the length of the questionnaire was feasible and acceptable. There was a good internal consistency for the 16-item KOPEQ with a Cronbach’s alpha of 0.83 (95% confidence interval 0.71–0.94). Sixty-one percent of the variance was explained by a four-factor model and the factors were named “didactics”, “addressability”, “empowerment” and “theory”. Results of a factor analysis provided a loading of the separate items between 0.469 and 0.958.
CONCLUSIONS: The KOPEQ can help to provide health professionals with reliable feedback on how patients assessed the applied patient education intervention. Interviews with patients and a factor analysis revealed new and important insight.
Key words: patient edication; questionnaire; knee; osteoarthritis
References
- Hall M, Migay AM, Persad T, Smith J, Yoshida K, Kennedy D, Pagura S. Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty. Physiother Theory Pract. 2008;24(3):167–81.
- Chang HJ, Mehta PS, Rosenberg A, Scrimshaw SC. Concerns of patients actively contemplating total knee replacement: differences by race and gender. Arthritis Rheum. 2004;51(1):117–23.
- Marcinkowski K, Wong VG, Dignam D. Getting back to the future: a grounded theory study of the patient perspective of total knee joint arthroplasty. Orthop Nurs. 2005;24(3):202–9.
- McGregor AH, Rylands H, Owen A, Dore CJ, Hughes SP. Does preoperative hip rehabilitation advice improve recovery and patient satisfaction? J Arthroplasty. 2004;19(4):464–8.
- Lithner M, Zilling T. Pre- and postoperative information needs. Patient Educ Couns. 2000;40(1):29–37.
- Hoermann S, Doering S, Richter R, Walter MH, Schussler G. Patients’ need for information before surgery. Psychother Psychosom Med Psychol. 2001;51(2):56–61.
- Trousdale RT, McGrory BJ, Berry DJ, Becker MW, Harmsen WS. Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc. 1999;74(10):978–82.
- Moran M, Khan A, Sochart DH, Andrew G. Evaluation of patient concerns before total knee and hip arthroplasty. J Arthroplasty. 2003;18(4):442–5.
- McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev. 2014, 5:CD003526.
- Hoogeboom TJ, Oosting E, Vriezekolk JE, Veenhof C, Siemonsma PC, de Bie RA, et al. Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis. PloS one. 2012;7(5):e38031.
- Sjoling M, Nordahl G, Olofsson N, Asplund K. The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Patient Educ Couns. 2003;51(2):169–76.
- Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273(1):59–65.
- Wilson IB, Kaplan S. Clinical practice and patients’ health status: how are the two related? Med Care. 1995;33(4 Suppl):AS209–214.
- Macario A, Schilling P, Rubio R, Bhalla A, Goodman S. What questions do patients undergoing lower extremity joint replacement surgery have? BMC Health Serv Res. 2003;3(1):11.
- Using the think aloud method (cognitive labs) to evaluate test design for students with disabilities and English language learners (Technical Report 44). Available from: [http://education.umn.edu/NCEO/OnlinePubs/Tech44/. 26 July 2014]
- Schepers VP, Ketelaar M, van de Port IG, Visser-Meily JM, Lindeman E. Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning, Disability and Health. Disabil Rehabil. 2007;29(3):221–30.
- World Health Organization. International Classification of Functioning, Disability and Health. Geneva, Switzerland
- Alviar MJ, Olver J, Brand C, Hale T, Khan F. Do patient-reported outcome measures used in assessing outcomes in rehabilitation after hip and knee arthroplasty capture issues relevant to patients? Results of a systematic review and ICF linking process. J Rehabil Med. 2011;43(5):374–81.
- Huber EO, Roos EM, Meichtry A, de Bie RA, Bischoff-Ferrari HA. Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial. BMC Musculoskelet Disord. 2015;16:101.
- Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
- Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.
- Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.
- Lawley DN, Maxwell AE. Factor analysis as a statistical method: American Elsevier Pub. Co.; 1971.
- Ledesma RDaPV-M. Determining the Number of Factors Retain in EFA: An easy-to-use computer program for carrying out Parallel Analysis. Practical Assessment Research & Evaluation 2007;12(2):1–11.
- Kaiser H. The varimax criterion for analytic rotation in factor analysis. Psychometrika. 1958;23(3):187–200.
- R Core Team. R: A language and environment for statistical computing [http://www.R-project.org/.]
- Feicke J, Sporhase U. Improvements in patient education from the didactical point of view. Rehabilitation. 2012;51(5):300–7.
- Loft M, McWilliam C, Ward-Griffin C. Patient empowerment after total hip and knee replacement. Orthop Nurs. 2003;22(1):42–7.
- MacDonald V, Arthur B, Parent S. The Vancouver General Hospital joint replacement rapid recovery program: Optimizing outcomes through focused pathways. Orthop Nurs. 2005;9(2):95–102.
- Lucas B. Preparing patients for hip and knee replacement surgery. Nursing standard (Royal College of Nursing (Great Britain): 1987) 2007;22(2):50–6; quiz 58.
- Jones S, Alnaib M, Kokkinakis M, Wilkinson M, St Clair Gibson A, Kader D. Pre-operative patient education reduces length of stay after knee joint arthroplasty. Ann R Coll Surg Engl. 2011;93(1):71–5.
- Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol. 2006;18(5):526–30.
- Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH, et al. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002;29(6):1273–9.
- Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, Sculco TP. Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res. 2008;466(2):424–31.
- Shoemaker SJ, Wolf MS, Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96(3):395–403.
- Eschalier B, Descamps S, Boisgard S, Pereira B, Lefevre-Colau MM, Claus D, Coudeyre E. Validation of an educational booklet targeted to patients candidate for total knee arthroplasty. Orthopaedics & traumatology, surgery & research: OTSR 2013;99(3):313–9.
- Newman S, Mulligan K, Steed L. What is meant by self-management and how can its efficacy be established? Rheumatology. (Oxford, England) 2001;40(1):1–4.