title: Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways.
abstract: Current musculoskeletal outcome tools are fragmented across different healthcare settings and conditions. Our objectives were to develop and validate a single musculoskeletal outcome measure for use throughout the pathway and patients with different musculoskeletal conditions: the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ).
  
  
  
  A consensus workshop with stakeholders from across the musculoskeletal community, workshops and individual interviews with a broad mix of musculoskeletal patients identified and prioritised outcomes for MSK-HQ inclusion. Initial psychometric validation was conducted in four cohorts from community physiotherapy, and secondary care orthopaedic hip, knee and shoulder clinics.
  
  
  
  Stakeholders (n=29) included primary care, physiotherapy, orthopaedic and rheumatology patients (n=8); general practitioners, physiotherapists, orthopaedists, rheumatologists and pain specialists (n=7), patient and professional national body representatives (n=10), and researchers (n=4). The four validation cohorts included 570 participants (n=210 physiotherapy, n=150 hip, n=150 knee, n=60 shoulder patients).
  
  
  
  Outcomes included the MSK-HQ's acceptability, feasibility, comprehension, readability and responder burden. The validation cohort outcomes were the MSK-HQ's completion rate, test-retest reliability and convergent validity with reference standards (EQ-5D-5L, Oxford Hip, Knee, Shoulder Scores, and the Keele MSK-PROM).
  
  
  
  Musculoskeletal domains prioritised were pain severity, physical function, work interference, social interference, sleep, fatigue, emotional health, physical activity, independence, understanding, confidence to self-manage and overall impact. Patients reported MSK-HQ items to be 'highly relevant' and 'easy to understand'. Completion rates were high (94.2%), with scores normally distributed, and no floor/ceiling effects. Test-retest reliability was excellent, and convergent validity was strong (correlations 0.81-0.88).
  
  
  
  A new musculoskeletal outcome measure has been developed through a coproduction process with patients to capture prioritised outcomes for use throughout the pathway and with different musculoskeletal conditions. Four validation cohorts found that the MSK-HQ had high completion rates, excellent test-retest reliability and strong convergent validity with reference standards. Further validation studies are ongoing, including a cohort with rheumatoid/inflammatory arthritis.
authors: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK.
authors: Jonathan C
authors: JC
authors: Hill
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Sujin
authors: S
authors: Kang
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Elena
authors: E
authors: Benedetto
authors: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK.
authors: Helen
authors: H
authors: Myers
authors: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK.
authors: Steven
authors: S
authors: Blackburn
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Stephanie
authors: S
authors: Smith
authors: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK.
authors: Kate M
authors: 0000-0002-6202-2606
authors: KM
authors: Dunn
authors: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK.
authors: Elaine
authors: E
authors: Hay
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Jonathan
authors: J
authors: Rees
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: David
authors: D
authors: Beard
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Sion
authors: S
authors: Glyn-Jones
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Karen
authors: K
authors: Barker
authors: Arthritis Research UK, London, UK.
authors: Benjamin
authors: B
authors: Ellis
authors: Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK.
authors: Ray
authors: R
authors: Fitzpatrick
authors: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, Oxfordshire, UK.
authors: Andrew
authors: A
authors: Price
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D032921:Consensus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care / Q000592:standards*; D059408:Pain Management; D026741:Physical Therapy Modalities; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*; D006113:United Kingdom
keywords: Cohort studies; Outcome Assessment; Questionnaires; Validation studies