Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation

Abstract Background A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis. Methods The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined. Results In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not. Conclusions The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals

An ethnographic action research approach to investigate the experiences of Aboriginal women participating in the group fitness and walking component of a community owned health promotion program Aboriginal women participating in group fitness and walking

This article discusses the experiences of a group of Australian Aboriginal yorgas (women) in a regional setting in south west Western Australia, who participated in the group fitness and walking group component of the Binjareb Yorgas Health Program (BYHP). The BYHP was community owned and collaboratively developed and facilitated with non-Indigenous health professional researchers from September 2012 to September 2013. The study used an ethnographic action research approach guided by the Making Two Worlds Work Aboriginal health promotion framework and aimed to explore the ways in which the BYHP facilitated lifestyle changes. The group fitness and the walking group aimed to provide a culturally appropriate platform for the development of new skills and knowledge regarding the implementation and importance of regular exercise to maintain personal and family wellbeing. Seventeen yorga participants aged between 18 and 60 years consented to participate in the BYHP, which comprised cooking and nutrition classes, group fitness classes, walking group sessions, and a community vegetable garden project. The group fitness classes and the walking group classes were facilitated weekly during the school terms for the period of the study. Data were gathered in the form of participant and direct observation, group yarning (focus group) and individual yarning (interview) sessions, and works of art. Four major themes emerged: loss of traditional knowledge and practices; withdrawal due to shame; community facilitation enabling enjoyment in engagement; and experiencing a sense of place and reconnection to land and culture