Background/Purpose: The Musculoskeletal Health Questionnaire (MSK-HQ) is a patient reported outcome measure (PROM) validated to assess disease outcomes in patients with MSK disorders. This study evaluates the validity of the MSK-HQ in an ePROM system as part of routine care in rheumatology. We assess reliability and validity of the MSK-HQ across different conditions and evaluate correlation of the total score and activity score with other PROMs.

Methods: Data were extracted via the King’s College Hospital IMPARTS ePROM system which sends an SMS link 24hrs before a clinic appointment to complete PROMs tailored to the patient condition. The MSK-HQ includes 14 items summed to give a total score (0-56, higher scores indicate better quality of life) and a final item for physical activity in the past week. In addition, data were extracted for mental health (PHQ9 & GAD7), functional limitation (HAQ), and disease specific measures (BASDAI & DLQI). Data are reported as mean±SD with Pearson correlations estimated to test association and linear regression to test group differences.

Results: Data was available for 1323 encounters between 06/20 and 01/21. The MSK-HQ was completed on 1216 (92%) occasions (31.4±13.9). RA had the greatest impact compared to AS and PsA (RA: 30.3±14.4; AS:36.0±13.1; 33.3±12.8; other:31.1±13.6; p< .001). Chronbach’s alpha coefficients indicated excellent reliability of the MSK-HQ total score (alphas:overall=.95;RA=.96;PsA=.96;AS=.95). Factor analysis confirmed a unidimensional solution supporting use of the total score.

Across all encounters patients reported 2.3±2.3 active days in the last week. Patients with RA, AS and PsA were active on 2.0± 2.2, 2.9± 2.3 and 2.6± 2.4 days respectively again suggesting RA has greater disease impact (p< .001). MSK-HQ scores were positively correlated with active days (r=.36, p< .01).

The MSK-HQ total score demonstrated good convergent validity with condition specific PROMs. BASDAI and BASFI in AS (r=-.89 p< .001 & r=-.81 p< .001 respectively) and DLQI in PsA (r=-.44, p< .001). BASDAI and BASFI strongly correlated with active days (r=-.30 p< .05 & r=-.37 p< .05 respectively) however DLQI didn’t show significant correlation (r=-.07, p=.42).

Good convergent validity was demonstrated against HAQ. There was a r=-.38 correlation (p< .05) with active days per week. A HAQ score ≤1 was associated with a mean of 3.01 active days compared to a HAQ score >1 associated with a mean of 1.44 active days (t=8.81, p< .05).

Both MSK-HQ total score and number of active days could discriminate between those with and without mental health symptoms. The correlation between PHQ9 and GAD7 score and active days was r=-.27 and r=-.19 (both p< .01). Individuals with mild depressive symptoms were active 0.9 days less per week compared to those without symptoms (t -4.06, p< .01). Individuals with probable major depression were active 1.4 days less per week compared to those with no symptoms (t -7.99, p< .01).

Conclusion: This study demonstrated acceptability and validity for both the MSK-HQ total score and activity score delivered via an ePROM system. The activity score in isolation discerned patients with and without symptoms of anxiety or depression highlighting the value of using this PROM in the healthcare setting.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validity-of-the-musculoskeletal-health-questionnaire-real-world-analysis-of-data-collection-via-an-electronic-patient-reported-outcome-platform/