Background
Methods
Development of item pool
Pilot testing
Patients and measures
Sample 1: Factor structure and internal consistency
Sample 2: Test-retest reliability analysis
Statistical analyses
Step 1: Initial item reduction
Step 2: Factor analysis and internal consistency
Step 3: Further refinement
Test-retest reliability
Results
Participants
Sample 1
Demographic characteristics | |
Age (years), mean (SD) | 62.8 (12.3) |
Gender (female), n (%) | 217 (63.1) |
Married or cohabiting, n (%) | 273 (79.4) |
Currently employed, n (%)
b
| 145 (44.1) |
Education level, n (%)
c
| |
Low | 62 (18.0) |
Middle | 175 (50.9) |
High | 107 (31.1) |
Clinical characteristics | |
Body Mass Index (BMI) (kg/m2), n(%) | |
Normal weight (BMI <25) | 106 (31.0) |
Overweight (BMI 25–30) | 146 (42.7) |
Obese (BMI > 30) | 90 (26.3) |
Duration of OA symptoms (years), mean (SD)
b
| 11.1 (9.8) |
Affected joint(s), n (%) | |
Hip | 82 (24) |
Knee | 169 (49.5) |
Hip and knee | 91 (26.5) |
Comorbidities, n(%)
d
| |
No comorbidities | 141 (40.8) |
High blood pressure | 97 (28.0) |
Heart disease | 39 (11.2) |
Diabetes | 27 (7.8) |
Lung disease | 28 (8) |
Other | 42 (12) |
Previous or current treatments for OA, n (%)
d
| |
Pain medication | 291 (85.3) |
Physiotherapy | 234 (68.6) |
Injections | 133 (39.0) |
Surgery | 112 (32.8) |
WOMACe (Likert scale 0–4), unstandardized mean (SD), theoretical range | |
Pain
b
| 10.0 (4.5), 0–20 |
Stiffness | 4.5 (2.0), 0–8 |
Functioning | 32.4 (14.8), 0–68 |
Total (sum score)
b
| 46.7 (20.0), 0–96 |
Sample 2
Step 1: Initial item reduction
Step 2: Factor structure and internal consistency
Step 3: Further refinement
Module 1: Physical activities | ||
Items
|
Factor loadings
| |
Factor I
|
Factor II
| |
M1Q32: I learn to deal with my symptoms better by doing physical activities | .77 | |
M1Q19: I can do household chores better by doing physical activities | .72 | |
M1Q22: Doing physical activities produces good results at my age | .71 | |
M1Q33: I can do my job better by doing physical activities | .70 | |
M1Q39: I can tailor doing physical activities to my goals | .63 | |
M1Q10: I can postpone surgery by doing physical activities | .53 | |
M1Q14: I can do physical activities together with others | .48 | |
M1Q8: The only way to reduce my OA symptoms is by doing physical activities | .47 | |
M1Q20: I enjoy doing physical activities | .45 | |
M1Q24: By doing physical activities I will overload my knee/hip | .72 | |
M1Q23: I think that doing physical activities causes pain | .66 | |
M1Q7: I think that doing physical activities involves risks | .65 | |
M1Q28: I am scared to do physical activities | .55 | |
Eigenvalue | 4.03 | 1.06 |
Percentage of variance | 31% | 8% |
Cronbach’s Alpha | .84 | .79 |
Correlation between factors | −.51 | |
Module 2: Pain medication | ||
Items
|
Factor loadings
| |
Factor I
|
Factor II
| |
M2Q10: I can move more freely by using painkillers | .80 | |
M2Q18: I can do household chores better by using painkillers | .76 | |
M2Q2: My quality of life increases by using painkillers | .74 | |
M2Q20: Using painkillers produces good results at my age | .73 | |
M2Q9: I can postpone surgery by using painkillers | .50 | |
M2Q15: Using painkillers is harmful to my health | .70 | |
M2Q6: I think that using painkillers involves risks | .67 | |
M2Q11: I think that painkillers have side-effects | .64 | |
M2Q28: I think that using painkillers is invasive | .52 | |
M2Q25: I am scared to use painkillers | .47 | |
M2Q19: I think that using painkillers leads to habituation | .38 | |
M2Q22: By using painkillers I will overload my knee/hip | .35 | |
Eigenvalue | 2.74 | 2.00 |
Percentage of variance | 23% | 17% |
Cronbach’s Alpha | .82 | .72 |
Correlation between factors | −.14 | |
Module 3: Physiotherapy | ||
Items
|
Factor loadings
| |
Factor I
|
Factor II
| |
M3Q23: Doing physiotherapy produces good results at my age | .86 | |
M3Q20: I can do household chores better by physiotherapy | .85 | |
M3Q34: I can do my job better by physiotherapy | .76 | |
M3Q3: My quality of life increases by physiotherapy | .71 | |
M3Q22: I need to actively get going with physiotherapy myself | .60 | |
M3Q10: I can postpone surgery by physiotherapy | .52 | |
M3Q25: By physiotherapy I will overload my knee/hip | .71 | |
M3Q24: I think that physiotherapy causes pain | .70 | |
M3Q7: I think that physiotherapy involves risks | .62 | |
Eigenvalue | 3.49 | 1.09 |
Percentage of variance | 39% | 12% |
Cronbach’s Alpha | .86 | .74 |
Correlation between factors | −.36 | |
Module 4: Injections | ||
Items
|
Factor loadings
| |
Factor I
|
Factor II
| |
M4Q33: I can do my job better by an injection | .89 | |
M4Q20: I can do household chores better by an injection | .88 | |
M4Q3: My quality of life increases by an injection | .76 | |
M4Q30: An injection gives quick results | .76 | |
M4Q10: I can postpone surgery by an injection | .62 | |
M4Q31: I think that an injection can be repeated | .47 | |
M4Q24: By an injection I will overload my knee/hip | .62 | |
M4Q15: I am becoming dependent on an injection | .61 | |
M4Q34: An injection damages my knee/hip | .60 | |
M4Q32: I think that an injection is invasive | .54 | |
M4Q7: I think that an injection involves risks | .48 | |
M4Q40: An injection takes a lot of my time | .38 | |
Eigenvalue | 3.54 | 1.78 |
Percentage of variance | 30% | 15% |
Cronbach’s Alpha | .87 | .72 |
Correlation between factors | −.11 | |
Module 5: Arthroplasty | ||
Items
|
Factor loadings
| |
Factor I
|
Factor II
| |
M5Q4: My pain increases by a joint replacement | −.61 | |
M5Q9: My knee/hip deteriorates faster by a joint replacement | −.51 | |
M5Q10: I can move more freely after a joint replacement | .78 | |
M5Q17: I can do household chores better after a joint replacement | .77 | |
M5Q18: A joint replacement produces good results at my age | .81 | |
M5Q21: More people with OA choose to do a joint replacement | .43 | |
M5Q29: I think that a joint replacement can be repeated | .45 | |
M5Q38: I think that an artificial joint lasts a long time | .44 | |
M5Q1: I think a joint replacement is painful | .51 | |
M5Q23: I think an artificial joint carries the chance of an infection | .57 | |
M5Q24: I think a joint replacement carries the chance of an infection | .67 | |
M5Q27: A joint replacement takes up my energy | .53 | |
M5Q30: I think that a joint replacement is invasive | .62 | |
M5Q37: A joint replacement takes a lot of my time | .60 | |
Eigenvalue | 3.13 | 2.14 |
Percentage of variance | 22% | 15% |
Cronbach’s Alpha | .81 | .75 |
Correlation between factors | −.03 |
Factor interpretation
Test-retest reliability
Module | Subscale | ICC | Mean difference | LoA | SEM |
---|---|---|---|---|---|
Physical activity | positive
9 items
| .88 | −.44 | −7.65; 6.78 | .06 |
negative
4 items
| .74 | .81 | −4.60; 6.23 | .10 | |
Pain medication | positive
5 items
| .80 | .19 | −6.44; 6.82 | .09 |
negative
7 items
| .83 | .59 | −6.82; 8.00 | .08 | |
Physiotherapy | positive
6 items
| .88 | .16 | −6.35; 6.67 | .08 |
negative
3 items
| .72 | −0.40 | −4.81; 4.01 | .11 | |
Injections | positive
6 items
| .88 | 0.05 | −5.85; 5.96 | .07 |
negative
6 items
| .83 | .45 | −5.06; 5.96 | .07 | |
Arthroplasty | positive
8 items
| .66 | −.20 | −9.14; 8.75 | .08 |
negative
6 items
| .77 | .45 | −5.52; 6.41 | .07 |