Background
Methods
Study design
Prospective longitudinal cohort study
Patient recruitment
Chinese (Hong Kong) e-EQ-5D-5L/VAS
Patient PEOU and PU questionnaire
Patient socio-demographic questionnaire
Doctors’ PEOU and PU questionnaire
Feasibility and acceptability outcome measures
Individual and focus group interviews
Data analysis
Quantitative
Qualitative
Results
Quantitative results
Characteristics | n | % |
---|---|---|
Socio-demographic | ||
Gender | (665) | |
Male | 204 | 30.7 |
Female | 461 | 69.3 |
Age (years old) | (665) | |
18–50 | 20 | 3.0 |
51–60 | 99 | 14.9 |
61–70 | 270 | 40.6 |
71–80 | 183 | 27.5 |
81 or above | 93 | 14.0 |
Education | (664) | |
None received/Primary | 388 | 58.4 |
Secondary | 232 | 35.0 |
Tertiary or above | 44 | 6.6 |
Marital status | (663) | |
Never married/Separated/Divorced/Widowed | 173 | 26.1 |
Married | 490 | 73.9 |
Occupation | (618) | |
Unemployed/Retired/Homemaker | 522 | 84.5 |
Labour work | 55 | 8.9 |
clerical work | 22 | 3.6 |
Professional or manager | 19 | 3.0 |
Clinical | ||
Types of musculoskeletal disease | (665) | |
Back only | 154 | 23.2 |
Knee only | 437 | 65.7 |
Both | 74 | 11.1 |
Duration of musculoskeletal disease | (658) | |
< 1 year | 101 | 15.3 |
1–5 years | 187 | 28.4 |
5–10 years | 137 | 20.8 |
> 10 years | 233 | 35.5 |
Number of the comorbidity | (665) | |
0 | 81 | 12.1 |
1 | 305 | 45.9 |
2 | 187 | 28.1 |
3 | 71 | 10.7 |
4 + | 21 | 3.2 |
Comorbidities | (299) | |
Hypertension only | 272 | 91.0 |
Diabetes mellitus only | 27 | 9.0 |
Both hypertension and diabetes | 158 | 52.8 |
EQ-5D-5L response distribution | ||
Mobility | (665) | |
No problem | 276 | 41.5 |
Slight problems | 215 | 32.3 |
Moderate problems | 114 | 17.1 |
Severe problems/Unable to | 60 | 9.0 |
Self-care | (665) | |
No problem | 524 | 78.8 |
Slight problems | 94 | 14.1 |
Moderate problems | 29 | 4.4 |
Severe problems/Unable to | 18 | 2.7 |
Usual activities | (664) | |
No problem | 359 | 54.1 |
Slight problems | 175 | 26.4 |
Moderate problems | 91 | 13.7 |
Severe problems/Unable to | 39 | 5.9 |
Pain/Discomfort | (665) | |
No problem | 83 | 12.5 |
Slight problems | 297 | 44.7 |
Moderate problems | 197 | 29.6 |
Severe problems/Unable to | 88 | 13.2 |
Depression/anxiety | (665) | |
No problem | 359 | 54.0 |
Slight problems | 203 | 30.5 |
Moderate problems | 63 | 9.5 |
Severe problems/Unable to | 40 | 6.0 |
EQ-5D-5L/VAS scores (mean, SD) | (664) | |
Utility score (range: − 0.8637 to 1) | 0.66 | 0.28 |
VAS score (out of 100) | 64.01 | 18.20 |
Patient perspective | Baseline | 1st follow-up | 2nd follow-up | p-value |
---|---|---|---|---|
Feasibility | N = 665 | N = 595 | N = 460 | – |
Completion ratea of e-EQ-5D-5L/VAS (% (n)) | 99.8 (664) | 100.0 (595) | 100.0 (459) | – |
Response rateb of e-EQ-5D-5L | 100% | 91.11% | 90.00% | |
Time to complete e-EQ-5D-5L/VAS (in seconds) (mean ± SD)§ | 120.66 ± 110.74 (665) | 83.99 ± 57.16 (544)# | 105.22 ± 82.93 (334)# | < 0.001 |
Perceived Ease of Use | N = 635 | N = 567 | N = 401 | |
Overall Agree/Strongly agree to all items (% (n))† | 37.2 (236) | 46.9 (266) | 47.1(189) | < 0.001 |
Summative score (mean ± SD, out of 20)§ | 12.26 ± 3.82 | 13.00 ± 3.57 | 13.22 ± 3.27 | < 0.001 |
Perceived Usefulness | N = 635 | N = 567 | N = 401 | |
Agree/Strongly agree to at least one item (% (n))† | 85.5 (543) | 86.9 (493) | 85.3 (342) | 0.221 |
Summative score (mean ± SD, out of 20)§ | 14.65 ± 2.37 | 14.78 ± 2.45 | 14.49 ± 2.68 | 0.173 |
Doctor perspective | Baseline (N = 655) | 1st follow-up (N = 560) | 2nd follow-up (N = 415) | p-value |
---|---|---|---|---|
Extra time spent on interpreting e-EQ-5D-5L/VAS (in minutes) (mean ± SD)§ | 2.02 ± 1.51 | 1.72 ± 1.28 | 1.66 ± 2.00 | 0.006 |
Perceived ease of use | ||||
Overall Agree/Strongly agree to all items (% (n))† | 76.2 (499) | 79.3 (444) | 85.1 (353) | < 0.001 |
Summative score (mean ± SD, out of 10)§ | 7.74 ± 1.07 | 7.83 ± 1.20 | 7.95 ± 1.10 | 0.007 |
Perceived usefulness | ||||
Agree/Strongly agree to at least one item (% (n)) † | 72.0 (471) | 69.2 (387) | 72.0 (299) | 0.160 |
Summative score (mean ± SD, out of 15)§ | 10.89 ± 1.93 | 11.14 ± 2.14 | 11.22 ± 2.07 | 0.022 |
Variable | Patient PEOU | Patient PU | ||
---|---|---|---|---|
Baseline summative score | Baseline summative score | |||
Standardized β-coefficient | p-value† | Standardized β-coefficient | p-value† | |
Socio-demographic | ||||
Gender | ||||
Male | 0.021 | 0.580 | − 0.064 | 0.138 |
Female§ | – | – | – | – |
Age | − 0.230 | < 0.001* | − 0.061 | 0.208 |
Education | ||||
None received/Primary | − 0.453 | < 0.001* | − 0.129 | 0.139 |
Secondary | − 0.158 | 0.032* | − 0.041 | 0.628 |
Tertiary or above§ | – | – | – | – |
Occupation | ||||
Unemployed/Homemaker/Retired | 0.049 | 0.362 | 0.137 | 0.027* |
Labour work | 0.123 | 0.008* | 0.066 | 0.208 |
Clerical work | 0.076 | 0.058 | 0.066 | 0.454 |
Professional or manager§ | – | – | – | – |
Marital Status | ||||
Never married/Separated/Divorced/Widowed§ | – | – | – | – |
Married | 0.038 | 0.303 | − 0.034 | 0.454 |
Clinical characteristic | ||||
Number of chronic diseases | 0.038 | 0.282 | − 0.046 | 0.272 |
Type of musculoskeletal disease | ||||
Back only | 0.019 | 0.599 | 0.009 | 0.819 |
Knee only | 0.054 | 0.136 | < 0.001 | 0.994 |
Both§ | – | – | – | – |
Duration of diagnosis | ||||
< 1 year§ | – | – | – | – |
1–5 years | − 0.006 | 0.906 | − 0.048 | 0.245 |
5–10 years | 0.058 | 0.231 | − 0.054 | 0.352 |
> 10 years | 0.002 | 0.967 | − 0.035 | 0.527 |
e-EQ-5D-5L utility score | − 0.111 | 0.005* | − 0.019 | 0.741 |
VAS score | 0.089 | 0.025* | 0.090 | 0.044* |
Variable | Doctor PEOU | Doctor PU | ||
---|---|---|---|---|
Baseline summative score | Baseline summative score | |||
Standardized β-coefficient | p-value† | Standardized β-coefficient | p-value† | |
Socio-demographic | ||||
Gender | ||||
Male | − 0.051 | 0.233 | − 0.069 | 0.103 |
Female§ | – | – | – | – |
Age | − 0.009 | 0.843 | 0.059 | 0.213 |
Education | ||||
None received/ Primary | 0.023 | 0.787 | 0.047 | 0.588 |
Secondary | 0.107 | 0.199 | 0.117 | 0.157 |
Tertiary or above§ | – | – | – | – |
Occupation | ||||
Unemployed/Homemaker/Retired | 0.004 | 0.950 | − 0.009 | 0.876 |
Labour work | 0.019 | 0.709 | 0.019 | 0.714 |
Clerical work | 0.104 | 0.021* | 0.132 | 0.003* |
Professional or manager§ | – | – | – | – |
Marital status | ||||
Never married/Separated/Divorced/Widowed§ | – | – | – | – |
Married | − 0.037 | 0.371 | − 0.015 | 0.712 |
Clinical characteristic | ||||
Number of the chronic diseases | 0.059 | 0.146 | 0.075 | 0.064 |
Type of musculoskeletal disease | ||||
Back only | − 0.030 | 0.466 | − 0.037 | 0.371 |
Knee only | − 0.011 | 0.793 | − 0.040 | 0.330 |
Both§ | – | – | – | – |
Duration of diagnosis | ||||
< 1 year§ | – | – | – | – |
1–5 years | 0.019 | 0.748 | 0.024 | 0.675 |
5–10 years | 0.044 | 0.425 | 0.047 | 0.386 |
> 10 years | − 0.002 | 0.972 | − 0.034 | 0.551 |
e-EQ-5D-5L utility score | 0.039 | 0.377 | − 0.009 | 0.843 |
VAS score | 0.027 | 0.546 | 0.053 | 0.235 |
Qualitative results
Themes | Subthemes | Source of information | |
---|---|---|---|
Patients | Research assistants | ||
Ease of use in terms of methods of administration | |||
Difficulty in using an e-platform | Technology-related problems | V | V |
Difficulty of self-administration | Vision-related problems | V | V |
Requiring assistance to understand the survey question | V | V | |
Literacy problems | V | ||
Increasing age | V | ||
Ease of use in terms of questions | |||
Difficulties in understanding | Unclear definition of the terms | V | V |
Improved understanding after repeated use | V | V | |
Difficulties in answering | Unable to describe own health in levels | V | V |
Unable to specify score due to fluctuating health conditions | V | V | |
Providing a score range instead of an exact score | V | ||
Perceiving the response options in e-EQ-5D-5L/VAS as too “severe” | V | ||
Perceived usefulness | |||
Usefulness to patients | Understand the patient situation | V | |
Helpful for treatment | V | ||
Uncertain usefulness | V | ||
Not useful to patient | V | V | |
Usefulness to others | Useful to researcher | V | |
Useful to other patients | V | ||
Feasibility | |||
Time for completing the e-EQ-5D-5L/VAS | Short completion time | V | V |
Feel like chatting | V | ||
Difficulties with finding the patients in the clinic | V | ||
Slight impact by unstable network | V | ||
Limited time before consultation | V | ||
Time for consultation | Time-saving by knowing their painful condition before the consultation | V | |
Poor patient attitudes | Annoyance by repeated surveys | V | |
Perceiving (the EQ-5D-5L information) useless | V |
Themes | Subthemes |
---|---|
Ease of use in terms of viewing the report | |
Clarity of information | Clear layout of the report |
Ease of interpretation | Easy to compare with the population mean |
Easy to see the trend of scores | |
Limitations in interpretation | Other confounders present |
Positive feelings towards perceived usefulness | |
Understand the patient better | Better understanding of impact on patient's daily living |
Monitoring the progress of MSK condition | |
Useful for less active patients or patients with MSK issues as the chief complaint | |
Prompting a discrepancy in pain perception between doctor and patient | |
Manage the patient better | Increased lifestyle management/counselling patients |
Selecting treatment based on the trend | |
Negative feelings towards perceived usefulness | |
Situations where the report is not useful | Patients who already actively share about their MSK problems during consultation |
(Patient) Having follow-up by a specialist for MSK problem/ not coming for MSK issues | |
Aspects of care not addressed | Patient needs are better communicated verbally than by a score |
Feasibility | |
Time for interpretation | Quick reference |
Time-saving by knowing the patient’s pain condition before the consultation | |
Time to address the result | Balancing between the usefulness and additional time for addressing the MSK problem |
Limited consultation time/ The need in addressing other medical problems (in the same consultation) |