IBADAN KNEE/HIP OSTEOARTHRITIS OUTCOME MEASURE: PROCESS OF DEVELOPMENT

A.C. Odole*, N.A. Odunaiya and A.O. Akinpelu

Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria

Abstract

The development of instruments for the assessment of therapeutic intervention has been an age long practice. However, many of the published instruments do not have detailed information on how the instruments were developed. It is necessary for authors to provide detailed (step by step) information on how measuring scales/instruments are developed. The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed as a Nigerian-environment and culturefriendly instrument for the assessment of the effectiveness of therapeutic interventions in individuals with osteoarthritis of the knee and/or hip. This article outlines the steps involved in developing an outcome measure using IKHOAM as a template.

Introduction

Outcomes in clinical practice provide the mechanism by which the health care provider (HCP), the patient, the public, and the payer are able to assess the end results of care and its effect upon the health of the patient and society.¹ Measuring results of treatment in clinical setting has been an age long practice, however, the last three decades have witnessed the development of many standardized outcome measures in the health sector and effort has been redirected at integrating outcome assessment into clinical practice.¹ The major impetus to the development of standardized outcome measures in the health sector includes the demands of the third party payers of health care services and policy changes which have challenged health workers in developed countries to quantitatively account for the effectiveness of their therapeutic interventions more rigorously than before. ^1-2

The measurement of clinical outcomes in the health care delivery system is one of the most efficacious areas within the area of clinical decision making. ³ There is a shift from Health care provider (HCP) centeredness to customer centeredness in outcomes assessment. What is important in health care is what matters to the customers. Customers in the health transaction can now be patients, employers, governments, managed care organizations, insurance companies, HCP or society as a whole.⁴ The methods of outcomes assessment, even in this currently evolving form may help provide tools that HCP can use to learn to focus on important attributes of care that not only meet accountability but patient satisfaction.

The development of instruments for the assessment of therapeutic intervention has been an age long practice. A number of well documented reliable and valid measures of functional health and activities of daily living (ADL) status have been developed for osteoarthritis. These include the Arthritis Impact Measurement Scales (AIMS)⁵, Knee Osteoarthritis Outcome Score (KOOS)⁶, Hip Osteoarthritis Outcome Score (HOOS)⁷, Western Ontario and McMaster University (WOMAC) Osteoarthritis Index⁸, Short Form (SF) 36 Arthritis Specific (SF 36 ASHI)⁹, Functional Status Index (FSI)¹⁰, Osteoarthritis Severity Indices of Lequesne (LEQUESNE)^11-12, Health Assessment Questionnaire¹³, Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM)¹⁴. According to McKay and Lyons, a standardized outcome measure refers to a published measurement tool, designed for a given population with detailed information on administration, scoring, interpretation and psychometric properties.15 The Ibadan Knee/Hip Osteoarthritis Outcome Measure was developed as an environment and culture friendly tool for the assessment of therapeutic interventions in Nigerian patients with osteoarthritis of the knee and/or hip. However, many of these published existing instruments do not have all the detailed information on how the instruments were developed. There are many publications on IKHOAM but none has detailed information on how it was developed. In the development of IKHOAM, we discovered there was no simple to read information on the development of existing scales from our review of literature.

This stimulated the desire to write out this piece for healthcare providers intending to develop an indigenous tool for use in their environments.