Stakeholder views about a novel consumer health resource for knee osteoarthritis.

Objective: This study aimed to explore consumers', clinicians', and arthritis advocates' perceptions of a novel osteoarthritis (OA) information booklet that challenged existing beliefs, integrated a biopsychosocial perspective, and incorporated consumer voice and experience. Design: A mixed-methods study was conducted using an evaluation survey completed after first reading the booklet and subsequent focus groups with Thematic Analysis. Focus groups were conducted with consumers (people with OA; four groups; n = 19), general practitioners (two groups; n = 11), primary healthcare nurses (two groups; n = 14) and arthritis advocates (two groups; n = 12). Results: Quantitative data identified positive initial impressions of the booklet. Four key themes emerged from the focus groups related to: i) an informative and empowering booklet; ii) the need to be clear about the booklet's purpose and audience; iii) discordance between clinician, advocate, and consumer perspectives; and iv) information and advice conflicting with prior beliefs or experience. Conclusion: A novel information booklet was well received by consumers, clinicians, and arthritis advocates. New information resources can be improved in partnership with consumers and key stakeholders. Co-design with consumers needs to be carefully considered during resource development as consumer views often contrasted with professionals' perceptions of consumer needs. Successful implementation of updated OA information will require a multi-faceted approach that also targets clinicians' knowledge and beliefs.

Translation, cross-cultural adaptation and psychometric properties of the Nepali versions of numerical pain rating scale and global rating of change.

BACKGROUND: Pain intensity and patients' impression of global improvement are widely used patient-reported outcome measures (PROMs) in clinical practice and research. They are commonly assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC) questionnaires. The GROC is essential as an anchor for evaluating the psychometric properties of PROMs. Both of these PROMs are translated to many languages and have shown excellent psychometric properties. Their availability in Nepali would facilitate pain research and cross-cultural comparison of research findings. Therefore, the objectives of this study were to translate and cross-culturally adapt the NPRS and GROC into Nepali and to assess the psychometric properties of the Nepali version of the NPRS (NPRS-NP). METHODS: After translating and cross-culturally adapting the NPRS and GROC into Nepali using recommended guidelines, NPRS-NP was administered to 104 individuals with musculoskeletal pain twice. The Nepali version of the GROC (GROC-NP) was administered at the follow-up for anchor-based assessment. (1) Test-retest reliability and minimum detectable change (MDC) among the stable group, (2) construct validity (by single sample t-test within the improved group and independent sample t-test between groups), and (3) concurrent validity were assessed. Receiver operating characteristic (ROC) curves were plotted to determine the responsiveness of the NPRS-NP using the area under the curve (AUC), and minimum important changes (MIC) for small, medium and large improvements. RESULTS: Significant cultural adaptations were required to obtain relevant Nepali versions of both the NPRS and GROC. The NPRS-NP showed excellent test-retest reliability and a MDC of 1.13 points. NPRS-NP demonstrated a good construct validity by significant within-group difference in mean of NPRS score- t(63)= 7.57, P < 0.001 and statistically significant difference of mean score- t(98)= -4.24, P < .001 between the stable and improved groups. It demonstrated moderate concurrent correlation with the GROC-NP; r = 0.43, P < 0.01. Responsiveness of the NPRS-NP was shown at three levels with AUC = 0.68-0.82, and MIC = 1.17-1.33. CONCLUSIONS: The NPRS and GROC were successfully translated and culturally adapted into Nepali. The NPRS-NP demonstrated good reliability, validity and responsiveness in assessing musculoskeletal pain intensity in a Nepali population.

Accuracy of physical therapists' prognosis of low back pain from the clinical examination: a prospective cohort study.

OBJECTIVES: To investigate, in patients with chronic or recurrent low back pain (LBP), the predictive validity of history items, demographic variables, outcome measure questionnaire scores, clinical examination items, and physical therapists' (PTs') summative estimation of prognosis on a four-point scale. Little is known about the ability of PTs to predict functional outcomes for patients with LBP. METHODS: This was a multi-centre prospective cohort study of 138 patients with LBP. We used backward stepwise linear regression modelling to estimate the predictive validity of the baseline variables. The endpoint outcome measure was the 18-item Roland-Morris Disability Questionnaire (RM18) at 1 year. RESULTS: Of 138 patients with LBP recruited, 89 (64%) completed follow-up at one year. Univariate analysis indicated that PTs' opinion of prognosis (P = 0.01) and eleven other baseline variables were significantly associated with RM18 at 12 months. In the final multivariate model PTs' opinion of prognosis (P = 0.022; beta = 0.73, CI 0.55, 0.95), an abnormality detected by passive physiological flexion testing (P = 0.043, beta = 1.61, CI 1.02, 2.57), heavy work (P = 0.069, beta = 0.80, CI 0.62, 1.01), and age (P = 0.079, beta = 1.01 CI 0.99, 1.04) were independent prognostic factors for RM18 outcome, explaining 24% of the variance in the model. CONCLUSIONS: Musculoskeletal PTs' summative clinical impression regarding prognosis, following a clinical examination, provides a valid predictive estimation of functional outcome at 1 year in patients with chronic or recurrent LBP.