Abstract
BackgroundUse of conservative treatment modalities in osteoarthritis (OA) is suboptimal, which appears to be partly due to patients’ beliefs about treatments. The aim of this study was to develop a research instrument assessing patients’ beliefs about various treatment modalities of hip and knee OA: the ‘Treatment beliefs in OA (TOA) questionnaire’.MethodsThe item pool that was retrieved from interviews with patients and healthcare providers comprised beliefs regarding five treatment modalities: physical activity, pain medication, physiotherapy, injections and arthroplasty. After an extensive selection procedure, a draft questionnaire with 200 items was constructed. Descriptive analyses and exploratory factor analyses with oblique rotation were conducted for each treatment modality separately to decide upon the final questionnaire. Internal consistency and test-retest reliability were determined.ResultsThe final questionnaire comprised 60 items. It was completed by 351 patients with knee or hip OA. Each of the five treatment modalities yielded a two factor solution with 37% to 51% explained variance and high face validity. Factor I included ‘positive treatment beliefs’ and factor II ‘negative treatment beliefs’. Internal consistency (Cronbach α’s from 0.72 to 0.87) and test-retest reliability (i.e. intraclass correlation coefficient from 0.66–0.88; standard error of measurement from 0.06–0.11) were satisfactory to good.ConclusionsThe TOA questionnaire is the first questionnaire assessing positive and negative treatment beliefs regarding five treatment modalities for knee and hip OA. The instrument will help to understand whether and to what extent treatment beliefs influence treatment choices.
Highlights
Use of conservative treatment modalities in osteoarthritis (OA) is suboptimal, which appears to be partly due to patients’ beliefs about treatments
Several national and international recommendations and guidelines for the management of hip and knee OA recommend that patients first are provided with conservative treatment options, and that they are referred to surgical treatment only when conservative treatment does not lead to adequate pain relief and functional improvement [2,3,4]
The draft Treatment beliefs in OA (TOA) questionnaire consisted of five modules, based on five treatment options recommended in the ‘stepped care strategy’ for knee and hip OA in the Netherlands [3]: physical activities, pain medication, physiotherapy, injections and arthroplasty
Summary
Use of conservative treatment modalities in osteoarthritis (OA) is suboptimal, which appears to be partly due to patients’ beliefs about treatments. In clinical practice, health care utilisation is suboptimal in terms of underutilisation of conservative treatment modalities [5,6,7] and an increased use of surgical treatment modalities [8]. This is undesirable because surgery does not always result in Selten et al BMC Musculoskeletal Disorders (2017) 18:402 good outcomes and pain reduction [9, 10] and may lead to higher health care costs. Identifying patients’ beliefs about various treatment modalities of OA may help to increase the understanding of treatment decisions
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