Patient perspectives of hand osteoarthritis in relation to current measures of function

Abstract

Research objective: To explore whether the concepts of importance to patients with hand osteoarthritis within five European countries are covered by the most commonly used instruments measuring function. Design: The study was carried out in two qualitative focus groups formed in each Rheumatology centre, within five European countries. Setting: Rheumatology centres in Austria (Medical University of Vienna), The Netherlands (Leiden University Medical Centre), Norway (Diakonhjemmet Hospital Oslo), Sweden (Spenshult Hospital and Lund University) and the United Kingdom (Newcastle University). Participants: A total of 56 people (51 women, mean (SD) age 62.7 (7.9) years) with hand osteoarthritis participated in this study. Participants were required to meet the American College of Rheumatology criteria (Altman et al., 1990) for hand osteoarthritis to be included in this study and in Austria, the Netherlands and Norway, participants from previous hand osteoarthritis cohort studies were invited to participate. Maximum variety sampling was used based on the following criteria: gender, disease duration and age. Methods: Following Ethics Committee approval at each of the centres, moderators with experience of qualitative research met for a training session at the start of the project. Eligible patients were sent a letter of invitation and information sheet about the study, and were contacted by phone to determine if they were interested in participating. Verbal and written consent was obtained prior to the focus groups. Each group was chaired by the moderator, and supported by one or two assistants who observed. The focus group guide comprised five open questions based on the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF). Questions were forward and back translated into each of the appropriate native languages. Data analysis: Each focus group data were audio recorded, transcribed in the local language and checked by local investigators. Qualitative analysis comprised a modified form of content analysis; ‘meaning condensation’ (Kvale, 1996), with the WHO ICF forming the underpinning theoretical framework. The six most commonly used instruments to measure function in hand osteoarthritis were analysed, and their content mapped to appropriate ICF categories. Comparisons were then carried out between the concepts identified in the focus groups, and categories identified within the instruments. To ensure rigour, each investigator extracted concepts within the same two pages of (English) transcription, and participated in discussion, until consensus was reached. Main findings: A total of 63 concepts were identified within the focus groups, with 21 (33%) covered by at least one instrument. Important exclusions of concepts from the instruments were: psychological consequences, different qualities of pain, aesthetic changes and leisure activities. Authors’ conclusions: It was possible to combine the focus group concepts from each participating centre into a common qualitative analysis. The concepts of importance to people with hand osteoarthritis are not fully represented in the most commonly used instruments.