SAT0630 DUTCH TRANSLATION AND PSYCHOMETRIC PROPERTIES OF A PATIENT REPORTED EXPERIENCE MEASURE (PREM) FOR PATIENTS WITH RHEUMATOID ARTHRITIS AND SPONDYLOARTHRITIS

Abstract

Background: Evaluating the quality of care provided as perceived by patients can be helpful in order to reveal areas for improvement, identify best practices and stimulate interventions to further improve these. This can be done with a patient reported experience measure (PREM). Such a PREM, containing 23 questions in 7 domains has been developed and validated specifically for patients with rheumatic conditions, including rheumatoid arthritis (RA) and spondyloarthritis (SpA) in the United Kingdom (box 1) (1). Until now, no translated and validated Dutch questionnaire is available for patients with SpA or RA in the Netherlands. Objectives: To translate the PREM into Dutch and to study its psychometric properties in patients with SpA or RA. Methods: The PREM was independently translated into Dutch by two researchers fluent in the English language (one rheumatologist and one healthcare scientist) and a consensus version was generated which was checked by two other researchers (one rheumatologist and one methodologist). The final version was piloted in two Dutch real-life quality registries for patients with SpA or RA; SpA-Net and DREAM-RA, respectively. Patients completed the PREM annually starting from December 2016. For the current cross-sectional analysis, the most recently completed PREM from each patient was included. Feasibility was assessed by the median and interquartile ranges (IQR) of completion times. Reliability was assessed by internal consistency (Cronbach’s α) and homogeneity (corrected item-total correlations (rp)) within each domain. Content validity was assessed by floor- and ceiling effects (>15%) for each question. Divergent validity was assessed by Spearman rank correlation coefficients (rs) between the average score of each domain and outcome measures for disease activity (BASDAI, ASDAS or DAS28), daily functioning (BASFI, HAQ or HAQ-S), health status (ASAS-HI) and quality of life (SF-36). Results: The PREM was completed by 282 patients with SpA and 378 patients with RA. The average age and the proportion of female patients with SpA was lower compared to patients with RA (54.2 (SD 12.2) versus 61.5 (SD 11.9) years and 47.9% versus 65.1% female patients, respectively). Average disease activity was high in patients with SpA but low in patients with RA (mean ASDAS 2.2 (SD 0.9), mean DAS28 2.3 (SD 1.2)). The median time to complete the PREM was 5.5 minutes (IQR 2.7) in SpA-Net and 5.4 minutes (IQR 2.3) in DREAM-RA. Internal consistency of all domains was considered good for patients with SpA or RA (0.70 ≥ α ≤ 0.95), except for the domain Daily living and physical comfort in patients with RA (α=0.65). In both populations, thresholds for homogeneity were exceeded within three domains (rp > 0.7) suggesting possible item redundancy. Ceiling effects were found in 75% (SpA) and 90% (RA) of the questions. As expected, correlation coefficients showed that nearly all domains of the Dutch PREM were independent of scores on outcomes measures in both patients with SpA and RA (-0.3 ≤ rs ≤ 0.3). Conclusion: The Dutch PREM has acceptable psychometric properties to assess perceived quality of care in patients with SpA or RA. The homogeneity within three domains could be improved. The results for perceived quality of care are not affected by scores on outcome measures for disease activity, physical functioning, health status and quality of life.