Musculoskeletal Health Questionnaire Research Articles

MulTI-domain self-management in older People wiTh OstEoarthritis and multi-morbidities: protocol for the TIPTOE randomised controlled trial

BackgroundFour out of five people living with osteoarthritis (OA) also suffer with at least one other long-term health condition. The complex interaction between OA and multiple long-term conditions (MLTCs) can result in difficulties with self-care, restricted mobility, pain, anxiety, depression and reduced quality of life. The aim of the MulTI-domain Self-management in Older People wiTh OstEoarthritis and Multi-Morbidities (TIPTOE) trial is to evaluate the clinical and cost-effectiveness of the Living Well self-management support intervention, co-designed with people living with OA, integrated into usual care, in comparison to usual care alone.MethodsTIPTOE is a multi-centre, two-arm, individually randomised controlled trial where 824 individuals over 65 years old with knee and/or hip joint pain from their OA affected joint and at least one other long-term health condition will be randomised to receive either the Living Well Self-Management support intervention or usual care. Eligible participants can self-refer onto the trial via a website or be referred via NHS services across Wales and England. Those randomised to receive the Living Well support intervention will be offered up to six one-to-one coaching sessions with a TIPTOE-trained healthcare practitioner and a co-designed book. Participants will be encouraged to nominate a support person to assist them throughout the study. All participants will complete a series of self-reported outcome measures at baseline and 6- and 12-month follow-up. The primary outcome is symptoms and quality of life as assessed by the Musculoskeletal Health Questionnaire (MSK-HQ). Routine data will be used to evaluate health resource use. A mixed methods process evaluation will be conducted alongside the trial to inform future implementation should the TIPTOE intervention be found both clinically and cost-effective. An embedded ‘Study Within A Project’ (SWAP) will explore and address barriers to the inclusion of under-served patient groups (e.g. oldest old, low socioeconomic groups, ethnic groups).DiscussionTIPTOE will evaluate the clinical and cost-effectiveness of a co-designed, living well personalised self-management support intervention for older individuals with knee and/or hip OA and MLTCs. The trial has been designed to maximise inclusivity and access.Trial registrationISRCTN 16024745. Registered on October 16, 2023.

Cross-sectional study assessing sleep behavior and musculoskeletal symptoms in elite junior badminton athletes.

Sleep inadequacy has previously been associated with increased risk of injury and reduced performance. It is unclear if sleep disorders are associated with musculoskeletal symptoms, which may be a predictor of serious injury and affect performance. The aim was therefore to assess sleep behavior in elite junior badminton players and its association to musculoskeletal symptoms. In 2018, players at the World Junior Badminton Championship completed the Athlete Sleep Behavior Questionnaire and a modified version of the World Olympic Association Musculoskeletal Health Questionnaire. Participants were categorized with poor or moderate/good sleep behavior as the independent variable. Musculoskeletal symptoms were the primary outcome and was categorized using yes/no questions. Relevant musculoskeletal symptoms were defined as pain higher than 30 mm Numeric Rating Scale pain score or more than 30 minutes of joint stiffness a day. Group comparison was performed using chi-square analysis and logistic regression for primary outcome adjusted for age, sex, ethnicity, previous injury, training load, and resting days. Of the 153 participants, 28% reported poor sleep scores. There was no difference between poor and moderate/good sleep score concerning demographic variables such as sex, age, ethnicity, previous injury, training load, and resting days. There were 27% with current musculoskeletal symptoms but with no difference in groups between poor and moderate/good sleep score (P = .376). This yielded an adjusted odds ratio of 1.23 (95% confidence intervals 0.52; 2.90). Twenty-eight percent of the participants reported poor sleep behavior. Twenty-seven percent experienced current musculoskeletal symptoms. We found no statistical differences in reported musculoskeletal symptoms when comparing athletes with poor sleep behavior to athletes with moderate/good sleep behavior.

Influence of Meditative Technique on Musculoskeletal Pain, Sleep Quality, Stress and State Anxiety on Geriatric Participants: A Randomized Controlled Trial

ObjectiveMusculoskeletal pain, sleep disturbances and psychological stress are common issues faced by the elderly. There are limited studies eliciting the effects of specific meditation techniques among the elderly. The present study was undertaken to assess the effect of the Mind Sound Resonance Technique (MSRT) on pain, sleep quality, stress and state anxiety. MethodsSeventy elderly participants with self-reported pain symptoms were randomly assigned to meditation and control groups with an equal allocation ratio. The meditation group received practice of MSRT for 8 weeks. The control group was offered lifestyle suggestions. The primary outcome of this study is Musculoskeletal Health Questionnaire (MSHQ), secondary outcomes are Perceived Stress Scale (PSS), Geriatric Anxiety Scale (GAS) and Pittsburgh Sleep Quality Index (PSQI). They were assessed at baseline and 8 weeks. Independent and paired t-tests were performed to assess the between and within group changes. ResultsThe Between-group analysis has shown MSRT meditation to be better than control for MSHQ (p <0.01), PSQI global score (p <0.01), and GAS global score (p<0.01) along with its subscale (p <0.01). Within group analysis for primary variable MSHQ (p <0.05) secondary variable PSQI, PSS AND GAS has shown significant improvement (p <0.001) when compared to baseline. ConclusionMSRT is safe and useful for geriatric population to reduce musculoskeletal pain, improve sleep quality, while reducing stress and anxiety.

Decision Support for Managing Common Musculoskeletal Pain Disorders: Development of a Case-Based Reasoning Application.

Common interventions for musculoskeletal pain disorders either lack evidence to support their use or have small to modest or short-term effects. Given the heterogeneity of patients with musculoskeletal pain disorders, treatment guidelines and systematic reviews have limited transferability to clinical practice. A problem-solving method in artificial intelligence, case-based reasoning (CBR), where new problems are solved based on experiences from past similar problems, might offer guidance in such situations. This study aims to use CBR to build a decision support system for patients with musculoskeletal pain disorders seeking physiotherapy care. This study describes the development of the CBR system SupportPrim PT and demonstrates its ability to identify similar patients. Data from physiotherapy patients in primary care in Norway were collected to build a case base for SupportPrim PT. We used the local-global principle in CBR to identify similar patients. The global similarity measures are attributes used to identify similar patients and consisted of prognostic attributes. They were weighted in terms of prognostic importance and choice of treatment, where the weighting represents the relevance of the different attributes. For the local similarity measures, the degree of similarity within each attribute was based on minimal clinically important differences and expert knowledge. The SupportPrim PT's ability to identify similar patients was assessed by comparing the similarity scores of all patients in the case base with the scores on an established screening tool (the short form Örebro Musculoskeletal Pain Screening Questionnaire [ÖMSPQ]) and an outcome measure (the Musculoskeletal Health Questionnaire [MSK-HQ]) used in musculoskeletal pain. We also assessed the same in a more extensive case base. The original case base contained 105 patients with musculoskeletal pain (mean age 46, SD 15 years; 77/105, 73.3% women). The SupportPrim PT consisted of 29 weighted attributes with local similarities. When comparing the similarity scores for all patients in the case base, one at a time, with the ÖMSPQ and MSK-HQ, the most similar patients had a mean absolute difference from the query patient of 9.3 (95% CI 8.0-10.6) points on the ÖMSPQ and a mean absolute difference of 5.6 (95% CI 4.6-6.6) points on the MSK-HQ. For both ÖMSPQ and MSK-HQ, the absolute score difference increased as the rank of most similar patients decreased. Patients retrieved from a more extensive case base (N=486) had a higher mean similarity score and were slightly more similar to the query patients in ÖMSPQ and MSK-HQ compared with the original smaller case base. This study describes the development of a CBR system, SupportPrim PT, for musculoskeletal pain in primary care. The SupportPrim PT identified similar patients according to an established screening tool and an outcome measure for patients with musculoskeletal pain.

Identification of Musculoskeletal Health Status, Pain Acceptance, and Coping Strategies in Individuals with Chronic Pain and Physical Disabilities: A Cross-Sectional Comparative Study

Purpose: The purpose of this study is to determine the musculoskeletal health status, pain acceptance, and coping strategies of individuals with chronic pain and physical disabilities and compare them with control group. Material and Methods: This cross-sectional study included a total of 88 participants, divided into two groups: the study group (individuals with chronic pain and physical disabilities; n=44) and the control group (individuals with chronic pain but without disabilities; n=44). Participants' musculoskeletal health was assessed using the Musculoskeletal Health Questionnaire (MHQ), pain acceptance using the Chronic Pain Acceptance Questionnaire (CPAQ), and coping strategies were evaluated using the COPE inventory. Results: Significant differences were observed between the groups in terms of MHQ scores and COPE scores (p0.05). Discussion: This results emphasizes the need for a careful assessment of coping strategies in individuals with chronic pain and physical disabilities in interdisciplinary chronic pain management programs, as well as the inclusion of personalized coping strategies in the intervention program.

OA20 Serious infections hospital admissions and mortality in patients with early inflammatory arthritis: results from the National Early Inflammatory Arthritis Audit

Abstract Background/Aims To identify the risk of serious infections (SI) according to initial treatment strategy, using conventional synthetic disease modifying anti-rheumatic drugs (csDMARD) and corticosteroids, in patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA). Methods An observational cohort study design was used. The population included adults in England with a new onset rheumatoid arthritis (RA), fulfilling ACR/EULAR 2010 criteria, between April 2018-March 2021. Outcomes studied were SI, defined by infections requiring hospitalisation (primary admission diagnosis/nosocomial acquisition) or death (SI stated on death certificate), identified using NHS Digital linkage. Patients' characteristics were tabulated by treatment strategies. Hazard ratios (HR) were calculated using single failure Cox proportional-hazards models, with confounders-adjusted models (age, gender, smoking status, comorbidities, social deprivation) and fully-adjusted models including disease factors (seropositivity, DAS28). Individuals were considered at risk from the date of RA diagnosis, and censored at SI event, death, or March 2021 (whichever was earliest). Results 20,060 patients with RA were included. Initial DMARD therapy was known for 19,572 patients, of whom 11,966 were on methotrexate/MTX based strategies (mono or combo), 5,059 on csDMARD combination strategies (other than MTX) and 2,547 on no DMARD strategy. 15,319 patients were on corticosteroids at baseline. Mean age 59.5 years (+/-15); 63% female; smoking status (20% current; 30% ex-smokers); comorbidities (21% hypertension; 10% diabetes; and 12% lung disease). Rheumatoid Factor/CCP antibodies were positive in 68%. At presentation, median disease scores were 5.1 (interquartile range [IQR]: 4.0-5.9) for DAS28, 1.1 (IQR: 0.6-1.7) for health assessment questionnaire (HAQ) and 24 (IQR: 16.0-33.0) for musculoskeletal health questionnaire (MSKHQ).There were 519 SI admissions and 17 SI deaths, corresponding to incidence rates per 100 person-years for admissions: 3.19 (95% CI: 2.93-3.48) and deaths: 0.10 (95% CI: 0.06-0.16). In fully-adjusted models, increasing age predicted both SI admissions and deaths. Being a smoker, having a comorbidity, higher disease activity (DAS28), symptom burden (MSKHQ) and disability (HAQ) at presentation associated with more SI admissions. For each 1 unit increase in DAS28, the risk of SI increased by 8% (HR 1.08 [95% CI:1.01-1.16]). Seropositivity did not associate with SI. MTX-based strategies 0.75 (95% CI:0.62-0.91) and csDMARD combination therapy 0.70 (95% CI:0.53-0.94) associated with fewer SI admissions compared to no DMARD. In unadjusted models, corticosteroid associated with more SI admissions 1.29 (95% CI:1.10 -1.62); however, in fully-adjusted models this association was no longer statistically significant. csDMARD strategies did not associated with SI deaths in any of the models. Conclusion Patient and disease factors at diagnosis appear to be important predictors of admissions and mortality for serious infections. Infection risk appears to be greatest in those with higher RA disease activity. An important limitation is that NEIAA does not capture data on treatment changes over time and steroid use beyond baseline. Disclosure M. Adas: None. K. Bechman: None. M. Russell: Honoraria; Lilly and Menarini. Other; upport for attending conferences from Lilly, Pfizer, Janssen, and UCB, and advisory board fees from Biogen.. I. Karafotias: None. D. Nagra: None. S. Patel: None. S. Gallagher: None. E. Price: None. M. Garton: None. A. Rutherford: None. A. Cope: None. S. Norton: None. J. Galloway: Honoraria; from Abbvie, Biovitrum, Bristol Myers Squib (BMS), Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi, and UCB.

Evaluation of the Psychometric Properties of the Musculoskeletal Health Questionnaire (MSK-HQ) in a Population of Professional Basketball Players: A Cross-Sectional Study.

Background and Objective: Musculoskeletal disorders affect a large portion of the population worldwide. The musculoskeletal health questionnaire is a helpful tool for assessing the health state of patients with these disorders. The primary goal of this study is to evaluate the psychometric properties of the MSK_HQ-IT in a population of professional basketball players. The secondary aim is to assess the prevalence of musculoskeletal disorders. Material and Methods: The study was performed from September to October 2022. The questionnaire was completed using an online or paper form, to which personal data were collected. Data were collected by submitting a translated version of the musculoskeletal health questionnaire directly to professional athletes. Results: A total of 63 basketball players were recruited. Regarding functional limitations, the body parts mentioned by the sample were the left ankle (23.8%) and the right ankle (17.5%), followed by the lumbar column and right hip (15.9%). Regarding pain, the data are more homogeneous, with a distribution in line with functional limitations. A peak of pain was perceived in the left foot, with a mean score of 4. Cronbach's alpha showed a value of 0.85. Conclusions: The musculoskeletal health questionnaire shows promising results in evaluating the health state of a population of professional athletes. Further studies are needed to enlarge the sample and possibly open it to more categories of professional sports.

Translation and adaptation of the Arabic version of the injustice experience questionnaire in patients with chronic musculoskeletal pain.

The objectives of this study were to (1) translate the short version of the Injustice Experience Questionnaire (IEQ-SF) from English to Arabic and (2) test the validity and reliability of the translated Arabic version of the IEQ-SF. A cross-sectional study in which the original English version of the IEQ-SF was translated into Arabic was conducted in accordance with Beaton's translation process. Internal consistency, reproducibility (retest within 5 days), and validity of the translated Arabic version of the IEQ-SF were tested in Arabic-speaking participants (n = 20). Individuals with chronic pain (n = 99) completed the Arabic versions of the IEQ-SF and the Musculoskeletal Health Questionnaire (MSK-HQ) from June to August 2021. The main analyses included Cronbach's alpha (α), Intraclass Correlation Coefficients (ICC), and Spearman's rank correlations (ρ). The internal consistency (α = 0.74) and test-retest reliability (ICC = 0.88, 0.83-0.92 95% CI) for the translated Arabic version of IEQ-SF were high. There was also a high correlation between the translated Arabic version of the IEQ-SF and different health-related questionnaires such as the MSK-HQ (ρ = -0.738; p < 0.001), Hospital Anxiety and Depression Scale (ρ = 0.701-0.791; all, p < 0.001), and Pain Catastrophizing Scale (ρ = 0.762; p < 0.001). The Arabic version of the IEQ-SF demonstrated high reliability and validity and would be useful for clinicians and researchers studying Arabic-speaking individuals with chronic pain.

The impact of musculoskeletal ill health on quality of life and function after critical care: a multicentre prospective cohort study.

Physical disability is a common component of post-intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health-related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392-0.589); anxiety, rs = -0.433 (95%CI -0.538 to -0.315); and depression, rs = -0.537 (95%CI -0.631 to -0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0-3.25 [0-7]) vs. 4 (1-7 [0-7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high-risk groupsto target in future interventional studies.

Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians-Italian Version (MPIIQM-IT): Multicenter Validation, Translation and Cultural Adaptation.

The study aimed to translate, culturally adapt, and test the psychometric properties of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) in an Italian population of professional and amateur musicians. The translation and cultural adaptation process followed international guidelines, while the reliability and validity of the questionnaire were assessed against the COSMIN checklist. The internal consistency was calculated using Cronbach's alpha (a) coefficient. Construct validity was analyzed using exploratory factor analysis (EFA) with principal axis factoring (PAF) extraction. The sample adequacy and data suitability were assessed through the Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity tests, respectively. Concurrent validity was analyzed by assessing Pearson's correlation coefficient with the Italian version of the Musculoskeletal Health Questionnaire (MSK-HQ-I). Finally, the cross-cultural validity was investigated by analyzing score differences between amateur and professional musicians, and differences based on musical practice habits. The tool was administered to 311 subjects recruited from across Italy. The MPIIQM-IT was found to have high levels of internal consistency for the entire tool and each of the two subscales (Cronbach's a = 0.875, 0.877, and 0.845, respectively). The recruited sample was found to be adequate (KMO = 0.810) and the data suitable (C2 = 341.040, p < 0.001) for factor analysis, which produced 9 items contained in two main factors. Pearson's correlation coefficients showed a positive, statistically significant correlation between the MSK-HQ-I and the two subscales of the MPIIQM-IT with p < 0.01. Analysis of Student's t-test for independent samples and the ANOVA test for continuous variables showed statistically significant differences between male and female, professional and non-professional musicians, and conservatory and non-conservatory students. The MPIIQM-IT is a valid and reliable tool, useful for investigating the presence of pain and playing-related musculoskeletal disorders (PRMDs) in both professional and non-professional musicians.

Cross-cultural adaptation and reliability of the European Portuguese version of the Musculoskeletal Health Questionnaire: A methodological study.

To culturally adapt the Musculoskeletal Health Questionnaire (MSK-HQ) to European Portuguese and evaluate its reliability in individuals with musculoskeletal conditions. The study was carried out in two phases. In the first phase, the MSK-HQ was translated and culturally adapted. In the second phase, a longitudinal observational study was carried out with a convenience sample of participants with musculoskeletal conditions. Data collection began at the start of physiotherapy treatments by filling in the MSK-HQ and Numeric Pain Rating Scale (NPRS). After 4-7 days, the participants were asked to fill out the MSK-HQ once again, as well as the Patient Global Improvement Change (PGIC) scale. The data collected was used to study internal consistency, test-retest reliability, and measurement error. Floor and ceiling effects were also analysed. The MSK-HQ was successfully translated and adapted into European Portuguese. The second phase of the study had a sample of 191 participants. This study demonstrated high internal consistency (Cronbach's α = 0.885) and excellent test-retest reliability (ICC(2,1) = 0.908). The analysis of measurement error resulted in an SEM of 2.818 and an SDC at 7.811. No floor or ceiling effect was observed. The MSK-HQ-PT is a reliable instrument for measuring musculoskeletal health. Further studies on its validity and responsiveness are needed.

Effects of alpha music rhythm on inflammation and physical function in chronic knee osteoarthritis: A randomized control trial

Abstract Background: Alpha wave stimulation of the brain using music is a relatively new intervention concept for individuals suffering from chronic osteoarthritis of the knee. Objectives: To determine the effects of alpha music rhythm on inflammation and physical function in chronic knee osteoarthritis. Materials and Methods: Individuals from various in patient and out patient departments of the South Gujarat region were selected and evaluated in a randomized control group trial. Individuals with chronic knee osteoarthritis were randomly allocated into two groups: Group I was given alpha music rhythm, exercise therapy, and pain relief electrical modalities, while group II was given only exercise therapy and pain relief electrical modalities. Results: Extent of inflammation and physical function were measured using an infrared camera, visual analog scale, muscle girth measurement, musculoskeletal health questionnaire, range of motion, and muscle strength. Conclusion: A repeated measure ANOVA and independent t test (confidence interval 95%, P &lt; 0.05) revealed that alpha music rhythm combined with electrical modalities and exercise treatment relieved inflammation and improved physical function in individuals with chronic knee osteoarthritis compared to only exercises and electrical modalities.

The effectiveness of strict adherence to ergonomic principles on injury prevention and work performance in metal industry workers

Introduction: The primary strategy to prevent musculoskeletal trauma is the use of ergonomic principles to modify hand tools and to improve workstation design and work practices. To reduce the chance of injury, work tasks should be designed to limit exposure to ergonomic risk factors. Objective: To determine the effectiveness of strict adherence to ergonomic principles on injury prevention and work performance in metal industry workers by assessing musculoskeletal questionnaire and grip strength. Method: Total of 50 subjects were divided equally into 2 groups by random sampling after checking the criteria for selection. Group A experimental (n= 25) and group B control (n=25). The experimental group underwent 1month of strict ergonomic principles whereas the control group underwent normal working protocol. The pre and post measurements were measured by using grip strength and musculoskeletal health questionnaire (msk-hq). Result: The mean MSK-hq post score in Experimental Group was 53.24 with a standard deviation 2.50 and the mean MSK-hq post score in Control Group was 48.08 with a standard deviation 4.63 which was statistically significant (p value &lt;0.00012). The mean Grip(kg)post score in Experimental Group was 45.83 with a standard deviation 0.55 and the mean Grip(kg) post score in Control Group was 45.08 with a standard deviation 1.39 which was statistically significant (p value &lt;0.01546). Hence Experimental group was found to be better than the control group. Conclusion: Based the study's findings and review of supporting evidence, this study concludes that applying ergonomic principles has substantial evidence suggesting that ergonomics can help prevent musculoskeletal injuries and improve grip strength among metal industry workers.

The Swedish version of the STarT MSK Tool: cross-cultural adaption, test–retest reliability, and aspects of validity

BackgroundMusculoskeletal disorders (MSDs) are a common reason for seeking primary health care. The STarT Musculoskeletal (MSK) tool is designed to stratify patients suffering from MSDs to risk groups, based on prognostic factors.AimThe aim was to translate and cross-culturally adapt the STarT MSK tool in a Swedish primary health care context through testing of reliability and construct validity.MethodsWe included consecutive patients with MSDs seeking primary care (n = 99). The STarT MSK was translated using international recommendations. Construct validity was investigated by correlation analysis (Spearmans Rho) with the following reference instruments: the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), the EuroQol 5-dimension (EQ-5D) and the Musculoskeletal Health Questionnaire (MSKHQ). Reliability was tested using test–retest (Intra Class Correlation, ICC2.1) (n = 31). Known-groups validity was calculated with a difference of 10% between risk groups based on how the participants had answered.ResultsThe STarT MSK was successfully translated into Swedish. The participants were grouped into low risk (n = 28), medium risk (n = 60) and high risk (n = 11). The construct validity showed a moderate to high correlation with the ÖMPQ (r = .61), EQ-5D (r = .59) and MSK-HQ (r = .56). All separate items except item 2 and 9 correlated according to predefined hypotheses. Test–retest demonstrated an excellent reliability for the total score (ICC2.1 0.85) (n = 31). The STarT MSK tool was able to differentiate by 10% between the risk groups, based on how the participants had answered.ConclusionThe STarT MSK has been successfully translated and adapted into Swedish and shows acceptable measurement properties regarding test–retest reliability and aspects of validity and seems to be able to discriminate between the proposed risk groups. The tool can therefore be useful in a Swedish primary health care context. A future study needs to determine the tools predictive validity and to investigate if stratification to risk groups leads to a faster recovery and to lower health care costs.

Cross-Cultural Adaptation and Validation of a Marathi Version of the Versus Arthritis Musculoskeletal Health Questionnaire (MSK-HQ).

Introduction Musculoskeletal (MSK) well-being plays a crucial role in determining one's quality of life. Musculoskeletal Health Questionnaire (MSK-HQ) score is a tool recently developed by the Versus Arthritis group of Oxford University in English to measure MSK health. Marathi is a regional language in western India spoken by more than 100 million people. There is a scarcity of valid and reliable tools to measure MSK health in this language. Hence, we decided to cross-culturally adapt and translate MSK-HQ to Marathi. Method We translated MSK-HQ score to Marathi (MSK-HQ-Ma) as per the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. We tested its internal consistency, construct validity and reproducibility. It was compared with other health status scores EQ-5D-5L and overall health using the Visual Analogue Scale (VAS). Test-retest reliability was tested in those subjects who were having stable MSK health after two weeks. Results We recruited 158 consecutive subjects attending musculoskeletal clinics who had Marathi as their native language. Mean age was 44.8±17 years, females were 78 (49%).It showed good internal consistency (Cronbach's alpha = 0.95). For construct validity we found a strong correlation between MSK-HQ-Ma and EQ-5D-5L values (Spearman's r = 0.82, p<0.001). There was also a good correlation between MSK-HQ-Ma and overall health by VAS (Spearman's r = 0.76, p<0.001). An excellent test-retest reliability (Spearman's r = 0.94, p<0.001) was seen in 105 subjects who had stable MSK condition after two weeks of first appearance. Conclusion The MSK-HQ-Ma instrument has demonstrated good consistency, reliability and construct validity when evaluating the musculoskeletal health of individuals who can understand the Marathi language. Hence it can be used as a validated tool for the evaluation of musculoskeletal health in western India where Marathi is a commonly used language.

Effect of an Artificial Intelligence–Based Self-Management App on Musculoskeletal Health in Patients With Neck and/or Low Back Pain Referred to Specialist Care

Self-management is a key element in the care of persistent neck and low back pain. Individually tailored self-management support delivered via a smartphone app in a specialist care setting has not been tested. To determine the effect of individually tailored self-management support delivered via an artificial intelligence-based app (SELFBACK) adjunct to usual care vs usual care alone or nontailored web-based self-management support (e-Help) on musculoskeletal health. This randomized clinical trial recruited adults 18 years or older with neck and/or low back pain who had been referred to and accepted on a waiting list for specialist care at a multidisciplinary hospital outpatient clinic for back, neck, and shoulder rehabilitation. Participants were enrolled from July 9, 2020, to April 29, 2021. Of 377 patients assessed for eligibility, 76 did not complete the baseline questionnaire, and 7 did not meet the eligibility criteria (ie, did not own a smartphone, were unable to take part in exercise, or had language barriers); the remaining 294 patients were included in the study and randomized to 3 parallel groups, with follow-up of 6 months. Participants were randomly assigned to receive app-based individually tailored self-management support in addition to usual care (app group), web-based nontailored self-management support in addition to usual care (e-Help group), or usual care alone (usual care group). The primary outcome was change in musculoskeletal health measured by the Musculoskeletal Health Questionnaire (MSK-HQ) at 3 months. Secondary outcomes included change in musculoskeletal health measured by the MSK-HQ at 6 weeks and 6 months and pain-related disability, pain intensity, pain-related cognition, and health-related quality of life at 6 weeks, 3 months, and 6 months. Among 294 participants (mean [SD] age, 50.6 [14.9] years; 173 women [58.8%]), 99 were randomized to the app group, 98 to the e-Help group, and 97 to the usual care group. At 3 months, 243 participants (82.7%) had complete data on the primary outcome. In the intention-to-treat analysis at 3 months, the adjusted mean difference in MSK-HQ score between the app and usual care groups was 0.62 points (95% CI, -1.66 to 2.90 points; P = .60). The adjusted mean difference between the app and e-Help groups was 1.08 points (95% CI, -1.24 to 3.41 points; P = .36). In this randomized clinical trial, individually tailored self-management support delivered via an artificial intelligence-based app adjunct to usual care was not significantly more effective in improving musculoskeletal health than usual care alone or web-based nontailored self-management support in patients with neck and/or low back pain referred to specialist care. Further research is needed to investigate the utility of implementing digitally supported self-management interventions in the specialist care setting and to identify instruments that capture changes in self-management behavior. ClinicalTrials.gov Identifier: NCT04463043.

Low Back Pain Among Students of Medical University of Tunis.

Low Back Pain (LBP) is the most common musculoskeletal disorder among working adults. It is one of the most prevalent complaints among students. Medical students are among those who are most exposed to this condition; due to stress, numerous hours of studying, and the sedentary lifestyle. Our study aimed to determine the prevalence and associated factors of LBP among the students of Tunis Faculty of Medicine and to assess its impact on student life. This cross-sectional study was carried out on the Tunis Faculty of Medicine students. Data were collected through an online self-administered questionnaire. Sociodemographic, personal, and lifestyle characteristics were collected. LBP was assessed using the Nordic Musculoskeletal Health Questionnaire and Its impact using the Oswestry Disability Index (ODI). One hundred and forty-eight students were included. The mean age was 22.9 ± 2.3 years (19.64-38.21). The sex ratio was 0.29. According to the Nordic questionnaire, the point, annual and lifetime prevalence of LBP were 37.8%, 80.4%, and 90.5%, respectively. The mean ODI score was 10.32 ± 8.48 % (0-32). The ODI score was minimal in 87.3% and moderated in 12.7% of cases. The associated factors with LBP were: young age (p = 0.015), spending more than 4 hours in a sitting position (p = 0.059), second cycle of medical studies (p = 0.006), low screen projection in the amphitheater (p = 0.029) and poor layout of the amphitheatres (p = 0.000). The feeling of depression was significantly higher among LBP students (p = 0.018). In the multivariate analysis, the factors that remained statistically significant were the second cycle of medical studies (OR= 3.41), feeling of depression (OR = 3.7), and the belief in the responsibility for the poor layout of the amphitheaters in the genesis or maintenance of LBP (OR = 7.66). LBP in medical students is multifactorial across both personal and college-life domains.

P038 A psychometric evaluation of the Musculoskeletal Health Questionnaire (MSK-HQ): validation and sensitivity to change in inflammatory arthritis

Abstract Background/Aims The Musculoskeletal Health Questionnaire (MSK-HQ) is a patient-reported outcome measure developed for use across the spectrum of musculoskeletal diseases. This study assesses the validity of the MSK-HQ. Specifically, it analyses convergent validity, construct validity, reliability and sensitivity to change in inflammatory arthritis in a national prospective cohort, with a minimum clinically important difference (MCID) defined. Methods The study sample included patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and March 2020, with a diagnosis of inflammatory arthritis, returning a baseline PROM with at least half of the MSK-HQ items completed. Patients also completed PROMs at 3 and 12 months, contemporaneously to their clinic visits. Convergent validity was assessed in relation to the Health Assessment Questionnaire (HAQ)-II, Patient Health Questionnaire (PHQ)-4 and Disease Activity Score (DAS)-28. Construct validity was assessed using confirmatory factor analysis. Due to lack of an appropriate anchor, MCID was estimated based on two estimates for reliable change: standard error of the measurement (SEM) and one-third of a standard deviation (SD). Results A total of 13,129 patients were recruited to NEIAA, of whom 5,106 met the inclusion criteria. Of these 73% had rheumatoid arthritis, 13% psoriatic arthritis, 2% axial spondyloarthritis, and 12% undifferentiated arthritis. The MSK-HQ total score was approximately normally distributed, without floor or ceiling effects. The MSK-HQ correlated well with the HAQ-II (r = -0.79), PHQ-4 (r = -0.66) and moderately with the DAS-28 (r = -0.42). A unidimensional structure for the MSK-HQ was confirmed only when items 12 and 13, corresponding to disease understanding and self-efficacy, were excluded. The factor structure was found to be equivalent across disease subtypes with no major indications for differential item functioning. The MSK-HQ total score demonstrated good sensitivity to change with baseline to 12-month change having a large effect size (standardised response mean 1.01; 95%CI 0.95 to 1.07). This change compared well against the DAS-28 (-1.23; 95%CI -1.29 to -1.17) and was stronger than the HAQ-II (-0.62; 95%CI -0.68 to -0.56) and PHQ-4 (-0.57; 95%CI -0.63 to -0.51). MCID for the overall sample was 3.9 based on SEM and 3.6 assessed with one-third of an SD, both rounding to an integer of 4-points across the inflammatory arthritis subtypes. Conclusion This study provides evidence for the validity and sensitivity to change of the MSK-HQ in patients with inflammatory arthritis. In these patients, a change of more than 4 units is likely to be clinically meaningful. The MSK-HQ has high convergent and construct validity and is sensitive to change, providing a valuable tool for clinical care and research studies. Disclosure N. Arumalla: None. J. Galloway: Consultancies; AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. J. Ledingham: Other; BSR trustee. T. Garrood: None. S. Norton: None.

P093 Clinical outcomes and care quality standards in young adult patients with early inflammatory arthritis: Results from a national cohort

Abstract Background/Aims Emerging adulthood is a unique developmental period between late adolescence and establishment of personal and social identity associated with adulthood. Emerging adult populations may have distinctive experiences of adult healthcare and their needs may differ from those of older healthcare users. Little is known about the patterns of presentation, experiences of care or disease outcomes of emerging adults in adult rheumatology settings. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe differences between emerging and older adult patients diagnosed with early inflammatory arthritis (EIA). Methods NEIAA is an observational cohort design study assessing care against National Institute for Health and Clinical Excellence quality metrics. Adults in England and Wales with a confirmed new diagnosis of inflammatory arthritis between May 2018 and April 2022 were grouped into two categories: emerging adults (16-24 years) and older patients (≥25 years). Patient characteristics, disease phenotype (including oligo- or polyarticular presentation) and initial treatment strategy were described. Results A total of 20,472 patients were included. 571 (2.8%) diagnosed with EIA were emerging adults (EA); this group had higher proportions of females (71.8%). Compared to older patients, EA patients were less likely to ever smoke (44.1% vs 69.5%) and had fewer comorbidities. EA patients were more likely to have oligoarticular symptoms (&amp;lt;5 tender and swollen joints; 53% vs 37%). Symptom duration prior to diagnosis was longer for EA patients (46% describing symptom duration &amp;gt;6 months vs 37%). Median Disease Activity Score/DAS28 at presentation was lower (4.2 vs 4.7). There were no differences in symptom burden as measured by the mean musculoskeletal health questionnaire (25 vs 24). EA patients completed fewer patient reported outcomes (33% vs 39%), but were more likely to complete all forms (20% vs 17%). Disease modifying anti-rheumatic drugs treatment strategies appeared similar, although more EA patients did not start medications by three months (26% vs 19%). Fewer EA patients received steroids (56% vs 71%).There were no significant differences between groups in patient numbers referred within three days of symptom onset from primary care or reviewed within three weeks with treatment initiation within six weeks in rheumatology care. More of the EA group were in employment at diagnosis. The EA population reported higher impairment at work (Work Productivity and Activity Index overall score 38% vs 30%, driven by difference in presenteeism). Conclusion Low proportion of EA patients in this EIA population raises concern that the study is not capturing a representative sample of this younger and developmentally distinct population. Available data suggest important differences in time to presentation, disease pattern and pathways of care between EA and older patients. EA population deserves further detailed investigation, exploring frequency and patterns of EIA and identifying particular issues faced when using adult rheumatology services. Disclosure M. Adas: None. N. Arumalla: None. D. Mclaughlin: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. J. Ledingham: Other; is a BSR trustee. F. Mcerlane: None.

Validation of the Musculoskeletal Health Questionnaire in a general population sample: a cross-sectional online survey in Hungary

BackgroundThe Versus Arthritis Musculoskeletal Health Questionnaire (MSK-HQ) measures symptom severity and health-related quality of life (HRQoL) of people with musculoskeletal (MSK) conditions. We aimed to test the psychometric properties of the MSK-HQ among the general adult population and identify the determinants of MSK-HQ states. In addition, we aimed to explore the relationship between MSK-HQ and standard well-being measurement tools.MethodsThe translation proccess of the MSK-HQ into Hungarian followed the standard methods provided by the developer. A cross-sectional online survey was performed in Hungary involving a population normative sample (N = 2004, women: 53.1%; mean age: 48.3, SD = 16.6 years). Socio-demographic characteristics and self-reported MSK disorders were recorded. Alongside the MSK-HQ, standard measures of HRQoL (EQ-5D-5L), physical functioning (HAQ-DI) and well-being (ICECAP-A/O, WHO-5, Happiness VAS) were applied. Clinical and convergent validity were assessed by subgroup comparisons (Mann–Whitney-U and Kruskal–Wallis tests) and Spearman’s rank correlations. Internal consistency was assessed by Cronbach’s alpha. Test–retest reliability (N = 50) was evaluated by intraclass correlation coefficient (ICC). Predictors of MSK-HQ were analysed by ordinary least square multiple regressions.ResultsThe mean MSK-HQ index score was 44.1 (SD = 9.9). MSK-HQ scores were significantly lower in subgroups with self-reported MSK disorders. Correlations were strong between MSK-HQ and EQ-5D-5L (0.788), EQ VAS (0.644) and HAQ-DI (-0.698) and moderate with the well-being measures (p < 0.05). Cronbach’s alpha was 0.924 and ICC was 0.936 (p < 0.05). Being a man, living in the capital, having higher income and education were positively associated with MSK-HQ scores.ConclusionsThis is the first study to prove the validity and reliability of the MSK-HQ among the general public. The impact of socio-demographic characteristics on MSK-HQ scores deserves consideration in clinical studies.