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Validation of the Impact Index: can we measure disease effects on quality of life in patients with hip and knee osteoarthritis?

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Abstract

Purpose

To validate the Impact Index, a short, publicly available scale that measures the extent to which a respondent’s health problem adversely impacts their quality of life.

Methods

Secondary analysis of patients with hip or knee osteoarthritis surveyed after visiting a surgeon at baseline (N = 322) and about 6 months after the visit (N = 283). Patients responded to the Impact Index and previously validated questionnaires about overall health, pain, and function. The Impact Index includes four questions that ask how much the respondent is bothered, worried, limited, or in pain due to their health condition over the past 30 days. Total scores range from 0 to 12; higher scores indicate more deleterious impact.

Results

Patients were mostly female (55%), majority white (95%), had an average age of 65 (SD = 9), and most had surgery (64%). The baseline Impact Index score was 9.48 (SD = 2.63); at follow up 4.75 (SD = 3.54). Impact Index was related to overall health at baseline (r =  − 0.49). For knee patients at baseline, Impact Index was negatively related to their knee symptoms (r =  − 0.49) and knee pain (r =  − 0.67). For hip patients at baseline, Impact Index was negatively related to the Harris Hip score (r =  − 0.62). Scale directions varied; however, the signs of all correlations were as hypothesized. The Impact Index was predictive of surgical choice (p < .001, OR = 1.45), however, overall health (p = .88) and comorbidity (p = .24) measures were not. Reliability was acceptable (α = 0.85). Responsiveness statistics suggested overall health, pain, function, and Impact Index measures reflected improvement patients experienced from surgery. The Impact Index had the largest effect sizes (> − 3.4) and Guyatt Responsiveness Statistics (> − 2.3).

Conclusions

The Impact Index demonstrated strong evidence of validity, reliability, and responsiveness in hip or knee osteoarthritis patients.

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Data availability

Data can be accessed by contacting Drs. Barry or Sepucha and completing the necessary Institutional Review Board and data use agreements.

Code availability

All analytic code is provided in an R markdown document located in the Open Science Framework Repository here: osf.io/hrwp4.

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Acknowledgements

The study was funded in part through a Patient-Centered Outcomes Research Institute® (PCORI) Award (CDR#1503-28799). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. Drs. Barry’s and Brodney’s time were funded in part through a grant from Healthwise, Incorporated, a nonprofit.

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Authors and Affiliations

  1. Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA

    K. D. Valentine, S. Brodney, Ha Vo, Karen Sepucha & Michael J. Barry

  2. Harvard Medical School, Boston, MA, USA

    K. D. Valentine, Karen Sepucha & Michael J. Barry

  3. Center for Survey Research, University of Massachusetts, Boston, Boston, MA, USA

    Floyd J. Fowler

Authors
  1. K. D. Valentine
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  2. S. Brodney
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  3. Ha Vo
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  4. Karen Sepucha
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  5. Floyd J. Fowler
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  6. Michael J. Barry
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Contributions

Each author has contributed significantly to, and is willing to take public responsibility for, one or more aspects of the study. All authors have been actively involved in the drafting and critical revision of the manuscript, and each has provided final approval of the version submitted. Study design: HV, KS. Data acquisition: HV, KS. Analysis and interpretation: KDV, SB, HV, KS, FF, MJB. Drafting and critical revision of the manuscript: KDV, SB, HV, KS, FF, MJB.

Corresponding author

Correspondence to Michael J. Barry.

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Conflict of interest

With regards to potential conflicts of interest for this study. Drs. Fowler and Valentine have no conflicts of interest to disclose. Both Drs. Barry and Brodney receive Grant funding through Massachusetts General Hospital from Healthwise, a nonprofit.

Ethical approval

Partners Human Research Committee was the Central Institutional Review Board for the study. The DECIDE-OA study is registered on Clinicaltrials.gov (# NCT02729831).

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Valentine, K.D., Brodney, S., Vo, H. et al. Validation of the Impact Index: can we measure disease effects on quality of life in patients with hip and knee osteoarthritis?. Qual Life Res 30, 1191–1198 (2021). https://doi.org/10.1007/s11136-020-02728-7

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  • DOI: https://doi.org/10.1007/s11136-020-02728-7

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