Psychometric validation of the Coronary Revascularisation Outcome Questionnaire (CROQv2) in the context of the NHS Coronary Revascularisation PROMs Pilot

Abstract

ObjectivesThe Coronary Revascularisation Outcome Questionnaire (CROQ) is a patient-reported outcome measure (PROM) for coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). We tested the psychometric properties of a modified version (CROQv2) when administered in a National Health Service (NHS)/Department of Health (DH) funded pilot of PROMs for coronary revascularisation.DesignPsychometric validation study.Setting11 English hospitals in the UK taking part in the NHS/DH funded pilot of PROMs for coronary revascularisation.ParticipantsComprehensive analyses of acceptability, reliability, validity and responsiveness were conducted independently for each of the prerevascularisation (n=2685 and n=3711) and postrevascularisation (n=869 and n=837) versions of the CROQ-CABG and CROQ-PCI, respectively.ResultsAll versions met prespecified stringent criteria for (1) acceptability of items (missing data) and scales (missing data, floor and ceiling effects, skewness); (2) tests of scaling assumptions; (3) reliability: internal consistency (Cronbach's α, item-total correlations); (4) construct validity based on within-scale analyses (internal consistency, intercorrelations between scales, factor analysis and hypothesis testing); (5) construct validity based on comparisons with external measures (convergent and discriminant validity and hypothesis testing) and (6) responsiveness. Results were also confirmed when tests were repeated on subsamples of CABG (n=639) and PCI (n=615) patients who reported receiving help completing prerevascularisation questionnaires.ConclusionsThe availability of a psychometrically robust procedure-specific tool that could be used as part of a large-scale coronary revascularisation PROMs programme to capture the patients' perspective of coronary revascularisation will enable outcomes important to patients to be routinely collected alongside clinical outcomes. The CROQ is suitable for administration by postal survey or the prerevascularisation versions can be administered in the clinical setting as in the Coronary Revascularisation PROMs Pilot.

Translation and validation of the Norwegian version of the Coronary Revascularisation Outcome Questionnaire

“…Earlier studies have shown that patients with known heart disease tend to report lower HRQOL than patients without previous known disease. 13 In this study the patients with known heart disease scored significantly lower on four of the six CROQ scales. The CROQ’s satisfaction scale which includes questions about rehabilitation, treatment results and how the patients’ consider their heart disease now compared with before the PCI showed a significant difference between the groups.…”

“…The initial version of the CROQ was published in 2004, 4 but it has been revised and revalidated recently. 13 In recent years, the techniques of PCI treatment have evolved and the instrument has been modified to reflect these changes (CROQv2). Nowadays PCI is more often done via the radial artery than the femoral artery.…”

“…21 As such the items in version 2 of the CROQ-PCI post-revascularisation adverse effects scale now include treatment via the radial artery as an option. 13 In this study we only translated and validated the CROQ-PCI post-revascularisation (version 2).…”

“…Rigorous psychometric testing has shown that it is an acceptable, reliable, valid and responsive instrument. 4,12,13 The original version is in English but it has been translated using international guidelines into several languages. [14][15][16][17] This paper describes the translation and psychometric validation process for developing a Norwegian version of the CROQ-PCI post-revascularisation version using internationally recommended guidelines.…”

Outcomes following surgery: are we measuring what really matters?

“…This will collaborate with patients, carers, research groups and other relevant stakeholders through various methodologies including systematic reviews, expert consensus statements and Delphi processes in order to develop and harmonise outcome reporting . An example of what can be achieved was recently demonstrated in the NHS Coronary Revascularisation PROMs pilot study . The authors modified a pre‐existing, validated questionnaire (the Coronary Revascularisation Outcomes Questionnaire), which is used to measure outcomes before and after coronary revascularisation and undertook a psychometric validation study across 11 hospitals in England.…”