Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users

Abstract

Recent advances in upper limb prosthetics include sensory restoration techniques and osseointegration technology that introduce additional risks, higher costs, and longer periods of rehabilitation. To inform regulatory and clinical decision making, validated patient reported outcome measures are required to understand the relative benefits of these interventions. The Patient Experience Measure (PEM) was developed to quantify psychosocial outcomes for research studies on sensory-enabled upper limb prostheses. While the PEM was responsive to changes in prosthesis experience in prior studies, its psychometric properties had not been assessed. Here, the PEM was examined for structural validity and reliability across a large sample of people with upper limb loss (n = 677). The PEM was modified and tested in three phases: initial refinement and cognitive testing, pilot testing, and field testing. Exploratory factor analysis (EFA) was used to discover the underlying factor structure of the PEM items and confirmatory factor analysis (CFA) verified the structure. Rasch partial credit modeling evaluated monotonicity, fit, and magnitude of differential item functioning by age, sex, and prosthesis use for all scales. EFA resulted in a seven-factor solution that was reduced to the following six scales after CFA: social interaction, self-efficacy, embodiment, intuitiveness, wellbeing, and self-consciousness. After removal of two items during Rasch analyses, the overall model fit was acceptable (CFI = 0.973, TLI = 0.979, RMSEA = 0.038). The social interaction, self-efficacy and embodiment scales had strong person reliability (0.81, 0.80 and 0.77), Cronbach’s alpha (0.90, 0.80 and 0.71), and intraclass correlation coefficients (0.82, 0.85 and 0.74), respectively. The large sample size and use of contemporary measurement methods enabled identification of unidimensional constructs, differential item functioning by participant characteristics, and the rank ordering of the difficulty of each item in the scales. The PEM enables quantification of critical psychosocial impacts of advanced prosthetic technologies and provides a rigorous foundation for future studies of clinical and prosthetic interventions.

Prosthesis usability experience is associated with extent of upper limb prosthesis adoption: A Structural Equation Modeling (SEM) analysis

“…The survey included demographic questions related to sex, Veteran status, race, and ethnicity. It also included the Trinity Amputee Prosthetic Evaluation Scale (TAPES)-Upper prosthesis satisfaction measure [ 30 ], the Orthotics and Prosthetics User Survey (OPUS), Client Satisfaction with Device (CSD) scale [ 31 ], three new subscales from a revised OPUS CSD (Comfort, Appearance, Utility) [ 32 ] and additional items and measures related to psychosocial adjustment [ 33 ], activity performance [ 34 , 35 ], patient experience [ 36 ], and residual limb health [ 37 ], and prosthesis affordability [ 38 ], all reported elsewhere.…”

Out-of-pocket costs and affordability of upper limb prostheses

“…The survey included demographic questions related to sex, Veteran status, race, and ethnicity. It also included the TAPES-Upper prosthesis satisfaction measure, 20 the OPUS CSD scale, 18 3 new subscales from a revised OPUS CSD (Comfort, Appearance, and Utility), 21 and additional items and measures related to psychosocial adjustment, 22 activity performance, 23,24 patient experience, 25 and residual limb health (details reported on elsewhere).…”

Measuring embodiment: A review of methods for prosthetic devices

“…Beyond the RHI questionnaire and its variants, other questionnaires have been developed to measure psychosocial experiences of prosthesis users, including aspects of embodiment (Imaizumi et al, 2016 ; Petrini et al, 2019 ; Rognini et al, 2019 ; Engdahl et al, 2020 ; Resnik et al, 2021 ; Sturma et al, 2021 ; Bekrater-Bodmann, 2022 ). For example, the Embodiment scale of the Patient Experience Measure assesses experiences of ownership and some aspects of body image using a Likert scale (Resnik et al, 2021 ). Resnik et al assessed the structural validity and reliability of the Patient Experience Measure across a large sample of people with upper limb loss ( n = 677).…”

“…This topic is timely, as many research, government, and industry groups have recently increased their interest in the embodiment of prosthesis technology (Bekrater-Bodmann, 2020 ; Zbinden et al, 2022 ). In addition, the lack of psychometrically valid measures for upper limb prostheses in particular is a known limitation in the field, and efforts are underway to validate measures of upper limb prosthesis function, psychosocial experience, and disability (Resnik and Borgia, 2012 , 2015 ; Resnik et al, 2013 , 2021 ).…”