The use of self-report questions to examine the prevalence of musculoskeletal problems: a test-retest study

Abstract

BackgroundCase definition has long been an issue for comparability of results obtained for musculoskeletal pain prevalence, however the test-retest reliability of questions used to determine joint pain prevalence has not been examined. The objective of this study was to determine question reliability and the impact of question wording, ordering and the time between questions on responses.MethodsA Computer Assisted Telephone Interviewing (CATI) survey was used to re-administer questions collected as part of a population-based longitudinal cohort study. On two different occasions questions were asked of the same sample of 203 community dwelling respondents (which were initially randomly selected) aged 18 years and over at two time points 14 to 27 days apart (average 15 days). Reliability of the questions was assessed using Cohen’s kappa (κ) and intraclass correlation coefficient (ICC) and whether question wording and period effects existed was assessed using a crossover design.ResultsThe self-reported prevalence of doctor diagnosed arthritis demonstrated excellent reliability (κ = 0.84 and κ = 0.79 for questionnaires 1 and 2 respectively). The reliability of questions relating to musculoskeletal pain and/or stiffness ranged from moderate to excellent for both types of questions, that is, those related to ever having joint pain on most days for at least a month (κ = 0.52 to κ = 0.95) and having pain and/or stiffness on most days for the last month (κ = 0.52 to κ = 0.90). However there was an effect of question wording on the results obtained for hand, foot and back pain and/or stiffness indicating that the area of pain may influence prevalence estimates.ConclusionsJoint pain and stiffness questions are reliable and can be used to determine prevalence. However, question wording and pain area may impact on estimates with issues such as pain perception and effect on activities playing a possible role in the recall of musculoskeletal pain.

Epidemiology of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis among 1.5 million patients in Australian general practice: NPS MedicineWise MedicineInsight dataset

“…Using self-report data, the AIHW estimated that osteoarthritis affects 8.0% of all Australians adults, back pain 7.1%, osteoporosis 3.1%, and rheumatoid arthritis 1.9%. However, the use of self-reported information can undermine the ability to truly identify the scale of MSK within the population, especially for chronic pain, as the reliability of this information is also affected by question wording [ 15 ]. According to the BEACH program, chronic pain among Australian patients attending general practices changed from 18% in 2005 ( N = 3211) to 19% in 2008–09 ( N = 5793) [ 11 , 26 ].…”

“…A few surveys have used self-reported data to investigate the prevalence of these conditions among Australian adults [ 6 , 9 , 10 ], while the Bettering the Evaluation and Care of Health (BEACH) program reported encounter rates and medication use for MSK and chronic pain in adults attending a random sample of Australian general practices [ 11 , 12 ]. Estimates for MSK and chronic pain vary across studies and information bias has been highlighted as one of the reasons for these differences [ 13 – 15 ]. Self-report for chronic pain and some MSK is less accurate than for sociodemographic characteristics, lifestyle, or other chronic conditions, thus affecting the ability of population-based surveys to provide accurate estimates for the total burden of MSK [ 14 , 15 ].…”

“…Estimates for MSK and chronic pain vary across studies and information bias has been highlighted as one of the reasons for these differences [ 13 – 15 ]. Self-report for chronic pain and some MSK is less accurate than for sociodemographic characteristics, lifestyle, or other chronic conditions, thus affecting the ability of population-based surveys to provide accurate estimates for the total burden of MSK [ 14 , 15 ]. On the other hand, studies on this topic using nationally representative samples and based on medical diagnosis are scarce in the scientific literature [ 3 – 5 , 13 ].…”

Functional improvement in hip pathology improves anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being

“…Finally, concern regarding the validity and reliability of using self-report measures to evaluate musculoskeletal complaints has been documented in previous literature. 47,48 We attempted to addressed this issue by using validated assessments, but our reliance on using patient-reported outcomes to determine hip functionality and psychological comorbidity could affect the internal validity of the study.…”

The Accuracy of Self-report in Rheumatic Diseases

“…However, Lo, et al suggested caution with self-reported arthritis to determine prevalence because these authors demonstrated only moderate agreement between the self-report and the reference standard of musculoskeletal (MSK) signs or symptoms, and a sensitivity of 66.7% and specificity of 75.5% 4 . Other studies have demonstrated good to excellent recall of self-reported, doctor-diagnosed arthritis using population surveys 5,6 .…”