Bert M. Chesworth

The increased use of electronic medical records (EMRs) in Canadian primary health care practice has resulted in an expansion of the availability of EMR data. Potential users of these data need to understand their quality in relation to the uses to which they are applied. Herein, we propose a basic model for assessing primary health care EMR data quality, comprising a set of data quality measures within four domains. We describe the process of developing and testing this set of measures, share the results of applying these measures in three EMR-derived datasets, and discuss what this reveals about the measures and EMR data quality. The model is offered as a starting point from which data users can refine their own approach, based on their own needs. Using an iterative process, measures of EMR data quality were created within four domains: comparability; completeness; correctness; and currency. We used a series of process steps to develop the measures. The measures were then operationalized, and tested within three datasets created from different EMR software products. A set of eleven final measures were created. We were not able to calculate results for several measures in one dataset because of the way the data were collected in that specific EMR. Overall, we found variability in the results of testing the measures (e.g. sensitivity values were highest for diabetes, and lowest for obesity), among datasets (e.g. recording of height), and by patient age and sex (e.g. recording of blood pressure, height and weight). This paper proposes a basic model for assessing primary health care EMR data quality. We developed and tested multiple measures of data quality, within four domains, in three different EMR-derived primary health care datasets. The results of testing these measures indicated that not all measures could be utilized in all datasets, and illustrated variability in data quality. This is one step forward in creating a standard set of measures of data quality. Nonetheless, each project has unique challenges, and therefore requires its own data quality assessment before proceeding.

The Questionnaire to Identify Knee Symptoms (QuIKS) was recently developed to promote activity by screening for experiences related to early symptoms in people with emergent chronic knee pain problems, such as osteoarthritis (OA) – like knee pain. The main purpose of the current study was to evaluate measurement properties of the QuIKS using Rasch analysis in a sample of people with knee symptoms consistent with symptomatic knee OA. This study used cross-sectional data. The sample was 200 subjects along the following knee health continuum: pain-free healthy knees (n = 55) from a university community, knee pain with no knee OA diagnosis (n = 111) from a university-affiliated medical clinic, and patients with surgeon-diagnosed symptomatic knee OA awaiting high tibial osteotomy (n = 34) from a sports medicine surgical clinic. The 13-item QuIKS was evaluated for its factor structure, item- and person-fit, item’s category response structure, differential item functioning by sex and obesity status, local item dependency, unidimensionality, and test precision. Subsequently, the QuIKS underwent known-groups analysis and convergent validity with the Knee injury and Osteoarthritis Outcome Score (KOOS). In the QuIKS, each item’s category response structure was modified. No differential item functioning was observed. Local item dependency informed the formation of four testlets. This refined QuIKS obtained summary fit to the Rasch measurement model, unidimensionality, reliability (person separation index = 0.82), and interval-level scoring. Subsequently, the Rasch-validated QuIKS (QuIKS-R) demonstrated excellent known-groups validity and good convergent validity with the KOOS (Spearman’s rho = 0.45 to 0.77). The QuIKS-R provides interval-level quantification of knee symptoms-related experiences in people with knee symptoms consistent with symptomatic knee OA. Its scores might be useful for clinicians for promoting activity in individuals with early symptoms consistent with symptomatic knee OA.

A validated and reliable instrument was developed to knowledge, attitudes and behaviours with respect to evidence-based practice (EBB-KABQ) in medical trainees but requires further adaptation and validation to be applied across different health professionals. A modified 33-item evidence-based practice scale (EBP-KABQ) was developed to evaluate EBP perceptions and behaviors in clinicians. An international sample of 673 clinicians interested in treatment of pain (mean age = 45 years, 48% occupational therapists/physical therapists, 25% had more than 5 years of clinical training) completed an online English version of the questionnaire and demographics. Scaling properties (internal consistency, floor/ceiling effects) and construct validity (association with EBP activities, comparator constructs) were examined. A confirmatory factor analysis was used to assess the 4-domain structure EBP knowledge, attitudes, behavior, outcomes/decisions). The EBP-KABQ scale demonstrated high internal consistency (Cronbach’s alpha = 0.85), no evident floor/ceiling effects, and support for a priori construct validation hypotheses. A 4-factor structure provided the best fit statistics (CFI =0.89, TLI =0.86, and RMSEA = 0.06). The EBP-KABQ scale demonstrates promising psychometric properties in this sample. Areas for improvement are described.

Purpose: To examine the reliability, validity, and sensitivity to change of the 20-item version and the Rasch-refined 15-item version of the Upper Extremity Functional Index (UEFI-20 and UEFI-15, respectively) and to determine the impact of arm dominance on the positive minimal clinically important difference (pMCID). Methods: Adults with upper-extremity (UE) dysfunction completed the UEFI-20, Upper Extremity Functional Scale (UEFS), Pain Limitation Scale, and Pain Intensity Scale at their initial physiotherapy assessment (Time 1); 24–48 hours later (Time 2); and 3 weeks into treatment or at discharge, whichever came first (Time 3). Demographics, including working status, were obtained at Time 1. Global ratings of change (GRC) were provided by the treating physiotherapist and patient at Time 3. The UEFI-15 was calculated from relevant items in the UEFI-20. The intra-class correlation coefficient (ICC) and minimal detectable change (MDC) quantified test–retest reliability (Time 1–Time 2). Cross-sectional convergent validity was determined by the association (Pearson's r) between Time 1 measures of function and pain. Known-groups validity was evaluated with a one-way ANOVA across three levels of working status. Longitudinal validity was determined by the association (Pearson's r) between function and pain change scores (Time 1–Time 3). Receiver operating characteristic (ROC) curves estimated the pMCID using Time 1–Time 3 change scores and average patient/therapist GRC. Results: Reliability for the UEFI-20 and UEFI-15 was the same (ICC=0.94 for both measures). MDC values were 9.4/80 for the UEFI-20 and 8.8/100 for the UEFI-15. Cross-sectional, known-groups, and longitudinal validity were confirmed for both UEFI measures. pMCID values were 8/80 for the UEFI-20 and 6.7/100 for the UEFI-15; pMCID was higher for people whose non-dominant arm was affected. Conclusions: Both UEFI measures show acceptable reliability and validity. Arm dominance affects pMCID. The UEFI-15 is recommended because it measures only one dimension: UE function.

Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1) examine the characteristics of the family caregivers' experience of communication and information sharing and (2) identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers. Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8) and health care providers (n = 24). Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting. As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.

Purpose: To determine whether activity-modifying behaviour mediates the relationship between the severity of knee pain and each of physical function and knee-related quality of life. Methods: A total of 105 participants with medial knee pain and no diagnosis of knee osteoarthritis (mean age 52.2 [SD 6.7] y) completed two self-report questionnaires. The Questionnaire to Identify Knee Symptoms assessed activity-modifying behaviour; the Knee injury and Osteoarthritis Outcome Score assessed pain severity, physical function, and knee-related quality of life. Simple mediation analysis was performed using linear regression. Results: The unstandardized regression coefficient for activity-modifying behaviour revealed partial mediation of the effect of pain severity on physical function (0.31 (SE 0.09), ppConclusion: Activity-modifying behaviour partially mediates the relationship between pain severity and physical function and between pain severity and knee-related quality of life. Activity-modifying behaviour may thus counteract the impact of knee pain on physical function and knee-related quality of life, which explains why it is used by people with emergent knee pain.

Purpose: To examine reliability and validity of the Lunge Test (LT) of dorsiflexion range of motion and determine the impact of different approaches to obtain a score on these parameters. Methods: Fifty-three patients with ankle injury/dysfunction provided initial assessment data for cross-sectional convergent and known-groups validity analysis with the Pearson coefficient (r) and paired t-test, respectively; data after 4–8 weeks of treatment for longitudinal validity analysis with coefficient r; and data 3 days later for test–retest reliability using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). LT scores were determined for the affected leg only (LT_Aff) and for the difference between the two limbs (LT_Diff). Two strategies were used to calculate LT scores: a single series and the mean of three series of lunges. LTs were correlated with the Lower Extremity Functional Scale and Global Foot and Ankle Scale. Results: Reliability coefficients were high (ICC=0.93–0.99). The MDC=1.0/1.5 cm, LT_Aff/LT_Diff, respectively. Cross-sectional validity was confirmed for LT_Diff (r=−0.40 to −0.50). Between-limb differences (pDiff on initial assessment and either LT to assess change.