Open Access Research article

Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation

Karen R Sepucha1*, Dawn Stacey2, Catharine F Clay3, Yuchiao Chang4, Carol Cosenza5, Geoffrey Dervin6, Janet Dorrwachter7, Sandra Feibelmann8, Jeffrey N Katz9, Stephen A Kearing10, Henrik Malchau11, Monica Taljaard12, Ivan Tomek13, Peter Tugwell14 and Carrie A Levin15

Author Affiliations

1 General Medicine Division, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, USA

2 Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI) and Faculty of Health Sciences, University of Ottawa (U of O), Ottawa, Canada

3 Center for Shared Decision Making, Dartmouth-Hitchcock Medical Center, Lebanon NH USA

4 General Medicine Division, MGH, HMS, Boston, MA, USA

5 Center for Survey Research, University of Massachusetts Boston, MA USA

6 Division of Orthopaedic Surgery, The Ottawa Hospital and U of O, Ottawa, Canada

7 Department of Orthopedic Surgery, MGH Boston MA, USA

8 General Medicine Division, MGH Boston MA, USA

9 Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, HMS, Boston, MA USA

10 The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School (DMS), Lebanon, NH, USA

11 Department of Orthopedic Surgery, MGH, HMS, Boston, MA, USA

12 Clinical Epidemiology Program, OHRI and Department of Epidemiology and Community Medicine, U of O, Ottawa, Canada

13 Department of Orthopedic Surgery, DMS, Lebanon, NH USA

14 Department of Medicine, Ottawa Hospital; Senior Scientist, OHRI, Ottawa, Canada

15 Foundation for Informed Medical Decision Making, Boston, MA USA

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BMC Musculoskeletal Disorders 2011, 12:149  doi:10.1186/1471-2474-12-149

Published: 5 July 2011



A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis.


The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined.


In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not.


The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals.

shared decision making; patient centered care; quality measurement; osteoarthritis; total joint replacement; decision quality