The Warwick Holistic Health Questionnaire : the development and validation of a patient-reported outcome measure for craniosacral therapy : a mixed methods study

• Main Author: Brough, Nicola
• Published: University of Warwick 2017
• Subjects: 610; RZ Other systems of medicine
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.759658

Aims: This thesis aims to design and evaluate a Patient Reported Outcome (PRO) capable of assessing change in Craniosacral Therapy (CST) users. CST is a mind-body based complementary therapy with limited evidence base partly due to lack of suitable PROs. Methods: Mixed methods including focus groups and cognitive interviews were adopted to develop and evaluate a conceptual framework and the new PRO (Warwick Holistic Health Questionnaire WHHQ). Classical Test Theory and Exploratory Factor Analysis were used for psychometric testing. Results: 1. A conceptual framework (CF) of CST outcomes was refined and approved in 3 focus groups of practitioners and CST users. 2. 73 items were generated covering domains of the CF from an existing qualitative study of CST outcomes and PRO literature. 3. Face and content validity was tested in a consensus meeting with practitioners and two round of semi-structure interviews with CST users. The WHHQ was refined accordingly (52 items). 4. The WHHQ was pre-tested in cognitive interviews. 5. Item response, construct validity and item redundancy was assessed in 142 CST users. 6. The WHHQ was refined to 25 items including representations of new concepts in healthcare evaluation. 7. Reliability, internal consistency, external validity (SF-12v2, WEMWBS and HEHIQ), repeatability and responsiveness were assessed with 105 new CST users. Conclusions: The conceptual framework of CST outcomes, the first of its kind, identifies important new domains of health and wellbeing including the development of self-awareness and the capacity to take responsibility for self. Measurement properties show the WHHQ is psychometrically sound, having good internal consistency and convergent validity with WEMWBS and HEHIQ. Test of repeatability showed mixed results: errors were bigger than the change value but comparable to WEMWBS and SF-12v2. Respondents reported improvements in health and wellbeing with small changes shown during evaluation of responsiveness. Testing in a larger sample might confirm these findings.