Developing outcome measures for patients with vascular conditions.

The electronic patient assessment questionnaire for vascular conditions (ePAQ-VAS) was developed by the Sheffield Vascular Research group. It consists of the following sections: generic, carotid artery disease, abdominal aortic disease, lower limb vascular disease and a second generic section that include EQ-5D. The six papers included in this thesis present some of the work I have done to develop ePAQ-VAS, including qualitative evidence synthesis, systematic reviews, developing the conceptual work and psychometric analysis. The first stages of developing ePAQ-VAS comprised of five systematic reviews to identify patient-reported outcome measures (PROMs) that can be directly included into ePAQ-VAS. These reviews did not identify any PROMs that fulfilled the psychometric criteria defined by the authors. Since no PROMs were identified, qualitative evidence synthesis was undertaken to develop new PROMs. This included five qualitative evidence synthesis reviews and a primary qualitative study that was completed before I joined the team. The qualitative evidence was used to develop the primary pool of ePAQ-VAS items. I helped develop the conceptual framework of ePAQ-VAS including a clinicians’ consensus study, and modifications of the instrument based on the face validity study. The last of the six papers in this PhD by publication is the paper on the validation of ePAQ-VAS. This paper presents the results of the survey in which vascular patients completed ePAQ-VAS. I used the data from this survey to perform factor analysis and reduce items from the instrument. The paper also presents the results of internal reliability, test-re-test, known-group validity and responsiveness analyses. In the additional chapters of this thesis, I have provided further insight into the methods used in developing ePAQ-VAS. ePAQ-VAS is a holistic tool for the assessment of patients with a vascular disease with acceptable validity, reliability and responsiveness. This tool can be used to measure outcomes to improve service provisions.