Is the SF‐12 version 2 Health Survey a valid and equivalent substitute for the SF‐36 version 2 Health Survey for the Chinese?

Rationale and objectives The scoring algorithm of the 12‐item Short‐Form Health Survey (SF‐12) was revised in the second version (SF‐12v2), but information on its psychometric properties is lacking. This study determined whether the SF‐12v2 was a valid and equivalent substitute for the SF‐36v2 Health Survey (version 2) for the Chinese. Methods A total of 2410 Chinese adults in Hong Kong completed the SF‐36 Health Survey by telephone. The SF‐12v2 data were extracted from the SF‐36 data. Internal consistency was assessed by Cronbach's alpha, and test–retest reliabilities were evaluated by intraclass correlation. Criterion validity and equivalence were assessed using the SF‐36v2 scores as a gold standard. Construct validity and sensitivity were assessed by known‐group comparison. Results Internal consistency and test–retest reliabilities were good (range 0.67–0.82) for all except three scales. The SF‐12v2 summary scores explained >80% of the total variances of the SF‐36v2 summary scores. Construct validity and sensitivity were confirmed by significantly lower SF‐12v2 scores in people with chronic diseases than those without. Effect size differences were less than 0.3 and relative validities were greater than 0.7 between SF‐12v2 and SF‐36v2 scores for different groups. Conclusion The SF‐12v2 was valid, reliable and sensitive for the Chinese. It is an equivalent substitute for the SF‐36v2 for the summary scales.     

Health-related quality of life, disability and severity of disease in patients with migraine attending to a specialty headache center

(Headache 2010;50:1576‐1586) Background.— The impact of migraine on patients’ daily life has been evaluated in several studies. The relationship between disability and health‐related quality of life (HRQoL) in patients with migraine, however, has not been systematically evaluated. Objective.— To assess the impact of migraine on patients’ HRQoL and disability patterns and to describe the relationship between disability and HRQoL in patients with migraine attending a specialty Italian headache center according to the biopsychosocial model of disability endorsed by the International Classification of Functioning, Disability and Health. Methods.— In this observational study, adult patients with migraine were consecutively recruited. Disability was measured with the MIDAS (Migraine Disability Assessment) and the WHO‐DAS II (World Health Organization Disability Assessment Schedule), HRQoL with the SF‐36 (Medical Outcome Survey 36‐item Short‐Form Health Survey). Spearman's rank correlation between MIDAS score, SF‐36 and WHO‐DAS II scales was performed to evaluate the relationships between quality of life and disability. The impact of migraine on disability and HRQoL was assessed by comparing WHO‐DAS II and SF‐36 scores against Italian normative values, and by evaluating the different disability and HRQoL profiles in patients with different severity of migraine, defined according to migraine frequency and pain intensity. Results.— A total of 102 patients with migraine (87 females) were enrolled. Mild to moderate correlations were reported between WHO‐DAS II and SF‐36's PCS (r = ?0.67, P < .01) and MCS (r = ?0.36, P < .05) scales; MIDAS score correlations to SF‐36's PCS (r = ?0.44, P < .01) and MCS (not significant) were lower than WHO‐DAS II summary score. The correlation between MIDAS score and the WHO‐DAS II summary score was mild (r = ?0.36, P < .05). The majority of HRQoL and disability scales (with the exception of SF‐36's Physical Functioning, and WHO‐DAS II Getting along with people scales) scored significantly lower than normative values. A trend towards worsening of both HRQoL and disability, consistent with increasing migraine severity, was reported (Mann‐Whitney's U = 119.5 for MIDAS; U = 113.0 for WHO‐DAS II summary score, both with P < .01; U = 152.9 for PCS; U = 171.0 for MCS, both with P < .05) Conclusions.— In migraineurs attending an Italian specialty headache clinic, disability scores were worse and HRQoL scores lower than those of the general population, and worsened consistently with increased migraine severity. Measures of HRQoL and disability evaluate different psychosocial aspects of migraine and researchers should continue to employ them in public health and clinical research on migraine. They provide information on a poorly recognized part of migraine's burden, where economic impact is minimal but there are important effects on patients’ daily lives in terms of interpersonal relationships, perceived quality of life and emotional status.     

Construct validity of the SF-12 in three different samples

Rationale, aims and objectives Studies have challenged the validity and underlying measurement model of the physical and mental component summary scores of the 36‐item Short‐Form Health Survey in, for example the elderly and people with neurological disorders. However, it is unclear to what extent these observations translate to physical and mental component summary scores derived from the 12‐item short form (SF‐12) of the 36‐item Short‐Form Health Survey. This study evaluated the construct validity of the SF‐12 in elderly people and people with Parkinson's disease (PD) and stroke. Methods SF‐12 data from a general elderly (aged 75+) population (n = 4278), people with PD (n = 159) and stroke survivors (n = 89) were analysed regarding data quality, reliability (coefficient alpha) and internal construct validity. The latter was assessed through item‐total correlations, exploratory and confirmatory factor analyses. Results Completeness of data was high (93–98.8%) and reliability was acceptable (0.78–0.85). Item‐total correlations argued against the suggested items‐to‐summary scores structure in all three samples. Exploratory factor analyses failed to support a two‐dimensional item structure among elderly and stroke survivors, and cross‐loadings of items were seen in all three samples. Confirmatory factor analyses showed lack of fit between empirical data and the proposed items‐to‐summary measures structure in all samples. Conclusions These observations challenge the validity and interpretability of SF‐12 scores among the elderly, people with PD and stroke survivors. The standard orthogonally weighted SF‐12 scoring algorithm is cautioned against. Instead, when the assumed two‐dimensional structure is supported in the data, oblique scoring algorithms appear preferable. Failure to consider basic scoring assumptions may yield misleading results.     

Measurement properties of the short form (SF)-12 applied to patients with stroke

The purpose of this study was to examine the reliability and validity of the Short Form (SF)-12 and to determine its ability to detect changes in health related quality of life (HRQOL) following stroke. The study involved a cohort of 90 patients admitted with an ischemic stroke to a hospital in the northeastern United States. The items of the SF-12 were found to be reliable (alpha=0.833-0.894) and to load on a physical and mental component. Three months post-stroke the physical component summary (PCS) scores of the SF-12 were significantly less than population norms. The PCS scores were also lower after stroke (3 month=42.5, 12 month=46.3) than before stroke (48.8). Mental component summary (MCS) scores did not differ significantly from population norms or across time (range=53.6 to 54.9). We conclude that the reliability and validity of the SF-12, as well as its brevity and capacity to document changes in the physical component of HRQOL, provide support for its use in patients with stroke.     

Health status rated with the Medical Outcomes Study 36-Item Short-Form Health Survey after spinal cord injury

OBJECTIVE: To describe the health status of Australians with spinal cord injury (SCI). DESIGN: Survey. SETTING: Australian population-based sample. PARTICIPANTS: Participants (N=305) with SCI at recruitment to a randomized trial. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) health questionnaire. RESULTS: Compared with the general population, our sample reported significantly lower scores in 6 SF-36 domains (physical function, role-physical, bodily pain, general health, social function, vitality) and the physical component summary (PCS) score, but unexpectedly higher mental component summary (MCS) scores (difference in mean MCS scores, 4.6; 95% confidence interval [CI], 2.4-6.8). Compared with people with tetraplegia, those with paraplegia had better physical function and PCS scores (difference, 21; 95% CI, 17-24; difference, 3; 95% CI, 1-5, respectively), and worse bodily pain scores (difference, 9; 95% CI, 2-15). Recent urinary infections were associated with worse general health, vitality, mental health, and MCS scores. Receiving family or external physical care was associated with worse physical function and PCS scores, but better mental health and MCS scores. Older age at injury was associated with lower bodily pain and PCS scores. CONCLUSIONS: Using the SF-36, Australians with SCI rate their physical (not mental) health status as worse than the general population.     

The effects of gender and age on health-related quality of life following kidney transplantation

Aims and objectives. To evaluate whether gender, age and their interaction affect health‐related quality of life and overall health status following kidney transplantation. Background. Some investigators have examined the main effects of gender and/or age on health‐related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported. Design. This was a cross‐sectional, single‐centre study, based in one US geographic area. Methods. Self‐report survey data were provided by adult kidney transplant recipients using the SF‐36 Health Survey (SF‐36) and a visual analogue scale of overall health. SF‐36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post‐transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post‐transplant). Results. Subjects (n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (all p ≥ 0·12). Physical component summary scale data demonstrated: (i) a significant effect of gender (p = 0·025); (ii) a statistically marginal effect of age group (p = 0·068); and (iii) a statistically marginal gender by age group interaction effect (p = 0·066). Women reported poorer scores on the SF‐36 physical functioning (p = 0·049), role physical (p = 0·014) and bodily pain scales (p = 0·028). There was an effect of age group on physical functioning (p = 0·005), with younger patients reporting higher scores. Conclusions. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health‐related quality of life than men. Physical functioning declines with age following kidney transplantation. Relevance to clinical practice. Findings may help healthcare professionals to develop gender‐ and age‐specific interventions to optimize health‐related quality of life of kidney transplant patients.     

Validity, reliability, and responsiveness of the work productivity and activity impairment questionnaire in Crohn's disease

Background: Crohn's disease (CD) is a chronic inflammatory bowel disease usually diagnosed in early adult life and characterized by unpredictable flares and debilitating symptoms such as diarrhea, abdominal pain, and fever, which can interfere with a patient's ability to work and perform daily activities. Objective: The aim of this study was to assess the validity, reliability, and responsiveness of the Work Productivity and Activity Impairment questionnaire in CD (WPAI:CD). Methods: The WPAI:CD was tested in CD patients enrolled in a 26-week randomized clinical trial of cer-tolizumab pegol versus placebo. Discriminative validity of WPAI:CD absenteeism, presenteeism(reduced on-the-job effectiveness), overall work productivity loss (absenteeism + presenteeism), and activity impairment scores was assessed relative to 5 measures of disease severity and health status: CD Activity Index (CDAI), Short Form-36 physical component summary (PCS) and mental health component summary (MCS) scores, Inflammatory Bowel Disease Questionnaire (IBDQ), and the 5-dimensional EuroQoL health-related quality-of-life visual analog scale (EQ-VAS). Responsiveness was assessed by comparing changes in WPAI:CD scores from baseline to week 26 for patients in remission (CDAI <150 points) versus no remission. Standardized Response Means (SRMs) were calculated to evaluate the magnitude of the changes. Results: A total of 662 patients (mean [range] age, 37.4 [18-77] years; male, 288 [43.5%]; white, 629 [95.0%]) were enrolled in the study. Patients with CD of the worst severity (CDAI > median) showed significantly higher impairment in work (+10.5%) and activities (+10.4%) versus patients with "best health" (no problems) (both, P 0.5) for patients in remission. Conclusions: The discriminative validity, reliability, and responsiveness of the WPAI:CD were demonstrated. The WPAI:CD may be useful for evaluating drug impact on CD.     

A psychometric evaluation of the Chinese version of the Cardiovascular Limitations and Symptoms Profile in patients with coronary heart disease

Aims and objectives. The aim of this study was to translate from English and evaluate the validity, reliability and cultural relevance of the Cardiovascular Limitations and Symptoms Profile (CLASP) as a health‐related quality‐of‐life (HRQL) measure in Chinese patients with coronary heart disease. Background. Improvement in HRQL is increasingly used as a primary outcome in determining the treatment benefit using a generic instrument. However, disease‐specific instruments are being cited as more responsive and sensitive in detecting even the smallest changes in health status. Therefore, valid and reliable disease‐specific measures for patients with coronary heart disease are now being developed and evaluated. Design. Questionnaire design. Methods. The translation equivalence and content validity of the Chinese version of CLASP were evaluated by an expert panel. Measurement performance was tested on a convenience sample of 369 Chinese coronary heart disease patients. Results. The instrument demonstrated good content validity (content validity index 0·94), acceptable internal consistency (>0·70), except for two subscales of angina and tiredness and significant positive correlations among the subscales of CLASP, Hospital Anxiety Depression Scale and the Short Form 36 Health Survey. Principal components analysis revealed nine factors that together explained 69% of the variance. Conclusions. The results of this study support that CLASP is a valid and reliable disease‐specific health status measure for Chinese patients with coronary heart disease. However, further item modifications and testings are needed when considering the cross‐cultural context. Relevance to clinical practice. The use of disease‐specific HRQL measures could effectively evaluate nursing interventions in clinical practice. Further validations of CLASP among different diagnostic groups, such as patients with heart failure and those who have survived an acute myocardial infarction, would provide further empirical support for its use with all patients with heart disorders.     

Quality of life and depression of people living with type 2 diabetes mellitus and those at low and high risk for type 2 diabetes: findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD)

Objectives: This study compared health‐related quality of life (HRQoL) and depression among individuals with type 2 diabetes mellitus (T2D) and those at low or high risk for T2D. Methods: Respondents in a population‐based US 2004 survey reported whether they had T2D (n = 3530) or risk factors for T2D [abdominal obesity, body mass index (BMI) ≥ 28 kg/m², dyslipidaemia, hypertension and history of cardiovascular disease]. Respondents without T2D were stratified into low risk (0–2 risk factors, n = 5335) and high risk (3–5 risk factors, n = 5051). SF‐12 version 2 (SF‐12) and Patient Health Questionnaire (PHQ)‐9 were used to measure HRQoL and depression. Mean scores were compared across the three groups using analysis of variance. Linear regression identified factors associated with SF‐12 Physical and Mental Component Summary scores (PCS and MCS), adjusting for age, gender, race, income, geographic region, household size, BMI and group. Results: Respondents were mostly women (60%) with mean age of 54 years. Mean PCS scores for T2D and high risk (39.5 and 41.7, respectively) were significantly lower than for low risk (50.6, p < 0.001). After adjustment, high‐risk and T2D groups were associated with lower PCS and MCS scores compared with low risk group (p < 0.05). Mean PHQ‐9 scores and per cent with moderate‐to‐severe depression were significantly higher for T2D and high risk than for low risk (p < 0.01). Conclusions: Health‐related quality of life and depression scores in T2D were similar to those at high risk, and indicated significant decrements in physical health and greater depression compared with low‐risk respondents.     

The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12

Objective: The current review describes how the health status profile of people with fibromyalgia (FM) compares to that of people in the general population and patients with other health conditions. Methods: A review of 37 studies of FM that measured health status with the 36‐item Medical Outcomes Study Short‐Form Health Survey (SF‐36) or the 12‐item Short‐Form Health Survey (SF‐12). Results: Studies performed worldwide showed that FM groups were significantly more impaired than people in the general population on all eight health status domains assessed. These domains include physical functioning, role functioning difficulties caused by physical problems, bodily pain, general health, vitality (energy vs. fatigue), social functioning, role functioning difficulties caused by emotional problems and mental health. FM groups had mental health summary scores that fell 1 standard deviation (SD) below the general population mean, and physical health summary scores that fell 2 SD below the general population mean. FM groups also had a poorer overall health status compared to those with other specific pain conditions. FM groups had similar or significantly lower (poorer) physical and mental health status scores compared to those with rheumatoid arthritis, osteoarthritis, osteoporosis, systemic lupus erythematosus, myofacial pain syndrome, primary Sjögren's syndrome and others. FM groups scored significantly lower than the pain condition groups mentioned above on domains of bodily pain and vitality. Health status impairments in pain and vitality are consistent with core features of FM. Conclusions: People with FM had an overall health status burden that was greater in magnitude compared to people with other specific pain conditions that are widely accepted as impairing.     

Validity and reliability study on traditional Chinese FACT-C in Chinese patients with colorectal neoplasm

Objective To establish the validity and reliability of traditional Chinese version of the Functional Assessment of Cancer Therapy‐Colorectal (FACT‐C). Methods A total of 536 subjects self‐administered (n = 331) or interviewer‐administered (n = 205) FACT‐C (version 4), EORTC QLQ‐C30/CR38 and SF‐12v2 instruments for health‐related quality of life assessment. Construct validity was examined by item–scale correlation, scaling success and concurrent validity. Reliability was evaluated by test–retest reliability and internal consistency. Sensitivity was assessed by known‐groups comparisons. Results The completion rates for FACT‐C were almost perfect (>98%). The FACT‐C demonstrated item‐internal consistency and item discriminant validity through item–scale correlation. Scaling success and concurrent validity were satisfactory to support the construct validity. The five subscales of the FACT‐C showed good internal consistency with Cronbach alpha coefficient and substantial reproducibility, demonstrating good reliability. Sensitivity was supported when there were significant differences in scores related to physical condition between patients who were receiving treatment and those who were not. Conclusion Traditional Chinese version of the FACT‐C was demonstrated to have satisfactory psychometric properties in terms of applicability, reliability, validity and sensitivity in Chinese patients with colorectal neoplasm. The FACT‐C was valid colorectal‐specific health‐related quality of life tool for the Chinese population.     

A comparative study of patient perceived quality of life pre and post coronary artery bypass graft surgery.

OBJECTIVE: Traditionally, evaluation of outcome post cardiac surgery has focused on objective measures of cardiovascular status. The emphasis has shifted to examining an individual's quality of life (QoL). However a gap in Australian prospective research assessing QoL from a pre-operative period to the early stage of six weeks post-operatively exists. The aim of this study was to investigate recovery from coronary artery bypass graft surgery (CABGS) on the basis of patient perceived QoL and in particular, physical and mental health. DESIGN AND SETTING: Prospective longitudinal quasi-experimental study in a tertiary hospital in Melbourne, Australia. SUBJECTS: Fifty four patients undergoing their first or second CABGS completed pre- and post-operative questionnaires. MAIN OUTCOME MEASURES: The Short Form 36 (SF-36) questionnaire was used to measure physical and mental QoL pre- and post CABGS and gives eight domain scores as well as a physical (PCS) and mental component summary score (MCS). RESULTS: SF-36 scores following CABGS were significantly improved in three of the eight domains: physical functioning (p < 0.001); general health perception (p < 0.001); energy/vitality (p < 0.005); and PCS (p < 0.001). No statistical difference was found in patients' MCS pre- and post-operatively. Of importance, patients reported higher levels of pain at six weeks post-operatively compared to their pre-operative levels but scores were not significantly different. CONCLUSIONS: The SF-36 demonstrates improvements in physical QoL six weeks after CABGS compared to preoperative results but no difference in mental QoL suggesting psychological adaptation. An increase in the pain score at six weeks suggests inadequate pain management in these patients.     

Patients reported health-related quality of life five years post coronary artery bypass graft surgery--a methodological study.

BACKGROUND: The number of individuals undergoing Coronary Artery Bypass Graft Surgery (CABGS) to treat coronary artery disease is steadily increasing. AIM: The purpose of the study was to describe the cohort's characteristics, their angina and breathless symptoms and report health-related quality of life (HRQoL) five years after CABGS. METHODS: One hundred and twenty-eight patients participated in the follow-up study using the quality of life Short-Form 36 (SF-36) questionnaire. Angina and breathless symptoms were also recorded. RESULTS: One hundred and nine patients were interviewed (face-to-face) and 19 completed postal questionnaires. The SF-36 component summaries of the face-to-face patients indicated that their physical (PCS) and mental (MCS) health was relatively good (45.8 and 53.6, respectively, with 0=worst health and 100=best health and 50 being the mean score), compared to the postal patients' mean PCS of 30.8 (p<.001). The postal MCS was also lower but not statistically significant (49.6, p=.081). At follow-up, the majority of patients were asymptomatic in terms of angina and breathlessness compared to their pre-operative status. CONCLUSION: The findings demonstrate that patient perceived HRQoL five years after CABGS is generally good and patients remain relatively asymptomatic although data collection methods highlight differences in physical HRQoL.     

Assessment of quality of life in haemodialysis patients: A comparison of the Nottingham Health Profile and the Short Form 36

This study aimed to compare the psychometric properties of the Nottingham Health Profile (NHP) and the Medical Outcomes Study Short Form Health Survey (SF‐36), which evaluates health‐related quality of life in haemodialysis patients. Data were gathered using the NHP and the SF‐36. Quality of life scores obtained from the NHP and the SF‐36 were compared according to sociodemographic characteristics. It was found that the internal consistency values of the NHP and the SF‐36 were similar. The floor effect of the two NHP subscales and the ceiling effect of all the NHP subscales were higher than those pertaining to the. It was observed that the NHP mean subscale scores were higher than those of the SF‐36, except for one subscale of the SF‐36. There was a significant positive correlation between the similar subscales of the NHP and the SF‐36 and between the total scores. These results seem to support the utility of the NHP and the SF‐36 in evaluating quality of life in haemodialysis patients.     

Improved health-related quality of life 12 months after bypass or angioplasty for peripheral arterial disease

Revascularization procedures are known to have a favorable influence on multiple outcomes for patients with peripheral arterial disease. Their affect on health-related quality of life (HRQOL) is less certain. This study was conducted to document changes in HRQOL associated with revascularization procedures and to identify variables associated with HRQOL and changes in HRQOL 12 months after revascularization. Forty-four patients undergoing arterial bypass or angioplasty improved significantly in their HRQOL as measured by the physical component summary (PCS) and mental component summary (MCS)scales of the SF-12. These measurements of HRQOL at 12 months were most highly correlated with the same measures at baseline. For the 12-month PCS, regression analysis showed that a higher baseline PCS, a greater improvement in vascular status, and a higher baseline MCS were predictive of higher scores. For the change in PCS, regression analysis revealed that men with lower baseline PCS scores showed the greatest improvements. Higher 12-month MCS but lesser changes in MCS were shown by regression analysis to be predicted by a higher baseline MCS. Obesity contributed positively to 12-month MCS but negatively to MCS change. In conclusion, the results of this study verify that HRQOL can be improved by revascularization procedures, but that HRQOL at 12 months and improvement in HRQOL are determined by baseline measures. (J Vasc Nurs 2000;18:75-82)     

Treatment-related side effects and quality of life in cancer patients

Background

Cancer leads to a complicated pattern of change in quality of life (QoL).

Objective

The aims of this study were to assess the impact of treatment-related side effects on QoL in cancer patients and to explore which other factors, and to what extent, contribute to explain low QoL scores.

Methods

One hundred twenty-three cancer patients receiving chemotherapy completed the self-administered questionnaires (Medical Outcomes Short-Form-36 (SF-36) and 12-item General Health Questionnaire). Multiple regression analyses were conducted with the SF-36 physical component summary (PCS) and SF-36 mental component summary (MCS) scores as the dependent variables and demographic and clinical factors as independent variables.

Results

Seventy-two percent of patients experienced treatment-related side effects, and 32% resulted positive for psychiatric diseases. Two multivariate analyses showed that worse PCS scores, like worse MCS scores, were significantly and independently predicted by treatment-related side effects (odds ratio (OR)?=?5.00, 95%CI 1.29–19.45; OR?=?8.08, 95%CI 2.03–32.22, respectively) and changes in health over the last 12?months (OR =2.34, 95%CI 1.47–3.76; OR?=?3.21, 95%CI 1.90–5.41, respectively), after adjustment for age, gender, years of school, time from cancer diagnosis, and psychiatric disease.

Conclusions

Given the new emphasis on QoL, we suggest that physicians have a responsibility to openly discuss therapy efficacy, prognosis as well as the potential for adverse events with their patients. Changes in health, as perceived by patient, should also be monitored at follow-up.     

Quality-of-life assessment in an outpatient parenteral antibiotic program

OBJECTIVE: To measure changes and to identify predictors of change of health-related quality of life (HRQoL) for enrollees into an outpatient parenteral antibiotic therapy (OPAT) program. METHODS: A multidisciplinary, single-center, prospective investigation was conducted at a 1000-bed Canadian adult tertiary-care teaching hospital. Over a 15-month study period, consenting patients who were enrolled in the OPAT program completed paired Short Form-36 (SF-36) questionnaires within 48 hours prior to discharge from the hospital and again 26-30 days after discharge. Sociodemographic data and clinical variables were also collected for the purpose of determining potential predictors of change in quality of life. RESULTS: During the study period, 134 patients were enrolled in the OPAT program and 82 completed the paired SF-36 questionnaires. Study participants experienced a significant improvement in 3 SF-36 domains (physical functioning, bodily pain, role emotional) and the mental component summary scale (MCS) scores when they were transferred from the hospital to home setting. The SF-36 scores for all domains and summary scales were lower than the Canadian population average (all p < 0.001). Multiple linear-regression analysis revealed that infectious disease diagnosis and baseline physical component summary scale (PCS) scores were predictors of the change in the PCS score when patients transferred from the hospital to the home setting. Length of hospital stay and baseline MCS scores were predictors of the change in MCS scores when patients transferred from the hospital to the home setting. CONCLUSIONS: This study reveals that some domains in HRQoL appear to improve 4 weeks after discharge for adults enrolled in an OPAT program and that there are different predictors for changes in physical and mental health.     

Problems in using health survey questionnaires in older patients with physical disabilities. The reliability and validity of the SF-36 and the effect of cognitive impairment

Reliability and validity of the SF‐36 Health Survey Questionnaire was assessed in older rehabilitation patients, comparing cognitively impaired with cognitively normal subjects. The SF‐36 was administered by face‐to‐face interview to 314 patients (58–93 years) in the day hospital and rehabilitation wards of a department of medicine for the elderly. Reliability was measured using Cronbach’s alpha (for internal consistency) on the main sample and intraclass correlation coefficients on a test–retest sample; correlations with functional independence measure (FIM) were examined to assess validity. In 203 cognitively normal patients (Mini‐Mental State Examination ≥24), Cronbach’s alpha scores on the eight dimensions of the SF‐36 ranged from 0.545 (social function) to 0.933 (bodily pain). The range for the 111 cognitively impaired patients was 0.413–0.861. Cronbach’s alpha values were significantly higher (i.e. reliability was better) in the cognitively normal group for bodily pain (P = 0.003), mental health (P = 0.03) and role emotional (P = 0.04). In test–retest studies on a further 67 patients, an intraclass correlation coefficient of 0.7 was attained for five out of eight dimensions in cognitively normal patients, and four out of eight dimensions in the cognitively impaired. Only the physical function dimension in the cognitively normal group attained the criterion level (r > 0.4) for construct validity when correlated with the FIM. In this group of older physically disabled patients, levels of reliability and validity previously reported for the SF‐36 in younger subjects were not attained, even on face‐to‐face testing. Patients with coexistent cognitive impairment performed worse than those who were cognitively normal.     

Validity and reliability of Turkish Caregiver Burden Scale among family caregivers of haemodialysis patients

Aims and objectives. To investigate the validity and reliability of the Caregiver Burden Scale in family members who provide primary care for haemodialysis patients. Background. In Turkey, there is a need for a multi‐dimensional instrument to evaluate the caregiver burden in people who provide care for patients with chronic diseases. Design. A methodological study. Methods. The study sample consisted of 161 family members who provide primary care for haemodialysis patients. The forward‐backward translation method was used to develop the Turkish Caregiver Burden Scale. The reliability was based on internal consistency investigated by Cronbach’s alpha and item–total correlation. The factorial construct validity of the scale was tested with confirmatory factor analysis. By means of convergent and divergent validity, correlation between Caregiver Burden Scale and 36‐Item Short Form Health Survey (SF‐36) and correlation between Caregiver Burden Scale and the Maslach Burnout Scale were investigated. Results. Cronbach’s alpha and item–total correlations results suggested that there was good internal reliability. We found five underlying factors similar to original Scale’s five‐factor solution. The confirmatory factor analysis five‐factor model represented an acceptable fit. Factor loadings were significant, with standardised loadings ranging from 0·43–0·81. By means of divergent validity, all sub‐dimension scores and the total score of the Caregiver Burden Scale were negatively correlated with the SF‐36, whereas there was a positive correlation with the emotional exhaustion and depersonalisation subscales of the Maslach Burnout Scale as expected. Conclusion. These results suggest that the Caregiver Burden Scale is a reliable and valid instrument which can be used with confidence in Turkish caregivers for haemodialysis patients to screen caregiver burden. Relevance to clinical practice. The burden experienced by people who provide care for patients with chronic diseases can be evaluated with the Caregiver Burden Scale. Additionally, the Caregiver Burden Scale can be used in the evaluation of the effectiveness of attempts to decrease caregiver burden.