Spanish version of the Nottingham Health Profile: translation and preliminary validity.

We report the transfer into Spanish of a multi-dimensional measure of perceived health originally developed in Great Britain, the Nottingham Health Profile (NHP), and an assessment of the preliminary validity of the version is presented. Translation of the questionnaire was obtained from experts and from a Spanish monolingual lay group. Construct validity of the version was assessed in two studies: testing relationship of NHP scores to other self-reported measures of health in a general population survey; and comparing NHP scores for a group of frequent users and for a group of non-users of primary health services. Mean scores of NHP dimensions were higher for people with poorer self-reported health and higher for the frequent health services users than for the non-users. Findings suggest that the Spanish version of the NHP is culturally equivalent to the original questionnaire, and has a similar level of construct validity. Nevertheless, further research on reliability and on the weighting system is required to establish the equivalence of the Spanish version definitively.     

The Spanish version of the Nottingham Health Profile: a review of adaptation and instrument characteristics

The increased interest in measuring health status implies a need for instruments that are appropriate and valid. Adaptation of existing instruments may be a cost-effective strategy. In this paper we describe the adaptation into Spanish of the Nottingham Health Profile (NHP), a self-administered perceived health questionnaire developed in the UK. The characteristics of the adapted questionnaire (validity, reliability, and sensitivity to change), as well as current and purposed applications, are discussed. Some of the principles that were applied in the described adaptation process may be useful for similar future research: involving the investigators that developed the original instrument; using a panel of lay individuals in the translation process; testing the characteristics of the adapted instrument by replicating previous studies with the original instrument, and organizing an international group for the development and use of the European versions of the NHP. Adaptation of health status measures is an opportunity for gaining comparability when measuring health, and for learning about cross-cultural differences in health-related quality of life.A preliminary version of this paper was presented at the Satellite Symposium of the Inaugural Meeting of the International Health-related Quality of Life Society, Brussels, Belgium, 3–4 February 1994.     

Use of the Nottingham Health Profile with patients after a stroke.

The Nottingham Health Profile (NHP) is easy to use with stroke patients and may be used with those who cannot manage more complicated mood questionnaires, such as the General Health Questionnaire (GHQ). Stroke patients rate their health, and especially emotions and feelings of social isolation, as much worse than that of people of similar age. NHP emotion scores correlate with objective measures of disability, length of hospital stay, and GHQ scores. The NHP is a valid indicator of depressed mood, and combining its components into a total score gives the greatest accuracy in detecting depression. Patients with high scores at one month continued to report large numbers of problems at six months after their stroke. Many patients experienced pain, disturbed sleep, and social isolation, which are important, potentially treatable problems not usually considered in the management of stroke patients. Many patients with problems did not see their general practitioner or any other source of help, and additional follow up was needed.     

Kappa值在Nottingham健康量表信度测量中的应用

本文用Ｋａｐｐａ值测量Ｎｏｔｉｎｇｈａｍ健康量表（ＮＨＰ）的条目信度表明：（１）用Ｋａｐｐａ值测量ＮＨＰ的信度是比较适当的，因为它考虑到了测量中重复的机遇性，更能表达信度含义；（２）ＮＨＰ的条目一致率在０．７５～０．９１之间，都高于相应的期望一致率；Ｋａｐｐａ值在０．１５～０．７６之间，多数在０．５０～０．６０之间，经过ｕ检验，除一个条目的一致性不存在外，其余条目的一致性较好（Ｐ＜０．０１），信度较高，并有八个条目的总体Ｋａｐｐａ值在０．７５以上。因而，Ｎｏｔｉｎｇｈａｍ健康量表的信度是较高的，实用性较好，但仍有个别条目需要改进。     

A comparison of two multidimensional measures of health status: The Nottingham Health Profile and the RAND 36-Item Health Survey 1.0

In this study the applicability of two multidimensional instruments, the NHP and the RAND 36-Item Health Survey 1.0, for measuring health status in population surveys was examined. A population sample of 1,063 persons aged over 17 years participated in the study. It was shown that, as compared with the NHP, the RAND 36-Item Health Survey 1.0 is a more reliable measure of health status. Second, within a group of subjects who scored zero on the NHP, considerable dispersion in RAND 36-Item Health Survey 1.0 scores was found. For the whole group, no significant differences were found in the amount of variance explained by the corresponding scales from both instruments in the prevalence of chronic diseases. However, among subjects with a zero score on the NHP, the RAND 36-Item Health Survey 1.0 scores were still predictive of the occurrence of chronic diseases. it was concluded that, compared with the NHP, the RAND 36-Item Health Survey 1.0 seems to be a more sensitive instrument for the use in population samples.     

A Measure of Perceived Health in Evaluating General Practice: the Nottingham Health Profile

The paper describes two ways in which the Nottingham HealthProfile (NHP) may be useful in evaluating general practice:it can provide useful and relevant information about the needsof patients, and can also be used to evaluate outcome by examiningthe relationship between changes in perceived health statusbefore and 4 weeks after a consultation in relation to carereceived during that consultation. Findings are based on a sampleof 1979 consulters who completed the Nottingham Health Profileprior to consultation and 732 consulters aged 16 years who alsocompleted a Nottingham Health Profile 4 weeks after consultation.Comparisons are made according to the age, sex and illness statusof the consulters, length of consultation and psychosocial carereceived. As a measure of need, significant differences were found inthe health profile according to age, sex and illness status,length of consultation and doctors perception of the presenceof relevant psychosocial issues. The only variable which wassignificantly related to short-term outcome was reported presenceof a long term illness relevant to the consultation. The NHPis shown to have shortcomings as a measure of outcome for across-section of general practice consulters; it is, however,useful in demonstrating how processes of care relate to needin general practice.     

A comparison of the Nottingham Health Profile and Short Form 36 Health Survey in patients with chronic lower limb ischaemia in a longitudinal perspective

Background

Different generic quality of life instruments such as the Nottingham Health Profile (NHP) and the Short Form 36 Health Survey (SF-36) have revealed conflicting results in patients with chronic lower limb ischaemia in psychometric attributes in short-term evaluations. The aim of this study was to compare the NHP and the SF-36 regarding internal consistency reliability, validity, responsiveness and suitability as outcome measures in patients with lower limb ischaemia in a longitudinal perspective.

Methods

48 patients with intermittent claudication and 42 with critical ischaemia were included. Assessment was made before and one year after revascularization using comparable domains of the NHP and the SF-36 questionnaires.

Results

The SF-36 was less skewed and more homogeneous than the NHP. There was an average convergent validity in three of the five comparable domains one year postoperatively. The SF-36 showed a higher internal consistency except for social functioning one-year postoperatively and was more responsive in detecting changes over time in patients with intermittent claudication. The NHP was more sensitive in discriminating among levels of ischaemia regarding pain and more able to detect changes in the critical ischaemia group.

Conclusion

Both SF-36 and NHP have acceptable degrees of reliability for group-level comparisons, convergent and construct validity one year postoperatively. Nevertheless, the SF-36 has superior psychometric properties and was more suitable in patients with intermittent claudication. The NHP however, discriminated better among severity of ischaemia and was more responsive in patients with critical ischaemia.

     

A longitudinal comparison of charge-based weights with cost-based weights

The diagnosis-related group weights that determine prices for Medicare hospital stays are recalibrated annually using charge data. Using data from fiscal years 1985 through 1987, the authors show that differences between these charge-based weights and cost-based weights are increasing only slightly. Charge-based weights are available in a more timely manner and, based on temporal changes in the weights, we show that this is an important consideration. Charge-based weights provide higher payments than cost-based weights to hospitals with higher case-mix indexes, but have little effect on hospitals with low cost-to-charge ratios, high capital costs, or high teaching costs.     

Longer response scales improved the acceptability and performance of the Nottingham Health Profile

OBJECTIVE: To test alternative response formats for the Nottingham Health Profile (NHP), in terms of acceptability, score distributions, and measurement properties. STUDY DESIGN AND SETTINGS: Randomized trial of four response formats for the NHP: original "yes/no" format, a 3-point similarity format ("applies completely/in part/not at all"), a 5-point intensity format ("completely true" to "completely false"), and a 5-point frequency format ("all the time" to "never"). Respondents were patients discharged from a hospital. We compared scores distributions, reliability coefficients, correlations with dimension-specific numerical scales, and patient ratings of the instrument. RESULTS: Response rates were similar for the four versions. The original response format had the fewest fully completed questionnaires, and the largest ceiling effects. Internal consistency and test-retest coefficients were acceptable for all versions, but were higher for the two 5-point formats. Correlations reflecting convergent and discriminant validity were higher for the longer response formats than for the original version. The frequency format received the highest ratings from patients, particularly from the sicker and older subgroups. CONCLUSIONS: The psychometric performance and patient acceptability of the NHP can be improved by using a 5-point frequency response format instead of the original dichotomous response format.     

The Nottingham Health Profile: an analysis of its sensitivity in differentiating illness groups

A recent criticism of the Nottingham Health Profile (NHP) claimed it was an insensitive instrument for use in population surveys, because its modal response was zero, and domains measured by the instrument are insufficiently distinct. It is argued here that the NHP was designed specifically to uncover the chronically ill in populations and, further, research undertaken here indicates that the instrument is sufficiently sensitive to be successful in permitting variations within and between illness groups to be determined. However, the domains of mobility and pain, as measured by the instrument, are found to be confounded.     

医疗机构关于新版医疗服务价格项目的思考

通过对《全国医疗服务价格项目规范(2012年版)》(简称新版项目规范)的研究,探索非营利性医疗机构(简称医疗机构)关于新版项目规范工作的思路。通过研究得出,新版项目规范主要呈现出4个方面的政策性变化及特点,同时认为新版项目规范在项目打包定价原则及辅助操作类项目的落实上值得进一步探讨。     

The Nottingham Health Profile as a measure of quality of life following combined heart and lung transplantation.

This paper reports on the use of the Nottingham Health Profile as a measure of patient quality of life before and after combined heart and lung transplantation at Harefield Hospital. A total of 125 profiles from 48 patients were analysed. In both section 1 and section 2 of the profile, large and statistically significant (p less than 0.05) improvements in quality of life were associated with transplantation. The profile proved easy to use either as part of an interview during assessment for transplantation or as a postal follow-up postoperatively.     

Using the Nottingham Health Profile (NHP) among Older Adult Inpatients with Varying Cognitive Function

Background: High rates of missing, non-applicable items and insufficient reliability have been frequently reported as limitations of the generic Quality of Life questionnaires for older patients. The Nottingham Health Profile (NHP) might be more suitable as it contains easy to respond (yes/no) items covering moderate-to-severe health deterioration. Objectives: To assess feasibility, reliability and validity of the NHP in disabled, older patients. Design: Cross-sectional study. Setting: Acute care hospital. Subjects: 134 inpatients aged ≥65 with severe disability, abnormal cognitive function, or other persistent health problems precluding their discharge. Methods: The (interviewer-administered) NHP, Mini-Mental State Examination (MMSE), Barthel Index, and diagnostic information were recorded. Results: Completion rates varied from 98% of the 49 patients with normal cognition (MMSE ≥21) and 86.3% of the 51 with moderate cognitive impairment (MMSE 10–20), to 5.9% of the 34 with severe cognitive impairment (MMSE<10). Cronbach’s alpha of the total NHP score was near 0.9 (0.82 and 0.87 for patients with MMSE ≥ 21 and 10–20, respectively; p = 0.291). The correlation between ‘Physical Mobility’ of the NHP and Barthel Index was also similar in both cognitive groups (0.39 and 0.40). Conclusion: Interviewer-administered NHP is suitable, reliable and valid, even in patients with moderate cognitive function.     

Properties of the 15D and the Nottingham Health Profile questionnaires in patients with lower limb atherosclerotic disease

OBJECTIVES: The aim of this study was to compare the generic health-related quality of life (HRQoL) instruments, the 15D and the Nottingham Health Profile (NHP), in terms of feasibility, cross-sectional construct validity, discriminatory power, and responsiveness to the change in patients with lower limb atherosclerosis disease (LLAD). METHODS: Patients who were treated conservatively (64 patients), scheduled for endovascular treatment (85 patients), or for elective surgery (31 patients) filled in the NHP and the 15D questionnaires before treatment and 12 months after. The methods of analysis included calculations of the completion rate, the multitrait-multimethod matrix, extreme group comparisons with the t-test, and calculations of "floor" and "ceiling" effects and effect sizes. RESULTS: Both the 15D and the NHP instruments were feasible because full data were obtained at baseline from 84.1 percent of patients and 82 percent at 12 months with the 15D and, respectively, 75.8 percent and 79 percent with the NHP. The multitrait-multimethod matrix and extreme group comparisons provided a clear convergent and discriminant evidence of the cross-sectional construct validity of the instruments. The convergent validity correlations were quite high, ranging between .40 and .682. The tendency for higher percentages at the "ceiling" and "floor" for the NHP suggests that it has less discriminatory power than the 15D on roughly comparable dimensions. The 15D and the NHP were almost equally responsive to change. CONCLUSIONS: This study provided evidence that both the 15D and the NHP are appropriate for measuring HRQoL among patients with LLAD.     

Development of a French version of the Endometriosis Health Profile 5 (EHP-5): cross-cultural adaptation and psychometric evaluation

Purpose

The Endometriosis Health Profile 5 (EHP-5) is a short version of an endometriosis-specific quality of life questionnaire. The objective of the study was to assess the psychometric validity of its French version.

Methods

A total of 125 patients with histologically proven endometriosis who underwent surgery for painful symptoms and 80 asymptomatic controls completed the EHP-5. Principal components analysis was performed to determine the dimensions of the instrument. Internal consistency was assessed using Cronbach’s alpha. Construct validity was assessed by testing the relationship between the EHP-5 and the characteristics of endometriosis.

Results

For each item of EHP-5, endometriosis patients scored significantly higher than control women (p > 0.0001). Eleven items of the EHP-5 were unidimensional with excellent internal consistency (Cronbach’s alpha = 0.92), and a summary aggregated index was then constructed. The EHP-5 index was sensitive to the presence of endometriosis, the type, location, severity of the disease, and pain or infertility as the main complaint with effect sizes ranging from 0.48 (95 % CI 0.11–0.85) for superficial endometriosis to 2.56 (95 % CI 2.18–2.93) for deeply infiltrating endometriosis.

Conclusion

The French version of EHP-5 is valid and can be used for reporting patient-orientated outcome in future studies of French-speaking patients with endometriosis.

     

Adaptation of the Nottingham Health Profile: a simple measure to assess quality of life

The aim of the present study was to evaluate the psychometric properties of the Brazilian version of the Nottingham Health Profile (NHP), a generic instrument for quality of life assessment. This NHP was translated to Portuguese, following recommended methodology, and applied to 215 subjects, being 170 community elderly (66.3 +/- 8.5 years), 30 chronic stroke survivors (56.4 +/- 10.9 years), and 15 parkinsonians (59.6 +/- 10.2 years). The data was analysed by Rasch analysis. Out of the 38 items of NHP, only two items (5%) did not fit the statistical model, indicating that the items collaborated to measure a unidimensional construct. However, some items of NHP were very easy for the elderly, stroke survivors and Parkinsonians, characterizing a ceiling effect, which could limit the use of the scale for individuals with higher levels of ability. The results, in spite of indicating that the instrument fits the Rasch statistical model for this sample, indicate a need for revision of the items, in order to make the questionnaire more clinically useful.     

A comparison of an electronic version of the SF-36 General Health Questionnaire to the standard paper version

Because of its sound psychometric properties the SF-36 General Health Questionnaire is used throughout the world, yet it is difficult to analyse and score. Using a newly developed software package, onto which any questionnaire can be loaded, we developed an electronic version of the SF-36 General Health Questionnaire. The purpose of this study is test the effect of the electronic mode of administration on the measurement properties of the SF-36. In a randomised cross-over design study 79 healthy individuals and 36 chronic pain patients completed both electronic and paper versions of the SF-36. Seventy-one percent preferred the electronic SF-36, 7% stated no preference, and 22% preferred the paper version. Completion time for the electronic SF-36 was slightly less, and there were no missing or problematical responses, whereas 44% of participants had at least one missing or problematical response in the paper version. Data entry and auditing time was 8 hours. There was less than 4% inter-version difference for any of the SF-36 sub-scales. The electronic SF-36 was well accepted and slightly quicker to complete than the paper version. We conclude that the electronic SF-36 is equivalent in performance and more effective than the paper version.     

Comparison of the SF-36 health survey questionnaire with the Nottingham Health Profile in long-term survivors of a myocardial infarction

BACKGROUND: Health-related quality of life, an important outcome measure in health interventions, can readily be assessed by questionnaire. Two widely evaluated examples are the Short Form 36 (SF-36) and Nottingham Health Profile (NHP) questionnaires, but as yet the discriminatory power of these tools has not been compared in a large population of patients with coronary heart disease. METHODS: All 4-year survivors of a myocardial infarction, identified from the Nottingham heart attack register, were sent the SF-36, NHP and additionally the Rose angina and dyspnoea questionnaires. Mean scores on the SF-36 and NHP were compared with age- and sex-adjusted norms in patients under and over 65 years. Sensitivity of the respective tools was assessed in distinguishing patients with differing degrees of cardiovascular symptomatology. RESULTS: In patients under 65 years the SF-36 and NHP differed to the same extent from normative data--scores were lower in the comparable domains physical functioning/mobility, bodily pain/pain and energy/vitality, but not in mental health/emotional reaction scores. In social functioning/social isolation results were disparate--SF-36 scores were lower and the NHP similar to normative data. In patients over 65 years mean scores in all five domains were not significantly different from normative data for either tool. The SF-36 was more sensitive than the NHP at detecting the impact of breathlessness, particularly in patients with mild symptoms. Similarly, the SF-36, but not the NHP, could distinguish the effect of differing degrees of angina severity and frequency on social functioning. CONCLUSION: At least in myocardial infarction survivors, the SF-36 appears a more sensitive tool and may have benefits for assessing health-related quality of life in this patient group.