Psychometric evaluation of the Schizophrenia Quality of Life Scale (SQLS) in English- and Chinese-speaking Asians in Singapore

Objective To assess the psychometric properties of the Schizophrenia Quality of Life Scale (SQLS) in Asians with schizophrenia in Singapore. Methods A consecutive sample of outpatients with schizophrenia completed the English or Chinese version of the SQLS and the Short-Form 36 Health Survey (SF-36) twice during two different clinic visits. The patients were also assessed for presence or absence of 22 psychiatric symptoms. Results About 202 patients (English-speaking: 140) participated in the study. Correlations between SQLS scales and other measures assessing similar constructs ranged from 0.46 to 0.69 (P < 0.001 for all). For SQLS psychosocial and symptoms/side effects scales, item-to-scale correlations were >0.4, Cronbach’s alpha and intra-class correlation coefficient values were close to or exceed 0.7, and Cohen’s effect size, standardized response mean, and Guyatt’s responsiveness index values approximated or exceeded 0.2 for both SQLS language versions; however, for the energy/motivation scale, item-to-scale correlations (range: 0.08–0.51), reliability (range: 0.46–0.66) and responsiveness (range: 0.04–0.08) statistics were not satisfactory for both SQLS versions. Conclusions The SQLS psychosocial and symptoms/side effects scales are valid, reliable and responsive in Singaporean patients with schizophrenia; the appropriateness of energy/motivation scale requires further investigation.     

Italian translation of the Manchester-Oxford Foot Questionnaire, with re-assessment of reliability and validity

Purpose  To cross-culturally adapt and validate the Italian version of the Manchester-Oxford Foot Questionnaire (MOXFQ) in patients affected by hallux valgus. Methods  The MOXFQ was translated into Italian and culturally adapted following the forward and backward translation method. A sample of 172 patients with hallux valgus was asked to fill in the MOXFQ and the Short-Form 36 Health Survey (SF-36). Two-week retest was performed on a random sub-sample of 40 patients. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed with the use of Spearman’s rank correlation coefficient, using a priori hypothesized correlations with SF-36 domains. Results  The internal consistency reliability was acceptable for all MOXFQ domains (Pain, Walking/standing and Social interaction) with Cronbachs’ alpha coefficients ranging from 0.72 to 0.83. The assessment of test–retest reliability reveals satisfactory values with ICCs ranging from 0.85 to 0.92. Construct validity was supported by the presence of all the hypothesized correlation, with the exception of Italian Walking/standing domain with the SF-36 Role-Physical domain (ρ = −0.29). Conclusions  The Italian version of MOXFQ is a valid and reliable instrument for evaluating foot pain and functional status in patients affected by hallux valgus.     

The feasibility and responsiveness of the health utilities index in patients with early-stage breast cancer: A prospective longitudinal study

Background The health utilities index (HUI3) is a health measurement instrument based on individuals’ preferences for different health states. Breast cancer (BC) is common, with a high proportion of long-term survivors, making evaluation of treatment effects important. Feasibility and responsiveness of HUI3 was compared to the short-form 36 (SF-36) in patients with BC. Methods HUI3 and SF-36 were administered eight times: at initial surgical consultation, 1 week before surgery; 1 week, 3, 6, 12, 18, and 24 months after surgery. Effect size, analysis of variance, and Pearson product moment correlations were calculated. BC data were compared to normative values. Results Eighty-five patients were enrolled. Ninety-one percent of planned assessments were completed. HUI3 showed significant responsiveness (P < 0.01) after surgery and during recovery. HUI3 scores correlated with SF-36 scores. Comparison to normative data demonstrated the significant detrimental effect of BC diagnosis. Results showed long-term effects of treatment on physical health and positive effects on mental/emotional health in BC survivors. Conclusion(s) HUI3 was found to be feasible and responsive in our cohort of BC patients. Changes in HUI3 values over time, and compared to normative data, paralleled SF-36 scores. HUI3 is a valuable tool in health-related quality of life and cost-utility studies in patients with BC.     

Validation of the Chinese version of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) in Taiwanese patients with schizophrenia

We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). One hundred Taiwanese individuals with schizophrenia were recruited. The internal consistency reliability was satisfactory for both the psychosocial and vitality domains (Cronbach’s α = 0.92, 0.84). The test–retest reliability was also high (psychosocial: ICC = 0.84, vitality: ICC = 0.84) for those individuals whose psychological conditions remained stable between the two-week interval. However, the responsiveness coefficient for those with considerable changes in psychological conditions ranged from very small to moderate, suggesting either low responsiveness for the vitality domain or a complex relationship between the change of psychological conditions and quality of life, and the need to estimate responsiveness more conclusively in a future intervention study. The convergent validity was supported by moderate-to-large correlations between domains measuring related constructs of the SQLS-R4 and SF-36 (r = −0.65 to −0.67). Overall, the results of this study provide preliminary evidence for the reliability and validity of the SQLS-R4 used in Taiwanese individuals with schizophrenia. This study provides a common ground for international researchers to understand quality of life in Taiwanese patients with schizophrenia.     

Evidence on the construct validity of the Health Utilities Index Mark 2 and Mark 3 in patients with chronic kidney disease

OBJECTIVE: This study assessed the construct validity of the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in the context of chronic kidney disease (CKD) and compared their ability to discriminate between groups of patients with varying disease severity. STUDY DESIGN AND SETTING: The HUI2 and HUI3 were correlated with the Medical Outcomes 36-Item Short-Form, Kidney Disease Quality of Life Questionnaire, and the Beck Depression Inventory II in 185 patients with stage 4 and 5 CKD. RESULTS: About 86% of a priori hypotheses were confirmed for HUI2 and 95% for HUI3, providing support for the construct validity of both measures. Mean (SD) overall utility score for the HUI2 was 0.74 (0.20), significantly higher than that for the HUI3, 0.58 (0.26) (P<0.001). The cognitive, emotion, and pain attributes of the HUI3 were able to identify a significantly greater proportion of patients with impairment compared to the HUI2. CONCLUSION: The results are consistent with construct validity for the HUI2 and HUI3 in patients with stage 4 and 5 CKD. However, the HUI3 appears to have superior psychometric properties compared with the HUI2 in this patient population.     

The Validity and Reliability of the Functional Impairment Checklist (FIC) in the Evaluation of Functional Consequences of Severe Acute Respiratory Distress Syndrome (SARS)

Severe acute respiratory distress syndrome (SARS) contributed to significant mortality and morbidity worldwide. We aimed to establish the validity, reliability and responsiveness of the functional impairment checklist (FIC) as a measurement tool for physical dysfunction in SARS survivors. One hundred and sixteeen (65 females and 51 males, mean age 45.6) patients who joined the SARS rehabilitation programme were analysed. The factor analysis yielded two latent factors. The mean FIC-symptom and FIC-disability score were 24.12 (SD ± 20.2) and 26.11 (SD ± 27.32), respectively. Based on the item-scale correlation coefficients, the Cronbach’s alpha coefficients reflecting the internal consistency reliability of scale score were 0.75 for FIC-symptom and 0.86 for FIC-disability. Test–retest reliability in 23 patients showed no statistical significant difference in the FIC scores between tests with intraclass correlation coefficient (ICC) 0.49–0.57. The FIC scales correlated both with 6 munute walking test (6MWT) distance (−0.26 and −0.38) and handgrip strength (HGS) (−0.20 and −0.27). Moreover, the FIC scales correlated with St. George’s respiratory questionnaire (SGRQ) (0.19 to 0.52) and short form 36 Hong Kong (SF-36) domains (−0.19 to −0.59). Both FIC scales correlated stronger with physical component summary (PCS) (−0.41 and −0.55) than with mental component summary (MCS) (−0.30 and −0.23). FIC reduced significantly at 6 months while the SF-36 PCS and MCS did not show any change. In conclusion, the study results indicate the FIC is reliable, valid and responsive to change in symptom and disability as a consequence of SARS, suggesting it may provide a means of assessing health related quality of life (HRQOL) outcomes in a longitudinal follow up.     

Comparing Short Form 6D,Standard Gamble,and Health Utilities Index Mark 2 and Mark 3 utility scores: Results from total hip arthroplasty patients

Objective: The objectives are to compare SF-6D, standard gamble (SG), and Health Utilities Index (HUI) utility scores, compare change scores, and compare responsiveness. Methods: A cohort of osteoarthritis patients referred for total hip arthroplasty (THA) were evaluated at the time of referral and followed until 3months after THA. Patients were assessed using the SF-36, HUI2, HUI3, and the SG. Agreement is assessed using the intra-class correlation (ICC). Responsiveness is assessed using effect size, standardized response mean, and paired t-test. Results: Data was available for 86 patients at baseline and for 63 at both pre- and post-surgery. At baseline mean SF-6D (0.61), SG (0.62), and HUI2 (0.62) scores were similar; the mean HUI3 score (0.52) was lower. Standard deviations were 0.10, 0.32, 0.19, and 0.22. At baseline, agreement between SF-6D and SG scores was 0.13, agreement between SF-6D and HUI2 was 0.47, and agreement between SF-6D and HUI3 was 0.28. Agreement at pre- and post-surgery was similar. The change in scores between post- and pre-surgery was 0.10 for SF-6D, 0.16 for SG, 0.22 for HUI2, and 0.23 for HUI3. Effect sizes were 1.10 for HUI2, 1.08 for HUI3, 1.06 for SF-6D, and 0.48 for the SG. Conclusions: Agreement between SG scores and SF-6D and HUI scores was low. The estimate of change in utility associated with THA was lowest for SF-6D. Additional longitudinal studies to compare utility measures appear to be warranted.     

Self-Reported Functional Status as Predictor of Observed Functional Capacity in Subjects with Early Osteoarthritis of the Hip and Knee: A Diagnostic Study in the CHECK Cohort

Objectives Patients with hip or knee osteoarthritis (OA) may experience functional limitations in work settings. In the Cohort Hip and Cohort Knee study (CHECK) physical function was both self-reported and measured performance-based, using Functional Capacity Evaluation (FCE). Relations between self-reported scores on SF-36 and WOMAC (Western Ontario and McMaster Arthritis Index, function scales) and FCE performance were studied, and their diagnostic value for clinicians in predicting observed physical work limitations was assessed. Methods Ninety-two subjects scored physical function on SF-36 (scale 0–100, 100 indicating the best health level) and WOMAC (scale 0–68, 68 indicates maximum restriction) and performed the FCE. Correlations were calculated between all scores. Cross-tables were constructed using both questionnaires as diagnostic tests to identify work limitations. Subjects lifting <22.5 kg on the FCE-test ‘lifting-low’ were labeled as having physical work limitations. Diagnostic aspects at different cut-off scores for both questionnaires were analysed. Results Statistically significant correlations (Spearman’s ρ 0.34–0.49) were found between questionnaire scores and lifting and carrying tests. Results of a diagnostic cross-table with cut-off point <60 on SF-36 ‘physical functioning’ were: sensitivity 0.34, specificity 0.97 and positive predictive value (PV+) 0.95. Cut-off point ≥21 on WOMAC ‘function’ resulted in sensitivity 0.51, specificity 0.88 and PV+ 0.88. Conclusion Low self-reported function scores on SF-36 and WOMAC diagnosed subjects with limitations on the FCE. However, high scores did not guarantee performance without physical work limitations. These results are specific to the tested persons with early OA, in populations with a different prevalence of limitations, different diagnostic values will be found. FCE may be indicated to help clinicians to assess actual work capacity.     

Is Psychometric Scoring of the McNew Quality of Life After Myocardial Infarction Questionnaire Superior to the Clinimetric Scoring? A Comparison of the Two Approaches

Objective: ‘Clinimetric’ and ‘psychometric’ approaches are currently used to develop health related quality of life questionnaires. The Quality of Life after Myocardial Infarction questionnaire (QLMI) was originally developed using ‘clinimetric’ criteria; it was subsequently modified (McNew QLMI) and a new domain structure was defined using factor analysis. The objective of this study was to compare the measurement properties of the McNew QLMI scores when both approaches for scoring are used. Methods: The McNew QLMI and SF-36 were administered to patients 2 weeks and 2 months after myocardial infarction. Two sets of scores for the McNew QLMI were computed using the original ‘clinimetric’ and the subsequent ‘psychometrically’ derived scoring systems. Reliability statistics for the two sets of domains were compared and construct validity was assessed by establishing a priori hypotheses on the expected correlation between each score and the dimensions of the SF-36. Results: Both sets of scores had similar reliability (Cronbach’s α between 0.64 and 0.93) and responsiveness (SRMs between 0.17 and 0.87) while validity was better for the ‘clinimetric’ set of scores (concordance between observed and expected correlations was moderate for the ‘clinimetric’ scores and fair for the ‘psychometric’ scores). Conclusion: Since overall measurement properties of the ‘clinimetrically’ scored McNew QLMI are better than the ‘psychometrically’ scored version, we suggest that either the original ‘clinimetric’ system is used or that an improved ‘psychometric’ version is developed.     

Utility-based Quality of Life Measures in Alzheimer’s Disease

Objectives: To explore whether Alzheimer’s disease patients could rate their quality of life (QOL) using utility-based health indexes, and to provide new knowledge about the measurement properties of these instruments for patient and caregiver proxy ratings. Methods: A convenience sample of 60 mild-moderate AD patients and their caregivers were randomized to complete the Quality of Well-Being Scale (QWB), Health Utilities Index (HUI3) or EQ-5D and visual analogue scale (VAS) on two occasions. Test–retest reliability (intraclass correlation coefficients) and convergent validity (Spearman correlations) of utility scores with global health status, activities of daily living, comorbidity, mood, cognition and other utility measures were assessed. Results: Completion time was shortest for the combined EQ-5D and VAS. For patients with mild dementia and for proxies, reliability was ≥ 0.70 for the EQ-5D, QWB and HUI3. The EQ-5D had a ceiling effect for patient ratings. Convergent validity was demonstrated for patient and proxy ratings, with the strongest validity for EQ-5D ratings and the weakest validity for HUI3 patient ratings. Mean patient utility scores were significantly higher than mean proxy scores for all measures (p<0.001). Conclusions: For patient and proxy ratings, the EQ-5D had the best combination of measurement properties, although it had a substantial ceiling effect for patient ratings. Proxy QOL ratings did not accurately reflect patients’ ratings.     

Comparison of preference-based utilities of the Short-Form 36 Health Survey and Health Utilities Index before and after treatment of patients with intermittent claudication.

The authors compared SF-36 utilities with Health Utilities Index (HUI) utilities (HUI2 and HUI3) assessed in patients with intermittent claudication. A total of 87 patients with intermittent claudication completed the SF-36 and HUI before and 1, 3, and 12 months after revascularization. Utilities were estimated using SF-36 and HUI published algorithms (i.e., both algorithms were based on standard-gamble utilities assessed in random samples of the general population). The utilities were compared using repeated-measures multivariate analysis of variance, paired t tests, and univariate linear regression analyses. Before treatment, the mean SF-36 and HUI3 utilities were the same (0.66 vs. 0.66, P = 0.92) and less than the mean HUI2 utility (0.70, P = 0.02). After treatment, all utilities showed improvement from before treatment (P < 0.05); the gain in utilities from treatment was lowest when using the SF-36 (e.g., 0.74, 0.80, 0.77 at 3 months for the SF-36, HUI2, and HUI3, respectively). The correlations of changes over time of the SF-36 with HUI2 utilities and of the SF-36 with HUI3 utilities were 0.39 and 0.49, respectively. The relationships between the SF-36 and HUI2 or HUI3 utilities were moderate to good (i.e., range-adjusted R2 = 31% to 72%). The results suggest that SF-36 data can be transformed to preference-based utilities and be used for economic evaluation in health care. The gain in utilities from treatment, however, was less for SF-36 utilities than for HUI utilities.     

Measuring Stroke Impact with SIS: Construct Validity of SIS Telephone Administration

Objectives: The purpose of this study was to examine the construct validity of the Stroke Impact Scale (SIS) using telephone mode of administration. Methods: Stroke patients were identified using national VA administrative data and ICD-9 codes in 13 participating VA hospitals. Stroke was confirmed by reviewing electronic medical records. Patients were administered SIS by telephone at 12-weeks post-stroke, and administered the Functional Independence Measure (FIM) and SF-36V at 16 weeks post-stroke. The instrument’s convergent validity and its ability to differentiate between groups of stroke patients with different disability levels were examined using Pearson’s correlations and Kruskal–Wallis one way ANOVA tests. Results: All the relevant relationships yielded high correlation coefficients with statistical significance: 0.86 for FIM-motor vs. SIS-ADL, and 0.77 for PF in SF-36V vs. SIS-PHYSICAL. The SIS presented better score discrimination and distribution for different severity of stroke than FIM and SF-36V without severe ceiling and floor effects. Kruskal–Wallis tests showed the Physical Component Score of SF-36V did not discriminate any disability levels. Physical functioning (PF) in SF-36V, FIM-motor, SIS-PHYSICAL, SIS-16, and SIS-ADL showed better discrimination in person’s functioning. The pairwise comparisons showed that SIS-PHYSICAL, SIS-16, and SIS-ADL discriminated more Rankin levels than FIM-motor and PF in SF-36V. Conclusions: SIS telephone survey had superior convergent validity and was better at differentiating between groups of stroke patients with different disability levels than the FIM and SF-36V with no evidence of ceiling and floor effects. Telephone administration of SIS would be a useful and cost-effective method to follow-up community dwelling veterans with stroke.     

Responsiveness of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale (AAQoL)

Aims This study examined responsiveness of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale (AAQoL), which was developed to assess health-related quality of life (HRQL) among adults with attention-deficit/hyperactivity disorder (ADHD). Methods Adults with ADHD completed the AAQoL, Conners’ Adult ADHD Rating Scale (CAARS), SF-36, and Endicott Work Productivity Scale (EWPS) at baseline and week 8 of a randomized, placebo-controlled trial of atomoxetine. Clinicians rated symptom severity and improvement (CGI-ADHD-S, CGI-ADHD-I). Responsiveness was examined through effect sizes and association with change in the measures listed previously (Spearman correlations, GLMs). Results Analyses included 328 patients (58.8% male; mean age = 36.9 years). All AAQoL scales reflected significant improvement from baseline to week 8 (P < 0.0001). AAQoL change scores were significantly correlated with change in the CGI-ADHD-S (r = −0.37 to −0.50), EWPS (r = −0.43 to −0.63), and CAARS (r = −0.35 to −0.62) (all P < 0.001). AAQoL change scores significantly discriminated among patients with various levels of symptom improvement. AAQoL effect sizes (−0.67 to −1.11) were larger than effect sizes for the SF-36 (0.15 to −0.39). Conclusions The AAQoL was responsive to change in symptoms of ADHD, and it appears to be a useful outcome measure for treatments of ADHD in adults.     

Psychometric properties of the Japanese version of the quality of life-Cancer Survivors Instrument

The purpose of this study was to describe the psychometric properties of the Japanese version of the Quality of Life-Cancer Survivors Instrument (QOL-CS-J) developed in the U.S. This study was conducted as a mail survey to survivors of more than 5 years post curative resection for non-small-cell lung cancer (NSCLC) and who had participated in an earlier survey. This survey included the medical and demographic factors, the QOL-CS scores, and the Medical Outcome Study 36-Item Short Form (SF-36). A total of 113 survivors completed the survey. To confirm the reliability, the Cronbach’s α coefficient of each subscale was calculated as an internal consistency (α = 0.65–0.89). To confirm the validity of the trial as conducted, Pearson’s correlation coefficients between the subscales of the QOL-CS and the subscales of the SF-36 were calculated. There were moderate correlations between associated subscales including QOL-CS physical to SF-36 bodily pain (r = 0.45) and vitality (r = 0.52), QOL-CS psychological to SF-36 mental health (r = 0.55), QOL-CS social to SF-36 general health perception (r = 0.31) and mental health (r = 0.47), and QOL-CS total to each subscale of SF-36 (r = 0.25–0.64). Findings demonstrated that the QOL-CS-J adequately measured the QOL in long-term NSCLC survivors.     

Do the SF-36 and WHOQOL-BREF Measure the Same Constructs? Evidence from the Taiwan Population*

Background: The SF-36 and WHOQOL-BREF are available for international use, but it is not clear if they measure the same constructs. We compared the psychometric properties and factor structures of these two instruments. Methods: Data were collected from a national representative sample (n=11,440) in the 2001 Taiwan National Health Interview Survey, which included Taiwan versions of the SF-36 and WHOQOL-BREF. We used Cronbach’s alpha coefficient to estimate scale reliability. We conducted exploratory factor analysis to determine factor structure of the scales, and applied multitrait analysis to evaluate convergent and discriminant validity. We used standardized effect size to compare known-groups validity for health-related variables (including chronic conditions and health care utilization) and self-reported overall quality of life. Structural equation modeling was used to analyze relationships among the two SF-36 component scales (PCS and MCS) and the four WHOQOL subscales (physical, psychological, social relations, and environmental). Results: Cronbach’s alpha coefficients were acceptable (⩾0.7) for all subscales of both instruments. The factor analysis yielded two unique factors: one for the 8 SF-36 subscales and a second for the 4 WHOQOL subscales. Pearson correlations were weak (<0.3) among subscales of both instruments. Correlations for subscales hypothesized to measure similar constructs differed little from those measuring heterogeneous subscales. Effect sizes suggested greater discrimination by the SF-36 for health status and services utilization known groups, but greater discrimination by the WHOQOL for QOL-defined groups. Structural equation modeling suggested that the SF-36 PCS and MCS were weakly associated with WHOQOL. Conclusions: In this Taiwan population sample, the SF-36 and WHOQOL-BREF appear to measure different constructs: the SF-36 measures health-related QOL, while the WHOQOL-BREF measures global QOL. Clinicians and researchers should carefully define their research questions related to patient-reported outcomes before selecting which instrument to use. * Presented in part at (1) 11th Annual Conference of the International Society for Quality of Life Research. Hong Kong, China, 2004. (2) 2004 Quality of Life Symposium – Conceptualization and Measurement issues in QOL. Tai-Chuan, Taiwan, 2004     

Psychometric evaluation of the fatigue severity scale for use in chronic hepatitis C

Evidence exists demonstrating that infection with hepatitis C virus impairs health-related quality of life, but less is known about the effect of fatigue, a common symptom, on everyday life. The psychometric properties of the fatigue severity scale (FSS) were explored to determine suitability as an outcome measure in clinical trials. The FSS includes nine items developed to measure disabling fatigue and a visual analog scale (VAS) to measure overall fatigue. Using baseline data from three clinical trials (n = 1225) involving chronic hepatitis C patients, scaling and psychometric characteristics of the FSS were assessed. The SF-36 was also used in the trials. Item response theory analysis demonstrated that the FSS items can be placed along a single homogenous domain, fatigue. Internal consistency reliability was 0.94. Test–retest reliability was 0.82 for the total score and 0.80 for the VAS. The total score and the VAS were significantly correlated with the SF-36 vitality subscale (r = −0.76 and r = −0.76 respectively). Correlations with other SF-36 subscales were moderate (r = −0.46 to r = −0.67, all p < 0.0001). In summary, the FSS possesses good psychometric properties. This revised version was published online in June 2006 with corrections to the Cover Date.     

Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses

Background  Heart failure (HF) is an increasingly common condition affecting patients’ health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses. Methods and results  Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach’s alpha coefficients were generally high (0.83–0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] ‘Physical’ and ‘Social Functioning’) were moderate to strong (0.41–0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from −9.6 (95% confidence interval [CI]: −4.1; −15.2) for placebo to −17.7 (95% CI: −15.3; −20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change. Conclusions  Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

The construct validity of the Health Utilities Index Mark 3 in assessing mental health in population health surveys

Purpose  To examine the construct validity of the Health Utilities Index Mark 3 (HUI3) by exploring relationships among several well-recognized measures of mental health, the K6 and the Composite International Diagnostic Interview (CIDI), and the HUI3 in a large, nationally representative sample of community-dwelling subjects. Known-group comparisons were also included in the validation process. Methods  We specified a priori hypotheses about the expected degree of association between the measures. Correlation coefficients of <0.1 were defined as negligible, 0.1 to <0.3 as small, 0.3 to <0.5 as medium, and ≥0.5 as large. Data from the Statistics Canada National Population Health Survey (NPHS) Cycle 2 (1996/97) for respondents 20 years of age or older (n = 66,435) were used to test the a priori hypotheses. Results  In 58.1% of cases, predictions of association were correct. Predictions were off by one category in 38.9% of cases and a priori predictions were off by two categories in 3.0% of cases. Conclusions  Our results provide evidence supporting the cross-sectional construct validity of the HUI3 emotion and HUI3 in a nationally representative sample of the community-dwelling population. The results also provide further evidence of the cross-sectional construct validity of the HUI3 in assessing population health. An erratum to this article can be found at     

Cultural adaptation and application of the IBS–QOL in China: a disease-specific quality-of-life questionnaire

Background Irritable bowel syndrome (IBS) is a chronic and episodic illness characterized by altered bowel habits and associated abdominal pain. At present, IBS is one of the most common functional gastrointestinal and motility disorders affecting countries around the world. Surveys have found that patients with IBS have a significantly lower health-related quality of life. Objectives The aim of this study was to translate and examine the validity of the Irritable Bowel Syndrome–Quality of Life questionnaire (IBS–QOL) in patients suffering from IBS in China. Methods A structured procedure was used for the translation and cultural adaptation of the original English IBS–QOL into Chinese. The questionnaire was administered to 73 clinical patients with IBS and␣70 healthy individuals. Psychometric testing for reliability, validity and responsiveness followed standardized procedures. Test–retest reliability (10–20 hours) was assessed using the clinical patients. Follow-up (4 weeks) was collected for 61 clinical patients. All enrolled patients also completed the Short Form-36 Health Survey (SF-36) at the baseline visit. Responsiveness to treatment (Venlafaxine and traditional Chinese herbal medicine) was assessed by one-way ANOVA methods. Results The average length of time required to complete the questionnaire was short (5.63 min for IBS patients and 5.54 min for healthy subjects by self-administration). Internal consistency (Cronbach’s alpha) values ranged from 0.722 to 0.914 for the Chinese IBS–QOL subscales and test–retest reliability coefficients were higher than 0.920 on all subscales. The convergent and discriminate validity results comparing the Chinese translation of the IBS–QOL overall score and the SF-36 subscales confirmed our predicted hypotheses. The Chinese IBS–QOL scores are more highly correlated with social functioning, vitality and general health (SF-36) and show weaker associations with physical functioning, role physical, mental health, and bodily pain (SF-36). The Chinese translation of the IBS–QOL was responsive to treatment. Conclusion In general, the Chinese translation of the IBS–QOL, after cultural adaptation and revision, possesses good reliability, validity and responsiveness. It is a reliable and valid instrument to assess the quality of life in Chinese patients suffering from IBS and is an appropriate measure to use in further clinical trials or for related research projects in China.