The EORTC core quality of life questionnaire (QLQ-C30): validity and reliability when analysed with patients treated with palliative radiotherapy

The EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) is designed to measure cancer patients' physical, psychological and social functions. The questionnaire is composed of multi-item scales and single items. 247 patients completed the EORTC QLQ-C30 before palliative radiotherapy and 181 after palliative radiotherapy. The questionnaire was well accepted with a high completion rate in the present patient population consisting of advanced cancer patients with short life expectancy. In addition, the questionnaire was found to be useful to detect the effect of palliative radiotherapy over time. The scale reliability was excellent for all scales except the role functioning scale. Excellent criterion validity was found for the emotional functioning scale where it was correlated with GHQ-20. Performance of the questionnaire was improved after the second evaluation as compared with the first. The present study shows that the EORTC QLQ-C30 is found to be practical and valid in measuring quality of life in patients with advanced disease.     

The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer-specific questionnaires

A self-report questionnaire module consisting of 24 items, comprising 5 scales and 7 single items, has been developed for measuring health-related quality of life in patients with brain cancer. Module development proceeded through several stages, including a listing of patient, family and health care professional concerns, the writing of items, field testing in 105 patients with brain cancer and subsequent item reduction and scale construction after multitrait scaling analysis and assessment of internal consistency (Cronbach's coefficient alpha). The final version of the module exhibits reasonable test-retest stability over a period of one week. Differences in the responses between patients with recently-diagnosed and recurrent cancer and between patients with a Karnofsky Performance Score (KPS) of 50-70 and 80-100 were in the expected direction, indicating that the module of questions is responsive to differing conditions. Patients with either mental confusion, motor deficit or dysphasia indicated problems in several domains and single items as compared to patients without these neurological deficits. Thus, differences in the responses to the items in the brain cancer module appear to reflect differences in neurological status. In addition, deteriorating neurological status was accompanied by a marked increase in emotional distress, future uncertainty and motor dysfunction. A comparison of the responses in the module with the KPS and with a modified Barthel Activities of Daily Living Index (BADLI) shows moderate correlations, primarily with scales and items that pertain to motor dysfunction, while other scales (such as emotional distress, visual disorder and communication deficit) and most single items are not associated with the KPS or BADLI. Since the emotional distress scale of the module was found to be highly correlated with the emotional function scale of the EORTC QLQ-C30, it could be omitted when the module is used in combination with the QLQ-C30. This would reduce the module to a total of 20 items with four scales and seven single items. The intention is to combine this module of questions with other core or general quality-of-life questionnaires when studying patients with brain cancer in clinical trials.     

Assessing disharmony and disaffection in intimate relationships: Revision of the Marital Satisfaction Inventory factor scales.

Previous research has identified 2 broad components of distress in intimate relationships: overt conflict, or disharmony, and emotional distance, or disaffection. Using confirmatory factor analysis, the authors derived 2 broadband scales of disharmony and disaffection from the Marital Satisfaction Inventory-Revised (D. K. Snyder, 1997), building upon previous measures of these constructs (D. K. Snyder & Regts, 1982) derived from the original instrument. The new scales demonstrated high internal consistency and test-retest reliability, as well as discriminative validity and convergent validity with independent criteria of relationship functioning. Distinct distributions of these scales in community and clinical samples suggested their complementary role in research on intimate relationships and assessment of couples in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30

While quality of life (QOL) assessment is becoming more common, interpreting the results remains problematic. This paper demonstrates an approach to developing clinically-based interpretations for QOL outcomes, using the QLQ-C30 as an example. The results from 14 published QLQ-C30 studies which group patients by performance status, weight loss, toxicity, extent or severity of disease are collated. Groups with lower clinical status generally have worse QOL. The largest differences are between performance status groups, and the smallest differences are between groups of patients with local disease and those with metastases. The physical and role scores have the largest ranges of means across patient groups, and show the largest differences between clinical groups, while the cognitive and emotional scores have the smallest ranges of means and differences. Sicker groups have larger score standard deviations than healthier groups. Relatively large and small means and differences, and corresponding effect sizes, are presented. Collectively, the results provide a sense of the relative sizes of means and of differences, and of the types of clinical groups which give rise to them, thereby providing clinically-based benchmarks by which to interpret QLQ-C30 results.     

Three evaluation methods of a community health advocate program

BACKGROUND: The job demands-control model developed by Karasek has greatly influenced research on psychosocial factors at work and health. Validity of the English version of the psychological demands and decision latitude scales is documented. Psychometric qualities of the French version are investigated here in a representative sample of the general population, including blue-collars and white-collars. METHODS: The French translation of the psychological demand and decision latitude scales was administered by interview in a representative sample of the Quebec working population (N = 1,110). Internal consistency and factorial validity of the instrument were studied among white-collars and blue-collars separately. Discriminant validity was assessed for the whole population. RESULTS: Cronbach alpha coefficients, varying between 0.68 and 0.85, support the internal consistency of the scales. Demographic distribution of the scales and intercorrelations were consistent with the English version. Results of the factor analysis were consistent with the two dimensions expected from the theory. Mean scale scores and variations in the prevalence of high psychological demands combined with low decision latitude by age, sex, education, and job category support the discriminant validity of the instrument. CONCLUSIONS: Results support internal consistency, factorial validity, and discriminant validity of the French version of the psychological demands and decision latitude scales of the Karasek "Job Content Questionnaire" for white-collars and for blue-collars of the general population.     

The pediatric cancer quality of life inventory-32 (PCQL-32): I. Reliability and validity

BACKGROUND: Multidimensional measurement of pediatric cancer patients' health-related quality of life (HRQOL) in Phase III randomized controlled clinical trials is being recognized increasingly as an essential component in evaluating the comprehensive health outcomes of modern antineoplastic treatment protocols. The Pediatric Cancer Quality of Life Inventory-32 (PCQL-32) is a standardized patient self-report and parent proxy-report assessment instrument designed to assess systematically pediatric cancer patients' HRQOL outcomes. METHODS: To validate a patient-report form and a parent-report form, the PCQL-32 was administered to 291 pediatric cancer patients and to their parents. Both forms yield a total score and five a priori multidimensional scales. Clinical validity was determined by the known-groups approach by comparing patients classified as either on or off treatment. To determine construct validity, a battery of standardized psychosocial measures was administered and a multitrait-multimethod matrix was constructed. RESULTS: For both patient and parent forms, internal consistency reliability of the PCQL-32 total scale was high (0.91 and 0.92, respectively). The internal consistency reliabilities of the five component scales for both patient and parent forms were in the acceptable range for group comparisons. With regard to clinical validity, the PCQL-32 total scale and the disease/treatment and physical functioning scales of the PCQL-32 distinguished between patients on and off treatment for both patient- and parent-report. The results of the multitrait-multimethod matrix approach were consistent with hypotheses and lent evidence for the construct validity of the patient and parent forms of the PCQL-32 total scale and the psychological functioning, social functioning, cognitive functioning, physical functioning, and disease/treatment scales. CONCLUSIONS: The PCQL-32 has demonstrated acceptable internal consistency reliability, clinical validity, and construct validity for both patient-report and parent-report forms. Further field testing of the PCQL-32 will determine its practicality and utility in multisite pediatric cancer randomized controlled clinical trials.     

Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan

Development of the Japanese SF-36 was completed in two phases: Phase 1: Japanese version 1.1 was produced according to International Quality of Life Assessment (IQOLA) project guidelines, but some results of psychometric tests were unexpected. First, scores varied little across physical-functioning items. Second, using factor analysis, we could not clearly distinguish the scales designed to measure the "physical" component of quality of life from those designed to measure the "mental" component. Phase 2: Focus-group discussions revealed that limited had often been interpreted as limited by a doctor. Therefore, is difficult to do was used instead (version 1.2). Results of two surveys indicated that version 1.2 yields scores that are reliable by internal consistency and test-retest standards and yields two principal components. In Japan, however, the pattern of correlations between some scales and the principal components differs from that in the United States. Iterative use of qualitative and quantitative methods was very important in developing the Japanese SF-36.     

Kaposi''s sarcoma-associated herpesvirus in Kikuchi''s disease

Questions of meaning and challenge by illness, i.e., the spiritual dimension of quality of life (QL) traditionally played an important role in anthroposophically oriented medicine and have gained importance in palliative medicine and supportive care. In the context of a research project on QL in patients with advanced cancer, we therefore investigated the psychometric properties of a questionnaire covering spiritual QL issues, with the aim of providing a module for the assessment of cognitive-spiritual QL. PATIENTS AND METHODS: We investigated 89 patients with advanced breast and gastro-intestinal cancer. Construct validity of a modified version of the SELT (Skalen zur Erfassung von Lebensqualit?t bei Tumorkranken), the SELT-M was tested by multitrait scaling analysis. Discriminant and convergent validity were also tested. The EORTC QLQ-C30 was used as a standard for validation. Results showed the SELT-M as feasible in administration. Four of the five SELT-M subscales were internally consistent (Cronbach's Alpha = > 0.7). The subscale on spiritual QL showed higher within than outside subscale correlations for six of its eight items. Association of the SELT-M with the EORTC QLQ-C30 was good for the items and subscales covering the same aspects of QL in both questionnaires: emotional (Spearman r = 0.61), physical functioning (r = -0.54) and fatigue (r = -0.75). In accordance with expectations, there was no association between spiritual QL with any EORTC QLQ-C30 subscales. Self-assessed spiritual QL in the SELT-M corresponded well with interviewer assessments (test for trend accross ordered groups, P = 0.0023). CONCLUSIONS: Overall there is confirming evidence for the hypothesised structure of the SELT-M, especially for the newly developed module on spiritual QL. This module may be used as a module together with other cancer specific QL questionnaires.     

Validation canadienne-fran?aise de la mesure de conflit et d'ambigu?té de r?le de Rizzo et al. (1970).

The aim of this study was to validate a French-Canadian version of the Role Conflict and Ambiguity Scales (J. R. Rizzo et al, 1970). A sample of 470 Ss (mean age 39.4 yrs) was used to establish the psychometric properties of the instrument. The internal consistency coefficients were found to be .77 and .79 for the conflict and ambiguity scales, respectively. A confirmatory factor analysis supports the factor structure of the original version. Correlations between the role conflict and ambiguity scales with work satisfaction, role overload, and psychological distress provided some indication of construct validity. The two scales were weakly associated with social desirability. Future studies are needed to further investigate their construct validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-iatrogenic injuries of the ureter

Despite a rapid increase in disabled elderly in Japan, the burden of the caregiver has not been properly assessed due to a lack of objective measurements. Our study was aimed at adapting and validating the Zarit Caregiver Burden Interview (ZBI) in Japan, which is one of the most widely used measurements for caregivers' burden in the United States. Sixty-six caregivers answered the self-administered questionnaire, involving the Japanese version of the ZBI and questions regarding their caregiving situation. Our study demonstrated that the Japanese version of the ZBI had equally as high reliability and validity as the original version. The Japanese ZBI had a high test-retest reliability (r = 0.76) and internal consistency (Cronbach's alpha = 0.93). The total score of the ZBI was highly correlated with the caregivers' score of the Center for Epidemiologic Studies Depression Scale (CES-D) score (r = 0.50), as well as a single global rating of burden (r = 0.71). It was also shown that demographic distribution of the score of the Japanese version had a similar trend to that of the original version. Caregivers who looked after patients with behavioral disturbances were found to have a significantly higher ZBI score than those who looked after patients without behavioral disturbances, which is consistent with previous findings. It is concluded that the Japanese version of the ZBI can be used to measure feelings of burden of caregivers in the Japanese population and can be used for cross-cultural comparison.     

The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation

This article reports on the main developmental stages and on the preliminary psychometric assessment of the final French version of the SF-36. A standard forward/backward translation procedure was followed. When translating survey items, the emphasis was placed on conceptual equivalence. When translating response choices, we attempted to select a set of response choices that replicate the U.S. version. The distance between the response choices was checked using visual analogue scales (N = 30). The adaptation procedure also included formal ratings of the difficulty of the translation, of the quality of the translation, and of the equivalence between the American source version and the French target version. The face validity was checked during lay panel sessions at which the translated questionnaire was administered to subjects from the general public, hospital employees, and subjects with a low level of education. Standard psychometric techniques were used to evaluate the cultural adaptation of the SF-36, using data from a general population survey. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert-type scaling construction) of the SF-36 were satisfied. The results support the claim that the scaling properties of the French version of the SF-36 are adequate and that health outcomes may be reliably assessed using this version of the instrument.     

Reliability and Validity of the Revised Children's Manifest Anxiety Scale in a French-Canadian Sample.

The aim of this study was to examine the reliability and validity of a French version of the Revised Children's Manifest Anxiety Scale (RCMAS). A sample of 2,666 school-age French-Canadian children completed the questionnaire. With regard to factor structure, the 5-factor model found in U.S. normative samples was confirmed. The internal consistency of the 5 scales and of the 2 global scales was good to excellent. Test-retest reliabilities after a 6-month period were also similar to those of the original version. Finally, the concurrent validity, assessed by a correlation with the State-Trait Anxiety Inventory for Children, was also found to be good. Results of the present study show that the French version of the RCMAS is a good instrument to assess anxiety in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimacy and individuation in young adults: Development of the young adult version of the Personal Authority in the Family System Questionnaire.

Reports a series of studies on the development of the young adult version of the Personal Authority in the Family System Questionnaire (PAFS-QVC). The instrument includes 7 scales measuring individuation-fusion, intimacy-isolation, and personal authority-intimidation. In Study 1 (N?=?321 college students), exploratory factor analyses evaluated the conceptual scales and items. The theoretical scales were generally confirmed. Study 2 (N?=?712 college students) replicated the findings from Study 1 using confirmatory factor analysis. Concurrent validity was established through correlations with other measures of family relationships and psychological functioning. The PAFS-QVC discriminated between clinical and nonclinical samples, and gender differences were noted on the PAFS-QVC. Implications for use of the instrument in psychotherapy and intergenerational family systems theory are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural influences on cognitive representations of conflict: Interpretations of conflict episodes in the United States and Japan.

This article integrates theory from the cognitive tradition in negotiation with theory on culture and examines cultural influences on cognitive representations of conflict. The authors predicted that although there may be universal (etic) dimensions of conflict construals, there also may be culture-specific (emic) representations of conflict in the United States and Japan. Results of multidimensional scaling analyses of U.S. and Japanese conflict episodes supported this view. Japanese and Americans construed conflicts through a compromise versus win frame (R. L. Pinkley, 1990), providing evidence of a universal dimension of conflict construal. As the authors predicted, Japanese perceived conflicts to be more compromise-focused, as compared with Americans. There were also unique dimensions of construal among Americans and Japanese (infringements to self and giri violations, respectively), suggesting that identical conflict episodes are perceived differently across cultures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of patient and proxy EORTC QLQ-C30 ratings in assessing the quality of life of cancer patients

The aim of this study was to examine whether significant others can provide useful proxy information on the health-related quality of life (QL) of cancer patients. We examined the level and pattern of agreement between patient and proxy ratings of the EORTC QLQ-C30, the reliability and validity of both types of information, and the influence of several factors on the extent of agreement. QL ratings were obtained for 307 and 224 patient-proxy pairs (at baseline and follow-up, respectively). Agreement was moderate to good (ICC = 0.42 to 0.79). Multitrait-multimethod analysis showed good convergence and discrimination of specific QL domains. Comparison of mean scores revealed a small but systematic bias between patient and proxy ratings. The maximum level of disagreement was found at intermediate levels of QL, with smaller discrepancies noted for patients with either a relatively poor or good QL. Both patient and proxy QL ratings were reliable and responsive to changes over time. Several characteristics of the patients and their significant others were found to be associated with the level of agreement, but explained less than 15% of the variance in patient-proxy differences. In conclusion, the present findings lend support to the viability of employing significant others as proxy respondents of cancer patients' quality of life where this is necessary.     

An investigation of the psychometric properties of the 26 item Toronto Alexithymia Scale in a Japanese culture

We investigated the psychometric properties of the Japanese version of the 26 item Toronto Alexithymia Scale in a Japanese culture, testing a sample of 1,008. The validity and reliability of this Japanese version were suggested by significant correlations with the Beth Israel Hospital Psychosomatic Questionnaire and estimates to test-retest and internal consistency. These results suggest that this version may be suitable for Japanese populations. Although alexithymia scores were correlated negatively with increasing age, the result, based on the large sample, seems to be of minimal significance.     

Cognition and relationship maladjustment: Development of a measure of dysfunctional relationship beliefs.

The cognitive components of relationship distress have received increasing recognition from marital therapists. In particular, attention has focused on the beliefs people hold about intimate relationships and how these beliefs may adversely affect relationship quality. The present study describes the development and validation of an inventory measuring 5 such dysfunctional relationship beliefs. This Relationship Belief Inventory (RBI) was administered to 95 25–69 yr old clinical and 52 18–69 yr old nonclinical couples along with measures of marital functioning (the Marital Adjustment Test) and The Irrational Beliefs Test. Results demonstrate internal consistency, convergent validity, and construct validity for the RBI scales. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.     

Culture, cross-role consistency, and adjustment: Testing trait and cultural psychology perspectives.

Trait and cultural psychology perspectives on cross-role consistency and its relation to adjustment were examined in 2 individualistic cultures, the United States (N = 231) and Australia (N = 195), and 4 collectivistic cultures, Mexico (N = 199), the Philippines (N = 195), Malaysia (N = 217), and Japan (N = 180). Cross-role consistency in trait ratings was evident in all cultures, supporting trait perspectives. Cultural comparisons of mean consistency provided support for cultural psychology perspectives as applied to East Asian cultures (i.e., Japan) but not collectivistic cultures more generally. Some but not all of the hypothesized predictors of consistency were supported across cultures. Cross-role consistency predicted aspects of adjustment in all cultures, but prediction was most reliable in the U.S. sample and weakest in the Japanese sample. Alternative constructs proposed by cultural psychologists-personality coherence, social appraisal, and relationship harmony-predicted adjustment in all cultures but were not, as hypothesized, better predictors of adjustment in collectivistic cultures than in individualistic cultures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life in osteoporosis: reliability, consistency, and validity of the Osteoporosis Assessment Questionnaire

OBJECTIVE: To determine the reliability, consistency, and clinical utility of the Osteoporosis Assessment Questionnaire (OPAQ), an AIMS2 based self-assessment questionnaire. METHODS: Reliability of individual questions, scales, and domains were evaluated in 40 subjects by test-retest and intraclass correlation coefficients and internal consistency by Cronbach's alpha. Construct validity was evaluated by disease state. The relationships between domains and scales were modeled by confirmatory factor analysis. RESULTS: Mean kappa (79 questions) and intraclass correlation (18 health scales) coefficients were 0.58+/-0.16 (mean+/-SD) and 0.82+/-0.07, respectively. Internal consistency was greater than 0.8 in all but 3 scales. Construct validity was confirmed. Patients with hip fracture recorded lower OPAQ scores than patients with vertebral fracture. Correlation and confirmatory factor analyses grouped the 18 health scales into 7 domains. CONCLUSION: These findings suggest that OPAQ is a reliable, consistent, and valid instrument capable of distinguishing hierarchy of functional loss in disease states in osteoporosis.