Examining functional content in widely used Health-Related Quality of Life scales.

Purpose: Assess extent to which generic Quality of Life (QOL) and Health-Related Quality of Life (HRQOL) scales include function in assessment of health, and identify health assessment items that are free of functional content. Methods: An expert panel on measurement of health and disability reached consensus on definitions of health, disability, and function. They assessed all items of all generic (non-condition-specific) scales in the 2006 ProQolid database for being important to measuring health as distinct from function. Ratings were summarized as content validity ratios. Retained items were written into standard format and reviewed again by the expert panel and a validity panel with expertise in specific disabilities. Results: Of 85 scales, 21 were retained as containing items important for assessing health. Scales ranged from 100% (BRFSS HRQOL, WHO-5) to only 4% of items rated as important. In further review of “important” items, functional content was identified in many of the items, particularly with regard to mental functioning. Conclusions: Popular generic scales of QOL and HRQOL vary greatly in the degree to which they include content on function. A pool of items can be identified that are relatively free of function. Distinguishing measurement of function and health is particularly important for people with long-standing functional limitations and for assessing the relationship of health with function. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment

Data from general population surveys (n = 1483 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to cross-validate the selection of questionnaire items for the SF-12 Health Survey and scoring algorithms for 12-item physical and mental component summary measures. In each country, multiple regression methods were used to select 12 SF-36 items that best reproduced the physical and mental health summary scores for the SF-36 Health Survey. Summary scores then were estimated with 12 items in three ways: using standard (U.S.-derived) SF-12 items and scoring algorithms; standard items and country-specific scoring; and country-specific sets of 12 items and scoring. Replication of the 36-item summary measures by the 12-item summary measures was then evaluated through comparison of mean scores and the strength of product-moment correlations. Product-moment correlations between SF-36 summary measures and SF-12 summary measures (standard and country-specific) were very high, ranging from 0.94-0.96 and 0.94-0.97 for the physical and mental summary measures, respectively. Mean 36-item summary measures and comparable 12-item summary measures were within 0.0 to 1.5 points (median = 0.5 points) in each country and were comparable across age groups. Because of the high degree of correspondence between summary physical and mental health measures estimated using the SF-12 and SF-36, it appears that the SF-12 will prove to be a practical alternative to the SF-36 in these countries, for purposes of large group comparisons in which the focus is on overall physical and mental health outcomes.     

The MOS SF-36 health survey questionnaire in severe chronic airflow limitation: comparison with the Nottingham Health Profile

This study documents the cross-sectional, health-related quality of life (HRQOL) measures obtained at baseline for patients with severe chronic airways limitation (CAL) being assessed for home oxygen therapy (HOT) at the Flinders Medical Centre, Adelaide, South Australia. Two generic quality of life instruments, the Nottingham Health Profile (NHP) and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36), were administered by interview to the same patients to permit comparisons to be made between the two instruments. SF-36 mean scores were also compared with scores obtained in separate studies of a South Australian elderly general population and of groups of Australian subjects with various medical and psychiatric conditions. NHP mean scores were compared with scores from an elderly group of Adelaide residents from a household survey. HRQOL measures were obtained for 60 patients, 32 males and 28 females. At assessment for HOT, patients with severe CAL were experiencing severe impairment in their quality of life in comparison to age-matched South Australian norms, with physical disability the major limitation. There were several significant correlations between the domains of the SF-36 and the NHP which were predominantly gender-specific. Only small decrements in mental health were found with the SF-36 questionnaire. The SF-36 and the NHP appear to provide discrepant information for severely disabled CAL patients for the subjective domains of emotional and mental health.     

Assessing adult leisure activities: An extension of a self-report activity questionnaire.

Everyday leisure activities in adulthood and old age have been investigated with respect to constructs such as successful aging, an engaged lifestyle, and prevention of age-related cognitive decline. They also relate to mental health and have clinical value, as they can inform diagnosis and interventions. In the present study, the authors enhanced the content validity of the Victoria Longitudinal Study activity questionnaire by adding items on physical and social activities and validated a shortened version of the questionnaire. The proposed leisure activity model included 11 activity categories: 3 types of social activities (i.e., activities with close social partners, group-centered public activity, religious activities), physical activities, developmental activities, experiential activities, crafts, game playing, TV watching, travel, and technology use. Confirmatory factor analyses validated the proposed factor structure in 2 independent samples. A higher order model with a general activity factor fitted the activity factor correlations with relatively little loss of fit. Convergent and discriminant validity for the activity scales were supported by patterns of their correlations with education, health, depression, cognition, and personality. In sum, the scores derived from of the augmented Victoria Longitudinal Study activity questionnaire demonstrate good reliability, and validity evidence supports their use as measures of leisure activities in young, middle-aged, and older individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey

Cross-sectional data from a representative sample of the general population in Japan were analyzed to test the validity of Japanese SF-36 Health Survey scales as measures of physical and mental health. Results from psychometric and clinical tests of validity were compared. Principal components analyses were used to test for the hypothesized physical and mental dimensions of health and the pattern of scale correlations with those components. To test the clinical validity of SF-36 scale scores, self-reports of chronic medical conditions and the Zung Self-Rating Depression Scale were used to create mutually exclusive groups differing in the severity of physical and mental conditions. The pattern of correlations between the SF-36 scales and the two empirically derived components generally confirmed hypotheses for most scales. Results of psychometric and clinical tests of validity were in agreement for the Physical Functioning, Role-Physical, Vitality, Social Functioning, and Mental Health scales. Relatively less agreement between psychometric and clinical tests of validity was observed for the Bodily Pain, General Health, and Role-Emotional scales, and the physical and mental health factor content of those scales was not consistent with hypotheses. In clinical tests of validity, the General Health, Bodily Pain, and Physical Functioning scales were the most valid scales in discriminating between groups with and without a severe physical condition. Scales that correlated highest with mental health in the components analysis (Mental Health and Vitality) also were most valid in discriminating between groups with and without depression. The results of this study provide preliminary interpretation guidelines for all SF-36 scales, although caution is recommended in the interpretation of the Role-Emotional, Bodily Pain, and General Health scales pending further studies in Japan.     

Assessing coping strategies: A theoretically based approach.

We developed a multidimensional coping inventory to assess the different ways in which people respond to stress. Five scales (of four items each) measure conceptually distinct aspects of problem-focused coping (active coping, planning, suppression of competing activities, restraint coping, seeking of instrumental social support); five scales measure aspects of what might be viewed as emotion-focused coping (seeking of emotional social support, positive reinterpretation, acceptance, denial, turning to religion); and three scales measuring coping responses that arguably are less useful (focus on and venting of emotions, behavioral disengagement, mental disengagement). Study 1 reports the development of scale items. Study 2 reports correlations between the various coping scales and several theoretically relevant personality measures in an effort to provide preliminary information about the inventory's convergent and discriminant validity. Study 3 uses the inventory to assess coping responses among a group of undergraduates who were attempting to cope with a specific stressful episode. This study also allowed an initial examination of associations between dispositional and situational coping tendencies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related quality of life after epilepsy surgery: a Swedish multicenter study

PURPOSE: To investigate health-related quality of life (HRQOL) in relation to seizure outcome as part of a multicenter follow-up of epilepsy surgery in Sweden. METHODS: A battery including the SF-36 Health Survey and the Hospital Anxiety and Depression scale (HAD) was distributed to all patients older than 16 years. Mean follow-up time was 4 years (range, 2-13 years) and response rate, 91% (103 of 113 patients). HRQOL data were related to seizure frequency and severity (Chalfont Seizure Severity Scale). RESULTS: Seventy-six percent considered their global health to be better than it was before surgery. Degree of improvement in seizure control correlated with improved satisfaction with health (Spearman's r = 0.44). Higher SF-36 scores (higher HRQOL ratings) correlated with percentage reduction of seizure frequency for all scales and was strongest for perception of general health (Spearman's r = 0.46). When the patients were divided into four categories [A, completely seizure free (n = 29); B, seizure free with aura (n = 18); C, > or =75% reduction in seizure frequency (n = 24); and D, <75% reduction in seizure frequency (n = 32)], a strong positive association was found between higher SF-36 scores (with the exception of physical functioning) and better seizure control. Health-related limitations in role performance differentiated best between the outcome categories. For patients with > or =75% reduction in seizure frequency, low seizure severity correlated with higher HRQOL ratings for scales measuring social function, vitality, and mental health. Depression levels (HAD scale scores) were on average low. Anxiety (HAD) increased significantly from A to D. CONCLUSIONS: HRQOL seems to be scored as a continuum in relation to seizure frequency. Seizure severity measures give complementary information.     

The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment

Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.     

Use of the Fagerstrom Tolerance Questionnaire for measuring nicotine dependence among adolescent smokers in China: A pilot test.

The validity of the Prokhorov adolescent version of the Fagerstrom Tolerance Questionnaire (FTQ) has not been demonstrated in assessing nicotine dependence among Chinese adolescents in China. Data for 48 tenth-grader 30-day'smokers in Wuhan, China (ages 16-17 years), were analyzed. Two different item scoring protocols were used, and self-reports of smoking were validated with saliva cotinine. When items were scored using Protocol A, Cronbach's alphas were .42 and .63 for the 7-item and the 4-item scales, respectively; while using Protocol B, the alphas were .67 and .79 for the 7-item and 4-item scales, respectively. The total FTQ scores were significantly associated with self-reported smoking and saliva cotinine levels. These results support the reliability and validity of the Prokhorov FTQ. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Updating Norman's "adequacy taxonomy": Intelligence and personality dimensions in natural language and in questionnaires.

Examined the correspondence between 2 systems for personality trait classification—W. T. Norman's (1963) 5-factor model and P. T. Costa and R. R. McCrae's (1980) NEO (Neuroticism, Extraversion, Openness) inventory—to evaluate their comprehensiveness as models of personality. 498 24–86 yr old participants in the Baltimore Longitudinal Study of Aging completed an instrument containing 80 adjective pairs, which included 40 pairs proposed to measure the 5 dimensions. Neuroticism and extraversion factors from these items showed substantial correlations with corresponding NEO inventory scales; however, analyses that included psychometric measures of intelligence suggested that the 5th factor in the Norman structure should be reconceptualized as openness to experience. Convergent correlations above .50 with spouse ratings on the NEO inventory that were made 3 yrs earlier confirmed these relations across time, instrument, and source of data. The relations among culture, conscientiousness, openness, and intelligence are discussed, and it is concluded that mental ability is a separate factor, though related to openness to experience. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents' perceptions of caregiving: development and validation of a measure of processes

The authors describe the development of a 56-item questionnaire, the Measure of Processes of Care (MPOC-56), designed to find out what parents of a child with a chronic health problem think of the services they and their child receive and of how those services affect psychosocial outcome. The instrument is internally consistent and is reliable on retests. Its validity was shown by positive correlations of its five scales with parents' satisfaction, and negative correlations with parents' stress in relation to services received. The MPOC-56 is a generic measure which can be used for clinical, quality assurance and research purposes.     

Problem-behavior factor correlates of Personality Inventory for Children profile scales.

Investigated the relationships between empirically determined dimensions of problem behaviors and the profile scales of the Personality Inventory for Children, a multidimensional objective personality inventory. Behavior problems and family characteristics of 430 children and adolescents (ages 2–17 yrs) tapping a variety of content areas were obtained on a 100-item checklist. Responses on the checklist were submitted to a principle components factor analysis with varimax rotation. Factor scores were generated for each S on the 16 interpretable factors. T scores of the 16 profile scales were correlated with the problem-behavior factor scores separately for male children, male adolescents, female children, and female adolescents. The resulting correlation matrices allowed identification of scale to correlates and their variation by age or sex and facilitated the estimate of generalizability of the data analysis. Results provide substantial evidence of scale convergent and discriminant validity and suggest the potential utility of this instrument. Further research is necessary to determine specific correlates suggested by scale elevation, setting, age-specific or sex-specific correlates, and development of profile classification rules. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence and functions of self-reported private speech in young adults: A self-verbalization questionnaire.

The present study employed a self-report approach to study the cognitive and self-regulatory functions of private speech (Vygotsky, 1934/1987, 1978) in young adults. The Self-Verbalization Questionnaire, assessing the use of self-directed speech, was administered to 1,132 undergraduate university students(aged 17–47 yrs). In general, self-verbalization scores were high. Exploratory factor analysis produced a four-factor solution that was readily interpretable in terms of Vygotskian theory. Consistent with the view that private speech serves as a cognitive tool system, the highest scores were reported for questionnaire items loading highly on a factor consisting of cognitive, mnemonic, and attentional uses of self-verbalization. The scales appear to have good internal consistency, high test-retest reliability, and good content and criterion validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of the original Ontario Child Health Study scales

This article presents evaluative information on the use of the original Ontario Child Health Study scales to serve as original-level measures of conduct disorder, hyperactivity and emotional disorder among children in the general (non clinic) population. Problem checklist assessments were obtained from parents and teachers of children aged six to 16 and youth aged 12 to 16 drawn from a general population (n = 1,751); and a mental health clinic sample (n = 1,027) in the same industrialized, urban setting. The results showed that the original OCHS scales possess adequate psychometric properties to be used as original-level measures of disorder. Correlations between individual items and their hypothesized scales were very strong, indicating convergent validity, while correlations between the same items and other (non hypothesized) scales were lower, indicating discriminant validity. Item analyses indicated that individual scale items possess both convergent and discriminant validity. Although the scales were skewed to the positive end of the continuum, they demonstrated good internal consistency (all estimates > or = 0.74) and test-retest (all estimates > or = 0.65) reliability. Finally, three different validity analyses confirmed hypotheses about how the original OCHS scales should perform if they provide useful measures of disorder.     

Analysis of defensiveness in relation to psychopathology.

Attempted (a) to determine what factors account for relationships among items representative of 5 well-known measures of defensiveness, and (b) to relate the factors found to homogeneous measures of psychopathology and extroversion-introversion. A 246-item inventory was administered to 217 undergraduate and graduate students. An initial analysis of the 110 defensive items yielded 8 factors of which the 1st, admission of common frailties, was defined by items from the Lie, the Good Impression, the Marlowe-Crowne, the K, and the Cofer malingering scales. Items best defining 6 of the defensive factors, 6 psychopathology factors, and an extroversion scale were grouped into homogeneous subsets. The 2 main factors yielded by the factor analysis of the subtest correlations were interpreted as dimensions of extra- and intropunitiveness. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potentiation of natriuretic peptide action by the beta-adrenergic blocker carvedilol in hypertensive rats: a new antihypertensive mechanism

PURPOSE: We report the development of a questionnaire to assess health-related quality-of-life (HRQOL) in people with epilepsy and the process of cross-cultural translations of the questionnaire. METHODS: A sample of 304 adults with epilepsy from 25 seizure clinics in the United States was used to derive an abbreviated questionnaire focusing on epilepsy-related issues from a longer, 89-item instrument (QOLIE-89). A rigorous forward-backward-forward system was used for cross-cultural translation. RESULTS: A 31-item questionnaire (QOLIE-31, version 1.0) resulted, comprising seven subscales covering general and epilepsy-specific domains. Subscale and total scores can be calculated. The subscales were grouped into two factors: Emotional/Psychological Effects (seizure worry, overall QOL, emotional well-being, energy/fatigue subscales) and Medical/Social Effects (medication effects, work-driving-social limits, cognitive function subscales). Cross-cultural translations were made from U.S.-English into Danish, Dutch, German, Canadian French, French, Italian, Spanish, Swedish, and U.K. English Versions 1.1. CONCLUSIONS: Our results support the reliability and validity of the QOLIE-31 (U.S.-English version 1.0) as a measure of HRQOLIE. Cross-cultural translations into nine other languages make it feasible to use the QOLIE-31 (version 1.1) in multinational clinical trials after validation in each population or concurrent with the clinical trial.     

The Mini-IPIP Scales: Tiny-yet-effective measures of the Big Five Factors of Personality.

The Mini-IPIP, a 20-item short form of the 50-item International Personality Item Pool-Five-Factor Model measure (Goldberg, 1999), was developed and validated across five studies. The Mini-IPIP scales, with four items per Big Five trait, had consistent and acceptable internal consistencies across five studies (= at or well above .60), similar coverage of facets as other broad Big Five measures (Study 2), and test-retest correlations that were quite similar to the parent measure across intervals of a few weeks (Study 4) and several months (Study 5). Moreover, the Mini-IPIP scales showed a comparable pattern of convergent, discriminant, and criterion-related validity (Studies 2-5) with other Big Five measures. Collectively, these results indicate that the Mini-IPIP is a psychometrically acceptable and practically useful short measure of the Big Five factors of personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring progress and outcome in community rehabilitation after brain injury with a new assessment instrument--the BICRO-39 scales. Brain Injury Community Rehabilitation Outcome

OBJECTIVE: Construction and validation of a new instrument, the Brain Injury Community Rehabilitation Outcome scales, to assess problems experienced by brain-injured patients living in the community. DESIGN: Seventy-six items describing aspects of personal and social functioning were generated. Two hundred thirty-five patients and/or their carers (separately) rated the items on 6-point scales, and patients retrospectively rated their functioning before injury. Seven scales were derived from factor analysis; one was included a priori. Thirty-nine items with high factor loadings were retained. Test-retest reliability, interrater reliability, and construct validity were examined in subsamples. SETTING: Patients were recruited from four centers: two community-based teams, a day-patient clinic, and an outpatient clinic. PATIENTS: Of the patients, 127 had traumatic brain injury, 72 had cerebrovascular accidents, 15 had multiple sclerosis, and 21 had acquired brain injury of other origins. Mean time since brain injury was 2.6 years; mean age was 43 years; 164 were men and 71 were women. RESULTS: All scales showed good test-retest reliability, and agreement between patient and carer ratings was moderate to high. They showed predicted moderate correlations with other relevant scales. Postinjury scores differed significantly from preinjury scores, and 6 of the 8 scales showed change over a period of recovery/rehabilitation. CONCLUSIONS: The scales appear reliable and easy to complete. They may have utility as quantitative measures of outcome for clinical and treatment evaluations.     

External validation of the Personality Inventory for Children: Comment on Lachar, Gdowski, and Snyder.

Comments on the D. Lachar et al (see record 1984-19420-001) evidence of external validity for Personality Inventory for Children (PIC), which is based on correlations of PIC scales with dimension scores derived from factor analyses of behavioral ratings. It is argued that due to considerable item overlap between PIC scales and behavior rating forms, correlations may be an indication of rater reliability rather than one of construct validity. This problem is thought to be especially evident for rating forms completed by parents because parents also completed the PIC, and many items are similar in both content and wording. The problem is illustrated using the hostility/dyscontrol dimension derived from parent ratings. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cross sectional assessment of health status instruments in patients with rheumatoid arthritis participating in a clinical trial. Minocycline in Rheumatoid Arthritis Trial Group

OBJECTIVE: To (1) validate the Short-Form Health Survey (SF-36) as a generic functional health status measure in patients with rheumatoid arthritis (RA); and (2) assess correlations between the SF-36 and other outcome measures used in the Minocycline in Rheumatoid Arthritis (MIRA) Trial. METHODS: We conducted a cross sectional analysis of the final visit outcome measures from the 48 week, multicenter, placebo controlled, double blind MIRA trial. Multitrait scaling analyses assessed convergent and discriminant validity and internal consistency reliability of the SF-36 in the study patients. Responses to comparable items on the SF-36 and modified Health Assessment Questionnaire (M-HAQ) regarding physical functioning were compared and questions from both instruments were also compared to other RA outcome measures. RESULTS: In patients with RA, the SF-36 had high internal consistency and reliability, high discriminant and high convergent validity. Moderate correlations were observed (r = -0.46 to -0.61, p < 0.01 in each case) for comparable items on the SF-36 and M-HAQ regarding dressing, walking, and bending. Joint tenderness score correlations with items on the M-HAQ and SF-36, and joint tenderness score correlations with the SF-36 scales were higher than for joint swelling scores. Physician and patient global assessments were most highly correlated (r = 0.58 and 0.66; p < 0.01, respectively) with the SF-36 bodily pain item. CONCLUSION: The SF-36 is a valid instrument for this RA population. The SF-36 correlates with the M-HAQ and the physician and patient global assessments. The usefulness of the SF-36 in measuring change in RA clinical trials requires testing in longitudinal studies.