Validation of the howRu and howRwe questionnaires at the individual patient level

Steven H Hendriks, Jojanneke Rutgers, Peter R van Dijk, Klaas H Groenier, Henk J G Bilo, Nanne Kleefstra, Janwillem W H Kocks, Kornelis J J van Hateren, Marco H Blanker, Steven H Hendriks, Jojanneke Rutgers, Peter R van Dijk, Klaas H Groenier, Henk J G Bilo, Nanne Kleefstra, Janwillem W H Kocks, Kornelis J J van Hateren, Marco H Blanker

Abstract

Background: The howRu and howRwe are new short questionnaires which are meant to measure health-related quality of life and patient experience. However, validation at the individual patient level has not yet taken place. We aimed to investigate the validity of both questionnaires at the individual patient level.

Methods: In this prospective validation study, patients were asked to complete both questionnaires and comment on their answers in a semi-structured in-depth interview. Based on the transcribed interviews, a panel of 45 general practitioners and 45 patients filled out the questionnaires as they thought the patients had completed them. The questionnaires were considered valid instruments when a reliable and acceptable level of agreement was reached between the patient's score and the score of a review panel, defined as a concordance correlation coefficient (CCC) of ≥0.70. Bland-Altman plots were also made.

Results: Ninety patients were included. The CCC of the howRu total score of the review panel and patients was 0.80 (95 % CI 0.73 to 0.86). Bland-Altman plots showed a mean difference of -0.96 and the limits of agreement ranged from -2.87 to 0.95. The CCC of the howRwe total score was 0.57 (95 % CI 0.42 to 0.69). The mean difference on the Bland-Altman plots was -0.54 and the limits of agreement ranged from -3.59 to 2.52.

Conclusions: The howRu seems to be a valid questionnaire for measuring health-related quality of life at the individual patient level. We do not advice to use the tested version of the howRwe questionnaire for assessing patient experience at the individual patient level.

Trial registration: The study was registered at clinicaltrials.gov NCT01830803 . Registration date: 5 April 2013.

Figures

Fig. 1
Fig. 1
Flow diagram of the selection process
Fig. 2
Fig. 2
Bland-Altman plot showing the relationship between the howRu total scores of patients and the review panel. The dashed lines represent the limits of agreement
Fig. 3
Fig. 3
Bland-Altman plot showing the relationship between the howRwe total scores of patients and the review panel. The dashed lines represent the limits of agreement

References

    1. Higginson IJ, Carr AJ. Measuring quality of life: using quality of life measures in the clinical setting. BMJ. 2001;322:1297–1300. doi: 10.1136/bmj.322.7297.1297.
    1. Greenhalgh J. The applications of PROs in clinical practice: what are they, do they work, and why? Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2009;18:115–123. doi: 10.1007/s11136-008-9430-6.
    1. Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483. doi: 10.1097/00005650-199206000-00002.
    1. Brooks R. EuroQol: the current state of play. Health Policy Amst Neth. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Grol R, Wensing M, Mainz J, Jung HJ, Ferreira P, Hearnshaw H, Hjortdahl P, Olesen F, Reis S, Ribache M, Szecsenyi J. Patients in Europe evaluate general practice care: an international comparison. Br J Gen Pract J R Coll Gen Pract. 2000;50:882–887.
    1. Parker SG, Bechinger-English D, Jagger C, Spiers N, Lindesay J. Factors affecting completion of the SF-36 in older people. Age Ageing. 2006;35:376–81. doi: 10.1093/ageing/afl003.
    1. Fung CH, Hays RD. Prospects and challenges in using patient-reported outcomes in clinical practice. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2008;17:1297–1302. doi: 10.1007/s11136-008-9379-5.
    1. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 1995;4:293–307. doi: 10.1007/BF01593882.
    1. Donaldson G. Patient-reported outcomes and the mandate of measurement. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2008;17:1303–1313. doi: 10.1007/s11136-008-9408-4.
    1. Benson T, Sizmur S, Whatling J, Arikan S, McDonald D, Ingram D. Evaluation of a new short generic measure of health status: howRu. Inform Prim Care. 2010;18:89–101.
    1. Acquadro C, Conway K, Giroudet C, Mear I. Linguistic validation manual for Patient-Reported Outcomes (PRO) instruments. Lyon: Mapi Research Institute; 2004.
    1. Van der Molen T, Kocks JWH. Do health-status measures play a role in improving treatment in chronic obstructive pulmonary disease? Expert Opin Pharmacother. 2006;7:57–61. doi: 10.1517/14656566.7.1.57.
    1. Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–268. doi: 10.2307/2532051.
    1. Lin L, Hedayat AS, Wu W. A unified approach for assessing agreement for continuous and categorical data. J Biopharm Stat. 2007;17:629–652. doi: 10.1080/10543400701376498.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310. doi: 10.1016/S0140-6736(86)90837-8.
    1. Fayers PM, Hand DJ, Bjordal K, Groenvold M. Causal indicators in quality of life research. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 1997;6:393–406. doi: 10.1023/A:1018491512095.
    1. Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80:99–103. doi: 10.1207/S15327752JPA8001_18.
    1. Kahneman D. Thinking fast and slow. New York: Farrar, Straus and Giroux; 2011.
    1. De Vet HCW, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59:1033–1039. doi: 10.1016/j.jclinepi.2005.10.015.
    1. Atkinson G, Nevill A. Comment on the use of concordance correlation to assess the agreement between two variables. Biometrics. 1997;53:775–777.
    1. Brinkman BS, van Hateren KJJ, Kleefstra N, Houweling ST, Groenier KH, Bilo HJG. Effects of writing down the request for help: a randomized controlled trial. Eur J Gen Pract. 2013;20:214–218. doi: 10.3109/13814788.2013.845877.
    1. Benson T, Potts H. A short generic patient experience questionnaire: howRwe development and validation. BMC Health Serv Res. 2014;14:499. doi: 10.1186/s12913-014-0499-z.
    1. Benson T, Potts HWW, Whatling JM, Patterson D. Comparison of howRU and EQ-5D measures of health-related quality of life in an outpatient clinic. Inform Prim Care. 2013;21:12–17. doi: 10.14236/jhi.v21i1.9.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren