The Danish version of the Nottingham Health Profile: its adaptation and reliability

A systematic review of measurement tools of health and well-being for evaluating community-based interventions

BACKGROUND

Those interested in evaluating the effectiveness of community interventions on health and well-being need information about what tools are available and best suited to measure improvements that could be attributed to the intervention.This study evaluated published measurement tools of health and well-being that have the potential to be used before and after an intervention.

METHODS

A literature search of health and sociological databases was undertaken for articles that utilised measurement tools in community settings to measure overall health, well-being or quality of life. Articles were considered potentially relevant because they included use of measurement tools related to general health or well-being. These tools were evaluated by further searching of the literature to assess each tool's properties including: reliability; validity; responsiveness; length; use in cross-cultural settings; global health or well-being assessment; use of subjective measures; clarity and cost. A composite score was made based on the average rating of all fields.

RESULTS

Of 958 abstracts that were screened, 123 articles were extracted for review. From those articles, 27 measurement tools were selected and assessed. Based on the composite score assessing across all domains, five tools were rated as excellent.

CONCLUSIONS

While tools may need to be selected for particular aims and interventions, a range of potential well-described tools already exist and should be considered for use in preference to ad hoc or bespoke tools. Any of the five tools rated as excellent are recommended to assess the impact of a community intervention.

Translation and validation of the Danish version of the Patient Rated Wrist Evaluation questionnaire

The need for validated outcome measures is increasing. The purpose is to translate and validate the Patient Rated Wrist Evaluation (PRWE) in Danish. Translation was done by an expert panel followed by evaluation of a lay panel and a field test on 10 patients. Sixty patients with wrist fractures were included. Both lay panel comments and field test revealed issues not dealt with by the expert panel, and a final version of the Danish PRWE was made. The validation process then continued and reliability results. were presented as Cronbach's alpha = 0.94, describing the homogeneity and the intraclass correlation coefficient = 0.88 and difference of mean = 5.7 (CI = 1.12-10.37, p = 0.017), describing the concordance of the results. Convergent validity at first and last control was for pain, 0.51 and 0.46, and physical mobility, 0.56 and 0.64, respectively, describing the correlation with a gold standard questionnaire. A minor floor effect was noticed, but not enough to indicate a lack of sensitivity of the PRWE. Effect size, the ability to measure sensitivity to change, was 0.62, also described as responsiveness. The translation resulted in a questionnaire that represents correct easy-understandable Danish. It is concluded that the modified Danish version is a valid questionnaire for patients with wrist fractures.

Reliability and validity of the Danish version of the disabilities of arm, shoulder, and hand questionnaire in patients with fractured wrists

The disabilities of arm, shoulder, and hand (DASH) questionnaire is a 30-item region-specific questionnaire that is used to measure the effect of treatment of the upper extremity. The purpose of this study was to assess the reliability of, and validate, the Danish version of the DASH score in patients with fractured wrists. Sixty patients were studied. We investigated internal consistency and test-retest reliability, convergent validity, content validity and responsiveness. Time to complete questionnaire was 11 minutes and two questionnaires were not usable. The internal consistency was sufficient (Cronbach's alpha 0.96 and intraclass correlation coefficient 0.89). The difference in the mean was 4.6 (CI: 0.48 to 8.72, p = 0.03). Convergent validity at first and last control was high for both pain, 0.46 and 0.40 respectively, and for physical mobility, 0.64 and 0.65 respectively, indicating that results confirmed other similar scores. We conclude that the Danish version of the 30-item DASH questionnaire is valid and practical for patients with fractured wrists.

No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty

BACKGROUND AND PURPOSE

Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged with local infusion analgesia (LINFA) into the soft tissue in the hip region through a catheter in the first postoperative days has gained major interest in THA fast-track settings within a short period of time. LIA at the time of surgery is a validated treatment. We investigated the additional effect of giving postoperative LINFA after THA in patients already having LIA during surgery.

PATIENTS AND METHODS

60 consecutive patients undergoing non-cemented THA were randomized into two groups in a double-blind and controlled study. During surgery, all patients received standardized pain treatment with LIA. Postoperatively, they were treated either with a solution of Ropivacain, Ketorolac, and Adrenaline (LINFA group) or placebo (placebo group) administered through a catheter to the hip 10 and 22 h after surgery. Pain score, opioid consumption, and length of stay (LOS) were evaluated.

RESULTS

After adjustment for multiple testing, there was no statistically significant postoperative difference between the LINFA group and the placebo group regarding pain and tiredness. We found some evidence of a short-term effect on nausea and vomiting. Opioid consumption and length of stay were similar in the two groups.

INTERPRETATION

We found some evidence of a short-term effect of LINFA on nausea and vomiting, but no evidence of an effect on postoperative pain and tiredness. Thus, LINFA cannot be recommended as a standard pain treatment in patients with THA.

Women with alcohol problems: the possible significance of personality clustering for treatment planning

INTRODUCTION AND AIMS

Establishing subgroups in clinical practice is important for treatment planning. The aim of the study was to cluster the study group subjects according to personality traits and psychological health variables and to establish possible differences in treatment outcome in terms of: (i) drinking outcomes (gram and number of drinking days); (ii) perceived physiological health; and (iii) use of treatment resources (length of time in treatment and number of visits) among 134 treatment-seeking women with alcohol problems in a clinical context, between the two clusters obtained.

DESIGN AND METHODS

Data were collected from 134 consecutive women at a Swedish clinic specialised in treating women with alcohol problems. A hierarchical cluster analysis was performed on the basis of self-rated personality scale scores and psychological health variables.

RESULTS

Two clusters were identified: one in which the women displayed personality and psychological health scores indicating problems (Cluster 1); and another where the women showed personality and psychological health scores within the norm range (Cluster 2). Alcohol consumption rates at the start of treatment were the same in both clusters. The consumption rates were also the same at the end of treatment for the cluster, showing a significant decrease in alcohol consumption in each. The Cluster 1 women, however, had a significantly higher number of visits at the clinic, and rated the consequences of their alcohol drinking as being significantly worse than Cluster 2 women.

DISCUSSION AND CONCLUSIONS

The importance of individual differences according to personality traits for treatment planning is discussed in terms of the need for variation in treatment time and methods.

Validation of a condition-specific measure for women having an abnormal screening mammography

OBJECTIVES

The aim of this study is to assess the validity of a new condition-specific instrument measuring psychosocial consequences of abnormal screening mammography (PCQ-DK33).

METHODS

The draft version of the PCQ-DK33 was completed on two occasions by 184 women who had received an abnormal screening mammography and on one occasion by 240 women who had received a normal screening result. Item Response Theories and Classical Test Theories were used to analyze data. Construct validity, concurrent validity, known group validity, objectivity and reliability were established by item analysis examining the fit between item responses and Rasch models.

RESULTS

Six dimensions covering anxiety, behavioral impact, sense of dejection, impact on sleep, breast examination, and sexuality were identified. One item belonging to the dejection dimension had uniform differential item functioning. Two items not fitting the Rasch models were retained because of high face validity. A sick leave item added useful information when measuring side effects and socioeconomic consequences of breast cancer screening. Five "poor items" were identified and should be deleted from the final instrument.

CONCLUSIONS

Preliminary evidence for a valid and reliable condition-specific measure for women having an abnormal screening mammography was established. The measure includes 27 "good" items measuring different attributes of the same overall latent structure-the psychosocial consequences of abnormal screening mammography.

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

OBJECTIVE

To test alternative response formats for the Nottingham Health Profile (NHP), in terms of acceptability, score distributions, and measurement properties.

STUDY DESIGN AND SETTINGS

Randomized trial of four response formats for the NHP: original "yes/no" format, a 3-point similarity format ("applies completely/in part/not at all"), a 5-point intensity format ("completely true" to "completely false"), and a 5-point frequency format ("all the time" to "never"). Respondents were patients discharged from a hospital. We compared scores distributions, reliability coefficients, correlations with dimension-specific numerical scales, and patient ratings of the instrument.

RESULTS

Response rates were similar for the four versions. The original response format had the fewest fully completed questionnaires, and the largest ceiling effects. Internal consistency and test-retest coefficients were acceptable for all versions, but were higher for the two 5-point formats. Correlations reflecting convergent and discriminant validity were higher for the longer response formats than for the original version. The frequency format received the highest ratings from patients, particularly from the sicker and older subgroups.

CONCLUSIONS

The psychometric performance and patient acceptability of the NHP can be improved by using a 5-point frequency response format instead of the original dichotomous response format.

Establishing a standard for patient-completed instrument adaptations in Eastern Europe: experience with the Nottingham Health Profile in Hungary

The widely used generic patient-completed measures of health status were developed in the USA or the UK. Few Eastern European versions of these measures have been produced and these have used questionable translation methodologies. Clinical trials now commonly include patients from Eastern Europe and require the use of patient-completed instruments. The absence of such instruments led to the development of a Hungarian version of the Nottingham Health Profile (NHP). The adaptation process employed (translation, field-testing and psychometric assessment) also served as a test of whether the standardised rigorous methodology used for adapting the NHP could be applied in Eastern Europe. Few problems were found in producing a conceptually equivalent Hungarian NHP that was acceptable to interviewees. Reliability and internal consistency of the Hungarian NHP were comparable to other language versions. The measure also correlated as expected with perceived physical disability, general health, disease severity and rating of day. This successful adaptation confirms the value of the methodology applied. The Hungarian NHP will be invaluable as an outcome measure in both clinical and health economic trials and (in the absence of a generic quality of life instrument) as a comparator instrument for the validation of future Hungarian adaptations of disease-specific quality of life instruments.

Nottingham health profile scores predict the outcome and support aggressive revascularisation for critical ischaemia

AIMS

to assess changes in health related quality of life (HRQoL) following peripheral arterial reconstruction for critical limb ischaemia (CLI).

METHODS

sixty patients with CLI were prospectively evaluated with the Nottingham Health Profile (NHP) before and 3 and 12 months after arterial reconstruction. In addition, at 12 months, patients were asked if their expectations of the revascularisation had been met and whether they considered the surgical treatment had been worthwhile.

RESULTS

primary amputations and mortality were 5% and 3% and after 12 months 12% and 12% respectively. Three months after surgery scores on the pain and sleep sections of the NHP had improved significantly (p < 0.05). These improvements were maintained at 12 months.

CONCLUSION

revascularisation for CLI improves HRQoL and pre-operative health perceptions are related to surgical outcome.

Improving drug therapy for patients with asthma--part 1: Patient outcomes

OBJECTIVE

To evaluate the effects of a therapeutic outcomes monitoring (TOM) program on selected process and outcome measures.

DESIGN

Prospective, controlled, multicenter study.

SETTING

Community pharmacies throughout Denmark (16 intervention, 15 control).

PATIENTS

Five hundred patients with asthma aged 16 to 60 years and treated in primary care.

INTERVENTION

TOM is a community-based program for pharmaceutical care. Using a structured, seven-step, cyclical outcome improvement process, TOM pharmacists identify and resolve (or refer) problems with drug therapy that, if not addressed, might result in therapeutic failure or adverse effects. Equal emphasis is placed on the patient's perspective (e.g., coping, control, and empowerment) and the professional's perspective (e.g., adherence, patient knowledge, and therapeutic problems). TOM requires cooperation among pharmacists, patients, and physicians.

MAIN OUTCOME MEASURES

Asthma symptom status, days of sickness, health-related and asthma-specific quality of life, use of health care services and resources, and satisfaction with health care and pharmacy. INTERMEDIATE OUTCOME AND PROCESS MEASURES: Peak expiratory flow rate (PEFR), knowledge of asthma and asthma medications, inhalation errors, and drug therapy problems in the TOM group.

RESULTS

The mean individual differences for TOM and control patients were tested. Beneficial effects were found for the following outcome measures: asthma symptom status, days of sickness, and health-related and asthma-related quality of life. Satisfaction with health care and pharmacy varied throughout the course of the project, with no significant difference between groups at the final evaluation. Although not statistically significant, differences in use of services were considered to be clinically significant and encouraging. Beneficial effects were found for knowledge of asthma and medications, inhalation errors, drug use and drug therapy problems. No significant differences were found for PEFR.

CONCLUSION

The project demonstrated that therapeutic outcomes monitoring by community pharmacists is an effective strategy for improving the quality of drug therapy for asthma patients in primary health care.

Differential item functioning in the Danish translation of the SF-36

Statistical analyses of Differential Item Functioning (DIF) can be used for rigorous translation evaluations. DIF techniques test whether each item functions in the same way, irrespective of the country, language, or culture of the respondents. For a given level of health, the score on any item should be independent of nationality. This requirement can be tested through contingency-table methods, which are efficient for analyzing all types of items. We investigated DIF in the Danish translation of the SF-36 Health Survey, using two general population samples (USA, n = 1,506; Denmark, n = 3,950). DIF was identified for 12 out of 35 items. These results agreed with independent ratings of translation quality, but the statistical techniques were more sensitive. When included in scales, the items exhibiting DIF had only a little impact on conclusions about cross-national differences in health in the general population. However, if used as single items, the DIF items could seriously bias results from cross-national comparisons. Also, the DIF items might have larger impact on cross-national comparison of groups with poorer health status. We conclude that analysis of DIF is useful for evaluating questionnaire translations.

Using neural networks to identify patients unlikely to achieve a reduction in bodily pain after total hip replacement surgery

OBJECTIVES

Fourteen patient-provided variables were chosen as potential predictors for improvement after total hip replacement surgery. These variables included patient demographic information, as well as preoperative physical function.

METHODS

A neural network was trained to predict the relative success of total hip replacement surgery using this presurgical patient survey information. The outcome measure was improvement in the Medical Outcomes Study 36 Short Form Health Survey pain score between the preoperative assessment and the 1-year postoperative assessment. For the study sample, 221 patients were selected who had complete information for the composite outcome variable. A backpropagation feedforward neural network was trained to predict the output variable using the jackknife method.

RESULTS

Performance of the neural network was assessed by calculating the area under the receiver operating characteristic curve for the network's ability to predict whether the pain score was improved after total hip replacement surgery. The observed area under the receiver operating characteristic curve was 0.79. For comparison, a linear regression model built using the same data had a receiver operating characteristic area of 0.74 (P = 0.23).

CONCLUSIONS

This research therefore showed the ability of neural networks to predict the success of total hip replacement more accurately. Our results further indicate that it may be possible to predict which patients are at greatest risk of a poor outcome.

Quality of life after cardiac surgery complicated by multiple organ failure

OBJECTIVE

To evaluate quality of life after prolonged multiple system intensive care treatment in cardiac surgical patients.

DESIGN

A case-control study.

SETTING

Adult 12-bed thoracic intensive care unit (ICU) at a university teaching hospital.

PATIENTS

Forty-seven patients surviving multiple organ failure requiring intensive care treatment for > or = 5 days (ICU group). Patients with a completely uncomplicated postoperative course were matched to the study group with respect to gender, age, and type and date of surgery. The Nottingham Health Profile was used to assess quality of life at least 1 yr after complicated cardiac surgery.

INTERVENTIONS

Quality of life measures were collected at least 1 yr after discharge from the ICU.

MEASUREMENTS AND MAIN RESULTS

Seventy-five percent of the patients in the ICU group suffered from multiple organ failure involving at least three organ systems, with a mean stay in the ICU of 9.0 +/- 1.2 (SEM) days. Quality of life was considerably reduced in the ICU group, with a higher total mean score of all dimensions of quality of life (22.7 +/- 2.6) compared with the control group (13.2 +/- 2.4 [SEM])(p < .01). The Nottingham Health Profile score was higher in three of six dimensions of health--i.e., energy (p < .05), physical mobility (p < .05), and emotional reactions (p < .05)--compared with the control group. A higher percentage of patients reported problems in three of six important activities of daily life--housework (p < .05), hobbies (p < .01), and sex life (p < .01)--compared with the control group.

CONCLUSION

Patients treated with prolonged multiple system intensive care after heart surgery have a poor outcome with respect to quality of life measured at least 1 yr after discharge from the ICU.

Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population

The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n = 1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n = 1,097) and 86% of them returned the questionnaire (n = 948), of which n = 795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisons. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.