Measuring quality of life in back patients: comparison of Health Status Questionnaire 2.0 and Quality of Life Inventory

The factor structure of the Quality of Life Inventory (QOLI) following traumatic brain injury

Quality of life is a key indicator of outcome following traumatic brain injury (TBI). Research has reported several different factor structures for the Quality of Life Inventory (QOLI, Frisch, 1994). We compared the fit of existing factor models and examined the clinical utility of the QOLI's factors in a sample of Australian adults with TBI. Archival data from 901 participants were provided by the Neurotrauma Register of Tasmania. Participants were aged 16-80 years and 63% were male. Approximately 69% had mild TBI (PTA < 24 h), approximately 24% had moderate TBI (PTA >1 day, <7 days) and 7% had severe TBI. Both cross sectional and longitudinal analyses were utilized, as participants provided data at one or more of seven time-points, up to 3 years following injury. The results showed the data best fitted a three-factor model, comprising Self-functioning and activity, Self-actualization and Family and environment factors, and a second order Overall QOL factor. Differences in the trajectory of recovery were noted between the QOLI factor scores over time and in relation to demographic and injury variables. In conclusion, the three-factor structure of the QOLI provided useful clinical information about the recovery of patients' subjective quality of life following TBI.

Integrating pain management in clinical practice

There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. In this paper, we briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain.

A review and critique of assessment instruments for patients with persistent pain

BACKGROUND

Early identification of individuals at risk of developing persistent pain is important to decrease unnecessary treatment costs and disability. However there is scant comprehensive information readily available to assist clinicians to choose appropriate assessment instruments with sound psychometric and clinical properties.

OBJECTIVE

A national insurer commissioned the development of a compendium of assessment instruments to identify adults with, or at-risk of developing, persistent pain. This paper reports on the instrument identification and review process.

METHODS

A comprehensive systematic literature review was undertaken of assessment instruments for persistent pain of noncancer origin, and their developmental literature. Only assessment instruments which were developed for patients with pain, or tested on them, were included. A purpose-built 'Ready Reckoner' scored psychometric properties and clinical utility.

RESULTS

One hundred sixteen potentially useful instruments were identified, measuring severity, psychological, functional and/or quality of life constructs of persistent pain. Forty-five instruments were short-listed, with convincing psychometric properties and clinical utility. There were no standard tests for psychometric properties, and considerable overlap of instrument purpose, item construct, wording, and scoring.

CONCLUSION

No one assessment instrument captured all the constructs of persistent pain. While the compendium focuses clinicians' choices, multiple instruments are required for comprehensive assessment of adults with persistent pain.

Validation of the short-form interactive computerized quality of life scale (ICQOL-SF)

OBJECTIVE

To evaluate the concurrent validity of the short form of an interactive computerized quality of life (ICQOL-SF) measure for patients with chronic pain.

METHODS

The ICQOL-SF, consisting of one global and four separate domains of quality of life, was administered to 300 chronic pain patients in two pain centers. Participants also completed the full 21-item interactive computerized quality of life (ICQOL) program, a computerized version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), and a computerized assessment of pain (CAP) program. In a second study, an independent group of 336 chronic pain patients completed the ICQOL-SF, the WHOQOL-BREF, and the CAP.

RESULTS

The ICQOL-SF in both studies demonstrated adequate concurrent validity with the WHOQOL-BREF (r = 0.75) and the CAP (r = 0.84). The five-item ICQOL-SF was also highly correlated with the full ICQOL (r = 0.90). Surprisingly, older individuals with more formal education and longer pain duration reported better quality of life. Number of past surgeries was negatively correlated with quality of life.

CONCLUSIONS

The five-item short-form interactive computerized method to assess quality of life demonstrates adequate concurrent validity and would be a useful, brief software measure in the assessment of persons with chronic pain. Additional studies are needed to determine the reliability and sensitivity to change of the ICQOL-SF.

Domains of life satisfaction in social anxiety disorder: relation to symptoms and response to cognitive-behavioral therapy

A general sense of satisfaction with life has been shown to be discriminable from symptom levels and disability in clinical populations. The current study focused on the utility of identifying domains of life satisfaction in social anxiety disorder and differential changes in these domains following cognitive-behavioral group therapy (CBGT). An exploratory principal axis factor analysis of the items of the Quality of Life Inventory in clients with a principal diagnosis of social anxiety disorder (N=138) yielded four domains of life satisfaction: (1) Achievement, (2) Social Functioning, (3) Personal Growth, and (4) Surroundings. Prior to treatment, clients reported dissatisfaction in the Achievement and Social Functioning domains. Further, levels of satisfaction in these domains were significantly related to severity of social anxiety and depressive symptoms. Finally, analyses of a subsample of clients completing 12-weeks of cognitive-behavioral group therapy revealed significant improvements in the Achievement and Social Functioning factors. These findings provide further support for the assertion that social anxiety disorder has important implications for clients' quality of life and that CBGT can successfully impact several domains of satisfaction.

Assessing instruments in a Cuban American population with type 2 diabetes mellitus

The purposes of this pilot study were to identify and adapt instruments for future use in assessing diabetes self-management in a sample of Cuban Americans with Type 2 diabetes. Eight instruments were selected from the literature, translated into Spanish, and administered to a sample of 20 Cuban Americans with Type 2 diabetes. Psychometric properties were examined along with clarity of wording, cultural appropriateness, and ease of use. Reliability data were compared, when possible, with original scores generated with non-Cuban populations. Results indicated that reliability scores among populations were similar. Support for using these instruments in clinical practice to assess initial knowledge and beliefs about aspects of diabetes management and to monitor changes is provided.

Reliability and validity of an interactive computer method for rating quality of life

OBJECTIVE

The purpose of this study was to describe the reliability and validity of an interactive computer method that assesses the quality of life of patients in chronic pain and healthy individuals.

METHODS

A software program to assess 21 aspects of quality of life was administered to 88 pain patients on two occasions separated by an average of 30 days. Comparison data were obtained from 105 healthy individuals retested after an average of 16 days.

RESULTS

For both groups, moderate test-retest correlations occurred for mean ratings based on an aggregation of data for all variables, single global ratings, and single ratings of individual variables. Patients in chronic pain scored significantly lower on all quality of life variables than did healthy individuals. High correlations were obtained between mean ratings from the present study and those from an earlier investigation using the same method.

CONCLUSIONS

The interactive computer method is both reliable and valid as a means to assess quality of life for patients in chronic pain as well as for healthy individuals.

Interactive Computer Method for Rating Quality of Life: Comparison of Chronic Pain Patients and Healthy Controls

OBJECTIVE

This study presents information on the development of an interactive computer-based rating method of quality of life that assesses the multidimensional impact of chronic pain on the individual.

METHOD

A software program assessing 20 categories of quality of life was created and administered to 103 chronic pain patients. Comparison data were obtained from 103 matched healthy controls.

RESULTS

High variability was found among pain patients in their ratings of quality of life, and pain patients rated all categories lower than controls. Three groups emerged from a cluster analysis of the data reflecting high, mixed, and low ratings of satisfaction with quality of life.

CONCLUSIONS

The rating method was convenient, was easy for the patient to understand, and took very little time to administer. Further investigation of the validity and reliability of this tool is needed.