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Rheumatology 2002; 41: 1380-1387
© 2002 British Society for Rheumatology
Original Papers |
Generic measures of health-related quality of life in ankylosing spondylitis: reliability, validity and responsiveness
1 Department of Health Sciences and Clinical Evaluation, University of York, York YO1 5DD,
2 Interdisciplinary Research Centre in Health, Physiotherapy and Dietetics Subject Group, School of Health and Social Sciences, Coventry University, Coventry CV1 5FB,
3 Unit of Health-Care Epidemiology, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF,
4 Department of Physiotherapy Studies and Primary Care Sciences Research Centre, Keele University, Staffordshire ST5 5BG and
5 Staffordshire Rheumatology Centre, High Lane, Burslem, Stoke-on-Trent, Staffordshire ST6 7AG, UK
Objective. To assess the acceptability and measurement properties of two generic measures of health-related quality of life (HRQL): the EuroQol and the Short Form 12-item Health Survey Questionnaire (SF-12) in ankylosing spondylitis (AS).
Methods. Instruments were administered by means of a self-completed questionnaire to AS patients recruited from across the United Kingdom. Instruments were assessed for data quality and scaling assumptions. Test–retest reliability was assessed in those patients reporting no change in general health at 2 weeks. The convergent validity of both instruments was assessed and scores were correlated with responses to health transition questions. Responsiveness was assessed for patients reporting change in health at 6 months.
Results. The instruments had high completion rates. Although slightly skewed towards better levels of health, scores covered the available range for both sections of the EuroQol [EQ-5D and EQ-visual analogue scale (EQ-VAS)]. Score distributions approximated normality for the SF-12. Test–retest reliability estimates support the use of both instruments in group evaluation and the SF-12 Physical Component Summary score (PCS) in individual evaluation (>0.90). Correlations between instruments were in the hypothesized direction and were of a moderate level. The EQ-VAS had the strongest linear relationship, with responses to both specific and general health transition questions (P<0.01). The EQ-VAS and SF-12 PCS were the most responsive instruments. The EQ-5D was the least responsive instrument.
Conclusion. The instruments have undergone a comprehensive comparative evaluation to assess the measurement properties required for patient-assessed measures of health outcome in AS. Adequate levels of acceptability, reliability and validity were found for both instruments. Although evidence supporting instrument responsiveness was strong for the EQ-VAS and SF-12 PCS, it was very weak for the EQ-5D and SF-12 Mental Component Summary Scale (MCS). The EQ-VAS and SF-12 PCS can both be recommended for use in group evaluation, and the SF-12 PCS is recommended in routine practice or research. However, the lower reliability of the SF-12 MCS and the limited ability of both the EQ-5D and SF-12 MCS to detect change in health may restrict these roles.
KEY WORDS: Ankylosing spondylitis, Generic instruments, Patient-assessed health outcome, Reliability, Responsiveness, Validity.
Correspondence to: K. Haywood, Interdisciplinary Research Centre in Health, Physiotherapy and Dietetics Subject Group, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK.
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