TheMedicalSymptomQuestionnaire(MSQ)andtheDynamicSF36 HealthQualityofLifeSurveyCorrelateFairlyHighly

Abstract _________________________________________________________________ Context FunctionalMedicinepractitionersliketousetheMSQtoassesspatients.TheMSQhasnot beenvalidated. Objective TodetermineifthereisasignificantcorrelationbetweentheMSQandavalidated,widely usedqualityoflifemetric,theDynamicSF36HealthSurvey. Design,Setting,andParticipants EightysevenintegrativemedicinecenterpatientstookboththeMSQandtheDynamicSF 36HealthSurvey.Thevariancebetweenthetwoscoreswasanalyzedusingversion11.5 SPSSsoftware. Results Spearmansrhowas()0.635.Theproportionofvarianceinonescorecanbeexplainedby theother40%ofthetime. ConclusionTheMedicalSymptomQuestionnaire(MSQ)correlatesfairlyhighlywiththe DynamicHealthAssessmentShortForm36.FutureversionsoftheMSQmightcontain othercandidateitemsfromtheMecalReviewofSymptoms(seeFigure2) ________________________________________________________________________

FullStudy
INTRODUCTION TheMedicalSymptomQuestionnaire(MSQ)(seefigure1)isusedinassessingpatientsand followingtheirresponsetotherapy.PractitionersofFunctionalMedicinei useitaspartof thepatientsmedicalhistory.TheMSQispromotedbytheInstituteforFunctionalMedicine. TheMSQwasdevelopedtoprovideaconvenientquantitativeindexofsymptomsrelatedto inflammatorymediators,andusefulinthecontextofaFunctionalMedicineapproachto chronicdisease.TheMSQisavailable,forclinicaluseontheinternet.Thereliabilityand validityoftheMSQhasnotbeenstudied.WestudiedtherelationshipoftheMSQtothe widelyusedandvalidatedqualityoflifeinstrument,theDynamicShortForm36(DYNHA SF)ii .TheDynamicHealthAssessmentShortForm36(DYNHASF36)isdesignedto measureonesoverallhealthandithassatisfiedthehighestclinicalstandardsof measurement.

METHODS Validity TheMSQcontains19domains,eachwith37items,totaling70symptomstoeachof whichthepatientassignsalikertscalenumberranking(0beingneverorseldomand4 beingfrequentlywithsevereeffect). Figure1MedicalSymptomsQuestionnaire (Ifmarkedwithanxconsiderdeleting) PatientName___________________________Date_____________Week________ Rateeachofthefollowingsymptomsbaseduponyourtypicalhealthprofilefor: Past30days Past48hours PointScale 0Neveroralmostneverhavethesymptom 1Occasionallyhaveit,effectisnotsevere 2Ocasionallyhaveit,effectissevere 3Frequentlyhaveit,effectisnotsevere 4Frequentlyhaveit,effectissevere ________Headaches ________Faintness ________Dizziness ________Insomnia ________Wateryoritchyeyes ________Swollen,reddenedorstickyeyelids ________Bagsordarkcirclesundereyes ________BlurredortunnelXvision (doesnotincludenearorfarsightedness) ________Itchyears ________Earaches,earinfections ________DrainagefromearX ________Ringinginears,hearingloss ________Stuffynose ________Sinusproblems ________Hayfever ________Sneezingattacks ________Excessivemucusformation

HEAD

Total________

EYES

Total________

EARS

Total________

NOSE

Total________

MOUTH/THROAT ________Chroniccoughing ________Gagging,frequentneedtoclearthroat ________Sorethroat,hoarseness,lossofvoice ________Swollenordiscoloredtongue,gums,lips ________Cankersores Total________ SKIN ________Acne ________Hives,rashes,dryskin ________Hairloss ________Flushing,hotflashes

________Excessivesweating HEART ________Irregularorskippedheartbeat ________Rapidorpoundingheartbeat ________Chestpain

Total________

Total________

LUNGS

________Chestcongestion ________Asthma,bronchitis ________Shortnessofbreath ________Difficultybreathing

Total________

DIGESTIVETRACT ________Nausea,vomiting ________Diarrhea ________Constipation ________Bloatedfeeling ________Belching,passingEXCESSIVEgas ________Heartburn ________Intestinal/stomachpain JOINTS/MUSCLE ________Painorachesinjoints ________Arthritis ________Stiffnessorlimitationofmovement ________Painorachesinmuscles ________Feelingofweaknessortiredness ________Bingeeating/drinking ________Cravingcertainfoods ________Excessiveweight ________Compulsiveeating ________Waterretention ________Underweight

Total________

Total________

WEIGHT

Total________

ENERGY/ACTIVITY ________ Fatigue,sluggishness ________Apathy,lethargy ________Hyperactivity ________Restlessness MIND ________Poormemory ________Confusion,poorcomprehension ________Poorconcentration ________Poorphysicalcoordination ________Difficultyinmakingdecisions ________Stutteringorstammering ________Slurredspeech ________Learningdisabilities

Total________

Total________

EMOTIONS

________Moodswings ________Anxiety,fear,nervousness ________Anger,irritability,aggressiveness ________Depression ________Frequentillness ________Frequentorurgenturination ________Genitalitchordischarge

Total________

OTHER

Total________ GRANDTOTAL TOTAL_________ 1997Metagenics,Inc.andImmunoLaboratories,Inc. Permissiontoreprintforclinicaluseonly

TheDYNHASF36hastwocomponentsummaryscores:PhysicalComponentScore(PCS) andMentalComponentScore(MCS).Itmeasurestheimpactofsymptomsondailyfunction. Consentingpatientswereassuredoftheconfidentialencodingofsurveyansers,andgiven theMSQsurveyimmediatelypriortoanappointmentwithapractitioner.Eitherjustafter thevisit,patientsloggedinatAmIhealthy.comtotaketheDYNHASF36(Qualitymetric, Lincoln,RhodeIsland).SSPSvarianceanalysiswasperformedusingversion11.5SPSSInc. (Chicago,Illinois)iii Reliability RESULTS

120.0
AA A A A

DYNATotal(MCS+PCS)

100.0

A 605alr A A 570bw A AA 617sef 432gwt 648jam 588lam 552jos A A A A642rsb AA A630dlg A 645nsr 576mkw A599an 641gek 565mw 632rej AA 631mac AA 628slb 592APB A 625gd A 612wjh A 672mac 695am 559jkl A 572wsr A A A494jbs A 688mef 622mmr A 29notins.s.! 661pjn 654sds 624amm AA A A 658mcb 677nbh 618gma A 597ecr A A A A 619rah 562krm A A 453jrk566zzz A A497cmp 589kaw 651jeb A A 627ead 603cmw A 660jcm A 669maw A AA 671sew 637kjb 668hr 535dcd 692cbm A A A A 676cbw 678jjd 587ccs A 636bas A A 554dco 646nam A 644gmc 696aad A

457cak 635peb 657sgf 609sef 683cmm 549dfg 614jsm

A 555djw A A A A

542rjt 578GS

682cal

80.0

A 684jt 425thd A 579bap 600ct A A 608ws 568tls A 681bwd A 607nrm A A 659rjm 616cdt A 667dcr A 611bjd A

A A 486jmc A 638jem A

580vlb

538kme

60.0

643ssf
40 80 120

MSQSubTotal

COMMENT DoesthisdegreeofcorrelationvalidatetheMSQ?Probablynot.Doesitincreaseour confidenceintheusefulnessoftheMSQinassessingpatients?Yes.Still,theMSQand DYNHASF36donotmeasurethesamethings.TheMSQisanersatzmetrictoquantify inflammationrelatedsymptoms.TheDYNHASF36isaresponsive,tailoredstateoftheart metricforhealthrelatedqualityoflife. Onepotentialflawwiththestudydesignisthatpatientstookthemsqimmediatelybefore encounterwithprovidersandtheDYNHA36surveyimmediatelyafterward.Directionsto takingbothsurveysaskthepatienttoconsidertherelevanttimeperiodthelastfour weeks.Still,thereissomepotentialforaproviderinterventioneffectbetweenthetakingof thetwosurveys. TherearelimitationsontheusefulnessoftheMSQ.OnelimitationoftheMSQisthatit assignsnumbersofequalweighttosymptomsthatmayhaveprofoundlydifferentclinical implications.Achestpainorshortnessofbreathscoreof2mightreflectapotentiallylife threateningcardiacorpulmonarycondition(coronaryischemia,pulmonaryembolusetc.) whileitchyearsoracnemaycontributethesamescorebuthavelessclinicalgravitas. AnotherfeatureoftheMSQisthatinadditiontosymptoms,someconditionsordiagnoses thatimplyormightincludesomeoftheotherlistedsymptomsarelisted,includingasthma, bronchitis,arthritisandfrequentillness.IstheMSQusefulasacomponentofhistory taking?Theshortanswerisyes.Still,Itisimportantforthecliniciantobeawareofits shortcomings.AlthoughtheMSQsharesanumberofhistoryitemswiththeclassicalmedical historyReviewofSystems(ROS)itonlyasksaboutaquarterofthehistoryitemsinthe medicalROS.TheMSQitemsymptomsareshownembeddedinboldintheROSofFigure 2.ROSUniv.IllinoisCollegeofMedicine.Documentationofaminimalnumberofitemsof

themedicalROSismandatedformedicalencountersthatarebilledasintermediatethrough extendedbyCMSMedicare(HCFA). TheDynamicSF36HealthSurveyisatoolusedtomeasurehealthrelatedqualityoflife. Itmeasuresaperson'sabilitytofunctiononthejob,athomeandinsocialsituations.The surveywasdevelopedbyaninternationalteamofcliniciansandmeasurementexperts,the sameresearchdevelopedtheSF36HealthSurvey.Thesurveygeneratesahealthprofile consistingof8scalesandtwosummarymeasuresforphysicalandemotionalwellbeing. TheDynamicSF36HealthSurveyhasproventobevalid.Itwasbuiltfromwidelyused healthsurveysthatwerevalidatedindependentlyanditprovidesareliablemethodfor evaluatinganindividualsprogressovertime.Surveysarepasswordprotected,storedon theinternet,andexportabletoexcelspreadsheets.AproblemwiththeDYNHASF36and anysurveyadministeredinthesettingofanintegrativemedicinepracticewherepatients haveahighdegreeofautonomy,isthatwhileitislessburdensomethanmanysurveys, manypatients,andproviders,stillperceiveitasaburdentologontoacomputerinspiteof thefactitmighttakeaslittleas5minutestocompletethesurvey.

Figure2(msqitemsinbold)ItemsmarkedwithaYmeritpotentialinclusioninafuture msq

MEDICALREVIEWOFSYSTEMS General
Weight Average Recentchange Minimum Maximum Weakness Fatigue FeverY SweatsY Chills AnorexiaY Insomnia(cantsleep) Hypersomnolence(sleepallthetime) Skin Lesions Lumps Growths SoresY Moles Changeincolor/pigmentation,eruptions/rashes Pruritus(itching)Y Dryness Excessivesweating Easybruising Changesinnails/hair Birthmarks Changeintemperature HEENT Head Headache Headinjury Changeinsize Deformity Dizziness Syncope(lightheaded) Vertigo(spinning) Eyes Vision,useofglasses/contacts Pain Diplopia(doublevision) Glaucoma Cataracts Itching Spots

Photophobia Colorblindness Nightblindness Blurryvision Ptosis(droopyeyelids) Halos(ringsaroundlights) Scotomata(blindspot) Redness Tearing Discharge(color,consistency) Useofeyedrops Lasteyeexam Ears Pain Hearingloss Deafness Discharge(color,consistency,bloody) Infections Tinnitus(ringing) Vertigo Pruritus(itching) Useofhearingaid Nose/Sinuses Runnynose Stuffiness Discharge(color,consistency) Pruritus(itching) Epistaxis(nosebleeds) Painoversinuses Hayfever Frequentcolds Mouth/Throat Sores Lesions Conditionofteethandgums SorethroatsY Hoarseness Dentalcaries LossofteethY Dentures Changeintaste Badtaste Malodorousbreath Bleeding Drymouth Lastdentalexam Neck Pain Swelling

Limitsinrangeofmotionorstiffness Lumps Swellings Swollenglands Breast Lumps Pain Swelling Nippledischarge Useofselfexam Lastmammogram Respiratory Cough Sputum(color,quantity)Y Hemoptysis(bloodfromlungs/bronchus) Wheezing Asthma Emphysema Bronchitis Pneumonia Tuberculosis Pleurisy Shortnessofbreath Lastchestxray CV Historyofheartdisease Chestpain(exertional/nonexertional,associatedsymptoms) Orthopnea(discomfortbreathingbylyingflat) PND(ParoxysmalNocturnalDyspena) Dyspneaonexertion(shortnessofbreath) Edema Cyanosis(blueskin) Palpitations(irregularheartbeats) Lossofconsciousness Hypertension Heartmurmur Claudication(limping/calfmuscleweakness) Thrombophlebitis(inflamedveins) Varicosities(dilatedveins) RaynaudsPhenomenon(bilateralcyanosisofdigits) RheumaticFever GI Changeinappetite Abdominalpain Difficulty/painwithswallowing Heartburn Indigestion Bloating Belching

Nausea Vomiting Hematemesis(vomitingblood) Jaundice Foodintolerance Frequencyofbowelmovements Changeinbowelhabits(frequency,consistency,caliber,constipation,diarrhea) Melena(darkcoloredstools) Hematochezia(bloodystools) Claycoloredstools Mucus(passingmucus) Excessivebelchingorpassingofgas Incontinence(inabilitytopreventdischarge) Hemorrhoids Rectalitching/burning Rectaldischarge/pain Laxativeuse Hepatitis Gallbladderdisease GU Frequencyofurination Dysuria(difficulty/painurination) Hematuria(bloodinurine) Changeincolorofurine Polyuria(excessurine) Nocturia(peealotatnight) Oliguria(notmuchurine) Anuria(nourine) Flank/suprapubicpain Retention(cantfullyvoid) Urgency(desiretovoid) Hesitancy(involuntarydelay) Incontinence Changeinforceofstream Dribbling Passageofair/stone Enuresis(leakageofurine) Pastinfections Female Menstrualhistory(onset,cycle,duration,amountofflow,changeincycle) LMP Amenorrhea(lossofcycle) Menorrhagia(excessivemenses) Metrorrhagia(irregularmenses) AssociatedpainorPMSsymptoms Contraceptivehistory Previouspregnancies(deliveries,abortions,complications,outcomes) ExposuretoDES(diethylstilbestrol) Ageatmenopause Menopausesymptoms Postmenopausalbleeding

Vaginaldischarge Pruritus Abscess Sores Lesions Infections STDs PID(PelvicInflammatoryDisease) RPRstatus(RapidPlasmaReagintestsyphilis) HIVstatus PreviousPAPs Premenstrualsymptoms Problemwithintercourse(pain,satisfaction,libido) Sexualorientation Numberofpartners Menopausalsymptoms(hotflashes,moodswings,changesinvaginallubrication) Male Hernias Peniledischarge Sores Testicularpainorlumps STDs RPR/HIVstatus Sexualorientation Numberofpartners Problemswithintercourse(impotence,satisfaction,limbido) Contraceptiveuse Endocrine Goiter Exophthalmos(eyeballsprotrude) Hot/coldintolerance Constipation/diarrhea Tremor Excessivesweating Palpitations Changeinvoice Skinchanges Hairdistribution Secondarysexcharacteristics Changesinbodycontourorweight Changesinhat/glove/shoesize Polyuria(increaseurine) Polydipsia(increasethirst) Polyphagia(increaseeating) Striae(stretchmarks) Acne Pigmentation Infertility Diabetes Thyroiddisorders

MS Paininanextremity Joinpain Swelling Redness Stiffness Deformity Limitedrangeofmotion Warmth Crepitation(notelocationofeachjointinvolved)(crackingjoints) Historyofarthritis MusclepainY Gout BackacheY NeckpainY Trauma Neurologic Syncope Dizziness Seizures Vertigo Ataxia(uncoordinatedmovements) Limp Frequentfalls Tremor Involuntarymovement Weakness Lossofmusclemass Paralysis Incoordination Clumsiness Pain Numbness Paresthesia(abnormalsensation,burning,tickling) Hyperesthesia(abnormalacutenesstotouch) Dysarthria(speechchange) Changinginhandwriting Incontinence(bowelorurine) Hematologic Anemia Easybruising Pasttransfusionsandanyreactionstothem IVdruguse Enlargedlymphnodes Hemoglobinopathies(abnormalhemoglobinse.g.,sicklecellanemia) Psychiatric Nervousness Anxiety Moodswings Depression

Changeinmemory Cryingspells Earlyawakening Problemssleeping Lossofenergy Changeinlibido Suicidalthoughts Changeinappetite Bingeeating Purging Excessiveexercising Hallucinations Paranoia Disturbing/unusualthoughts PanicepisodesY AuthorContributions:DrSemmeshadfullaccesstoallof thedatainthestudyandtakes responsibilityfortheintegrity ofthedataandtheaccuracyofthedataanalysis. Studyconceptanddesign:Semmes. Acquisitionofdata: Analysisandinterpretationofdata: Draftingofthemanuscript: Criticalrevisionofthemanuscriptforimportantintellectual content: Statisticalanalysis Obtainedfunding: Administrative,technical,ormaterialsupport: Studysupervision: FinancialDisclosures:DrSemmesreceivessupportforhisintegrativemedicinepractice fromTrueNorth,whichsellsMetagenicssupplements. Funding/Support: RoleoftheSponsors:Thesponsorshadnoroleinthedesign andconductofthestudy collection,management,analysis, andinterpretationofthedataorpreparation,review,or approval ofthemanuscript. Disclaimer:Theviewsexpressedarethoseoftheauthor Acknowledgment:WethankRobertSemmes,DivisionofPsychometrics,Universityof MinnesotaLeeLucasPhD,CenterforOutcomesResearchEvaluation(CORE)MaineHealth, Portland,ME,WilliamCookPhD,AssociateDirectorCenterforPsychiatryResearchMaine MedicalCenter,PortlandMEJ.RayHays,Ph.D.,J.D.,DiplomateinClinicalandForensic

Psychology,ABPP,BaylorCollegeofMedicine AuthorAffiliations:DepartmentsofMedicine,MercyHospitalandMaineMedicalCenter, Portland,MEDirectorofResearchTrueNorthHealthCenter,Falmouth,MEDoctorSemmes

REFERENCES
i

TextbookofFunctionalMedicineDavidS.JonesMD,SheilaQuinneds.InstituteofFunctional MedicineGigHarbor,WA2006ISBN0977371301 ii http://www.amihealthy.com/StaticDN/AboutSurveys.aspx iii 5SPSSInc.Headquarters,233S.WackerDrive,11thfloorChicago,Illinois60606