# 1751/Is Quality of Life Research Theory Based?

Author(s): Astrid K. Wahl, Tone Rustoen, Berit R. Hanestad, Geraldine Padilla

Source: Quality of Life Research, Vol. 12, No. 7, Abstracts: 10th Annual Conference of the
International Society for Quality of Life Research (ISOQOL) (Nov., 2003), p. 755
Published by: Springer
Stable URL: http://www.jstor.org/stable/4038361 .
Accessed: 23/08/2011 11:17
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755
# 1239/PSYCHOMETRIC PERFORMANCE OF 10 LANGUAGE
VERSIONS OF THE BENIGN PROSTATIC HYPERPLASIA PATIENT
IMPACT MEASURE (BPH-PIM)
Mona L. Martin, Mountlake Terrace, WA; Donald M. Bushnell, Health
Research Associates, Inc., Mountlake Terrace, WA, USA; Asha V.
Hareendran, Outcomes Research, Pfizer, Sandwich, Kent, UK
Objective: The BPH-PIM is a unique measure benefiting from the
strengths of both standardized and individualized items. Good psy-
chometric performance has been reported for the original measure.
This abstract presents the psychometric properties of the Canadian,
Czech, Estonian, Finnish, Lithuanian, Norwegian, Polish, Slovakian,
Australian and UK versions of this newly developed measure. Meth-
ods: Males 40 years or older, with documented evidence of benign
prostatic enlargement and an International Prostate Symptom Score
(IPSS) score of >12 were recruited from clinical trials. Internal con-
sistency was measured using Cronbach's a test-retest reproducibility
by intraclass correlation coefficients (ICC) between screening and
baseline (2-weeks), convergent validity using the IPSS total score and
the American Urological Association (AUA) QoL item, and discriminant
validity by severity groupings based on tertiles of IPSS scores. Re-
sponsiveness was assessed 4 weeks after baseline using effect sizes.
Results: Results were analysed on a per country basis using popula-
tions of n = 47 (Australia) to n = 180 (Lithuania). Mean ages ranged
between 59 and 67 across the 10 countries. The measurement model
(total score plus 3 subscales) was confirmed using factor analyses for
all versions. a Coefficients ranged between 0.89 and 0.93, and ICC
values were between 0.72 and 0.93. The BPH-PIM total score showed
moderate to strong associations across countries with the IPSS score
(0.31-0.50; p < 0.05) and with the AUA QoL item (0.24-0.61;
p < 0.05). BPH-PIM scores were able to discriminate between levels
of severity in all countries (F= 5.34 to 16.93, p < 0.01). Patients re-
porting small amounts of change in their condition had improvements
in BPH-PIM scores ranging from 3.46 (Slovakia) to 14.02 points
(Australia) with effect sizes ranging between 0.26 and 1.12. Conclu-
sion: The BPH-PIM performs well across these 10 language versions
and is capable of demonstrating statistically meaningful improvement
in BPH patient impact in multiple cultures.
# 1622/METRIC PROPERTIES OF THE 'MINIMUM CORE SET OF
SIX QUESTIONS' PROPOSED FOR PATIENTS WITH LOW BACK
PAIN
Angels Pont, Health Services Research Unit, Institut Municipal
d'lnvestigaci6 Medica; Ferran Pellis6, Unidad Cirugia Raquis, Hospital
Universitari de la Vall d'Hebron, Barcelona, Spain; Luis Alvarez,
Madrid, Spain; 0. Escudero, Unidad Cirugia Raquis, Hospital Uni-
versitari de la Vail d'Hebron; Jordi Alonso, Montse Ferrer, Health
Services Research Unit, Institut Municipal d'lnvestigaci6 Medica,
Barcelona, Spain
A Minimum Core Set of Six Questions (60-Core) has been proposed
for outcome measurement of patients with spinal disorders (Deyo
et al., Spine 1998; 23: 2003-2013), but its metric properties have not
been studied yet. The aim of this study is to evaluate them. Patients
consecutively recruited in a University Hospital in Barcelona suffering
degenerative low back pain (n = 81) and patients from a hospital in
Madrid with subacute osteoporotic fracture-vertebroplasty (n = 50)
completed the 6Q-Core. For test-retest analysis, the questionnaire
was readministered after 15 days in 28 patients with degenerative low
back pain. Responsiveness was assessed among all the patients with
subacute osteoporotic fracture-vertebroplasty after 3 months of sur-
gery. For the 60-Core, a score for each of five domains (Back Func-
tion, Generic Health Status, Pain, Work Disability and Patient
Satisfaction) and a total score have been calculated. Eighty-two
women and 49 men with a mean of 58.7 years were evaluated.
Missing items were low for all questions except for Work Disability and
Back Function (52 and 22% of patients, respectively). The total score
of the 6Q-Core achieved the internal consistency standard for indi-
vidual comparisons (Cronbach's a
= 0.91). Floor effect was high for
Back Function, Generic Health Status and Work Disability (37, 64 and
43%). Moreover, Work Disability presented a ceiling effect of 41%.
Test-retest showed stability with Intra-class Correlation Coefficient
equal or higher than 0.8 for all domains and 0.96 for total score. Re-
sponsiveness was high with an effect size of 4.1 for total score. These
results suggest that the 6Q-Core could be a reliable and responsive
instrument for outcome assessment in spinal disorders allowing for a
routine evaluation in the clinical practice. However, Work Disability
score presented some problems (high floor, ceiling and missing data)
that merit further research. Funded by: CIRIT 2001SGR 00405.
# 1751/lS QUALITY OF LIFE RESEARCH THEORY BASED?
Astrid K. Wahl & Tone Rustoen, Faculty of Nursing, Oslo University
College, 0167 Oslo; Berit R. Hanestad, Department of Public Health
and Primary Health care, University of Bergen, 5009 Bergen, Norway;
Geraldine Padilla, School of Nursing, University of California San
Francisco, CA, USA
There has been a rapid development of the concept QOL. However
quality of life research has been critiqued by the lack of theory based
research. Many of the instruments used in quality of life research are
empirically developed without a theoretical framework which makes
hypothesis generation and interpretation of results difficult. The aim of
this presentation is to give an overview of theory based quality of life
research. This review analysed papers published in the journal, Quality
of Life Research, from 1995 until the end of 2002. The analysis ad-
dressed six research questions: (1) how is quality of life defined, (2)
how is quality of life distinguished from other related concepts such as
happiness or well-being, (3) what are the targeted domains of studies
(4) what theoretical framework(s) or models are used, (5) do studies
include theory testing hypotheses, and (6) what reasons guide the
choice of measures? Preliminary results showed that quality of life
research is generally atheoretical. Few papers address the definition
of the concept quality of life, nor do they use theoretical frameworks or
theoretical models to guide the research. There is a need to explicate
the implicit conceptual context and theory-development contributions
in quality of life research. The field should move from psychometrics
and descriptive epidemiological studies to theory generating and
testing research. Future quality of life studies should attempt to provide
a definition of the concept, describe the theory from which the research
questions develope and explicate the conceptual model illustrating the
relationship among the concepts and measures.
# 3002/QUALITY OF LIFE IN SCHIZOPHRENIA: THE NEED FOR
CONCEPTUAL MODELS
George Awad, University of Toronto, Canada
Schizophrenia is a chronic and disabling psychiatric disorder, ac-
companied by acute psychotic relapses, which often require hospi-
talization. The illness significantly impacts on various behavioural,
mental and psychological domains resulting in long-term disability.
Schizophrenia presents as one of the most appropriate disease
models, whereby QOL should be a significant component in its man-
agement. The last three decades have witnessed an increase in in-
terest and publications about QOL in schizophrenia. While the majority
of published studies report data about QOL measurement in schizo-
phrenia, it is unclear about what is measured or what it means, in
terms of linking quality of life to important outcomes such as better
adherence to medications or improved psychosocial functioning. The
lack of interest in developing conceptual models for QOL in schizo-
phrenia has limited the meaningful development of such an important
construct. Additionally, the ongoing unresolved debate about the
subjective/objective dichotomy has uncovered significant inconsis-
tencies in the application of the construct of QOL in schizophrenia.
This presentation will review the available conceptual models, includ-
ing our conceptual model, which continues to be the only major model
for quality of life in medicated persons with schizophrenia. It is our
contention that, without coherent and reliable conceptual models that
can be experimentally validated; the field of quality of life in schizo-
phrenia will be limited in its impact on clinical management. It may also
be that one conceptual model in schizophrenia could prove inadequate
in dealing with various stages of the illness and its varied outcomes.
Possibly, different conceptual models are required, which can be ap-
propriate for the specific population, the stage of the illness and its
treatment, as well as societal expectations at a particular point of time.
Similarly, research interests have to look beyond QOL, not only as
an outcome by itself but also as a mediator for other important out-
comes.