Luis Rajmil

El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos

Objetivo: El Cuestionario SF-36 es uno de los instrumentos de Calidad de Vida Relacionada con la Salud (CVRS) mas utilizados y evaluados. Tras una decada de uso este articulo revisa criticamente el contenido, propiedades metricas y nuevos desarrollos de la version espanola. Metodos: Revision de los articulos indizados en Medline (PubMed) y en las bases de datos IBECS e IME que han utilizado la version espanola del cuestionario. Se seleccionaron los articulos con informacion sobre modelo de medida, fiabilidad, validez y sensibilidad al cambio del instrumento. Resultados: Se encontraron 79 articulos, 17 de los cuales describian caracteristicas metricas del cuestionario. En el 96% las escalas superaron el estandar propuesto de fiabilidad (α de Cronbach) de 0,7. Las estimaciones agrupadas obtenidas por metaanalisis fueron superiores a 0,7 en todos los casos. El SF-36 mostro buena discriminacion entre grupos de gravedad, correlacion moderada con indicadores clinicos y alta con otros instrumentos de CVRS. El SF-36 predijo mortalidad y detecto mejoria tras la angioplastia coronaria, la cirugia de hipertrofia prostatica benigna o la ventilacion domiciliaria no invasiva. Los nuevos desarrollos descritos (puntuaciones basadas en normas, la version 2, el SF-12 y el SF-8) mejoraron sus propiedades metricas y su interpretacion. Conclusiones: El SF-36, conjuntamente con las nuevas versiones desarrolladas, es un instrumento muy adecuado para su uso en investigacion y en la practica clinica.

KIDSCREEN-52 quality-of-life measure for children and adolescents

This study describes the development and reports the first psychometric results of the European KIDSCREEN-52 generic health-related quality-of-life questionnaire for children and adolescents. The KIDSCREEN-52, including ten dimensions, was applied in a European survey involving 12 countries (i.e., Austria, Switzerland, Czech Republic, Germany, Greece, Spain, France, Hungary, The Netherlands, Poland, Sweden and the UK) and 22,110 children and adolescents aged between 8 and 18 years of age. Questionnaire development included a literature search, expert consultation, and focus group discussions with children and adolescents. After definition of dimensions and collection of items, a translation process following international translation guidelines, cognitive interviews and a pilot test were performed. Analysis regarding psychometric properties showed Cronbach-α ranged from 0.77 to 0.89. Correlation coefficients between KINDLR and KIDSCREEN-52 dimensions were high for those assessing similar constructs (r = 0.51–0.68). All KIDSCREEN-52 dimensions showed a gradient according to socioeconomic status and most dimensions showed a gradient according to psychosomatic health complaints. The first results demonstrate that the KIDSCREEN-52 questionnaire is a promising cross-cultural measure of health-related quality-of-life assessment for children and adolescents in Europe.

THE KIDSCREEN-52 QUALITY OF LIFE MEASURE FOR CHILDREN AND ADOLESCENTS: PSYCHOMETRIC RESULTS FROM A CROSS-CULTURAL SURVEY IN 13 EUROPEAN COUNTRIES

OBJECTIVE This study assesses the reliability and validity of the European KIDSCREEN-52 generic health-related quality of life (HRQoL) questionnaire for children and adolescents. RESEARCH DESIGN The KIDSCREEN-52, which measures HRQoL in 10 dimensions, was administered to a representative sample of 22,827 children and adolescents (8 to 18 years) in 13 European countries. Psychometric properties were assessed using the Classical Test Theory approach, Rasch analysis, and structural equation modeling (SEM). A priori expected associations between KIDSCREEN scales and sociodemographic and health-related factors were examined. Test-retest reliability was assessed in 10 countries. RESULTS For the overall sample, Cronbachs alpha values ranged from 0.77 to 0.89. Scaling success (Multitrait Analysis Program) was >97.8% for all dimensions and Rasch analysis item fit (INFITmsq) ranged from 0.80 to 1.27. The intraclass correlation coefficients ranged from 0.56 to 0.77. No sizeable differential item functioning (DIF) was found by age, sex or health status. Four items showed DIF across countries. The specified SEM fitted the data well (root mean square error of approximation: 0.06, comparative fit index: 0.98). Correlation coefficients between Pediatric Quality of Life Inventory, Child Health and Illness Profile-Adolescent Edition, and Youth Quality of Life Instrument scales and KIDSCREEN dimensions assessing similar constructs were moderate for those (r = 0.44 to 0.61). Statistically significant differences between children with and without physical and mental health problems (Children with Special Health Care Needs screener: d = 0.17 to 0.42, Strengths and Difficulties Questionnaire: d = 0.32 to 0.72) were found in all dimensions. All dimensions showed a gradient according to socioeconomic status. CONCLUSIONS The KIDSCREEN-52 questionnaire has acceptable levels of reliability and validity. Further work is needed to assess longitudinal validity and sensitivity to change.

Health-Related Quality of Life Measurement in Children and Adolescents:A Systematic Review of Generic and Disease-Specific Instruments

OBJECTIVE To identify currently available generic and disease-specific health-related quality of life (HRQOL) instruments for children and adolescents up to 19 years old, to describe their content, and to review their psychometric properties. STUDY DESIGN Previous reviews on the subject and a new literature review from 2001 to December 2006 (MEDLINE, the ISI Science Citation Index, HealthSTAR and PsycLit) were used to identify measures of HRQOL for children and adolescents. The characteristics (country of origin, age range, type of respondent, number of dimensions and items, name of the dimensions and condition) and psychometric properties (reliability, validity, and sensitivity to change) of the instruments were assessed following international guidelines published by the Scientific Committee of the Medical Outcomes Trust. RESULTS In total, 30 generic and 64 disease-specific instruments were identified, 51 of which were published between 2001 and 2005. Many generic measures cover a core set of basic concepts related to physical, mental and social health, although the number and name of dimensions varies substantially. The lower age limit for self-reported instruments was 5-6 years old. Generic measures developed recently focused on both child self-report and parent-proxy report, although 26% of the disease-specific questionnaires were exclusively addressed to proxy-respondents. Most questionnaires had tested internal consistency (67%) and to a lesser extent test-retest stability (44.7%). Most questionnaires reported construct validity, but few instruments analyzed criterion validity (n = 5), structural validity (n = 15) or sensitivity to change (n = 14). CONCLUSIONS The development of HRQOL instruments for children and adolescents has continued apace in recent years, particularly with regard to disease-specific questionnaires. Many of the instruments meet accepted standards for psychometric properties, although instrument developers should include children from the beginning of the development process and need to pay particular attention to testing sensitivity to change.

Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

Study objective: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. Design and setting: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). Participants: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. Main results: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children’s physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. Conclusions: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.

Being bullied: Associated factors in children and adolescents 8 to 18 years old in 11 European countries

OBJECTIVES. To analyze the prevalence of bullying victims among children and adolescents aged 8 to 18 years in 11 European countries and to investigate the associated sociodemographic, physical, and psychosocial factors. METHODS. Being a bullying victim was measured by using the social acceptance (bullying) scale from the Kidscreen-52, a health-related quality-of-life questionnaire administered to 16 210 children and adolescents aged 8 to 18 and their parents in postal or school-based surveys in 11 European countries. Standardized mean differences (effect size) were computed to measure the percentage of children/adolescents scoring 1 SD below the mean on the Kidscreen bullying scale. Logistic regression models were used to determine which sociodemographic, physical, and psychosocial factors were associated with being bullied. RESULTS. The percentage of children being bullied was 20.6% for the entire sample, ranging from 10.5% in Hungary to 29.6% in the United Kingdom. In almost all countries the factors most strongly associated with being bullied were younger age, having probable mental health problems, having a low score on the Kidscreen-52 moods and emotions dimensions, and poor social support. Using the grand mean for all countries as the reference category, there was an above-average likelihood of children or adolescents reporting that they had been victims of bullying in 5 countries (Austria, Netherlands, Spain, Switzerland, and the United Kingdom), and a below-average likelihood in 3 countries (France, Greece, Hungary). CONCLUSIONS. This study indicated considerable variation between countries in the prevalence of those perceiving themselves to be victims of bullying but also revealed a clear profile of those likely to be bullied. The study also suggests that the Kidscreen bullying scale could be useful in identifying potential bullying victims.

The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments

OBJECTIVE The Short Form-36 Health Survey (SF-36) is one of the most widely used and evaluated generic health-related quality of life (HRQL) questionnaires. After almost a decade of use in Spain, the present article critically reviews the content and metric properties of the Spanish version, as well as its new developments. METHODS A review of indexed articles that used the Spanish version of the SF-36 was performed in Medline (PubMed), the Spanish bibliographic databases IBECS and IME. Articles that provided information on the measurement model, reliability, validity, and responsiveness to change of the instrument were selected. RESULTS Seventy-nine articles were found, of which 17 evaluated the metric characteristics of the questionnaire. The reliability of the SF-36 scales was higher than the suggested standard (Cronbachs alpha) of 0.7 in 96% of the evaluations. Grouped evaluations obtained by meta-analysis were higher than 0.7 in all cases. The SF-36 showed good discrimination among severity groups, moderate correlations with clinical indicators, and high correlations with other HRQL instruments. Moreover, questionnaire scores predicted mortality and were able to detect improvement due to therapeutic interventions such as coronary angioplasty, benign prostatic hyperplasia surgery, and non-invasive positive pressure home ventilation. The new developments (norm-based scoring, version 2, the SF-12 and SF-8) improved both the metric properties and interpretation of the questionnaire. CONCLUSIONS The Spanish version of the SF-36 and its recently developed versions is a suitable instrument for use in medical research, as well as in clinical practice.

Development of EMPRO: a tool for the standardized assessment of patient-reported outcome measures.

OBJECTIVE This study was aimed to develop a tool for the standardized assessment of patient-reported outcomes (PROs) to assist the choice of instruments. METHODS An expert panel adapted the eight attributes proposed by the Medical Outcomes Trust as evaluation review criteria, created items to evaluate them, and included a response scale for each item. A pilot test was designed to test the new tools feasibility and to obtain preliminary information concerning its psychometric properties. The Spanish versions of five measures were selected for assessment: the SF-36 Health Survey, the Nottingham Health Profile, the COOP-WONCA charts, the EuroQol-5D, and the Quality of Life Questionnaire EORTC-QLQ-C30. We assessed the new tools reliability (Cronbachs alpha and intraclass correlation coefficient [ICC]) and construct validity. RESULTS The new EMPRO (Evaluating the Measurement of Patient-Reported Outcomes) tool has 39 items covering eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, burden, alternative modes of administration, and cross-cultural and linguistic adaptations. Internal consistency was high (alpha = 0.95) as was interrater concordance (ICC: 0.87-0.94). Positive associations consistent with a priori hypotheses were observed between EMPRO attribute scores and the number of articles identified for the measures, the years elapsed since the publication of the first article, and the number of citations. CONCLUSION A new tool for the standardized assessment of PRO measures is available. It has shown good preliminary reliability and validity and should be a useful aid to investigators who need to choose between alternative measures. Further assessment of the tool is necessary.

Prevalence of Low Back Pain and Its Effect on Health-Related Quality of Life in Adolescents

OBJECTIVES To assess the prevalence of low back pain (LBP) in adolescents and the clinical features of LBP in 2 European countries and to evaluate the effect of LBP on health-related quality of life (HRQOL) using standardized validated generic and disease-specific instruments. DESIGN Cross-sectional study. SETTING Secondary schools of Barcelona, Spain, and Fribourg, Switzerland. PARTICIPANTS Representative sample of adolescents from the 2 cities. Intervention Selected adolescents completed a questionnaire including a generic HRQOL (KIDSCREEN-52) and 2 LBP-specific instruments. MAIN OUTCOME MEASURES Results of KIDSCREEN-52, the Roland-Morris Disability Questionnaire, and the Hanover Functional Ability Questionnaire. RESULTS A total of 1470 adolescents (52.6% male) with a mean (SD) age of 15.05 (1.17) years completed the questionnaires (response rate, 85.1%). Low back pain was reported by 587 adolescents (39.8%): isolated LBP in 250 (42.6%), LBP plus other pain in 271(46.2%), LBP plus whole-body pain in 50 (8.5%, and unclassifiable LBP in 16 (2.7%). Five hundred adolescents (34.7%) reported no pain, and 369 (25.6%) reported other pain without LBP. In those with isolated LBP, the percentage of adolescent boys was higher (54.6%; P < .001) and the LBP was mildest. In those with LBP plus whole-body pain, the percentage of adolescent girls was higher (62%; P < .001) and LBP was most severe. All KIDSCREEN scores in the group with LBP plus whole-body pain were significantly lower than in the other groups (effect size, 0.52-1.24). No differences were found between the groups who reported isolated pain, no pain, or other pain with no LBP. On the LBP-specific instruments, adolescents who reported LBP plus other pain had significantly poorer scores (P < .001) compared with those with isolated LBP but better scores (P < .001) than those with LBP plus whole-body pain. CONCLUSIONS Low back pain in adolescents is a prevalent symptom with overall low associated disability and little effect on health-related quality of life. A subset of adolescents in whom LBP is associated with whole-body pain report significant impairment and deserve more attention.

Gender inequalities in health and health care services use in Catalonia (Spain).

BACKGROUND AND OBJECTIVES: While socio-economically derived differences in health and health services use have long been a subject of study, differences based on gender, considered as the explicative variable, have scarcely been quantified from population-based data. The aim of this investigation was to analyse inequalities in health and health care services utilisation between men and women in Catalonia (Spain). DESIGN, SETTING, PARTICIPANTS, AND MEASURES: Data from the Catalan Health Interview Survey, a cross sectional survey conducted in 1994, were used. A total of 6604 women and 5641 men aged 15 years or over were included for analysis. Health related variables studied were self perceived health, restriction of activity (past two weeks), and presence of chronic conditions; health services use variables analysed were having visited a health professional (past two weeks), an optometrist (12 months), or a dentist (12 months); and hospitalisation (past 12 months). Age standardised proportions were computed according to gender, and prevalence odds ratios (OR) were derived from logistic regression equations. MAIN RESULTS: Women more frequently rated their health as fair or poor than men (29.8% v 21.4%; OR = 1.22; 95% CI: 1.10, 1.34). More women than men reported having restricted activity days (OR = 1.86; 95% CI: 1.59, 2.18) and chronic conditions (OR = 1.74; 95% CI: 1.60, 1.89). The proportion of women visiting a health professional was slightly greater than that for men (OR = 1.20; 95% CI: 1.09, 1.31), as was the proportion of women visiting an optometrist (OR = 1.21; 95% CI: 1.11, 1.33), and a dentist (OR = 1.43; 95% CI: 1.31, 1.55). The proportion of hospitalisation was lower in women (6.6%) than in men (7.7%; OR = 0.73; 95% CI: 0.63, 0.85). When health services use was analysed according to self perceived health, women declaring good health reported a greater probability of consulting a health professional (OR = 1.35; 95% CI: 1.20, 1.52). There were no differences in respect to hospitalisation, visits to the optometrist and to the dentist. CONCLUSIONS: These results indicate a pattern close to the inverse care law, as women, who express a lower level of health and thus would need more health care, are not, however, using health services more frequently than men.