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PubMedDate not supplied

Psychometric properties of the functional performance inventory in patients with chronic obstructive pulmonary disease.

BACKGROUND: The Functional Performance Inventory (FPI) is a subjective measure of the performance dimension of functional status, based on an explicit analytical framework and the experiences of patients themselves. OBJECTIVES: To describe the conceptual foundation of the instrument, the procedures used to maximize content validity, and the results of the initial psychometric testing of the FPI in patients with chronic obstructive pulmonary disease (COPD). METHOD: Items and response structure for the instrument were drawn from the literature and qualitative interviews with 12 men and women with COPD. Twenty-four clinical and scientific experts participated in content validation. To assess the FPI's psychometric characteristics, 154 patients participated in a cross-sectional mail survey; 54 took part in a 2-week reproducibility assessment. Forty relatives were also included in validity testing. RESULTS: The instrument was internally consistent (alpha = .96) and reproducible (ICC = .85). Validity was evident in the significant (p < .001) correlations found between the FPI total score and the Functional Status Questionnaire (activities of daily living, r = .68; instrumental activities of daily living, r = .68), Duke Activity Status Index (r = .61), Bronchitis-Emphysema Symptom Checklist (r = -.59), Basic Need Satisfaction Inventory (r = .61), and Cantril's Ladder of Life Satisfaction (r = .63). The relationship between patient FPI score and relative perception of functioning, using the Katz Adjustment Scale for Relatives, was also significant (socially expected activities, r = .53; free-time activities, r = .49, p < .01). The instrument discriminated between patients with severe and moderate levels of perceived severity and activity limitation (t = 8.52, p <.001) and patients with FEV1 greater than and less than 1.0 liter (t = 4.25, p < .001). CONCLUSIONS: Results suggest that the FPI is a useful measure of functional performance in patients with COPD. Further development of the spiritual activities and work and school domains is in order, as is additional study of the instrument's responsiveness to change.

Activities of Daily Living↗

PubMed2003

The Delirium Observation Screening Scale: a screening instrument for delirium.

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses' observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, alpha = 0.93 and alpha = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p < or = 0.001) in the hip fracture patients and Rs -0.66 (p < or = 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse's ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p < or = 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p < or = 0.001) in the study with the hip fracture patients and 0.33 (p < or = 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p < or = 0.05) in the geriatric medicine patients and -0.55 (p < or = 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses' observation.

Activities of Daily Living↗

PubMed1992

Alternate forms of HIV prevention attitude scales for teenagers.

The purpose of this study was to develop valid, alternate-form scales to measure teenagers' attitudes toward prevention of the transmission of human immunodeficiency virus (HIV). Using a three-component attitude model, a two-way table of specifications was constructed as a theoretical framework for generating attitudinal items relevant to HIV and HIV prevention. Thus, a large pool of Likert-type items was generated, reviewed for clarity and content validity, and prepared for the preliminary scale with 50 items. The scale was administered to 210 high school students. As a result of extensive analyses, two alternate forms with 15 items each were developed. The two forms were simultaneously administered to a sample of 600 high school students. The collected data were subjected to item analyses, factor analysis, and reliability estimation. The results of the analyses provided strong evidence of internal consistency, content validity, and comparability of both forms. The alternate reliability across the form was .82. The alpha reliability coefficients for forms A and B was .78 and .77 and the split-half .76 and .69, respectively. It is concluded that these alternate forms produce valid, reliable, and comparable results for measuring teenagers' attitudes toward HIV prevention. These forms are ideal for pretest/posttest designs used for evaluating educational approaches to HIV control.

Adolescent↗

PubMed1995

Validity and reliability of an oncology critical care patient acuity tool.

PURPOSE/OBJECTIVES: To test the reliability and validity of a patient acuity tool for use on a critical care oncology unit. DESIGN: Prototype classification system using therapeutic indicators to describe a patient's acuity. SETTING: Intensive care unit of a research and academic oncology hospital in the Southeastern United States. SAMPLE: Critical care nursing staff including management-level personnel at the research site. METHODS: An acuity tool for critical care was developed using the Johns Hopkins Oncology Center's patient classification system as a model. Content validity indexes were calculated based on ratings of nurse experts. interrater reliability was calculated based on two independent raters: a staff nurse and a patient care manager. MAIN RESEARCH VARIABLES: Appropriateness of language and categorization of therapeutic indicators developed for the tool. FINDINGS: The content validity index of the entire tool was 0.85; 24/25 indicators were retained. Reliability was r = 0.84. CONCLUSIONS: The tool is reliable and valid. IMPLICATIONS FOR NURSING PRACTICE: Acuity tools can be used to calculate unit productivity and assist with determination of staffing needs. In this age of healthcare reform, it is imperative that personpower needs in all care settings be accurately determined to provide cost-effective and safe care levels.

Critical Care↗

PubMedDate not supplied

The reliability and validity of the Chinese version of the caregiver burden inventory.

BACKGROUND: The assessment of burden has become a challenging task for most researchers because cultural, ethical, religious, and other personal values may influence perceptions of the meaning and consequences of burden. The lack of examination of the psychometric properties of the burden measures across studies limits the scientific rigor for generating additional research into "burden." OBJECTIVE: To examine the psychometric properties of the Chinese version of the Caregiver Burden Inventory for its utility in clinical and research practice. METHOD: The first investigation evaluated the consistency between the Chinese and English versions of the Caregiver Burden Inventory. The second investigation established the internal consistent reliability, test-retest reliability, content validity, concurrent validity, and construct validity. RESULTS: A paired -test and intra-class correlation indicated that the Chinese version of the Caregiver Burden Inventory was a very good reflection of the English version and demonstrated item equivalence. It also showed adequate internal consistency reliability, appropriate content validity, and concurrent validity. Factor analysis revealed moderate intercorrelations between subscales and high factor loadings also helped to clarify the psychometric meaning. DISCUSSION: The reliability and validity information presented in this paper support using the Chinese version of the Caregiver Burden Inventory as a research instrument in measuring the caregiver burden in the Chinese population. Further study is needed to discriminate the developmental, emotional, and social burden constructs.

Activities of Daily Living↗

PubMed1995

Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome.

OBJECTIVE: To develop an objective scale to measure the severity of the multiple organ dysfunction syndrome as an outcome in critical illness. DESIGN: Systematic literature review; prospective cohort study. SETTING: Surgical intensive care unit (ICU) of a tertiary-level teaching hospital. PATIENTS: All patients (n = 692) admitted for > 24 hrs between May 1988 and March 1990. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Computerized database review of MEDLINE identified clinical studies of multiple organ failure that were published between 1969 and 1993. Variables from these studies were evaluated for construct and content validity to identify optimal descriptors of organ dysfunction. Clinical and laboratory data were collected daily to evaluate the performance of these variables individually and in aggregate as an organ dysfunction score. Seven systems defined the multiple organ dysfunction syndrome in more than half of the 30 published reports reviewed. Descriptors meeting criteria for construct and content validity could be identified for five of these seven systems: a) the respiratory system (Po2/FIO2 ratio); b) the renal system (serum creatinine concentration); c) the hepatic system (serum bilirubin concentration); d) the hematologic system (platelet count); and e) the central nervous system (Glasgow Coma Scale). In the absence of an adequate descriptor of cardiovascular dysfunction, we developed a new variable, the pressure-adjusted heart rate, which is calculated as the product of the heart rate and the ratio of central venous pressure to mean arterial pressure. These candidate descriptors of organ dysfunction were then evaluated for criterion validity (ICU mortality rate) using the clinical database. From the first half of the database (the development set), intervals for the most abnormal value of each variable were constructed on a scale from 0 to 4 so that a value of 0 represented essentially normal function and was associated with an ICU mortality rate of < 5%, whereas a value of 4 represented marked functional derangement and an ICU mortality rate of > or = 50%. These intervals were then tested on the second half of the data set (the validation set). Maximal scores for each variable were summed to yield a Multiple Organ Dysfunction Score (maximum of 24). This score correlated in a graded fashion with the ICU mortality rate, both when applied on the first day of ICU admission as a prognostic indicator and when calculated over the ICU stay as an outcome measure. For the latter, ICU mortality was approximately 25% at 9 to 12 points, 50% at 13 to 16 points, 75% at 17 to 20 points, and 100% at levels of > 20 points. The score showed excellent discrimination, as reflected in areas under the receiver operating characteristic curve of 0.936 in the development set and 0.928 in the validation set. The incremental increase in scores over the course of the ICU stay (calculated as the difference between maximal scores and those scores obtained on the first day [i.e., the delta Multiple Organ Dysfunction Score]) also demonstrated a strong correlation with the ICU mortality rate. In a logistic regression model, this incremental increase in scores accounted for more of the explanatory power than admission severity indices. CONCLUSIONS: This multiple organ dysfunction score, constructed using simple physiologic measures of dysfunction in six organ systems, mirrors organ dysfunction as the intensivist sees it and correlates strongly with the ultimate risk of ICU mortality and hospital mortality. The variable, delta Multiple Organ Dysfunction Score, reflects organ dysfunction developing during the ICU stay, which therefore is potentially amenable to therapeutic manipulation. (ABSTRACT TRUNCATED)

Humans↗

PubMed2005

Measuring professionalism: a review of studies with instruments reported in the literature between 1982 and 2002.

PURPOSE: To describe the measurement properties of instruments reported in the literature that faculty might use to measure professionalism in medical students and residents. METHOD: The authors reviewed studies published between 1982 and 2002 that had been located using Medline and four other databases. A national panel of 12 experts in measurement and research in medical education extracted data from research reports using a structured critique form. RESULTS: A total of 134 empirical studies related to the concept of professionalism were identified. The content of 114 involved specific elements of professionalism, such as ethics, humanism, and multiculturalism, or associated phenomena in the educational environment such as abuse and cheating. Few studies addressed professionalism as a comprehensive construct (11 studies) or as a distinct facet of clinical competence (nine studies). The purpose of 109 studies was research or program evaluation, rather than summative or formative assessment. Sixty five used self-administered instruments with no independent observation of the participants' professional behavior. Evidence of reliability was reported in 62 studies. Although content validity was reported in 86 studies, only 34 provided strong evidence. Evidence of concurrent or predictive validity was provided in 43 and 16 studies, respectively. CONCLUSIONS: There are few well-documented studies of instruments that can be used to measure professionalism in formative or summative evaluation. When evaluating the tools described in published research it is essential for faculty to look critically for evidence related to the three fundamental measurement properties of content validity, reliability, and practicality.

Clinical Competence↗

PubMed2001

Development of a patient-orientated instrument to measure service quality in outpatient departments.

AIMS OF THE STUDY: To describe three stages in the development of an instrument to measure service quality from the patients' perspective in hospital outpatient departments. RATIONALE: A reliable and valid service quality instrument is a valuable tool for collecting feedback from patients when improving outpatient services. DESIGN: A multiphase process with several versions of the questionnaire testing its validity and reliability. The first version of the questionnaire was constructed from information collected in a previous interview study of patients' service experiences. Using this version (47 questions) information was collected in 15 outpatient departments (314 patients) and the second version of the questionnaire was developed. At this stage, a survey of employees (n=111) was included in the development process. This second version of the questionnaire (43 questions) was used to collect more data in three outpatient departments of a university hospital and in two outpatient departments of two regional hospitals on three different occasions (1416, 369 and 124 patients) within a period of 2 years. The reliability of the instrument was tested in terms of stability by using three repeated measurements, and using the Cronbach's alpha coefficient as an indicator of internal consistency. Content validity was assessed by means of percentage agreement between staff and patients. Logistic regression analysis was performed to assess construct validity. RESULTS: The final version of the questionnaire contained 12 items. Agreement between patient and staff ratings was found to be acceptable for most questions (content validity). Two measurements on different occasions yielded a similar structure (construct validity). Internal consistency was acceptable (Cronbach's alpha = 0.67-0.93 in the first and 0.71-0.94 in the second survey). The variance of the alpha coefficients was small in the retest (stability). CONCLUSIONS: The instrument developed is general to the extent that it is suitable for assessing service quality improvement needs in individual units and for making cross-departmental comparisons.

Adult↗

PubMed2001

Subjective health measure used on Chinese patients with neck pain in Hong Kong.

STUDY DESIGN: A prospective observational study was conducted on the use of the Chinese version of the Northwick Park Neck Pain Questionnaire. OBJECTIVE: To examine the reliability, validity, and responsiveness of the Chinese version of the Northwick Park Neck Pain Questionnaire in Chinese patients with neck pain in Hong Kong. SUMMARY OF BACKGROUND DATA: There is increasing recognition that patient perspectives are essential both in making medical decisions and in judging the treatment outcomes. A valid Chinese version of a neck disability index questionnaire is urgently needed for effective and reliable evaluation of the treatment outcomes for patients with neck pain. METHODS: Two samples with 532 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong who completed the Northwick Park Neck Pain Questionnaire were observed and measured at different intervals: at the beginning of physiotherapy, at 7 days, at 3 weeks, and 6 weeks after physiotherapy. RESULTS: The questionnaire had good content validity, very good test-retest reliability, and internal consistency (intraclass correlation coefficient, 0.95; Cronbach's alpha, 0.87). It also had good validity (Spearman correlation coefficient of 0.59 when the score was correlated with that of a generic 42-item Chinese health questionnaire) and good responsiveness (effect size of 1.11 at week 6 after treatment began). CONCLUSIONS: The Chinese version of the Northwick Park Neck Pain Questionnaire has been shown to demonstrate very good content validity, a high degree of test-retest reliability, and internal consistency. It also exhibited good construct validity and high sensitivity to changes in severity over time.

Adolescent↗

PubMed2004

The ED-EQoL: the development of a new quality of life measure for patients with erectile dysfunction.

PURPOSE: To identify the important issues which have an impact on the quality of life (QoL) of men suffering from erectile dysfunction (ED) and to generate a new ED-specific QoL questionnaire ready to undergo further psychometric testing. METHODS: QoL issues relating to ED were generated through in-depth qualitative interviews of 29 patients, literature review and consultation with other healthcare professionals. The issues were formulated into a questionnaire, which was piloted using 40 patients with ED and subsequently refined using well-established principles of questionnaire development. RESULTS: The qualitative interviews revealed numerous psychosocial problems associated with ED, which were operationalised into a 40-item questionnaire. Pilot testing allowed the questionnaire to be reduced to a manageable 15-item final questionnaire while maintaining face and content validity and the potential to discriminate between men with varying degrees of affected QoL. This questionnaire had a Cronbach's alpha of 0.94. CONCLUSIONS: A new ED-specific QoL measure has been developed using appropriate methodology. Qualitative techniques identified a range of psychosocial morbidity in men with ED, leading to a simple but robust instrument with face and content validity. This questionnaire, Erectile Dysfunction-Effect on quality of life (ED-EQoL), has now undergone psychometric testing for validity and reliability.

Adult↗

PubMed2002

[Development and evaluation of the multidimensional German pain questionnaire].

The German pain questionnaire (DSF) has been developed and validated by the Task force on "Standardization and Economy in Pain Management" of the German Chapter of the International Association for the Study of Pain (DGSS). The concept of the DSF is based on a bio (medical) - psycho - social pain model. The modular approach to pain assessment consists of:demographic data,pain variables (e. g. pain sites, temporal characteristics, duration, intensity),pain associated symptoms,affective and sensory qualities of pain (adjective list by Geissner, SESCopyright ),pain relieving and intensifying factors,previous pain treatment procedures,pain-related disability (Pain Disability Index by Tait et al.),depression test CES-D (Center for Epidemiological Studies Depression Test),comorbid conditions,social factors (educational level, occupation, retirement status, compensation and/or litigation status, disability for work),health related quality of life (SF-36Copyright ). Practicability and content validity were tested in some 3000 patients. Comparison with external criteria (e. g. medical and psychiatric-psychological diagnoses, physician-determined chronicity of pain) proved good content validity and excellent reliability of patients statements in the questionnaire. The great majority of patients stated that the DSF covered their pain history completely and in an orderly fashion. Difficulty to answer the questions was considered low. The German pain questionnaire is a reliable and valid instrument for recording the multidimensional experience of pain. Data from such questionnaires are indispensable for follow-up studies and internal and external quality assessments. The DSF can be ordered from the German Society for the Study of Pain (www.dgss.org) and is a core instrument of the computer program "quality assurance in pain management" (QUAST) of this society.

Chronic Disease↗

PubMed1994

Consent to electroconvulsive therapy: investigation of the validity of a competency questionnaire.

A valid consent is a necessary precondition to the administration of electroconvulsive therapy (ECT). However, the assessment of mental competence to consent may be both complicated and controversial because neither case law nor statutes provide a clear description of the necessary mental abilities. The closest approximation in the literature is that derived from judicial commentary on the relevant case law and summarized into four standards. We designed a 15-item questionnaire to define and test the content or essential elements of each of these standards, and surveyed lawyers and health care professionals with known expertise or interest in the field to investigate the content validity of the questionnaire. Of the 15 items, 12 were rated important or essential to the assessment of competence to consent to ECT by > or = 67% of the lawyers and 11 were so rated by > or = 67% of the health professionals. Ten items were rated as important or essential by > or = 67% of both groups. Only two items were not so endorsed by > or = 67% of one of the groups. We conclude that the questionnaire has a satisfactory content validity and may be considered a general guideline for assessing competence to consent to ECT.

Adult↗

PubMed1994

Development of a self-report functional status index for juvenile rheumatoid arthritis.

OBJECTIVE: There are few functional indices available for juvenile rheumatoid arthritis (JRA). Our goal was to develop a reliable, valid and responsive self-report physical functional status index for individuals with JRA, ages 8-18 years. METHODS: Activity (item) generation by interview of children, parents, teachers, clinicians yielded 280 items. Categories of self-care, domestic, mobility, school, and extracurricular were chosen by clinicians. Twelve clinicians sorted the items into categories. Item reduction was by these clinicians who rated items for common problems in JRA, importance of performance, and potential for change. RESULTS: Ninety-nine items were retained. A separate section was designed for respondents to identify their priority activities. Content validity of the questionnaire, the Juvenile Arthritis Self-Report Index (JASI), was evaluated by 17 different clinicians. One item was added and none eliminated; all rated the index as a credible functional measure for JRA. CONCLUSION: The JASI has been rigorously developed, and has demonstrated content validity. Index validation is being completed.

Activities of Daily Living↗

PubMed2005

Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home.

OBJECTIVE: To improve a self-administered questionnaire that includes 42 dichotomous items and measures activity limitations in rising and sitting down (R&S) in patients with lower-extremity disorders who live at home. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of secondary and tertiary care centers. PARTICIPANTS: Patients (N=759; 47% men; mean age +/- standard deviation, 60.7+/-15.2y) living at home, with lower-extremity disorders resulting from stroke, poliomyelitis, osteoarthritis, amputation, and complex regional pain syndrome type I. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Unidimensionality, indicating that items assess only a single construct; (2) fit with the one-parameter logistic model (OPLM), yielding information about patient and item location parameters; (3) intratest reliability, indicating consistency of patients' item scores; and (4) content validity, indicating completeness with which the items cover the important aspects of the construct that they are attempting to represent. RESULTS: Thirty-nine of 42 items: (1) loaded on 1 component (variance explained, 59%; item component loadings, >or=.51), (2) showed good fit with the OPLM (P=.15), (3) had a good intratest reliability (Cronbach alpha=.96), and (4) had a good content validity (all important aspects represented). CONCLUSIONS: A unidimensional scale that fits with the OPLM has been developed for measuring activity limitations in R&S in patients with lower-extremity disorders who live at home.

Activities of Daily Living↗

PubMed1997

Development of a radiology faculty appraisal instrument by using critical incident interviewing.

RATIONALE AND OBJECTIVES: To develop a valid and reliable radiology faculty appraisal instrument based on scientific methods. MATERIALS AND METHODS: Fifteen radiology residents participated in critical incident interviewing. During a 1-hour interview, a resident was asked to describe five incidents each of effective and ineffective faculty behavior. Two investigators independently listened to the tape-recorded interviews, and two different investigators sorted the incidents into broad categories. A faculty appraisal instrument was developed by listing similar incidents under broad categories. A five-point rating scale was applied to each item. Content validity was assessed by resident and faculty critique of the appraisal instrument. RESULTS: A total of 168 incidents of faculty behavior were generated. The frequency with which similar incidents were reported was recorded. The most common behaviors reported were related to staff expertise and teaching. Interjudge reliability was good, as determined by computing K indices of agreement (overall K = 0.59). There was good agreement regarding instrument content validity among residents but not among faculty. CONCLUSION: Residents supported the use of the new appraisal instrument, but further tests of validity and reliability and faculty acceptance of the instrument will determine its usefulness as a tool for monitoring faculty teaching performance and making decisions regarding faculty promotion.

Faculty, Medical↗

PubMed2002

Psychometric characteristics of dyspnea descriptor ratings in emergency department patients with exacerbated chronic obstructive pulmonary disease.

The purpose of this study was to evaluate the reliability, content validity, and factor structure of dyspnea sensory quality descriptor ratings in emergency department (ED) patients with exacerbated chronic obstructive pulmonary disease (COPD). During an ED visit 104 patients with COPD rated the intensity of 16 dyspnea sensory quality descriptors (numerical ratings of 0-10) in relation to how they felt when they decided to come to the ED (Decision) and 1 week before the visit. Content validity of 15 descriptors was supported. Factor analysis of Decision ratings resulted in seven descriptors and three factors (alpha=.88; 74% common variance): Smothering/Suffocating/Hunger for air (alpha=.87); Effort/Work (alpha=.87); and Tight/Constricted (alpha=.74). Results indicate that the intensity of sensory quality descriptors can be measured reliably in COPD patients during an exacerbation of COPD. The initial descriptor list of descriptors could be cut by more than half while retaining satisfactory psychometric properties.

Dyspnea↗

PubMed1984

Measuring adequacy of physician performance. A preliminary comparison of four methods in ambulatory care of chronic obstructive pulmonary disease.

Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmonary disease (COPD). Criteria for adequate care are contained in a "criteria map." No one of the four methods (physician interview, patient interview, videotaped observation, and chart audit) was best at capturing all aspects of the management of COPD. The relative content validity of a method depended on the aspect of care evaluated. The interviews provided the broadest range of information and the chart audit the most limited. The patient interview yielded the largest proportion of encounters upon which physician performance could be scored, although specific criteria map subscales were differentially scorable depending on the method used. Relative cost and acceptability are also discussed.

Ambulatory Care↗

PubMed2006

QOLLTI-F: measuring family carer quality of life.

BACKGROUND: The primary goal of palliative care is to optimize the quality of life (QOL) of people living with a life-threatening illness and that of their families. While there have been important advances in measurement of the QOL of palliative care patients, little attention has been paid to the QOL of their carers (family caregivers). To develop and deliver the most effective services to these carers, their QOL needs to be measured with acceptable and psychometrically sound instruments that have content validity. METHODS: This study reports three phases of the development and testing of such a measure: QOLLTI-F, Quality of Life in Life Threatening Illness--Family Carer Version, simultaneously in English and French. Participants were carers from 12 Canadian palliative care services who were asked to complete QOLLTI-F on three occasions. RESULTS: The final version of QOLLTI-F consists of 16 items. It was deemed acceptable by the vast majority of carers and a longer, 24-item version was completed in a median of 12 min. Content validity was assured by inclusion of all domains reported by carers to be important to their QOL: state of carer, patient wellbeing, quality of care, outlook, environment, finances and relationships. Construct validity was demonstrated, as principal components analysis indicated that the 16 items did indeed reflect these seven domains. Furthermore, the seven domain scores predicted 53% of the variance in global QOL, although the QOLLTI-F Total score predicted less well (43%). The test-retest reliability for the QOLLTI-F Total score was 0.77-0.80 and ranged from 0.50 to 0.79 for the seven domain scores. All QOLLTI-F scores were shown to be significantly different between days the carers considered bad, average and good, demonstrating responsiveness to change, with the exception of the Financial Concerns submeasure, which did not distinguish between average and good days. CONCLUSIONS: QOLLTI-F is unique in that in measuring one person's QOL (the carer's) it includes their perception of the condition of another (the patient). This attests to the close relationship between the two. It is also unique in that its content is derived from a qualitative study asking carers what is important to their own QOL, rather than focusing on the changes or burdens related to caregiving. QOLLTI-F also has the advantage of being briefer than other carer QOL measures. It contains measures of seven different domains that are determinants of carer QOL, in addition to a summary score. All these measures are valid, reliable and responsive to change in QOL.

Adult↗