Abstract
Objective
Quality of life (QoL) is still assessed using paper-based and fixed-length questionnaires, which is one reason why QoL measurements have not been routinely implemented in clinical practice. Providing new QoL measures that combine computer technology with modern measurement theory may enhance their clinical use. The aim of this study was to develop a QoL multidimensional computerized adaptive test (MCAT), the SQoL-MCAT, from the fixed-length SQoL questionnaire for patients with schizophrenia.
Methods
In this multicentre cross-sectional study, we collected sociodemographic information, clinical characteristics (i.e., duration of illness, the PANSS, and the Calgary Depression Scale), and quality of life (i.e., SQoL). The development of the SQoL-CAT was divided into three stages: (1) multidimensional item response theory (MIRT) analysis, (2) multidimensional computerized adaptive test (MCAT) simulations with analyses of accuracy and precision, and (3) external validity.
Results
Five hundred and seventeen patients participated in this study. The MIRT analysis found that all items displayed good fit with the multidimensional graded response model, with satisfactory reliability for each dimension. The SQoL-MCAT was 39% shorter than the fixed-length SQoL questionnaire and had satisfactory accuracy (levels of correlation >0.9) and precision (standard error of measurement <0.55 and root mean square error <0.3). External validity was confirmed via correlations between the SQoL-MCAT dimension scores and symptomatology scores.
Conclusion
The SQoL-MCAT is the first computerized adaptive QoL questionnaire for patients with schizophrenia. Tailored for patient characteristics and significantly shorter than the paper-based version, the SQoL-MCAT may improve the feasibility of assessing QoL in clinical practice.
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References
Awad, A. G., Voruganti, L. N., & Heslegrave, R. J. (1997). Measuring quality of life in patients with schizophrenia. PharmacoEconomics, 11(1), 32–47.
Bobes, J., García-Portilla, P., Sáiz, P. A., Bascarán, T., & Bousoño, M. (oct 2005). Quality of life measures in schizophrenia. European Psychiatry, 20(Suppl 3), S313–S317.
Boyer, L., Baumstarck, K., Boucekine, M., Blanc, J., Lançon, C., & Auquier, P. (2013). Measuring quality of life in patients with schizophrenia: An overview. Expert Review of Pharmacoeconomics & Outcomes Research, 13(3), 343–349.
Greenhalgh, J., Long, A. F., & Flynn, R. (1982). The use of patient reported outcome measures in routine clinical practice: Lack of impact or lack of theory? Social Science & Medicine, 60(4), 833–843.
Morris, J., Perez, D., & McNoe, B. (1998). The use of quality of life data in clinical practice. Quality of Life Research, 7(1), 85–91.
Awad, A. G., & Voruganti, L. N. P. (2012). Measuring quality of life in patients with schizophrenia: An update. PharmacoEconomics, 30(3), 183–195.
Halyard, M. Y., Frost, M. H., Dueck, A., & Sloan, J. A. (2006). Is the use of QOL data really any different than other medical testing? Current Problems in Cancer, 30(6), 261–271.
Halyard, M. Y., Frost, M. H., & Dueck, A. (2006). Integrating QOL assessments for clinical and research purposes. Current Problems in Cancer, 30(6), 319–330.
Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., & Reeve, B., et al. (2007). The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap cooperative group during its first two years. Medical Care, 45(5 Suppl 1), S3–S11.
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., & Yount, S., et al. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179–1194.
Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists (1 ed). Mahwah, NJ: Psychology Press.
Fayers, P., & Machin, D. (2007). Quality of life: The assessment, analysis and interpretation of patient-reported outcomes (2e éd). New York: Wiley.
Weiss. (2004). Computerized adaptive testing for effective and efficient measurement in counseling and education. Measurement and Evaluation in Counseling and Development, 37, 70–84.
Reeve, B. B., Hays, R. D., Bjorner, J. B., Cook, K. F., Crane, P. K., & Teresi, J. A., et al. (2007). Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS). Medical Care, 45(5 Suppl 1), S22–S31.
Hill, C. D., Edwards, M. C., Thissen, D., Langer, M. M., Wirth, R. J., & Burwinkle, T. M., et al. (2007). Practical issues in the application of item response theory: A demonstration using items from the pediatric quality of life inventory (PedsQL) 4.0 generic core scales. Medical Care, 45(5 Suppl 1), S39–S47.
Gardner, W., Kelleher, K. J., & Pajer, K. A. (2002). Multidimensional adaptive testing for mental health problems in primary care. Medical Care, 40(9), 812–823.
Petersen, M. A., Groenvold, M., Aaronson, N., Fayers, P., Sprangers, M., Bjorner, J. B. (2006). Multidimensional computerized adaptive testing of the EORTC QLQ-C30: Basic developments and evaluations. Quality Life Research, 15(3), 315–329.
Haley, S. M., Ni, P., Dumas, H. M., Fragala-Pinkham, M. A., Hambleton, R. K., & Montpetit, K., et al. (2009) Measuring global physical health in children with cerebral palsy: Illustration of a multidimensional bi-factor model and computerized adaptive testing. Quality Life Research, 18(3), 359–370.
Auquier, P., Simeoni, M. C., Sapin, C., Reine, G., Aghababian, V., & Cramer, J., et al. (2003). Development and validation of a patient-based health-related quality of life questionnaire in schizophrenia: The S-QoL. Schizophrenia Research, 63(1–2), 137–149.
Baumstarck, K., Boyer, L., Boucekine, M., Aghababian, V., Parola, N., & Lançon, C., et al. Self-reported quality of life measure is reliable and valid in adult patients suffering from schizophrenia with executive impairment. Schizophrenia Research, 147(1), 58–67.
Baumstarck, K., Boucekine, M., Boyer, L., Aghababian, V., Parola, N., & Reuter, F., et al. (2014). Quantification of relevance of quality of life assessment for patients with cognitive impairment: The suitability indices. BMC Neurology, 14(1), 78.
Auquier, P., Tinland, A., Fortanier, C., Loundou, A., Baumstarck, K., & Lancon, C., et al. (2013). Toward meeting the needs of homeless people with schizophrenia: The validity of quality of life measurement. PloS ONE, 8(10), e79677.
Boyer, L., Lançon, C., Baumstarck, K., Parola, N., Berbis, J., & Auquier, P. (2013). Evaluating the impact of a quality of life assessment with feedback to clinicians in patients with schizophrenia: Randomised controlled trial. The British Journal of Psychiatry, 202, 447–453.
Catherine, F.-A., Boyer, L., Jonathan, W., Jean-Philippe, R., Raphaelle, R., Elisabeth, S., et al. (2015). Neural substrate of quality of life in patients with schizophrenia: A magnetisation transfer imaging study. Scientific Reports, 5, 17650.
Boyer, L., Richieri, R., Faget, C., Padovani, R., Vaillant, F., Mundler, O., et al. (2012). Functional involvement of superior temporal sulcus in quality of life of patients with schizophrenia. Psychiatry Research, 202(2), 155–160.
McKenna, S. P. (1997) Measuring quality of life in schizophrenia. European Psychiatry, 12(Suppl 3), 267s–274s.
Calman, K. C. (1984). Quality of life in cancer patients–an hypothesis. Journal of medical ethics, 10(3), 124–127.
Caqueo-Urízar, A., Boyer, L., Boucekine, M., & Auquier, P. (2014). Spanish cross-cultural adaptation and psychometric properties of the Schizophrenia Quality of Life short-version questionnaire (SQoL18) in 3 middle-income countries: Bolivia, Chile and Peru. Schizophrenia Research, 159(1), 136–143.
Chou, C.-Y., Ma, M.-C., Yang, T.-T., Chen-Sea, M.-J. (2011). Psychometric validation of the S-QoL Chinese (Taiwan) version for patients with schizophrenia. Quality Life Research, 20(5), 763–767.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
Loi n° 78–17 du 6 janvier. (1978). relative à l’informatique, aux fichiers et aux libertés.
WMA Declaration of Helsinki - Ethical principles for medical research involving human subjects. (2013). Retrieved March 18, 2016, from http://www.wma.net/fr/30publications/10policies/b3/.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for Schizophrenia. Schizophrenia Bulletin, 13(2), 261–276.
Lançon, C., Reine, G., Llorca, P. M., & Auquier, P. (1999). Validity and reliability of the French-language version of the Positive and Negative Syndrome Scale (PANSS). Acta Psychiatrica Scandinavica, 100(3), 237–243.
Addington, D, Addington, J, & Schissel, B. (1990) A depression rating scale for schizophrenics. Schizophrenia Research, 3(4), 247–251.
Michel, P., Baumstarck, K., Ghattas, B., Pelletier, J., Loundou, A., & Boucekine, M., et al. A multidimensional computerized adaptive short-form quality of life questionnaire developed and validated for multiple sclerosis. The MusiQoL-MCAT. Medicine (Baltimore). 2016.
Fayers, P. M., & Hand, D. J.. (1997). Factor analysis, causal indicators and quality of life. Quality Life Research, 6(2), 139–150.
Costa, D. S. J. (2015). Reflective, causal, and composite indicators of quality of life: A conceptual or an empirical distinction? Quality Life Research, 24(9), 2057–2065.
Muthén, L., & Muthén, B. (2012). MPlus user’s guide (7th ed). Los Angeles: Muthén & Muthén.
Steiger, J. H. (2007). Understanding the limitations of global fit assessment in structural equation modeling. Personality and Individual Differences, 42(5), 893–898.
Samejima, F. (1969). Estimation of latent ability using a response pattern of graded scores. Iowa City: Psychometric Society.
Samejima, F. (1974). Normal ogive model on the continuous response level in the multidimensional latent space. Psychometrika, 39(1), 111–121.
Adams, R. J., Wilson, M., & Wang, W. (1997). The multidimensional random coefficients multinomial logit model. Applied Psychological Measurement, 21(1), 1–23.
Hays, R. D., Morales, L. S., & Reise, S. P. (2000). Item response theory and health outcomes measurement in the 21st century. Medical Care, 38(9 Suppl), II28-II42.
Cai L. (2010). Metropolis-Hastings Robbins-Monro algorithm for confirmatory item factor analysis. Journal of Educational and Behavioral Statistics, 35(3), 307–335.
Chalmers, R. P. (2012). mirt: A multidimensional item response theory package for the R environment. Journal of Statistical Software, 48, 1–29.
Kang, T., & Chen, T. T. (2008). Performance of the generalized S-X2 item fit index for polytomous IRT models. Journal of Educational Measurement, 45(4), 391–406.
Raju, N. S., Price, L. R., Oshima, T. C., & Nering, M. L. (2007). Standardized conditional SEM: A case for conditional reliability. Applied Psychological Measurement, 31(3), 169–80.
Wang, T, & Others, A. (1996). Conditional standard errors, reliability and decision consistency of performance levels using polytomous IRT. Retrieved February 18, 2015, from http://eric.ed.gov/?id=ED401323.
Wright, B. D., & Linacre, J. M. (1994) Reasonable mean-square fit values. Rasch Measurement Transactions, 8(3), 370.
Molenaar, I. W. (1991). A weighted Loevinger H-coefficient extending Mokken scaling to multicategory items. Kwant Methoden, 12(37), 97–117.
van der Ark, L. A. (2007). Mokken scale analysis in R. Journal of Statistical Software, 39(8), 1–30.
Stochl, J., Jones, P. B., & Croudace, T. J. (2012). Mokken scale analysis of mental health and well-being questionnaire item responses: A non-parametric IRT method in empirical research for applied health researchers. BMC Medical Research Methodology, 12, 74.
Siu, C. O., Harvey, P. D., Agid, O., Waye, M., Brambilla, C., & Choi, W.-K., et al. (2015). Insight and subjective measures of quality of life in chronic schizophrenia. Schizophrenia Research: Cognition, 2(3), 127–132.
Boyer, L., Cermolacce, M., Dassa, D., Fernandez, J., Boucekine, M., & Richieri, R., et al. (2012). Neurocognition, insight and medication nonadherence in schizophrenia: A structural equation modeling approach. PloS ONE, 7(10), e47655.
Choi, S. W., Gibbons, L. E., & Crane, P. K. (2011). Lordif: An R Package for detecting differential item functioning using iterative hybrid ordinal logistic regression/item response theory and Monte Carlo simulations. Journal of Statistical Software, 39(8), 1–30.
Zumbo, B. D. (1999). A handbook on the theory and methods of differential item functioning (DIF): Logistic regression modeling as a unitary framework for binary and likert-type (ordinal) item scores. Ottawa, Directorate of Human Resources Research and Evaluation, Department of National Defense.
Anatchkova, M. D., Saris-Baglama, R. N., Kosinski, M., & Bjorner, J. B. (2009). Development and preliminary testing of a computerized adaptive assessment of chronic pain. The Journal of Pain, 10(9), 932–943.
Huisman, M., & Molenaar, I. W. (2001). Imputation of missing scale data with item response models. In: Boomsma, A., van Duijn, M. A. J. & Snijders, T. A. B. (Eds.) Essays on item response theory, pp. 221–244. New York: Springer. (Lecture Notes in Statistics). Retrieved September 20, 2013, from http://link.springer.com/chapter/10.1007/978-1-4613-0169-1_13.
Peyre, H., Leplège, A., & Coste, J. (2010). Missing data methods for dealing with missing items in quality of life questionnaires. A comparison by simulation of personal mean score, full information maximum likelihood, multiple imputation, and hot deck techniques applied to the SF-36 in the French 2003 decennial health survey. Quality of Life Research, 20(2), 287–300.
Mulder, J, & van der Linden, W. J.. (2009). Multidimensional adaptive testing with Kullback–Leibler information item selection. In: van der Linden, W. J. & Glas, C. A. W. (Eds.) Elements of adaptive testing, pp. 77–101. New York: Springer. (Statistics for Social and Behavioral Sciences). Retrieved January 28, 2015, from http://link.springer.com/chapter/10.1007/978-0-387-85461-8_4.
Harvill, L. M. (1991). Standard error of measurement. Educational Measurement: Issues and Practice, 10(2), 33–41.
Babcock, B., & Weiss, D. J. (2013). Termination criteria in computerized adaptive tests: Do variable-length CATs provide efficient and effective measurement? Journal of Computerized Adaptive Testing, 1, 1–18.
Choi, S. W., Reise, S. P., Pilkonis, P. A., Hays, R. D., & Cella, D. (2010). Efficiency of static and computer adaptive short forms compared to full-length measures of depressive symptoms. Quality of Life Research, 19(1), 125–136.
R Core Team. (2016). R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. Retrieved from https://www.R-project.org/.
Alessandrini, M., Lançon, C., Fond, G., Faget-Agius, C., Richieri, R., & Faugere, M., et al. (2016). A structural equation modelling approach to explore the determinants of quality of life in schizophrenia. Schizophrenia Research, 171(1–3), 27–34.
Ruggeri, M., Nosè, M., Bonetto, C., Cristofalo, D., Lasalvia, A., Salvi, G., et al. (2005). Changes and predictors of change in objective and subjective quality of life: Multiwave follow-up study in community psychiatric practice. The British Journal of Psychiatry, 187, 121–130.
Reine, G., Simeoni, M.-C., Auquier, P., Loundou, A., Aghababian, V., & Lancon, C. (2005). Assessing health-related quality of life in patients suffering from schizophrenia: A comparison of instruments. European Psychiatry, 20(7), 510–519.
Kemmler, G., Holzner, B., Neudorfer, C., Meise, U., & Hinterhuber, H. (1997). General life satisfaction and domain-specific quality of life in chronic schizophrenic patients. Quality of Life Research, 6(3), 265–273.
Folsom, D. P., Depp, C., Palmer, B. W., Mausbach, B. T., Golshan, S., & Fellows, I., et al. (2009). Physical and mental health-related quality of life among older people with schizophrenia. Schizophrenia Research, 108(1–3), 207–213.
Smits, N. (2016). On the effect of adding clinical samples to validation studies of patient-reported outcome item banks: A simulation study. Quality of Life Research, 25(7), 1635–1644.
Yao, L. (2014). Multidimensional CAT item selection methods for domain scores and composite scores with item exposure control and content constraints. Journal of Educational Measurement, 51(1), 18–38.
Petersen, M. A., Giesinger, J. M., Holzner, B., Arraras, J. I., Conroy, T., & Gamper, E.-M., et al. (2013). Psychometric evaluation of the EORTC computerized adaptive test (CAT) fatigue item pool. Quality of Life Research, 22(9), 2443–2454.
Zhang, J. (2012). Calibration of response data using MIRT models with simple and mixed structures. Applied Psychological Measurement, 36(5), 375–398.
Baumstarck, K., Boyer, L., Boucekine, M., Aghababian, V., Parola, N., & Lançon, C., et al. (2013). Self-reported quality of life measure is reliable and valid in adult patients suffering from schizophrenia with executive impairment. Schizophrenia Research, 147(1), 58–67.
Girard, V., Tinland, A., Boucekine, M., Loubière, S., Lancon, C., & Boyer, L., et al. (2016). Validity of a common quality of life measurement in homeless individuals with bipolar disorder and schizophrenia. Journal of Affective Disorders, 204, 131–137.
Woods, C. M. (2014). Estimating the latent density in unidimensional IRT to permit non-normality. In Handbook of item response theory modeling: Applications to typical performance assessment. New York: Routledge.
Green, B. F., Bock, R. D., Humphreys, L. G., Linn, R. L., & Reckase, M. D. (1984). Technical guidelines for assessing computerized adaptive tests. Journal of Educational Measurement, 21(4), 347–360.
Nunnally, J. C, & Bernstein, I. H. (1994) Psychometric theory, p. 736 (3rd ed). New York: McGraw-Hill.
Carpenter, J. R., & Kenward, M. G. (2008). Missing data in randomised controlled trials—a practical guide. Birmingham: The National Institute for Health Research. RM03/JH17/MK.
Fielding, S., Fayers, P. M., & Ramsay, C. R. (2009). Investigating the missing data mechanism in quality of life outcomes: A comparison of approaches. Health and Quality of Life Outcomes, 7, 57.
Nortvedt, M. W., Riise, T., Myhr, K. M., & Nyland, H. I. (2000). Quality of life as a predictor for change in disability in MS. Neurology, 55(1), 51–54.
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Michel, P., Baumstarck, K., Lancon, C. et al. Modernizing quality of life assessment: development of a multidimensional computerized adaptive questionnaire for patients with schizophrenia. Qual Life Res 27, 1041–1054 (2018). https://doi.org/10.1007/s11136-017-1553-1
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DOI: https://doi.org/10.1007/s11136-017-1553-1