Journal of General Internal Medicine

, Volume 9, Issue 4, pp 181–186 | Cite as

Recurrent syncope as a chronic disease

Preliminary validation of a disease-specific measure of functional impairment
  • Mark Linzer
  • Deborah T. Gold
  • Michele Pontinen
  • George W. Divine
  • Alonzo Felder
  • W. Blair Brooks
Original Articles


Background: A disease-specific measure of functional health in syncope would provide an important outcome measure for use either in clinical trials or in the clinical management of patients with recurrent syncope.

Methods arid Measurements: In a previous study the authors used formal functional status measures to determine physical and psycho-social impairment in recurrent syncope. This study provides a preliminary assessment of a disease-specific measure of function. The measure was pilot tested on 84 subjects, and validated in a separate cohort of 49 patients. The measure consists of 1) an 11-question matrix of yes/no questions, assessing the ways that syncope interferes with a patient’s life (the result is expressed as a proportion of the total number of ways that syncope might interfere and is called the Impairment Score), and 2) three Likert-scale questions that assess the patient’s fear and worry about syncope. Correlations were obtained between scores on the disease-specific measure and other measures of functional health.

Results: Among the 49 patients in the test cohort, final scores on the disease-specific measure correlated with both physical and psycho-social dimension scores on a measure of functional status, the Sickness Impact Profile (r=0.35–0.36, p=0.01), and with five of ten subscale scores on a measure of psychological distress, the Symptom Checklist 90-R (r=0.30–0.43, p=0.004–0.02).

Conclusions: This new disease-specific quality-of-life measure in syncope measures both physical and psychosocial components of impairment and could be a valuable adjunct in measuring outcomes in syncope patients.

Key words

syncope clinical epidemiology functional status outcome measures 


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  1. 1.
    Day SC, Cook EF, Funkenstein H, Goldman L. Evaluation of emergency room patients with transient loss of consciousness. Am J Med. 1982;73:15–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Linzer M, Pontinen M, Gold D, Divine G, Felder A, Brooks WB. Impairment of physical and psychosocial function in recurrent syncope. J Clin Epidemiol. 1991;44:1037–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Kapoor WN, Karpf M, Weiand S, Peterson JR, Levey GS. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983;309:197–204.PubMedCrossRefGoogle Scholar
  4. 4.
    Guyatt GH, Bombardier C, Tugwell P. Measuring disease-specific quality of life in clinical trials. Can Med Assoc J. 1986;134:889–95.Google Scholar
  5. 5.
    Bergner M, Bobbit RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981;19:787–805.PubMedCrossRefGoogle Scholar
  6. 6.
    Derogatis I.R. SCL-90-R. Administration Scoring and Procedures Manual. Baltimore, MD: Clinical Psychometric Research, 1977.Google Scholar
  7. 7.
    Lewis-Beck MS. Applied Regression. Beverly Hills, CA: Sage Quantitative Method Library, #22, 1980.Google Scholar
  8. 8.
    Feinstein AR, Josephy BR, Wells CK. Scientific and clinical problems in indexes of functional disability. Ann Intern Med. 1986;105:413–20.PubMedGoogle Scholar
  9. 9.
    Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chron Dis. 1985;38:27–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Deyo R, Centor RM. Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. J Chron Dis. 1986;39:897–906.PubMedCrossRefGoogle Scholar
  11. 11.
    Guyatt G, Walter S, Geoff N. Measuring change over time: assessing the usefulness of evaluative instruments. J Chron Dis. 1987;40:171–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Milstein S, Buetikofer J, Dunnigan A, Benditt DG, Gornick C, Reyes WJ. Usefulness of disopyramide for prevention of upright tilt-induced hypotension-bradycardia. Am J Cardiol. 1990;65:1339–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Sra JS, Anderson AJ, Sheikh SH, et al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing. Ann Intern Med. 1991;114:1012–9.Google Scholar
  14. 14.
    Muller T, Talajic RM, Nattel LS, Cassidy D. Electrophysiologic evaluation and outcome of patients with syncope of unknown origin. Eur Heart J. 1991;12:139–43.PubMedGoogle Scholar
  15. 15.
    Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med. 1985;216:45–54.Google Scholar
  16. 16.
    Kapoor WN, Cha R, Peterson JR, Wieand HS, Karpf M. Prolonged electrocardiographic monitoring in patients with syncope. Am J Med. 1987;82:20–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kazis LE, Meenan RF, Anderson JJ. Pain in the rheumatic diseases: investigation of a key health status component. Arthritis Rheum. 1982;26:1017–22.CrossRefGoogle Scholar
  18. 18.
    Nelson E, Conger B, Douglass R, et al. Functional health status levels of primary care patients. JAMA. 183:249:3331–8.Google Scholar
  19. 19.
    Wachtel T, Piette J, Mor V, Stein M, Fleishman J, Carpenter C. Quality of life in persons with immunodeficiency virus infection: measurement by the Medical Outcomes Study instrument. Ann Intern Med. 1992;116:129–37.PubMedGoogle Scholar
  20. 20.
    Stewart A, Greenfield S, Hays RD, et al. Functional status and well being of patients with chronic conditions. JAMA. 1989;262:907–12.PubMedCrossRefGoogle Scholar

Copyright information

© the Society of General Internal Medicine 1994

Authors and Affiliations

  • Mark Linzer
    • 1
    • 7
  • Deborah T. Gold
    • 2
    • 3
    • 4
  • Michele Pontinen
    • 1
  • George W. Divine
    • 5
    • 6
  • Alonzo Felder
    • 1
  • W. Blair Brooks
    • 1
  1. 1.the Division of General Internal MedicineDuke University Medical CenterDurham
  2. 2.the Center for the Study on Aging and Human DevelopmentDuke University Medical CenterDurham
  3. 3.Department of MedicineDuke University Medical CenterDurham
  4. 4.the Division of Social and Community Psychiatry, Department of PsychiatryDuke University Medical CenterDurham
  5. 5.Department of PsychiatryDuke University Medical CenterDurham
  6. 6.the Division of Biometry, Department of Community and Family MedicineDuke University Medical CenterDurham
  7. 7.the Division of General MedicineUniversity of WisconsinMadison

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