Quality of Life Research

, Volume 24, Issue 11, pp 2591–2599 | Cite as

Reliability and construct validity of PROMIS® measures for patients with heart failure who undergo heart transplant

  • Kathryn E. Flynn
  • Mary Amanda Dew
  • Li Lin
  • Maria Fawzy
  • Felicia L. Graham
  • Elizabeth A. Hahn
  • Ron D. Hays
  • Robert L. Kormos
  • Honghu Liu
  • Mary McNulty
  • Kevin P. WeinfurtEmail author



To evaluate the reliability and construct validity of measures from the Patient-Reported Outcomes Measurement Information System® (PROMIS®) for patients with heart failure before and after heart transplantation.


We assessed reliability of the PROMIS short forms using Cronbach’s alpha and the average marginal reliability. To assess the construct validity of PROMIS computerized adaptive tests and short-form measures, we calculated Pearson product moment correlations between PROMIS measures of physical function, fatigue, depression, and social function and existing PRO measures of similar domains (i.e., convergent validity) as well as different domains (i.e., discriminate validity) in patients with heart failure awaiting heart transplant. We evaluated the responsiveness of these measures to change after heart transplant using effect sizes.


Forty-eight patients were included in the analyses. Across the many domains examined, correlations between conceptually similar domains were larger than correlations between different domains of health, demonstrating construct validity. Health status improved substantially after heart transplant (standardized effect sizes, 0.63–1.24), demonstrating the responsiveness of the PROMIS measures. Scores from the computerized adaptive tests and the short forms were similar.


This study provides evidence for the reliability and construct validity (including responsiveness to change) of four PROMIS domains in patients with heart failure before and after heart transplant. PROMIS measures are a reasonable choice in this context and will facilitate comparisons across studies and health conditions.


Congestive heart failure Outcomes research Patient-reported outcomes 



This study was supported by grants U01AR052186 and U01AR052155 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Flynn was supported in part by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin. Dr. Hays was supported by grants P30AG028748 and P30AG021684 from the National Institute on Aging and grant P20MD000182 from the National Center on Minority Health and Health Disparities. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest


Supplementary material

11136_2015_1010_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 kb)


  1. 1.
    Barnes, S., Gott, M., Payne, S., Parker, C., Seamark, D., Gariball, S., & Small, N. (2006). Prevalence of symptoms in a community-based sample of heart failure patients. Journal of Pain and Symptom Management, 32(3), 208–216.CrossRefPubMedGoogle Scholar
  2. 2.
    Dracup, K., Walden, J. A., Stevenson, L. W., & Brecht, M. L. (1992). Quality of life in patients with advanced heart failure. Journal of Heart and Lung Transplantation, 11(2 Pt 1), 273–279.PubMedGoogle Scholar
  3. 3.
    Rumsfeld, J. S., Alexander, K. P., Goff, D. C, Jr, Graham, M. M., Ho, P. M., Masoudi, F. A., et al. (2013). Cardiovascular health: The importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation, 127(22), 2233–2249.CrossRefPubMedGoogle Scholar
  4. 4.
    Garin, O., Herdman, M., Vilagut, G., Ferrer, M., Ribera, A., Rajmil, L., et al. (2014). Assessing health-related quality of life in patients with heart failure: A systematic, standardized comparison of available measures. Heart Failure Reviews, 19(3), 359–367.CrossRefPubMedGoogle Scholar
  5. 5.
    Rector, T. S., & Cohn, J. N. (1992). Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. American Heart Journal, 124(4), 1017–1025.CrossRefPubMedGoogle Scholar
  6. 6.
    Green, C. P., Porter, C. B., Bresnahan, D. R., & Spertus, J. A. (2000). Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure. Journal of the American College of Cardiology, 35(5), 1245–1255.CrossRefPubMedGoogle Scholar
  7. 7.
    Kappelman, M. D., Long, M. D., Martin, C., DeWalt, D. A., Kinneer, P. M., Chen, W., et al. (2014). Evaluation of the Patient-Reported Outcomes Measurement Information System in a large cohort of patients with inflammatory bowel diseases. Clinical Gastroenterology and Hepatology, 12(8), 1315–1323. e2.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Fries, J. F., Cella, D., Rose, M., Krishnan, E., & Bruce, B. (2009). Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing. Journal of Rheumatology, 36(9), 2061–2066.CrossRefPubMedGoogle Scholar
  9. 9.
    Hays, R. D., Spritzer, K. L., Fries, J. F., & Krishnan, E. (2013). Responsiveness and minimally important difference for the Patient-Reported Outcomes Measurement Information System (PROMIS) 20-item physical functioning short form in a prospective observational study of rheumatoid arthritis. Annals of Rheumatic Diseases,. doi: 10.1136/annrheumdis-2013-204053.Google Scholar
  10. 10.
    Broderick, J. E., Schneider, S., Junghaenel, D. U., Schwartz, J. E., & Stone, A. A. (2013). Validity and reliability of Patient-Reported Outcomes Measurement Information System instruments in osteoarthritis. Arthritis Care & Research, 65(10), 1625–1633.Google Scholar
  11. 11.
    Yost, K. J., Eton, D. T., Garcia, S. F., & Cella, D. (2011). Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients. Journal of Clinical Epidemiology, 64(5), 507–516.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Hahn, E. A., Devellis, R. F., Bode, R. K., Garcia, S. F., Castel, L. D., Eisen, S. V., et al. (2010). Measuring social health in the Patient-Reported Outcomes Measurement Information System (PROMIS): Item bank development and testing. Quality of Life Research, 19(7), 1035–1044.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., & PROMIS Cooperative Group. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS): Depression, anxiety, and anger. Assessment, 18(3), 263–283.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    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.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    McHorney, C. A., Ware, J. E, Jr, Lu, J. F., & Sherbourne, C. D. (1994). The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40–66.CrossRefPubMedGoogle Scholar
  16. 16.
    Ware, J. E, Jr, & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.CrossRefPubMedGoogle Scholar
  17. 17.
    Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292.CrossRefPubMedGoogle Scholar
  18. 18.
    Balke, B. (1963). A simple field test for the assessment of physical fitness. Oklahoma City, OK: Civil Aeromedical Research Institute, Aeromedical Research Division, 1963 Apr. Report No.: 63-6.Google Scholar
  19. 19.
    ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. (2002). ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166(1), 111–117.CrossRefGoogle Scholar
  20. 20.
    Grady, K. L., & Lanuza, D. M. (2005). Physical functional outcomes after cardiothoracic transplantation. Journal of Cardiovascular Nursing, 20(5 Suppl), S43–S50.CrossRefPubMedGoogle Scholar
  21. 21.
    Molzahn, A. E., Burton, J. R., McCormick, P., Modry, D. L., Soetaert, P., & Taylor, P. (1997). Quality of life of candidates for and recipients of heart transplants. Canadian Journal of Cardiology, 13(2), 141–146.PubMedGoogle Scholar
  22. 22.
    Paris, W., & White-Williams, C. (2005). Social adaptation after cardiothoracic transplantation: a review of the literature. Journal of Cardiovascular Nursing, 20(5 Suppl), S67–S73.CrossRefPubMedGoogle Scholar
  23. 23.
    Hays, R. D., & Reeve, B. B. (2010). Measurement and modeling of health-related quality of life. In J. Killewo, H. K. Heggenhougen, & S. R. Quah (Eds.), Epidemiology and demography in public health (pp. 195–205). San Diego: Academic Press.Google Scholar
  24. 24.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  25. 25.
    Efron, B., & Tibshirani, R. J. (1993). An introduction to the bootstrap. New York: Chapman & Hall.CrossRefGoogle Scholar
  26. 26.
    Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81–105.CrossRefPubMedGoogle Scholar
  27. 27.
    Bjorner, J. B., Rose, M., Gandek, B., Stone, A. A., Junghaenel, D. U., & Ware, J. E, Jr. (2014). Difference in method of administration did not significantly impact item response: An IRT-based analysis from the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. Quality of Life Research, 23(1), 217–227.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Hahn, E. A., Rao, D., Cella, D., & Choi, S. W. (2008). Comparability of interview- and self-administration of the Functional Assessment of Cancer Therapy-General (FACT-G) in English- and Spanish-speaking ambulatory cancer patients. Medical Care, 46(4), 423–431.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Kathryn E. Flynn
    • 1
  • Mary Amanda Dew
    • 2
    • 3
    • 4
  • Li Lin
    • 6
  • Maria Fawzy
    • 6
  • Felicia L. Graham
    • 6
  • Elizabeth A. Hahn
    • 8
  • Ron D. Hays
    • 9
  • Robert L. Kormos
    • 5
  • Honghu Liu
    • 9
  • Mary McNulty
    • 2
  • Kevin P. Weinfurt
    • 6
    • 7
    Email author
  1. 1.Center for Patient Care and Outcomes Research, Department of MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of PsychiatryUniversity of PittsburghPittsburghUSA
  3. 3.Department of PsychologyUniversity of PittsburghPittsburghUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of PittsburghPittsburghUSA
  5. 5.Department of SurgeryUniversity of PittsburghPittsburghUSA
  6. 6.Duke Clinical Research InstituteDuke University School of MedicineDurhamUSA
  7. 7.Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamUSA
  8. 8.Department of Medical Social Sciences and Center for Patient-Centered OutcomesNorthwestern University Feinberg School of MedicineChicagoUSA
  9. 9.Department of MedicineUniversity of California, Los AngelesLos AngelesUSA

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