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Quality of Life Research

, Volume 25, Issue 1, pp 51–61 | Cite as

Evaluating quality of life outcomes following joint replacement: psychometric evaluation of a short form of the WHOQOL-Bref

  • Deborah L. SnellEmail author
  • Richard J. Siegert
  • Lois J. Surgenor
  • Jennifer A. Dunn
  • Gary J. Hooper
Article

Abstract

Purpose

Reducing participant burden is important in health research and clinical assessment. We examined the psychometric properties of the EUROHIS-QOL 8-item index, a short version of the 26-item World Health Organisation Quality of Life questionnaire (WHOQOL-Bref), in a sample of people receiving joint replacement surgery.

Methods

Participants (n = 1008) completed the WHOQOL-Bref at either 6, 12, 24 or 60 months after hip or knee replacement. The factor structure, differential item functioning (DIF) and unidimensionality of the EUROHIS-QOL 8-item index were examined using exploratory and confirmatory factor analyses and Rasch analyses. Convergent validity was examined using correlations with the parent measure and other patient-reported outcome measures (Oxford scores, Western Ontario and McMaster Universities Osteoarthritis Index). Discriminant validity was assessed between groups reporting high versus low pain and function, and by joint replaced.

Results

The measure demonstrated high internal consistency (α = 0.86), adequate convergent (r = 0.47–0.82, p < 0.001) and discriminant validity (p < 0.001). Factor and Rasch analyses supported a unidimensional structure. However, there were also indications of multidimensionality, with support for a two-factor model focusing on general health and function, and psychosocial aspects of QOL. There was minimal evidence of DIF, with just one item evaluating energy level showing DIF for age.

Conclusions

The EUROHIS-QOL 8-item index demonstrated adequate properties as a unidimensional scale and as a two-factor scale evaluating general health and function, and psychosocial aspects of quality of life. It is low on clinical and participant burden, showed minimal ceiling effects and showed good concurrent and discriminant validity.

Keywords

Quality of life EUROHIS-QOL 8-item index Total joint replacement WHOQOL-Bref 

Notes

Acknowledgments

Thanks to our Research Assistants Lyn Jeffries and Caroline Norris for managing our database.

References

  1. 1.
    Collins, N., & Roos, E. (2012). Patient reported outcomes for total hip and knee arthroplasty. Clinics in Geriatric Medicine, 28, 367–394.PubMedCrossRefGoogle Scholar
  2. 2.
    Jeffrey, A., Wylde, V., Blom, A., & Horword, J. (2011). “Its there and Im stuck with it”: Patients experiences of chronic pain following total knee replacement. Arthritis Care & Research, 63(2), 286–292.CrossRefGoogle Scholar
  3. 3.
    Khan, F., Ng, L., Gonzalez, S., Hale, T., & Turner-Stokes, L. (2008). Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database of Systematic Reviews(2), Art. No.: CD004957. doi: 10.1002/14651858.CD004957.pub3.
  4. 4.
    Bischoff-Ferrari, H., Lingard, E., Losina, E., Baron, J., Roos, E., Phillips, C., et al. (2004). Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis and Rheumatism—Arthritis Care and Research, 51(5), 829–835.PubMedCrossRefGoogle Scholar
  5. 5.
    Westby, M. (2012). Rehabilitation and total joint arthroplasty. Clinics in Geriatric Medicine, 28(3), 489–507.PubMedCrossRefGoogle Scholar
  6. 6.
    Lavernia, C., Alcerro, J., Brooks, L., & Rossi, M. (2012). Mental health and outcomes in primary total joint arthroplasty. Journal of Arthroplasty, 27(7), 1276–1282.PubMedCrossRefGoogle Scholar
  7. 7.
    Ibrahim, M., Twaij, H., Giebaly, D., Nizam, I., & Haddad, F. (2013). Enhanced recovery in total hip replacement: A clinical review. The Bone & Joint Journal, 95B, 1587–1594.CrossRefGoogle Scholar
  8. 8.
    Bruyere, O., Ethgen, O., Neuprez, A., Ze´gels, B., Gillet, P., Huskin, J., et al. (2012). Health-related quality of life after total knee or hip replacement for osteoarthritis: A 7-year prospective study. Archives of Orthopaedic Trauma Surgery, 132, 1583–1587.PubMedCrossRefGoogle Scholar
  9. 9.
    Ackerman, I., Graves, S., Bennell, K., & Osbourne, R. (2006). Evaluating quality of life in hip and knee replacement: Psychometric properties of the World Health Organization quality of life short version instrument. Arthritis & Rheumatism (Arthritis Care & Research), 55(4), 583–590.CrossRefGoogle Scholar
  10. 10.
    The WHOQOL Group. (1998). The World Health Organisation quality of life assessment (WHOQOL): Development and general psychometric properties. Social Science and Medicine, 46(12), 1569–1585.CrossRefGoogle Scholar
  11. 11.
    Skevington, S., Lofty, M., & O’Connell, K. (2004). The World Health Organisation’s WHOQOL-Bref quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13, 299–310.PubMedCrossRefGoogle Scholar
  12. 12.
    Caballero, F., Miret, M., Power, M., Chatterji, S., Tobiasz-Adamczyk, B., Koskinen, S., et al. (2013). Validation of an instrument to evaluate quality of life in the aging population: WHOQOL-AGE. Health and Quality of Life Outcomes, 11, 177–189.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Ware, J., Kosinski, M., & Gandek, B. (2000). SF-36 health survey: Manual and interpretation guide. Lincoln, RI: Quality Metric Incorporated.Google Scholar
  14. 14.
    Bellamy, N., Buchanan, W., Goldsmith, C., Campbell, J., & Stitt, L. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient-relevant outcomes following total hip or knee arthroplasty in osteoarthritis. Journal of Orthopaedic Rheumatology, 1, 95–108.Google Scholar
  15. 15.
    Dawson, J., Fitzpatrick, R., & Carr, A. (1996). Questionnaire on the perceptions of patients about total hip replacement. Journal of Bone Joint Surgery, 78B, 185–190.Google Scholar
  16. 16.
    Dawson, J., Fitzpatrick, R., Murray, D., & Carr, A. (1998). Questionnaire on the perceptions of patients about total knee replacement. Journal of Bone Joint Surgery, 80, 863–869.CrossRefGoogle Scholar
  17. 17.
    Jones, C., & Pohar, S. (2012). Health-related quality of life after total joint arthroplasty a scoping review. Clinics in Geriatric Medicine, 28, 395–429.PubMedCrossRefGoogle Scholar
  18. 18.
    Sica da Rocha, N., Power, M., Bushnell, D., & Fleck, M. (2012). The EUROHIS-QOL 8-Item index: Comparative psychometric properties to Its parent WHOQOL-Bref. Value in Health, 15, 449–457.CrossRefGoogle Scholar
  19. 19.
    Schmidt, S., Muhlan, H., & Power, M. (2006). The EUROHIS-QOL 8-item index: Psychometric results of a cross-cultural field study. European Journal of Public Health, 16(4), 420–428.PubMedCrossRefGoogle Scholar
  20. 20.
    Gomez-Olive, F., Thorogood, M., Clark, B., Kahn, K., & Tollman, S. (2010). Assessing health and well-being among older people in rural South Africa. Global Health Action, S2, 23–35.Google Scholar
  21. 21.
    Kyobutungi, C., Egondi, T., & Ezeh, A. (2010). The health and well-being of older people in Nairobi’s slums. Global Health Action, S2, 45–53.Google Scholar
  22. 22.
    Morina, N., Ford, J., Risch, A., Morina, B., & Stangier, U. (2010). Somatic distress among Kosovar civilian war survivors: Relationship to trauma exposure and the mediating role of experiential avoidance. Social Psychiatry and Psychiatric Epidemiology, 45(12), 1167–1177.PubMedCrossRefGoogle Scholar
  23. 23.
    Bellamy, N. (2009). WOMAC Osteoarthritis Index: User guide IX. Brisbane.Google Scholar
  24. 24.
    Garbuz, D., Xu, M., & Sayre, E. (2006). Patients’ outcome after total hip arthroplasty: A comparison between the Western Ontario and McMaster Universities index and the Oxford 12-item hip score. Journal of Arthroplasty, 21, 998–1004.PubMedCrossRefGoogle Scholar
  25. 25.
    Rolfson, O., Rothwell, A., Sedrakyan, A., Chenok, K., Bohm, E., Bozic, K., et al. (2011). Use of patient-reported outcomes in the context of different levels of data. The Journal of Bone and Joint Surgery, 93(Suppl 3 (E)), 66–71.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Kalairajah, Y., Azurza, K., Hulme, C., Molloy, S., & Drabu, K. (2005). Health outcome measures in the evaluation of total hip arthroplasties-a comparison between the Harris hip score and the Oxford hip score. The Journal of Arthroplasty, 20(8), 1037–1041.PubMedCrossRefGoogle Scholar
  27. 27.
    Murray, D., Fitzpatrick, R., Rogers, K., Pandit, H., Beard, D., Carr, A., et al. (2007). The use of the Oxford hip and knee scores. Journal of Bone & Joint Surgery, British volume, 89(8), 1010–1014.CrossRefGoogle Scholar
  28. 28.
    Horn, J. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 32, 179–185.CrossRefGoogle Scholar
  29. 29.
    Wright, B., & Masters, G. (1982). Rating scale analysis. Chicago: Mesa Press.Google Scholar
  30. 30.
    Tennant, A., & Conaghan, P. (2007). The Rasch measurement model in rheumatology: What is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis & Rheumatism (Arthritis Care & Research), 57(8), 1358–1362.CrossRefGoogle Scholar
  31. 31.
    Tennant, A., McKenna, S., & Hagell, P. (2004). Application of Rasch analysis in the development and application of quality of life instruments. Value in Health, 7(Supplement 1), S22–S26.PubMedCrossRefGoogle Scholar
  32. 32.
    Turner, A., Barlow, J., Buszewicz, M., Atkinson, A., & Raitz, G. (2007). Beliefs about the causes of osteoarthritis among primary care patients. Arthritis and Rheumatism—Arthritis Care and Research, 57(2), 267–271.PubMedCrossRefGoogle Scholar
  33. 33.
    Power, M., Quinn, K., & Schmidt, S. (2005). Development of the WHOQOL-old module. Quality of Life Research, 14, 2197–2214.PubMedCrossRefGoogle Scholar
  34. 34.
    Fang, J., Power, M., Lin, Y., Zhang, J., Hao, Y., & Chatterji, S. (2011). Development of short versions for the WHOQOL-OLD module. The Gerontologist, 52(1), 6–78. doi: 10.1093/geront/gnr085.
  35. 35.
    Smith, G., McCarthy, D., & Anderson, K. (2000). On the sins of short-form development. Psychological Assessment, 12(1), 102–111.PubMedCrossRefGoogle Scholar
  36. 36.
    New Zealand Orthopaedic Association (2013). New Zealand Joint Registry: Fourteen Year Report (January 1999 to December 2012). In A. Rothwell, T. Hobbs, & C. Frampton (Eds.), New Zealand Joint Registry Reports. www.nzoa.org.nz. Accessed 28 May 2014.

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Deborah L. Snell
    • 1
    Email author
  • Richard J. Siegert
    • 3
  • Lois J. Surgenor
    • 2
  • Jennifer A. Dunn
    • 1
  • Gary J. Hooper
    • 1
  1. 1.Department of Orthopaedic Surgery and Musculoskeletal MedicineUniversity of Otago ChristchurchChristchurchNew Zealand
  2. 2.Department of Psychological MedicineUniversity of Otago ChristchurchChristchurchNew Zealand
  3. 3.School of Public Health and Psychosocial Studies, School of Rehabilitation and Occupation StudiesAUT University AucklandAucklandNew Zealand

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