Skip to main content

Advertisement

SpringerLink
Log in

Longitudinal construct validity of the Health Utilities Indices Mark 2 and Mark 3 in hip fracture

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study is to evaluate the longitudinal construct validity of the Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) using a convergent/divergent validity approach in patients recovering from hip fracture, with the Functional Independence Measure (FIM) as the comparator.

Methods

A total of 278 patients with a primary diagnosis of hip fracture were interviewed 3–5 days after surgery and then at 1 and 6 months using the HUI2, HUI3 and the FIM and a Likert-type rating of hip pain. A priori hypotheses were formulated. Convergent and divergent correlations between HUI2, HUI3 and FIM change scores for the baseline to 1-month and baseline to 6-month intervals were examined.

Results

Overall HUI2 detected continued gain in health-related quality of life between 1 and 6 months after fracture, as the change increased from 0.20 to 0.29 units. The correlation between change in the overall HUI2 score and total FIM score was moderate (r = 0.50) over the 6-month interval, but larger than the observed correlation over the 1-month interval (r = 0.36). The correlation between change in overall HUI3 score and total FIM over the 1-month interval was small (r = 0.32), and the correlation between change in overall HUI3 score and total FIM was moderate (r = 0.37) over the 6-month interval. All hypotheses for the divergent correlations were supported.

Conclusions

Weaker correlations were reported for change over 1 month as compared to change over the 6 months after fracture. Findings supported the longitudinal construct validity of the overall HUI2 and HUI3 for the assessment of recovery following hip fracture, particularly for change over the 6 months following fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bentler, S. E., Liu, L., Obrizan, M., Cook, E. A., Wright, K. B., Geweke, J. F., et al. (2009). The aftermath of hip fracture: Discharge placement, functional status change, and mortality. American Journal of Epidemiology, 170, 1290–1299.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Jette, A. M., Harris, B. A., Cleary, P. D., & Campion, E. W. (1987). Functional recovery after hip fracture. Archives of Physical Medicine and Rehabilitation, 68, 735–740.

    CAS  PubMed  Google Scholar 

  3. Magaziner, J., Simonsick, E. M., Kashner, T. M., Hebel, J. R., & Kenzora, J. E. (1990). Predictors of functional recovery one year following hospital discharge for hip fracture: A prospective study. Journal of Gerontology, 45, M101–M107.

    Article  CAS  PubMed  Google Scholar 

  4. Mossey, J. M., Mutran, E., Knott, K., & Craik, R. (1989). Determinants of recovery 12 months after hip fracture: The importance of psychosocial factors. American Journal of Public Health, 79, 279–286.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Lyons, A. R. (1997). Clinical outcomes and treatment of hip fractures. American Journal of Medicine, 103, 51S–63S.

    Article  CAS  PubMed  Google Scholar 

  6. Tidermark, J., Zethraeus, N., Svensson, O., Tornkvist, H., & Ponzer, S. (2002). Femoral neck fractures in the elderly: Functional outcome and quality of life according to EuroQol. Quality of Life Research, 11, 473–481.

    Article  PubMed  Google Scholar 

  7. Hallberg, I., Rosenqvist, A. M., Kartous, L., Lofman, O., Wahlstrom, O., & Toss, G. (2004). Health-related quality of life after osteoporotic fractures. Osteoporosis International, 15, 834–841.

    Article  CAS  PubMed  Google Scholar 

  8. Tseng, M. Y., Shyu, Y. I., & Liang, J. (2012). Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Gerontologist, 52, 833–842.

    Article  PubMed  Google Scholar 

  9. Revicki, D. A., Osoba, D., Fairclough, D., Barofsky, I., Berzon, R., Leidy, N. K., et al. (2000). Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Quality of Life Research, 9, 887–900.

    Article  CAS  PubMed  Google Scholar 

  10. Guyatt, G. H., Jaeschke, R., Feeny, D. H., & Patrick, D. L. (1996). Measurement in clinical trials: Choosing the right approach. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (pp. 41–48). Philadelphia: Lippincott-Raven Publishers.

    Google Scholar 

  11. Fayers, P. M., & Machin, D. (2007). Quality of life: The assessment, analysis and interpretation of patient-reported outcomes. Chicherster: Wiley.

    Book  Google Scholar 

  12. Cranney, A. B., Coyle, D., Hopman, W. M., Hum, V., Power, B., & Tugwell, P. S. (2005). Prospective evaluation of preferences and quality of life in women with hip fractures. Journal of Rheumatology, 32, 2393–2399.

    PubMed  Google Scholar 

  13. Kavirajan, H., Hays, R. D., Vassar, S., & Vickrey, B. G. (2009). Responsiveness and construct validity of the health utilities index in patients with dementia. Medical Care, 47, 651–661.

    Article  PubMed  Google Scholar 

  14. Naglie, G., Tomlinson, G., Tansey, C., Irvine, J., Ritvo, P., Black, S. E., et al. (2006). Utility-based quality of life measures in Alzheimer’s disease. Quality of Life Research, 15, 631–643.

    Article  PubMed  Google Scholar 

  15. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.

    Article  CAS  PubMed  Google Scholar 

  16. (1997) Guide for the uniform data set for medical rehabilitation ver 5.1. State University of New York at Buffalo, Buffalo, NY 14214.

  17. Petrella, R. J., Overend, T., & Chesworth, B. (2002). FIM after hip fracture: Is telephone administration valid and sensitive to change? American Journal of Physical Medicine and Rehabilitation, 81, 639–644.

    Article  CAS  PubMed  Google Scholar 

  18. Torrance, G. W., Feeny, D. H., Furlong, W. J., Barr, R. D., Zhang, Y., & Wang, Q. (1996). Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2. Medical Care, 34, 702–722.

    Article  CAS  PubMed  Google Scholar 

  19. Feeny, D. H., Torrance, G. W., & Furlong, W. J. (1996). Health Utilities Index. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (pp. 239–252). Philadelphia: Lippincott-Raven Publishers.

    Google Scholar 

  20. Furlong, W., Feeny, D., Torrance, G. W., Goldsmith, C., Depauw, S., Boyle, M., et al. (1998). Multiplicative Multi-attribute Utility Function for the Health Utilities Index Mark 3 (HUI3) System: A Technical Report. 98-11. (1998). McMaster University Centre for Health Economics and Policy Analysis Working Paper.

  21. Feeny, D., Furlong, W., Torrance, G. W., Goldsmith, C. H., Zhu, Z., Depauw, S., et al. (2002). Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Medical Care, 40, 113–128.

    Article  PubMed  Google Scholar 

  22. Horsman, J. R., Fluchel, M., Furlong, W., Castillo, L., & Barr, R. D. (2003). Agreement of Health Utilities Index scores among survivors of cancer in childhood their parents and their doctors in Uruguay. Value in Health, 6, 233.

    Article  Google Scholar 

  23. Downie, W. W., Leatham, P. A., Rhind, V. M., Wright, V., Branco, J. A., & Anderson, J. A. (1978). Studies with pain rating scales. Annals of the Rheumatic Diseases, 37, 378–381.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Jones, C. A., & Feeny, D. H. (2006). Agreement between patient and proxy responses during recovery after hip fracture: Evidence for the FIM instrument. Archives of Physical Medicine and Rehabilitation, 87, 1382–1387.

    Article  PubMed  Google Scholar 

  25. Furlong, W. J., Feeny, D. H., Torrance, G. W., & Barr, R. D. (2001). The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies. Annals of Medicine, 33, 375–384.

    Article  CAS  PubMed  Google Scholar 

  26. Papaioannou, A., Kennedy, C. C., Ioannidis, G., Sawka, A., Hopman, W. M., Pickard, L., et al. (2009). The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporosis International, 20, 703–714.

    Article  CAS  PubMed  Google Scholar 

  27. Grootendorst, P., Feeny, D., & Furlong, W. (2000). Health Utilities Index Mark 3: Evidence of construct validity for stroke and arthritis in a population health survey. Medical Care, 38, 290–299.

    Article  CAS  PubMed  Google Scholar 

  28. Drummond, M. (2001). Introducing economic and quality of life measurements into clinical studies. Annals of Medicine, 33, 344–349.

    Article  CAS  PubMed  Google Scholar 

  29. Horsman, J., Furlong, W., Feeny, D., & Torrance, G. (2003). The Health Utilities Index (HUI): Concepts, measurement properties and applications. Health Quality of Life Outcomes, 1, 54.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Maddigan, S. L., Feeny, D. H., & Johnson, J. A. (2003). A comparison of the Health Utilities Indices Mark 2 and Mark 3 in type 2 diabetes. Medical Decision Making, 23, 489–501.

    Article  PubMed  Google Scholar 

  31. Neumann, P. J., Sandberg, E. A., Araki, S. S., Kuntz, K. M., Feeny, D., & Weinstein, M. C. (2000). A comparison of HUI2 and HUI3 utility scores in Alzheimer’s disease. Medical Decision Making, 20, 413–422.

    Article  CAS  PubMed  Google Scholar 

  32. Granger, C. V., Cotter, A. C., Hamilton, B. B., Fiedler, R. C., & Hens, M. M. (1990). Functional assessment scales: A study of persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 71, 870–875.

    CAS  PubMed  Google Scholar 

  33. Beninato, M., Gill-Body, K. M., Salles, S., Stark, P. C., Black-Schaffer, R. M., & Stein, J. (2006). Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Archives of Physical Medicine and Rehabilitation, 87, 32–39.

    Article  PubMed  Google Scholar 

  34. Latham, N. K., Jette, D. U., Warren, R. L., & Wirtalla, C. (2006). Pattern of functional change during rehabilitation of patients with hip fracture. Archives of Physical Medicine and Rehabilitation, 87, 111–116.

    Article  PubMed  Google Scholar 

  35. Ottenbacher, K. J., Hsu, Y., Granger, C. V., & Fiedler, R. C. (1996). The reliability of the functional independence measure: A quantitative review. Archives of Physical Medicine and Rehabilitation, 77, 1226–1232.

    Article  CAS  PubMed  Google Scholar 

  36. Pollak, N., Rheault, W., & Stoecker, J. L. (1996). Reliability and validity of the FIM for persons aged 80 years and above from a multilevel continuing care retirement community. Archives of Physical Medicine and Rehabilitation, 77, 1056–1061.

    Article  CAS  PubMed  Google Scholar 

  37. Granger, C. V., Hamilton, B. B., Linacre, J. M., Heinemann, A. W., & Wright, B. D. (1993). Performance profiles of the functional independence measure. American Journal of Physical Medicine and Rehabilitation, 72, 84–89.

    Article  CAS  PubMed  Google Scholar 

  38. van der Putten, J. J., Hobart, J. C., Freeman, J. A., & Thompson, A. J. (1999). Measuring change in disability after inpatient rehabilitation: Comparison of the responsiveness of the Barthel index and the Functional Independence Measure. Journal of Neurology, Neurosurgery and Psychiatry, 66, 480–484.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Dodds, T. A., Martin, D. P., Stolov, W. C., & Deyo, R. A. (1993). A validation of the functional independence measurement and its performance among rehabilitation inpatients. Archives of Physical Medicine and Rehabilitation, 74, 531–536.

    Article  CAS  PubMed  Google Scholar 

  40. Leino, K. A., Kuusniemi, K. S., Lertola, K. K., & Olkkola, K. T. (2011). Comparison of four pain scales in patients with hip fracture or other lower limb trauma. Acta Anaesthesiologica Scandinavica, 55, 495–502.

    Article  CAS  PubMed  Google Scholar 

  41. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

    Article  CAS  PubMed  Google Scholar 

  42. Bishara, A. J., & Hittner, J. B. (2012). Testing the significance of a correlation with nonnormal data: Comparison of Pearson, Spearman, transformation, and resampling approaches. Psychological Methods, 17, 399–417.

    Article  PubMed  Google Scholar 

  43. Guyatt, G. H., Berman, L. B., Townsend, M., Pugsley, S. O., & Chambers, L. W. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax, 42, 773–778.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Feeny, D., Huguet, N., McFarland, B. H., & Kaplan, M. S. (2009). The construct validity of the Health Utilities Index Mark 3 in assessing mental health in population health surveys. Quality of Life Research, 18, 519–526.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Santana, M. J., Feeny, D., Ghosh, S., Nador, R. G., Weinkauf, J., Jackson, K., et al. (2010). The construct validity of the Health Utilities Index Mark 3 in assessing health status in lung transplantation. Health Quality of Life Outcomes, 8, 110.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Jones, C. A., & Feeny, D. H. (2005). Agreement between patient and proxy responses of health-related quality of life after hip fracture. Journal of the American Geriatrics Society, 53, 1227–1233.

    Article  PubMed  Google Scholar 

  47. Bitsch, M., Foss, N., Kristensen, B., & Kehlet, H. (2004). Pathogenesis of and management strategies for postoperative delirium after hip fracture: A review. Acta Orthopaedica Scandinavica, 75, 378–389.

    PubMed  Google Scholar 

  48. Amador, L. F., & Goodwin, J. S. (2005). Postoperative delirium in the older patient. Journal of the American College of Surgeons, 200, 767–773.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Jones was supported by postdoctoral fellowships from the Canadian Institutes of Health Research and Alberta Heritage Foundation for Medical Research when this research was conducted. Dr. Pohar contributed to this work while on leave from Canadian Agency for Drugs and Technologies in Health (CADTH). As such, the views presented in this article do not necessarily represent the views of CADTH.

This research project was supported by grants from Institute of Health Economics, University of Alberta Hospital Foundation, Royal Alexandra Hospital Foundation, Edmonton Orthopaedic Research Trust, and Alberta Heritage Foundation for Medical Research. These funding agencies played no role in the design, interpretation or analysis of the project reported here and have not reviewed or approved this manuscript.

We would like to express our gratitude toward the patients and their family caregivers for their interest and participation in this study. We are also grateful to the University of Alberta Hospital Orthopaedics Research Office for their assistance in patient recruitment and data collection. The authors also acknowledge the constructive comments provided by the reviewers and the editor.

Conflict of interest

It should be noted that David Feeny has a proprietary interest in Health Utilities Incorporated, Dundas, Ontario, Canada. HUInc. owns the copyright to and distributes HUI materials.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada

    C. Allyson Jones

  2. Canadian Agency for Drugs and Technologies in Health, Edmonton, AB, Canada

    Sheri L. Pohar

  3. Department of Economics, University of Alberta, Edmonton, AB, Canada

    David H. Feeny

  4. Health Utilities Inc, Dundas, ON, Canada

    David H. Feeny

  5. Institute of Health Economics, Edmonton, AB, Canada

    Ken Eng

Authors
  1. C. Allyson Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheri L. Pohar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David H. Feeny
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ken Eng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Allyson Jones.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jones, C.A., Pohar, S.L., Feeny, D.H. et al. Longitudinal construct validity of the Health Utilities Indices Mark 2 and Mark 3 in hip fracture. Qual Life Res 23, 805–813 (2014). https://doi.org/10.1007/s11136-013-0531-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-013-0531-5

Keywords

Search

Navigation