The symptom burden of heart failure is significant and impacts upon health-related quality of life. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is widely used in clinical practice to measure self-reported health-related quality of life, but the psychometric properties of the instrument are not fully elucidated. To address this gap, we investigated item and person fit, differential item functioning, item thresholds ordering, targeting and dimensionality of the MLHFQ.
Three approaches were used, exploratory factor analysis, Mokken analysis and Rasch analysis, on a convenience sample of 109 participants with a diagnosis of HF from the UK. Participants were typically male (67 %) with a mean age of 68 years (range 41–88).
Findings from the exploratory factor analysis of the MLHFQ revealed three factors (physical, emotional and social) that explained 72 % of the total variance. Mokken analysis confirmed the MLHFQ total scale, and the three subscales, as valid ordinal scales: the total MLHFQ scale [overall Loevinger coefficient (H) = 0.61], physical scale (H = 0.75), emotional scale (H = 0.79) and social scale (H = 0.552). Rasch analysis confirmed the physical scale as a unidimensional scale, but this was not consistent for the total MLHFQ scale which showed poor fit to the Rasch model (χ 2 = 162), df = 42, p < 0.0001). Six items of the total scale were misfitting (7, 8, 10, 14–16) and removing them improved the fit of the total scale. The physical subscale showed fit to the Rasch model (χ 2 = 20.24, df = 16, p = 0.21), and there was evidence of unidimensionality (t tests = 0.09, lower bound 95 % CI 0.04). There was evidence of disordered thresholds for the MLHFQ total and physical scale, and targeting was poor for both the total scale and its subscales.
We confirmed the MLHFQ subscales to be valid ordinal scales supporting the use of sum scores to assess quality of life in people diagnosed with HF. Floor effects were evident indicating that the ability of the instrument to identify differences across populations with mild HF may be suboptimal. The psychometric properties of the MLHFQ total scale may be improved by excluding problematic items from the total scale. Further research is warranted to verify findings from this study.
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Differential item functioning
Minnesota Living with Heart Failure Questionnaire
Heart failure-specific measure of health-related quality of life
Chronic Heart Failure Questionnaire
Questionnaire for severe heart failure
Kansas City Cardiomyopathy Questionnaire
Left Ventricular Dysfunction Questionnaire 36
New York Heart Association
Quality of life
Ischaemic heart disease
Item response theory
Person separation index
Analysis of variance
Exploratory factor analysis
Root mean square errors of approximation
Mokken model of monotone homogeneity
Comparative fit index
Item response theory
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The authors wish to acknowledge the study participants and thank the EuroQoL Steering Committee for giving access to the UK MLHF data set.
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Munyombwe, T., Höfer, S., Fitzsimons, D. et al. An evaluation of the Minnesota Living with Heart Failure Questionnaire using Rasch analysis. Qual Life Res 23, 1753–1765 (2014). https://doi.org/10.1007/s11136-013-0617-0
- Minnesota Living with Heart Failure Questionnaire
- Heart failure
- Quality of life
- Mokken analysis
- Rasch analysis