Skip to main content

Advertisement

SpringerLink
Log in

Exploring psychometric properties of the SF-6D, a preference-based health-related quality of life measure, in the context of spinal cord injury

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

Abstract

Purpose

The validity of the SF-6D, a preference-based measure of health-related quality of life, is not well explored in the context of spinal cord injury (SCI). The aim of this analysis was to assess appropriate measurement properties of the SF-6D in a sample of individuals living with SCI.

Methods

Longitudinal data from the Rick Hansen Spinal Cord Injury Registry were used. Responses to the 36-item short-form health survey were transformed into SF-6D utility scores. We investigated practicality, floor and ceiling effects, and responsiveness to change. Responsiveness to change was explored using three different anchors that reflected changes in self-reported health, functional independence, and life satisfaction. Discriminative validity was assessed by ten a priori defined hypotheses, with a distinction made between ‘strong’ and ‘weak’ hypotheses.

Results

Three hundred and fifty-eight individuals with SCI were included in this analysis. Practicality was deemed acceptable based on a completion rate of 94 %. The SF-6D showed low responsiveness to detect important health changes over time, and differences in responsiveness were found between individuals with paraplegia and tetraplegia. All five strong hypotheses and three weak hypotheses were confirmed.

Conclusion

The SF-6D demonstrated good practicality and discriminative validity in this sample. The failure to detect self-reported and clinically important health changes requires further consideration. Comparative performance of the SF-6D (i.e., how the SF-6D performs against other preference-based measures) is unknown in the SCI context and requires further research.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Strauss, D. J., Devivo, M. J., Paculdo, D. R., & Shavelle, R. M. (2006). Trends in life expectancy after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 87(8), 1079–1085.

    Article  PubMed  Google Scholar 

  2. Torrance, G. W. (1986). Measurement of health state utilities for economic appraisal. Journal of Health Economics, 5(1), 1–30.

    Article  CAS  PubMed  Google Scholar 

  3. Arnold, D., Girling, A., Stevens, A., & Lilford, R. (2009). Comparison of direct and indirect methods of estimating health state utilities for resource allocation: Review and empirical analysis. British Medical Journal, 339, b2688.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Dolan, P., Olsen, J. A., Menzel, P., & Richardson, J. (2003). An inquiry into the different perspectives that can be used when eliciting preferences in health. Health Economics, 12(7), 545–551.

    Article  PubMed  Google Scholar 

  5. Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21(2), 271–292.

    Article  PubMed  Google Scholar 

  6. Brazier, J. E., & Roberts, J. (2004). The estimation of a preference-based measure of health from the SF-12. Medical Care, 42(9), 851–859.

    Article  PubMed  Google Scholar 

  7. Brazier, J. E., Fukuhara, S., Roberts, J., Kharroubi, S., Yamamoto, Y., Ikeda, S., et al. (2009). Estimating a preference-based index from the Japanese SF-36. Journal of Clinical Epidemiology, 62(12), 1323–1331.

    Article  PubMed  Google Scholar 

  8. Cruz, L. N., Camey, S. A., Hoffmann, J. F., Rowen, D., Brazier, J. E., Fleck, M. P., et al. (2011). Estimating the SF-6D value set for a population-based sample of Brazilians. Value in Health, 14(5 Suppl 1), S108–S114.

    Article  PubMed  Google Scholar 

  9. Ferreira, L. N., Ferreira, P. L., Pereira, L. N., Brazier, J., & Rowen, D. (2010). A Portuguese value set for the SF-6D. Value in Health, 13(5), 624–630.

    Article  PubMed  Google Scholar 

  10. Lam, C. L., Brazier, J., & McGhee, S. M. (2008). Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population. Value in Health, 11(2), 295–303.

    Article  PubMed  Google Scholar 

  11. Mendez, I., Abellan Perpinan, J. M., Sanchez Martinez, F. I., & Martinez Perez, J. E. (2011). Inverse probability weighted estimation of social tariffs: An illustration using the SF-6D value sets. Journal of Health Economics, 30(6), 1280–1292.

    Article  PubMed  Google Scholar 

  12. Lee, B. B., King, M. T., Simpson, J. M., Haran, M. J., Stockler, M. R., Marial, O., et al. (2008). Validity, responsiveness, and minimal important difference for the SF-6D health utility scale in a spinal cord injured population. Value in Health, 11(4), 680–688.

    Article  PubMed  Google Scholar 

  13. Whitehurst, D. G., Noonan, V. K., Dvorak, M. F., & Bryan, S. (2012). A review of preference-based health-related quality of life questionnaires in spinal cord injury research. Spinal Cord, 50(9), 646–654.

    Article  CAS  PubMed  Google Scholar 

  14. Brazier, J., & Deverill, M. (1999). A checklist for judging preference-based measures of health related quality of life: Learning from psychometrics. Health Economics, 8(1), 41–51.

    Article  CAS  PubMed  Google Scholar 

  15. Noonan, V. K., Kwon, B. K., Soril, L., Fehlings, M. G., Hurlbert, R. J., Townson, A., et al. (2012). The Rick Hansen Spinal Cord Injury Registry (RHSCIR): A national patient-registry. Spinal Cord, 50(1), 22–27.

    Article  CAS  PubMed  Google Scholar 

  16. Brazier, J., Rowen, D., & Hanmer, J. (2008). Revised SF-6D scoring programmes: A summary of improvements. PRO Newsletter, 40, 14–15.

    Google Scholar 

  17. Fugl-Meyer, A. R., Bränholm, I.-B., & Fugl-Meyer, K. S. (1991). Happiness and domain specific life satisfaction in adult northern Swedes. Clinical Rehabilitation, 5, 25–33.

    Article  Google Scholar 

  18. Keith, R. A., Granger, C. V., Hamilton, B. B., & Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Advances in Clinical Rehabilitation, 1, 6–18.

    CAS  PubMed  Google Scholar 

  19. Anderson, K., Aito, S., Atkins, M., Biering-Sorensen, F., Charlifue, S., Curt, A., et al. (2008). Functional recovery measures for spinal cord injury: An evidence-based review for clinical practice and research. The Journal of Spinal Cord Medicine, 31(2), 133–144.

    PubMed Central  PubMed  Google Scholar 

  20. Whiteneck, G. G., Harrison-Felix, C. L., Mellick, D. C., Brooks, C. A., Charlifue, S. B., & Gerhart, K. A. (2004). Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers. Archives of Physical Medicine and Rehabilitation, 85(8), 1324–1335.

    Article  PubMed  Google Scholar 

  21. Terwee, C. B., Bot, S. D., de Boer, M. R., van der Windt, D. A., Knol, D. L., Dekker, J., et al. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42.

    Article  PubMed  Google Scholar 

  22. Fayers, P. M., & Machin, D. (2000). Quality of life: Assessment, analysis and interpretation. Chichester, West Sussex: Wiley.

    Book  Google Scholar 

  23. Lam, T., Noonan, V. K., & Eng, J. J. (2008). A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord, 46(4), 246–254.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Post, M. (2010). Measuring the subjective appraisal of participation with life satisfaction measures: Bridging the gap between participation and quality of life measurement. Topics in Spinal Cord Injury Rehabilitation, 15(4), 1–15.

    Article  Google Scholar 

  25. Post, M. W., van Leeuwen, C. M., van Koppenhagen, C. F., & de Groot, S. (2012). Validity of the life satisfaction questions, the life satisfaction questionnaire, and the satisfaction with life scale in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 93(10), 1832–1837.

    Article  PubMed  Google Scholar 

  26. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  27. Gurcay, E., Bal, A., Eksioglu, E., & Cakci, A. (2010). Quality of life in patients with spinal cord injury. International Journal of Rehabilitation Research, 33(4), 356–358.

    Article  PubMed  Google Scholar 

  28. Haran, M. J., Lee, B. B., King, M. T., Marial, O., & Stockler, M. R. (2005). Health status rated with the medical outcomes study 36-item short-form health survey after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 86(12), 2290–2295.

    Article  PubMed  Google Scholar 

  29. Vogel, L. C., Krajci, K. A., & Anderson, C. J. (2002). Adults with pediatric-onset spinal cord injuries: Part 3: Impact of medical complications. Journal of Spinal Cord Medicine, 25(4), 297–305.

    PubMed  Google Scholar 

  30. Westgren, N., & Levi, R. (1998). Quality of life and traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 79(11), 1433–1439.

    Article  CAS  PubMed  Google Scholar 

  31. IBM Corp. (2010). IBM SPSS statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.

    Google Scholar 

  32. StataCorp. (2011). Stata statistical software: Release 12. College Station, TX: StataCorp LP.

    Google Scholar 

  33. Meyers, A. R., Andresen, E. M., & Hagglund, K. J. (2000). A model of outcomes research: Spinal cord injury. Archives of Physical Medicine and Rehabilitation, 81(12 Suppl 2), S81–S90.

    Article  CAS  PubMed  Google Scholar 

  34. Liang, M. H. (2000). Longitudinal construct validity: Establishment of clinical meaning in patient evaluative instruments. Medical Care, 38(9 Suppl), II84–II90.

    CAS  PubMed  Google Scholar 

  35. Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science and Medicine, 48(11), 1507–1515.

    Article  CAS  PubMed  Google Scholar 

  36. Weitzenkamp, D., Gerhart, K., Charlifue, S., Whiteneck, G., Glass, C., & Kennedy, P. (2000). Ranking the criteria for assessing quality of life after disability: Evidence for priority shifting among long-term spinal cord injury survivors. British Journal of Health Psychology, 5(1), 57–69.

    Article  Google Scholar 

  37. Whitehurst, D. G., & Mittmann, N. (2013). The value of health economics research in spinal cord injury. Spinal Cord, 51(8), 586–587.

    Article  CAS  PubMed  Google Scholar 

  38. Krahn, G. L., Fujiura, G., Drum, C. E., Cardinal, B. J., & Nosek, M. A. (2009). The dilemma of measuring perceived health status in the context of disability. Disability and Health Journal, 2(2), 49–56.

    Article  PubMed  Google Scholar 

  39. Putzke, J. D., Richards, J. S., Hicken, B. L., & DeVivo, M. J. (2002). Predictors of life satisfaction: A spinal cord injury cohort study. Archives of Physical Medicine and Rehabilitation, 83(4), 555–561.

    Article  PubMed  Google Scholar 

  40. Post, M., & Noreau, L. (2005). Quality of life after spinal cord injury. Journal of Neurologic Physical Therapy, 29(3), 139–146.

    Article  PubMed  Google Scholar 

  41. Johnson, R. L., Gerhart, K. A., McCray, J., Menconi, J. C., & Whiteneck, G. G. (1998). Secondary conditions following spinal cord injury in a population-based sample. Spinal Cord, 36(1), 45–50.

    Article  CAS  PubMed  Google Scholar 

  42. Leduc, B. E., & Lepage, Y. (2002). Health-related quality of life after spinal cord injury. Disability and Rehabilitation, 24(4), 196–202.

    Article  PubMed  Google Scholar 

  43. McColl, M. A., Arnold, R., Charlifue, S., Glass, C., Savic, G., & Frankel, H. (2003). Aging, spinal cord injury, and quality of life: structural relationships. Archives of Physical Medicine and Rehabilitation, 84(8), 1137–1144.

    Article  PubMed  Google Scholar 

  44. Stensman, R. (1994). Adjustment to traumatic spinal cord injury. A longitudinal study of self-reported quality of life. Paraplegia, 32(6), 416–422.

    Article  CAS  PubMed  Google Scholar 

  45. Kreuter, M., Siosteen, A., Erkholm, B., Bystrom, U., & Brown, D. J. (2005). Health and quality of life of persons with spinal cord lesion in Australia and Sweden. Spinal Cord, 43(2), 123–129.

    Article  CAS  PubMed  Google Scholar 

  46. Holicky, R., & Charlifue, S. (1999). Ageing with spinal cord injury: The impact of spousal support. Disability and Rehabilitation, 21(5–6), 250–257.

    CAS  PubMed  Google Scholar 

  47. Putzke, J. D., Elliott, T. R., & Richards, J. S. (2001). Marital status and adjustment 1 year post-spinal-cord-injury. Journal of Clinical Psychology in Medical Settings, 8(2), 101–107.

    Article  Google Scholar 

Download references

Acknowledgments

This work has been conducted without financial support, and the authors declare no conflict of interest. We would like to thank the Rick Hansen Institute for the provision of the data and Dr. Penny Brasher for her contribution to the statistical analysis.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Lidia Engel & David G. T. Whitehurst

  2. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    Lidia Engel, Stirling Bryan & David G. T. Whitehurst

  3. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Stirling Bryan

  4. Department of Health Services Research, Maastricht University, Maastricht, The Netherlands

    Silvia M. A. A. Evers

  5. CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

    Silvia M. A. A. Evers & Carmen D. Dirksen

  6. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands

    Carmen D. Dirksen

  7. Rick Hansen Institute, Vancouver, BC, Canada

    Vanessa K. Noonan

  8. International Collaboration On Repair Discoveries (ICORD), Vancouver, BC, Canada

    David G. T. Whitehurst

Authors
  1. Lidia Engel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stirling Bryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvia M. A. A. Evers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmen D. Dirksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vanessa K. Noonan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David G. T. Whitehurst
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lidia Engel.

Appendix

Appendix

See Figs. 3, 4, 5, 6, and 7.

Fig. 3
figure 3

Scatterplot presenting individual-level scores (small markers) and mean scores (large markers) for the SF-6D across each response option of the self-reported health status item (SF-36v2 item 1)

Full size image
Fig. 4
figure 4

Scatterplot presenting individual-level scores (small markers) and mean scores (large markers) for the SF-6D across each response option of the ‘life satisfaction as a whole’ item (LiSat-11 item 1)

Full size image
Fig. 5
figure 5

Scatterplot presenting individual-level scores (small markers) and mean scores (large markers) for the SF-6D across each response option of the pain interference with quality of life question

Full size image
Fig. 6
figure 6

Scatterplots grouped by calculated health changes (improvement, no change, and worsening) between 1- and 2-year follow-up for a change scores in SF-6D and FIM and b change scores in SF-6D and LiSat-11 for individuals with paraplegia

Full size image
Fig. 7
figure 7

Scatterplots grouped by calculated health changes (improvement, no change, and worsening) between 1- and 2-year follow-up for a change scores in SF-6D and FIM and b change scores in SF-6D and LiSat-11 for individuals with tetraplegia

Full size image

Rights and permissions

Reprints and permissions

About this article

Cite this article

Engel, L., Bryan, S., Evers, S.M.A.A. et al. Exploring psychometric properties of the SF-6D, a preference-based health-related quality of life measure, in the context of spinal cord injury. Qual Life Res 23, 2383–2393 (2014). https://doi.org/10.1007/s11136-014-0677-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-014-0677-9

Keywords

Search

Navigation