Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Article DOI:
Cite this article as: de Boer, A., van Lanschot, J., Stalmeier, P. et al. Qual Life Res (2004) 13: 311. doi:10.1023/B:QURE.0000018499.64574.1f Abstract Purpose: To compare the validity, reliability and responsiveness of a single, global quality of life question to multi-item scales. Method: Data were obtained from 83 consecutive patients with oesophageal adenocarcinoma undergoing either transhiatal or transthoracic oesophagectomy. Quality of life was measured at baseline, 5 weeks, 3 and 12 months post-operatively with a single-item Visual Analogue Scale (VAS) ranging from 0 to 100, the multi-item Medical Outcomes Study Short Form-20 (MOS SF-20) and Rotterdam Symptom Check-List (RSCL). Convergent and discriminant validity, test–retest reliability and both distribution-based and anchor-based responsiveness were evaluated. Major findings: At baseline and at 5 weeks, the VAS showed high correlations with the MOS SF-20 health perceptions scale ( r = 0.70 and 0.72) and moderate to high correlations with all other subscales of the MOS SF-20 and RSCL ( r = 0.29–0.70). The test–retest reliability intra-class correlation for the VAS was 0.87. At 5 weeks post-operatively, the distribution-based responsiveness was moderate for the VAS (standardised response mean: −0.47; effect size: −0.56), high for the physical subscales of the MOS SF-20 and RSCL (−1.08 to −1.51) and low for the psychological subscales (0.11 to −0.25). Five weeks post-operatively, anchor-based responsiveness was highest for the VAS ( r = 0.54). Conclusion: The VAS is an instrument with good validity, excellent reliability, moderate distribution-based responsiveness and good anchor-based responsiveness compared to multi-item questionnaires. Its use is recommended in clinical trials to assess global quality of life. Oesophageal neoplasms Quality of life Questionnaires References
Berzon RA. Understanding and using health-related quality of life instruments within clinical research studies. In: Staquet MJ, Hays RD, Fayers PM (eds), Quality of Life Assessment in Clinical Trials. Oxford: Oxford University Press, 1998.
Langenhoff BS, Krabbe PFM, Wobbes T, Ruers TJM. Quality of life as an outcome measure in surgical oncology. Br J Surg 2001; 88: 643-652.
Fayers PM, Machin D. Quality of Life: Assessment, Analysis and Interpretation. Chichester: John Wiley and Sons, 2000.
Sloan JA, Aaronson NK, Cappelleri JC, Fairclough DL, Varricchio C. Assessing the clinical significance of single items relative to summated scores. Mayo Clinic Proc 2002; 77: 479-487.
Gill TM. Quality of life assessment: Values and pitfalls. J Roy Soc Med 1995; 88: 680-682.
Cunny KA, Perri M. Single-item vs. multi-item measures of quality of life. Psychol Rep 1991; 69: 127-130.
Patrick D, Bush J, Chen M. Methods for measuring levels of well-being for a health status index. Health Serv Res 1973; 8: 228-245.
Selby PJ, Chapman JA, Etazadi-Amoli J, Dalley D, Boyd NF. The development of a method for assessing the quality of life in cancer patients. Br J Cancer 1984; 50: 13-22.
Gudex C, Dolan P, Kind P, Williams A. Health state valuations from the general public using the Visual Analogue Scale. Qual Life Res 1995; 5: 521-531.
Schwenk W, Mall JW, Neudecker J, Muller JM. One visual analogue pain score is sufficient after laparoscopic cholecystectomy. Br J Surg 2002; 89: 114-115.
Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000; 343: 618-624.
Andren-Sandberg A, Viste A, Horn A, Hoem D, Gislason H. Pain management of pancreatic cancer. Ann Oncol 1999; 10(Suppl.): 265-268.
van Kampen M, de Weerdt W, van Poppel H, de Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: A randomised controlled trial. Lancet 2000; 355: 98-102.
O'Bichere A, Wilkinson K, Rumbles S, Norton C, Green C, Phillips RK. Functional outcome after restorative panproctocolectomy for ulcerative colitis decreases an otherwise enhanced quality of life. Br J Surg 2000; 87: 802-807.
Bernhard J, Sullivan M, Hürny C, Coates AS, Rudenstam C-M. Clinical relevance of single item quality of life indicators in cancer clinical trials. Br J Cancer 2001; 84: 1156-1165.
Bessette L, Sangha O, Kuntz KM, et al. Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome. Med Care 1998; 36: 491-502.
Sloan JA, Loprinzi CL, Kuross SA, et al. Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer. J Clin Oncol 1998; 16: 3662-3673.
Deyo RA, Diehr P, Patrick D. Reproducibility and responsiveness of health status measures. Control Clin Trials 1991; 12: 142S-158S.
Gardner DG, Cumming LL, Dunham RB, Pierce JL. Single-item versus multiple-item measurement scales: An empirical comparison. Educ Psychol Meas 1998; 58: 898-915.
Fries JF, Ramey DR. ‘Arthritis specific’ global health analog scales assess ‘generic’ health related quality-of-life in patients with rheumatoid arthritis. J Rheumatol 1997; 24: 1697-1702.
Youngblut JM, Casper GR. Single-item indicators in nursing research. Res Nurs Health 1993; 16: 459-465.
Fayers PM, Sprangers MAG. Understanding self-rated health. Lancet 2002; 359: 187-188.
Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H. Capturing the patient's view of change as a clinical outcome measure. JAMA 1999; 282: 1157-1162.
Stewart AL, Hays RD, Ware JE. The MOS short-form General Health Survey. Reliability and validity in a patient population. Med Care 1988; 26: 724-735.
Kempen GIJM. The measurement of the health status of the elderly. A Dutch version of the MOS. Tijdsch Gerontol Geriat 1992; 23: 132-140.
de Haes JCJM, van Knippenberg FCE, Neijt JP. Measuring psychological distress in cancer patients: Structure and application of the Rotterdam Symptom Checklist. Br J Cancer 1990; 62: 1034-1038.
de Boer AGEM, Onorbe Genovesi PI, Sprangers MAG, van Sandick JW, Obertop H, van Lanschot JJB. Quality of life in long-term survivors after curative transhiatal oesophagectomy for oesophageal carcinoma. Br J Surg 2000; 87: 1716-1721.
Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47: 81-87.
Campbell DT, Fiske DW. Convergent and discriminant validity by the multitrait-multimethod matrix. Psychol Bull 1959; 56: 81-105.
Cohen J. Statistical Power Analysis for the Behavioural Sciences. New York: Academic Press, 1977.
Norman GR, Sridhar FG, Guyatt GH, Walter SD. Relation of distribution-and anchor-based approaches in interpretation of changes in health-related quality of life. Med Care 2001; 39: 1037-1038.
Norman GR, Stratford P, Regehr G. Methodological problems in the retrospective computation of responsiveness to change: The lesson of Cronbach. J Clin Epidemiol 1997; 50: 869-879.
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