Quality of Life Research

, Volume 13, Issue 8, pp 1469–1481 | Cite as

The Liver Disease Symptom Index 2.0; Validation of a Disease-Specific Questionnaire

  • Simone M. van der Plas
  • Bettina E. Hansen
  • Josien B. de Boer
  • Theo Stijnen
  • Jan Passchier
  • Rob A. de Man
  • Solko W. Schalm


The available liver disease-specific questionnaires do address severity of symptoms but hardly evaluate how patients experience these specific symptoms during daily activities. The Liver Disease Symptom Index 2.0 (LDSI) includes 18 items that measure symptom severity and symptom hindrance in the past week. In a large survey (n = 1175) conducted in collaboration with the Dutch liver patient association, convergent and divergent construct validity and the surplus value of including symptom severity and symptom hindrance items in the LDSI were examined. The LDSI items showed expected convergent and divergent correlations with Short Form-36 (SF-36) and Multidimensional Fatigue Index-20 (MFI-20) scales. Correlations revealed only a slight to moderate overlap between LDSI items and SF-36 and MFI-20 scales. The impact of symptom severity and symptom hindrance on generic health related quality of life (HRQoL) varied in a different way across liver patients, which indicated that symptom severity items and the symptom hindrance items measure different aspects of HRQoL. We conclude that the LDSI provides information complementary to the information given by the SF-36 and the MFI-20 and that it is psychometrically sound to include both symptom severity items and symptom hindrance items in the LDSI.

Liver Liver diseases Quality of life Validity (epidemiology) 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Younossi ZM. Chronic liver disease and health-related quality of life. Gastroenterology 2001;120:305–307.Google Scholar
  2. 2.
    Foster GR, Goldin RD, Thomas HC. Chronic hepatitis C virus infection causes a signi cant reduction in quality of life in the absence of cirrhosis. Hepatology 1998;27:209–212.Google Scholar
  3. 3.
    Davis GL, Balart LA, Schiff ER, et al. Assessing health-related quality of life in chronic hepatitis C using the Sickness Impact Profile. Clin Ther 1994;16:334–343 (discussion 271–332).Google Scholar
  4. 4.
    Bonkovsky HL, Woolley JM. Reduction of health-related quality of life in chronic hepatitis C and improvement with interferon therapy. The Consensus Interferon Study Group. Hepatology 1999;29:264–270.Google Scholar
  5. 5.
    Bianchi G, Loguercio C, Sgarbi D, et al. Reduced quality of life in patients with chronic hepatitis C: Effects of interferon treatment. Dig Liver Dis 2000;32:398–405.Google Scholar
  6. 6.
    Bayliss MS, Gandek B, Bungay KM, Sugano D, Hsu MA, Ware JE, Jr. A questionnaire to assess the generic and disease-speci c health outcomes of patients with chronic hepatitis C. Qual Life Res 1998;7:39–55.Google Scholar
  7. 7.
    Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D. Development of a disease speci c questionnaire to measure health related quality of life in patients with chronic liver disease. Gut 1999;45:295–300.Google Scholar
  8. 8.
    Gralnek IM, Hays RD, Kilbourne A, et al. Development and evaluation of the Liver Disease Quality of Life instrument in persons with advanced, chronic liver disease–the LDQOL 1. 0. Am J Gastroenterol 2000;95:3552–3565.Google Scholar
  9. 9.
    Huet PM, Deslauriers J, Tran A, Faucher C, Charbonneau J. Impact of fatigue on the quality of life of patients with primary biliary cirrhosis. Am J Gastroenterol 2000;95: 760–767.Google Scholar
  10. 10.
    Miller ER, Hiller JE, Shaw DR. Quality of life in HCV-infection:Lack of association with ALT levels. Aust N Z J Public Health 2001;25:355–361.Google Scholar
  11. 11.
    Watson D, Pennebaker JW. Health complaints, stress, and distress:Exploring the central role of negative affectivity. Psychol Rev 1989;96:234–254.Google Scholar
  12. 12.
    Unal G, de Boer JB, Borsboom GJ, Brouwer JT, Essink-Bot M, de Man RA. A psychometric comparison of health-related quality of life measures in chronic liver disease. J Clin Epidemiol 2001;54:587–596.Google Scholar
  13. 13.
    Lauterburg BH, Pineda AA, Dickson ER, Baldus WP, Taswell HF. Plasmaperfusion for the treatment of intrac-table pruritus of cholestasis. Mayo Clin Proc 1978;53:403–407.Google Scholar
  14. 14.
    Bergasa NV, Alling DW, Talbot TL, et al. Effects of naloxone infusions in patients with the pruritus of cholestasis. A double-blind, randomized, controlled trial. Ann Intern Med 1995;123:161–167.Google Scholar
  15. 15.
    Ware JE, Jr., Snow KK, Kosinski M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide. Boston: The health institute, New England Medical Center, 1994.Google Scholar
  16. 16.
    Smets EMA, Garssen B, Bonke B: Het meten van ver-moeidheid met de multidimensionele vermoeidheidsindex (MVI-20), een handleiding. University of Amsterdam, Department of Medical Psychology, 1995.Google Scholar
  17. 17.
    Aadahl M, Hansen BA, Kirkegaard P, Groenvold M. Fatigue and physical function after orthotopic liver transplantation. Liver Transpl 2002;8:251–259.Google Scholar
  18. 18.
    Goldblatt J, Taylor PJ, Lipman T, et al. The true impact of fatigue in primary biliary cirrhosis:A population study. Gastroenterology 2002;122:1235–1241.Google Scholar
  19. 19.
    Fayers PM, Machin D. Quality of Life, Assesment, Analysis and Interpretation. Chichester: John Wiley & Sons, Ltd, 2000.Google Scholar
  20. 20.
    Simon GE: Treating depression in patients with chronic disease:Recognition and treatment are crucial;depression worsens the course of a chronic illness. West J Med 2001; 175:292–293.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Simone M. van der Plas
    • 1
  • Bettina E. Hansen
    • 1
  • Josien B. de Boer
    • 2
  • Theo Stijnen
    • 3
  • Jan Passchier
    • 2
  • Rob A. de Man
    • 1
  • Solko W. Schalm
    • 1
  1. 1.Department of Gastroenterology and HepatologyErasmus Medical Center RotterdamThe Netherlands
  2. 2.Department of Medical Psychology and PsychotherapyErasmus Medical Center RotterdamThe Netherlands
  3. 3.Department of Epidemiology and BiostatisticsErasmus Medical Center RotterdamThe Netherlands

Personalised recommendations