Skip to main content

Advertisement

SpringerLink
Log in

The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale

  • Research Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Background

There is no widely accepted validated scale to assess the comprehensive symptom burden and severity of neurogenic orthostatic hypotension (NOH). The Orthostatic Hypotension Questionnaire (OHQ) was developed, with two components: the six-item symptoms assessment scale and a four-item daily activity scale to assess the burden of symptoms. Validation analyses were then performed on the two scales and a composite score of the OHQ.

Methods

The validation analyses of the OHQ were performed using data from patients with NOH participating in a phase IV, double blind, randomized, cross over, placebo-controlled trial of the alpha agonist midodrine. Convergent validity was assessed by correlating OHQ scores with clinician global impression scores of severity as well as with generic health questionnaire scores. Test–retest reliability was evaluated using intraclass correlation coefficients at baseline and crossover in a subgroup of patients who reported no change in symptoms across visits on a patient global impression scores of change. Responsiveness was examined by determining whether worsening or improvement in the patients’ underlying disease status produced an appropriate change in OHQ scores.

Results

Baseline data were collected in 137 enrolled patients, follow-up data were collected in 104 patients randomized to treatment arm. Analyses were conducted using all available data. The floor and ceiling effects were minimal. OHQ scores were highly correlated with other patient reported outcome measures, indicating excellent convergent validity. Test–retest reliability was good. OHQ scores could distinguish between patients with severe and patients with less severe symptoms and responded appropriately to midodrine, a pressor agent commonly used to treat NOH.

Conclusion

These findings provide empirical evidence that the OHQ can accurately evaluate the severity of symptoms and the functional impact of NOH as well as assess the efficacy of treatment.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bleasdale-Barr KM, Mathias CJ (1998) Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension. J R Soc Med 91:355–359

    PubMed  CAS  Google Scholar 

  2. Consensus (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 6:125–126

  3. De La Loge C, Trudeau E, Marquis P, Revicki DA, Rentz AM, Stanghellini V, Talley NJ, Kahrilas P, Tack J, Dubois D (2004) Responsiveness and interpretation of a quality of life questionnaire specific to upper gastrointestinal disorders. Clin Gastroenterol Hepatol 2:778–786

    Article  PubMed  Google Scholar 

  4. Freeman R (2008) Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 358:615–624

    Article  PubMed  CAS  Google Scholar 

  5. Freeman R (2008) Current pharmacologic treatment for orthostatic hypotension. Clin Auton Res 18(Suppl 1):14–18

    Article  PubMed  Google Scholar 

  6. Gibbons CH, Freeman R (2005) Orthostatic dyspnea: a neglected symptom of orthostatic hypotension. Clin Auton Res 15:40–44

    Article  PubMed  Google Scholar 

  7. Guy W (1976) ECDEU Assessment manual for psychopharmacology. US Department of Health, Education, and Welfare, Rockville, MD

  8. Horowitz DR, Kaufmann H (2001) Autoregulatory cerebral vasodilation occurs during orthostatic hypotension in patients with primary autonomic failure. Clin Auton Res 11:363–367

    Article  PubMed  CAS  Google Scholar 

  9. Kaufmann H (1997) Neurally mediated syncope and syncope due to autonomic failure: differences and similarities. J Clin Neurophysiol 14:183–196

    Article  PubMed  CAS  Google Scholar 

  10. Kaufmann H, Biaggioni I (2003) Autonomic failure in neurodegenerative disorders. Semin Neurol 23:351–363

    Article  PubMed  Google Scholar 

  11. Kontos HA, Richardson DW, Norvell JE (1975) Norepinephrine depletion in idiopathic orthostatic hypotension. Ann Intern Med 82:336–341

    PubMed  CAS  Google Scholar 

  12. Low PA, Benrud-Larson LM, Sletten DM, Opfer-Gehrking TL, Weigand SD, O’Brien PC, Suarez GA, Dyck PJ (2004) Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 27:2942–2947

    Article  PubMed  Google Scholar 

  13. Marquis P, Chassany O, Abetz L (2004) A comprehensive strategy for the interpretation of quality-of-life data based on existing methods. Value Health 7:93–104

    Article  PubMed  Google Scholar 

  14. Mathias CJ, Mallipeddi R, Bleasdale-Barr K (1999) Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 246:893–898

    Article  PubMed  CAS  Google Scholar 

  15. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592

    PubMed  Google Scholar 

  16. Novak V, Novak P, Spies JM, Low PA (1998) Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke 29:104–111

    Article  PubMed  CAS  Google Scholar 

  17. Nunnally J, Bernstein I (1994) The assessment of reliability. In: Psychometric theory. McGraw-Hill, New York

  18. Reise SP, Waller NG, Comrey AL (2000) Factor analysis and scale revision. Psychol Assess 12:287–297

    Article  PubMed  CAS  Google Scholar 

  19. Robertson D (2008) The pathophysiology and diagnosis of orthostatic hypotension. Clin Auton Res 18(Suppl 1):2–7

    Article  PubMed  Google Scholar 

  20. Schoffer KL, Henderson RD, O’Maley K, O’Sullivan JD (2007) Nonpharmacological treatment, fludrocortisone, and domperidone for orthostatic hypotension in Parkinson’s disease. Mov Disord 22:1543–1549

    Article  PubMed  Google Scholar 

  21. Schrezenmaier C, Gehrking JA, Hines SM, Low PA, Benrud-Larson LM, Sandroni P (2005) Evaluation of orthostatic hypotension: relationship of a new self-report instrument to laboratory-based measures. Mayo Clin Proc 80:330–334

    Article  PubMed  Google Scholar 

  22. Senard JM, Rai S, Lapeyre-Mestre M, Brefel C, Rascol O, Rascol A, Montastruc JL (1997) Prevalence of orthostatic hypotension in Parkinson’s disease. J Neurol Neurosurg Psychiatry 63:584–589

    Google Scholar 

  23. Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA (1999) The autonomic symptom profile: a new instrument to assess autonomic symptoms. Neurology 52:523–528

    PubMed  CAS  Google Scholar 

  24. Traon AP, Amarenco G, Duerr S, Kaufmann H, Lahrmann H, Shaftman SR, Tison F, Wenning GK, Goetz CG, Poewe W, Sampaio C, Schrag A, Stebbins GT, Rascol O (2011) The movement disorders task force review of dysautonomia rating scales in Parkinson’s disease with regard to symptoms of orthostatic hypotension. Mov Disord (in press)

  25. Visser M, Marinus J, Stiggelbout AM, Van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: the SCOPA-AUT. Mov Disord 19:1306–1312

    Article  PubMed  Google Scholar 

  26. Weinberger M, Samsa GP, Hanlon JT, Schmader K, Doyle ME, Cowper PA, Uttech KM, Cohen HJ, Feussner JR (1991) An evaluation of a brief health status measure in elderly veterans. J Am Geriatr Soc 39:691–694

    PubMed  CAS  Google Scholar 

  27. Wenning GK, Tison F, Seppi K, Sampaio C, Diem A, Yekhlef F, Ghorayeb I, Ory F, Galitzky M, Scaravilli T, Bozi M, Colosimo C, Gilman S, Shults CW, Quinn NP, Rascol O, Poewe W (2004) Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord 19:1391–1402

    Article  PubMed  Google Scholar 

  28. Wright RA, Kaufmann HC, Perera R, Opfer-Gehrking TL, McElligott MA, Sheng KN, Low PA (1998) A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension. Neurology 51:120–124

    PubMed  CAS  Google Scholar 

  29. Zilliox L, Peltier AC, Wren PA, Anderson A, Smith AG, Singleton JR, Feldman EL, Alexander NB, Russell JW (2011) Assessing autonomic dysfunction in early diabetic neuropathy: the Survey of Autonomic Symptoms. Neurology 76:1099–1105

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, New York University School of Medicine, New York, NY, USA

    Horacio Kaufmann & Lucy Norcliffe-Kaufmann

  2. Neuroscience Therapeutic Area, Clinical Development, AstraZeneca, Wilmington, DE, USA

    Richard Malamut

  3. Clinical Research Program, School of Nursing, University of North Carolina Wilmington, Wilmington, NC, USA

    Kathleen Rosa

  4. Dysautonomia Center, Department of Neurology, NYU School of Medicine, 530 First Avenue, suite 9Q, New York, NY, 10016, USA

    Horacio Kaufmann

  5. Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA, 02215, USA

    Roy Freeman

Authors
  1. Horacio Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Malamut
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucy Norcliffe-Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathleen Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roy Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Horacio Kaufmann.

Appendix: Orthostatic hypotension questionnaire

Appendix: Orthostatic hypotension questionnaire

figure a
figure b
figure c

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaufmann, H., Malamut, R., Norcliffe-Kaufmann, L. et al. The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res 22, 79–90 (2012). https://doi.org/10.1007/s10286-011-0146-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-011-0146-2

Keywords

Search

Navigation