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Validity of patient-reported health-related quality of life global ratings of change using structural equation modeling

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Abstract

Background

Patient-perceived global ratings of change are often used as anchors of health-related quality of life (HRQoL) since they are easy for clinicians to interpret and incorporate the patient’s perception of change as a means to capture clinical significance. Although this approach may be preferred, the validity of the anchor-based approach is currently under scrutiny.

Objective

To estimate the explained variation in single-item domain-specific global ratings of change (GRCs) that is accounted for by time 1 (T1) and time 2 (T2) domain-specific summary change scores from the Short-Form 36, V2 (SF-36) Health Survey in asthma primary care patients.

Methods

The baseline and first follow-up enrollment data to be evaluated in this investigation were part of a larger longitudinal HRQoL study conducted from August 2000–December 2002, in which the 356 asthma patients from Midwestern primary care facilities completed telephone interviews for every two consecutive months for a year on multiple HRQoL measures, including the SF-36 and domain-specific GRCs. A structural equation modeling technique was employed to ascertain the explained variability in patient-reported GRCs for each SF-36 domain that is accounted for by the summary change scores at the two time-points for four SF-36 domains (bodily pain, general health perception, mental health, and physical functioning). The model was estimated by the maximum likelihood method with the Satorra-Bentler correction for ordinal variables using equal threshold asymptotic covariance matrices.

Results

Multicollinearity between T1 and T2 latent constructs clouded interpretation of the standardized structural coefficients leading to GRCs. Correlations, however, revealed that all four domain-specific GRCs were more strongly related to T2- than T1-domain summary scores, indicating that patients were not equally relying on T1 and T2 to generate the GRCs. Furthermore, T1-domain summary scores were not of equal magnitude and opposite sign as compared to T2 scores.

Conclusions

In this study, there is insufficient evidence to establish SF-36 domain-specific GRC validity in asthma primary care patients. Therefore, it is recommended to reassess validity before using domain-specific SF-36 GRCs to classify clinically important change over time.

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Author information

Authors and Affiliations

  1. Department of Health, West Chester University, West Chester, PA, 19383, USA

    Stacie M. Metz

  2. Research Methodology, Saint Louis University, 3750 Lindell Blvd., McGannon Hall, Room 230, St. Louis, MO, 63108, USA

    Kathleen W. Wyrwich

  3. Primary Care, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA

    Ajit N. Babu

  4. Amrita Institute of Medical Sciences, Elamakkara Post, Cochin, Kerala, 682 026, India

    Ajit N. Babu

  5. Division of General Internal Medicine and Geriatrics, Indiana University, Indianapolis, IN, 46202, USA

    Kurt Kroenke & William M. Tierney

  6. Regenstrief Institute, Inc, 6th Floor, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA

    Kurt Kroenke & William M. Tierney

  7. Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205-GH, Iowa City, IA, 52242, USA

    Fredric D. Wolinsky

  8. Health Services Research, Veterans Affairs Medical Center, Iowa City, IA, USA

    Fredric D. Wolinsky

Authors
  1. Stacie M. Metz
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  2. Kathleen W. Wyrwich
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  3. Ajit N. Babu
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  4. Kurt Kroenke
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  5. William M. Tierney
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  6. Fredric D. Wolinsky
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Corresponding author

Correspondence to Stacie M. Metz.

Additional information

Supported by grants from the Agency for Healthcare Research and Quality to Dr. Wolinsky (R01 HS10234) and Dr. Wyrwich (K02 HS11635).

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Metz, S.M., Wyrwich, K.W., Babu, A.N. et al. Validity of patient-reported health-related quality of life global ratings of change using structural equation modeling. Qual Life Res 16, 1193–1202 (2007). https://doi.org/10.1007/s11136-007-9225-1

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  • DOI: https://doi.org/10.1007/s11136-007-9225-1

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