Quality of lifeQuality of life

Hermann P.G. Schneider, Alastair MacLennan and David Feeny

OutlineOutline

• Definitions: health status and health-related quality of life

• Important measurement properties

• Determinants of health status and health-related quality of life

• Assessing health-related quality of life, menopause and aging

• Currently employed menopause-specific quality-of-life scales

• Quality-of life-measures in practice

• Conclusions

Selected definitions ofSelected definitions ofhealth and health statushealth and health status

• Health:– Physical and mental well-being; freedom

from disease, pain, or defects; normality of physical and mental functions; soundness

– Condition of body or mind [good or bad health] ...1

World Health Organization:Health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity2

1Webster’s Dictionary, 1982; 2WHO, 1948

Selected definitions ofSelected definitions ofhealth and health statushealth and health status

• Health:– The state of optimum capacity for the

effective performance of valued tasks1

• Illness:– A deviation from the social expectation

that a person performs the functions associated with his or her social role2

Talcott Parsons, 1958; Patrick, Erickson, 1993

A definition ofA definition ofhealth-related quality of lifehealth-related quality of life

• HRQOL– represents those parts of quality of life

that directly relate to an individual’s health– includes the domains of physical,

psychological, social, spiritual, and role functioning, as well as general well-being

Spilker, Revicki, 1996

Another definition ofAnother definition ofhealth-related quality of lifehealth-related quality of life

• HRQOL– is the value assigned to duration of life

as modified by the impairments, functional states, perceptions and social opportunities that are influenced by disease, injury, treatment or policy

Patrick, Erickson, 1993

Levels of quality of lifeLevels of quality of life

In their totality, these three levels constitute the scope of quality of life

Components of each domain

Broad domains

Physical, psychological, economic, spiritual, social

Overall assessment of well-being

Cramer, Spilker, 1998

Rationale for usingRationale for usinghealth-related quality-of-life measureshealth-related quality-of-life measures

• Goal of therapy is to make patients feel better

• Physiological measures may change without people feeling better

• People may feel better without measurable change in physiological function

• Trade-offs between treatment effects and side-effects

• The output of the health-care system is quality-adjusted survival/health-related quality of life. Why not measure it?

Guyatt, Feeny, Patrick, 1993

Assessment of measures of Assessment of measures of health-related quality of lifehealth-related quality of life

• Acceptability

• Burden

• Reliability

• Validity

• Responsiveness

• Interpretability

• Usefulness

Feeny, et al. 1999

Measures of Measures of health-related quality of lifehealth-related quality of life

• Generic measures

– The MOS 36-Item Short Form Survey (SF-36)1

– Nottingham Health Profile2

– Sickness Impact Profile3

• Individualized measures

– Patient-Generated Index (PGI)4

• General health and health-related measures

– WHO – International Classification of Functioning (ICF)5

1Ware, Sherbourne, 1992; 2McKenna, et al. 1993;3Gilson, et al. 1975; 4Camilleri-Brennan, et al. 2002; 5WHO, 2001

1Hunter MS, 1992; 2Beck, et al. 1961, short version 1969;

3Zigmond, Snaith, 1983; 4Feeny D, 2005; 5Weinstein, et al. 1996

Measures of Measures of health-related quality of lifehealth-related quality of life

• Disease- or Population-Specific MeasuresWomen‘s Health Questionnaire (WHQ)1

• Particular Aspect of HealthBeck Depression Inventory (BDI)2

• Hospital Anxiety and Depression Scale (HADS)3

• Utility Measures – Health EconomicsHealth Utilities Index (HUI)4

• Cost Effectiveness in Health and Medicine5

Psychometric response scalesPsychometric response scales

• After the questionnaire is completed, each item may be analyzed separately, or item responses may be summed to create a score for a group of items

• The Likert Scale is a bipolar scaling method, measuring either positive or negative agreement with a statement

• Traditionally a 5-point scale; many psychometricians advocate use of 7- or 9-point scales

Likert, 1932

Psychometric response scalesPsychometric response scales

• Typical test item in a Likert Scale is a statement

• A respondent is asked to indicate a degree of agreement with the statement

• <Ice cream is good for breakfast>– Strongly disagree– Disagree– Neither agree nor disagree– Agree– Strongly agree

Health outcome measures Health outcome measures used in published studiesused in published studies

• A total of 3921 reports

• Disease- or population-specific

46%Generic

22%Dimension-specific

18%Utility

10%Individualized

1%

• During 1990–1999, the number of new reports of development and evaluation rose from 144 to 690 per year

Garratt, et al. 2002

Garratt, et al. 2002

Most widely used measuresMost widely used measureswithin 3921 reports (1)within 3921 reports (1)

Instrument Number of recordsSF-36 408

Sickness Impact Profile 111

Nottingham Health Profile 93

EORTC QLQ-C30 82

QALY 79

EuroQOL 77

Health Assessment Questionnaire 62

Arthritis Impact Measurement Scale 59

Quality of Wellbeing Scale 53

General Health Questionnaire 43

Health Utilities Index 41

COOP Charts 33

Functional Assessment of Cancer 32

Most widely used measuresMost widely used measureswithin 3921 reports (2)within 3921 reports (2)

Instrument Number of recordsWHOQOL 24

Healthy Years Equivalent 24

Beck Depression Inventory 23

Asthma Quality of Life Questionnaire 21

McGill Pain Questionnaire 19

WOMAC 18

Hospital Anxiety and Depression Scale 18

Duke Health Profile 17

SF-12 15

Psychological General Wellbeing Scale 15

St George‘s Respiratory Disease Questionnaire 15

MOS-HIV 14

Rotterdam Symptom Check List 14Garratt, et al. 2002

General measures ofGeneral measures ofquality of lifequality of life

4 Vitality (VT)

2 Social functioning (SF)

3 Role emotional (RE)

5 Mental health (MH)

Items (n) Domains

10 Physical functioning (PF)

4 Role physical (RP)

2 Bodily pain (BP)

5 General health (GH)

Ware, Sherbourne, 1992

SF-36 Measurement ModelSF-36 Measurement Model

Summary scales

Physical health (PH)

Mental health (MH)

General health andGeneral health andhealth-related measures ofhealth-related measures of

quality of lifequality of life

The EuroQOL InstrumentThe EuroQOL InstrumentMobility• I have no problem in walking about• I have some problems in walking about• I am confined to bedSelf-care• I have no problems with self-care• I have some problems washing or dressing myself• I am unable to wash or dress myselfUsual activities• I have no problems with performing my usual activities

(e.g. work, study, housework, family or leisure activities)• I have some problems with performing my usual activities• I am unable to perform my usual activitiesPain/discomfort• I have no pain or discomfort• I have moderate pain or discomfort• I have extreme pain or discomfortAnxiety/depression• I am not anxious or depressed• I am moderately anxious or depressed• I am extremely anxious or depressed0

10

20

30

40

50

60

70

80

90

100 Best imaginable health state

Worst imaginable health state

Kind P, 1996

WHOQOL AssessmentWHOQOL AssessmentDomainsDomains

• Physical domain

• Psychological domain

• Level of independence

• Social relationships

• Environment

• Spirituality/religion/personal beliefs

WHO, 1993

Disease- or population-specificDisease- or population-specificmeasures of quality of lifemeasures of quality of life

Hospital anxietyHospital anxietyand depression scaleand depression scale

• 7 items on Anxiety; separate score, 0–21

• 7 items on Depression; separate score, 0–21

• 4-point scale for each item (0–3)

• Score of 11 or higher indicates probable case

• Administration takes 2–5 min

• Sample item:– “I have lost interest in my appearance”

Zigmond, Snaith, 1983

Health-related quality of life Health-related quality of life Issues in menopause and agingIssues in menopause and aging

• Vasomotor symptoms

• Cognitive functioning

• Vaginal dryness

• Mood symptoms

• Urinary complaints

• Uterine bleeding

• Sleep

• Attractiveness

• Sexual activity

• Anxiety

• Depression

• HRQOL associated with chronic conditions

Feeny, 2006

Health-related quality of life Health-related quality of life Issues in menopause and agingIssues in menopause and aging

• Importance of placebo effect in studies on symptoms

• Lack of standardization of reporting of symptoms

• Few studies consider HRQOL impact on partner

• Specific instruments for menopause and aging

• Generic instrument to capture chronic conditions and side-effects

• Utility measures to reflect preferences of patients and community

Feeny, 2006

Currently employedCurrently employedmenopause-specific quality-of-life scales (1)menopause-specific quality-of-life scales (1)Instrument Author Domains covered Items

Greene Climacteric Greene, JG Psychological List of symptoms Scale (1976, 1998) Somatic

Vasomotor

Women‘s Health Hunter, M Depressed mood Fully phrased statements Questionnaire (WHQ) (1992, 2006) Somatic symptoms (symptoms and feelings)

Vasomotor Anxiety/fearsSexual behaviorSleep problemsMenstrual symptomsMemory/concentrationAttractiveness

Qualifemme Floch, JP Climacteric List of symptoms (1994) Psychosocial

SomaticUrogenital

The Menopause-Specific Hilditch, TR Vasomotor List of symptoms, signs, QOL Questionnaire (1996) Psychosocial feelings (MENQOL) Physical

Sexual

Currently employedCurrently employedmenopause-specific quality-of-life scales (2)menopause-specific quality-of-life scales (2)

Instrument Author Domains covered Items

Menopause Rating Schneider, HPG Psychological List of symptoms Scale (MRS) (1996, 2000) Somatovegetative

Urogenital

Menopausal Symptom Perz, JM Psychological List of symptoms List (MSL) (1997) Vasosomatic

General somatic

Menopause Quality Jacobs, P, et al. Physical Fully phrased statements of Life Scale (MQOL) (2000) Vasomotor (symptoms and feelings)

PsychosocialSexual

Utian Quality of Life Utian, WH Occupational Fully phrased statements Scale (UQOL) (2002) Health-related (symptoms and feelings)

EmotionalSexual quality of life

Quality-of-lifeQuality-of-lifemeasures in practicemeasures in practice

Menopause rating scale (MRS)Menopause rating scale (MRS)

• Standardized scale to measure the severity of menopausal symptoms

• The scale comprises 11 items

• Symptom intensities range from 0 to 4– 0 – none 0–4%*– 1 – mild 5–24%– 2 – moderate 25–49%– 3 – severe 50–95%– 4 – complete 95–100%

* % population with symptoms, according to WHO standards

Schneider HPG, et al. 2000

0 10 20 30 40 50 60

Ba

se

line

to

tal s

co

re

Therapeutic improvement (%)

No/little symptoms

Mild symptoms

Moderate symptoms

Severe symptoms10.8 + 10.6

55.1 + 13.8

32.2 + 9.8

43.9 + 11.8

* Mean values (SD) in four categories of severity at baselineHeinemann, Schneider, 2007

HRT: relative change of the MRS*HRT: relative change of the MRS*

Comparison between quality-of-Comparison between quality-of-life studieslife studies

Depends on

• Suitable measure

• Appropriate selection of population

• Ethnicity, which varies greatly,– e.g. within Asian cultures1

1PAM Study, Limpaphayom et al. 2006

LEVELS OF ASSESSMENT

Handicap

Disability

Impairment

DOMAINS OF ASSESSMENT

TYPE OF MEASUREMENT

Physical Mental Emotional Social

Evaluative

Predictive

Discriminative

Primary purpose of functional assessmentPrimary purpose of functional assessmentDecision of investigatorsDecision of investigators

for the appropriate instrumentfor the appropriate instrument

Cramer, Spilker, 1998

MEDICAL TREATMENT(S)

Safety measures

Efficacy measures

Additional measures &

factors

Adverse reactions

Clinically beneficial effects

Convenience, costs, etc.

Patient's values, beliefs, judgements

Physical status Psychological Social Economic status

& abilities well-being interactions & factors

Patient's overall sense of well-being

I.Clinical

evaluation level

III.Quality of life level

II.Patient's

integration & assessment level

Cramer, Spilker, 1998

Clinical aspects, patientClinical aspects, patient''s s integration and quality of lifeintegration and quality of life

Conclusions (1)Conclusions (1)

• Quality-of-life measures are increasingly used for measuring health outcomes in evaluative research

• There is evidence of a lack of consistency in the selection of measures for clinical trials which hinders comparison among studies

• 67 clinical trials were studied, of these, 48 were found to use 62 different existing measures and 13 reported new measures

Sanders et al. 1998

Conclusions (2)Conclusions (2)

• There has been exponential growth in reports relating to the development and evaluation of quality-of-life measures

• Concurrent evaluation and professional consensus will assist to determine the most suitable measure for a particular application

• Researchers should undertake comprehensive literature searches to ascertain whether a suitable measure is available before they decide to develop a new one

Garratt et al. 2002

AddendumAddendum

LiteratureLiterature

• Beck AT, Ward CJ, Mendelsohn M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–74

• Camilleri-Brennan J, Ruta DA, Steele RJ. Patient generated index: new instrument for measuring quality of life in patients with rectal cancer. World J Surg 2002;26:1354–9

• Cramer JA, Spilker B, eds. Quality of Life and Pharmacoeconomics in Clinical Trials – An Introduction. Philadelphia: Lippincott-Raven, 1998

• Feeny D, Furlong W, Mulhern RK, et al. A framework for assessing health-related quality of life among children with cancer. Int J Cancer 1999;Suppl 12:2–9

• Feeny D. Personal communication, 2006

• Feeny D. The Health Utilities Index: A tool for assessing health benefits. PRO Newsletter #34, Spring 2005:2–6

• Garratt A, Schmidt L, Mackintosh A, et al. Quality of life measurement: bibliographic study of patient assessed health outcome measures. Br Med J 2002;324:1417

• Gilson BS, Gilson JS, Bergner M, et al. The sickness impact profile. Development of an outcome measure of health care. Am J Public Health 1975;65:1304–10

• Girod I, de la Loge C, Keininger D, Hunter M. Development of a revised version of the Women's Health Questionnaire. Climacteric 2006;9:4–12

• Greene JG. A factor analytic study of climacteric symptoms. J Psychosom Res 1976;20:425–30

• Greene JG. Constructing a standard climacteric scale. Maturitas 1998;29:25–31

• Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118:622–9

Literature (2)Literature (2)• Heinemann LAJ, Schneider HPG. Quality of life assessment in the menopause. In Eskin BA, ed.

The Menopause: Endocrinologic Basis and Management Options, 5th edn. Oxford: Informa Healthcare, 2007:79–85

• Hilditch JR, Lewis J, Peter A, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas 1996;24:161–75

• Hunter MS. The Women's Health Questionnaire (WHQ): a measure of mid-aged women's perceptions of their emotional and physical health. Psychol Health 1992;7:45–54

• Jacobs P, Hyland ME, Ley A. Self rated menopausal status and quality of life in women aged 40-63 years. Br J Health Psych 2000;5:395–411

• Kind P. The EuroQoL instrument: an index of health-related quality of life. In Spilker B, ed. QOL and Pharmacoeconomics in Clinical Trials, 2nd edn. Philadelphia: Lippincott-Raven, 1996:191–201

• Le Floch JP, Colau JCI, Zartarian M. Validation d'une méthode d'évaluation de la qualité de vie en ménopause. Refs en Gynécol Obstétr 1994;2:179–88

• Likert R. A technique for the measurement of attitudes. Arch Psychol 1932;140:55

• Limpaphayom KK, Darmasetiawan MS, Hussain RI, et al. Differential prevalence of quality-of-life categories (domains) in Asian women and changes after therapy with three doses of conjugated estrogens/medroxyprogesterone acetate: the Pan-Asia Menopause (PAM) study. Climacteric 2006;9:204–14

Literature (3)Literature (3)

• McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health status survey (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247–63

• McKenna SP, Hunt SM, Tennant A. The development of a patient-completed index of distress from the Nottingham Health Profile: a new measure for use in cost-utility studies. Br J Med Economics 1993;6:13–24

• Parsons T. Definitions of health and illness in light of American values and social structure. In Gartley Jaco E, ed. Patients, Physicians, and Illness. New York: Free Press, 1958:165–87

• Patrick DL, Erickson P. Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press, 1993:22, 61

• Perz JM. Development of the menopause symptom list: a factor analytic study of menopause associated symptoms. Women Health 1997;25:53–69

• Sanders C, Egger M, Donovan J, et al. Reporting on quality of life in randomised controlled trials: bibliographic study. Br Med J 1998;317:1191–4

• Schneider HPG, Hauser GA. The menopause rating scale (MRS II) – clusters of menopausal symptoms. Maturitas 1996;27(Suppl 1):201

• Schneider HPG, Heinemann LAJ, Rosemeier HP, et al. The Menopause Rating Scale (MRS): reliability of scores of menopausal complaints. Climacteric 2000;3:59–64

Literature (4)Literature (4)

• Spilker B, Revicki DA. Taxonomy of quality of life. In Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials, 2nd edn. Philadelphia: Lippincott-Raven, 1996:25–31

• Utian WH, Janata JW, Kingsberg SA, et al. The Utian Quality of Life (UQOL) Scale: development and validation of an instrument to quantify quality of life through and beyond menopause. Menopause 2002;9:402–10

• Webster’s New World Dictionary of the American Language, Second College Edition. New York: Simon and Schuster, 1982:645

• Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996;276:1253–8

• World Health Organization. International Classification of Functioning, Disability, and Health. Geneva: WHO, 2001

• World Health Organization. Preamble to the Constitution of the World Health Organization. International Health Conference, New York, June 19–July 22, 1946: Report of the US Delegation, Including the Final Act and Related Documents, Department of State publication 2703, Conference Series 91. New York: WHO, 1946, entered into force on 7 April 1948

• World Health Organization. WHOQOL study protocol. Geneva: WHO (MNH/PSF/93.9), 1993

• Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70

• Zoellner YF, Acquadro C, Schaefer M. Literature review of instruments to assess health-related quality of life during and after menopause. Qual Life Res 2005;2:309–27

Specialties coveredSpecialties coveredby 3921 reportsby 3921 reports

Garratt et al. 2002

Number of records

Rheumatology 462 (musculoskeletal)

Cancer 439

Older people 324

Mental health 299

Neurological diseases 253

General or healthy populations 235

Pediatric or adolescent 232

Respiratory 202

Cardiovascular diseases 188

Rehabilitation 114

Gastrointestinal diseases 100

AIDS 90

Proxy 71

Urology 71

Orthopedics 65

Number of records

Endocrinology 60

Renal 53

Dental 50

Ophthalmology 47

Dermatology 39

Carer 35

Addiction 32

Gynecology 29

Mental handicap 27

Ear/nose/throat 24

Palliative 22

Allergy 17

Intensive care 12

Burns trauma 11

Infection 11

MOS SF-36 Survey:MOS SF-36 Survey: Item Grouping (1) Item Grouping (1)

Ware, Sherbourne, 1992

Health Scale Abbreviated item content

Physical functioning Vigorous activities, such as running, lifting heavy objects, strenuous sportsModerate activities, such as moving a table, vacuuming, bowlingLifting or carrying groceriesClimbing several flights of stairsClimbing one flight of stairsBending, kneeling, or stoopingWalking more than a mileWalking several blocksWalking one blockBathing or dressing yourself

Role physical Limited in the kind of work or other activitiesCut down the amount of time spent on work or other activitiesAccomplished less than would likeDifficulty performing the work or other activities

Bodily pain Intensity of bodily painExtent pain interfered with normal work

MOS SF-36 Survey:MOS SF-36 Survey: Item Grouping (2) Item Grouping (2)

Ware, Sherbourne, 1992

Health scale Abbreviated item content

General health perceptions Is your health: excellent, very good, good, fair, poorMy health is excellentI am as healthy as anybody I knowI seem to get sick a little easier than other peopleI expect my health to get worse

Vitality Feel full of pepHave a lot of energyFeel worn outFeel tired

Social functioning Frequency health problems interfered with social activitiesExtent health problems interfered with normal social activities

Role emotional Cut down the amount of times spent on work or other activitiesAccomplished less than would likeDidn‘t do work or other activities as carefully as usual

Mental health Been a very nervous personFelt downhearted and blueFelt so down in the dumps nothing could cheer you upBeen a happy personFelt calm and peaceful

Reported change Rating of health now compared to 1 year ago

*5-point scale WHO, Geneva, 1993

WHOQOL domains and facets*WHOQOL domains and facets*• Domain I – Physical domain

– 1 Pain and discomfort– 2 Energy and fatigue– 3 Sexual activity– 4 Sleep and rest– 5 Sensory functions

• Domain II – Psychological domain– 6 Positive feelings– 7 Thinking, learning, memory, and

concentration– 8 Self-esteem– 9 Body image and appearance– 10 Negative feelings

• Domain III – Level of independence– 11 Mobility– 12 Activities and daily living– 13 Dependence on medical substances

and medical aids– 14 Dependence on non-medical

substances (alcohol, tobacco, drugs)– 15 Communication capacity– 16 Work capacity

• Domain IV – Social relationships– 17 Personal relationships– 18 Practical social support– 19 Activities as provider/supporter

• Domain V – Environment– 20 Freedom, physical safety, and

security– 21 Home environment– 22 Work satisfaction– 23 Financial resources– 24 Health and social care: accessibility

and quality– 25 Opportunities for acquiring new

information and skills– 26 Participation in and opportunities for

recreation/leisure activities– 27 Physical environment

(pollution/noise/traffic/climate )– 28 Transport

• Domain VI – Spirituality/religion/personal beliefs

Characteristics of the scalesCharacteristics of the scales

According to Zoellner YF, et al. Qual Life Res 2005;14:309–27

Scale Structure Scoring Psychometric properties

Scaling Aggregation

Greene Climacteric Scale

Psychological (P) scale(anxiety 1 to 6; depression 7 to 11):1. Tachycardia2. Nervousness3. Insomnia4. Being excitable5. Panic attacks6. Difficulty concentrating7. Tired, lack of energy8. Lost interest in most things9. Unhappy or depressed10. Crying spells11. IrritabilitySomatic (S) scale12. Dizzy or faint feelings13. Pressure, tightness in head, body14. Parethesia15. Headaches16. Arthralgia, myalgia17. Loss of feeling in hands, feet18. Breathing difficultiesVasomotor (V) scale19. Hot flushes20. Sweating at night"Probe" for sexual dysfunction:21. Loss of interest in sex

4-point scale

Indicate degree to which you are bothered "at the moment" by listed symptoms

0 – not at all1 – a little2 – quite a bit3 – extremely

Individual subscale scoresWithin domain summation of weighted severity scores (weighting factor = 2 if factor loading > 0.50)

Will yield three separate scores eventually (P, S, V)

Normative data exist from a general population sample (n = 200) of the same age band (40 – 55 years)

Reliability

Reliability coefficients:P-scale: 0.87S-scale: 0.84V-scale: 0.83

ValidityContent validity:

Only symptoms with statistically significant factor loading (confirmed by other factorial studies, in the latest version) have been included

Construct validity:

demonstrated in relation to- life stress- bereavement- psychological- treatment- HRT

Scale Structure Scoring Psychometric properties

Scaling Aggregation

WHQ Domains

Depressed moodSomatic symptomsVasomotorAnxiety/fearsSexual behaviorSleep problemsMenstrual symptomsMemory/concentrationAttractiveness

NB. Symptoms are not listed in blockwise manner to complete one domain and proceed to the next; rather, items from all domains are shuffled across the questionnaire

4-point scale

Indicate your agreement with statements as listed :

Yes, definitelyYes, sometimesNo, not muchNo, not at all

NB. Scoring had to be reversed for some items, as these were phrased positively rather than negatively

Within domain onlynot across domains

Overall subscale = mean subscale score

Factor scale scores obtained by summing up item scores (within domains only) and dividing by number of items in that domain

NB. Some authors sum up all item scores to one global score (min. 0, max. 144)

Reliability

Test-retest (2 weeks):

Correlation between factor scores (scores of same factor at two different points in time) range 0.69 to 0.96 across factors

Internal consistency:

Assessment not deemed necessary as underlying factor analysis provides sufficient information about item to scale relationship

Validity

Concurrent validity of psychological scales was estimated by comparison with the 30-item GHQ, correlated 0.81 with depression scale and

0.46 with anxiety scale

Characteristics of the scalesCharacteristics of the scales

Scale Structure Scoring Psychometric properties

Scaling Aggregation

MENQOL Domains (items)

Physical (16)Vasomotor (3)Psychosocial (10)Sexual (3)

Plus general QOL question, which was not included in analysis

7-point scale

Indicate how strongly you are bothered by symptoms listed :

0 – not at all1 –2 –3 –4 –5 –6 – extremely

Intermediate levels do not carry any description

NB. Scoring had to be reversed for some items, as these were phrased positively rather than negatively

Within domain onlynot across domainsOverall subscale score =mean subscale score (no weighting)

Reliability

Test-retest (1 month):

Correlation between factor scores (scores of same factor at two different points in time) range between 0.55 and 0.85 across factors

Internal consistency:

Cronbach‘s alpha ranges between 0.81 and 0.89

Validity

Construct validity:

Correlation coefficients are computed for both evaluative and discriminative validity and oscillate between 0.40 and 0.65 (discriminative), or 0.28 and 0.60 (evaluative validity) (global QOL item excluded)

Characteristics of the scalesCharacteristics of the scales

Scale Structure Scoring Psychometric properties

Scaling Aggregation

MRS Domains (items)

Psychological (4)Somatovegetative (4)Urogenital (3)

5-point scale

Indicate the severity of symptoms

0 – no symptoms1 – mild2 – moderate3 – marked4 – severe

Within domain onlynot across domainsOverall subscale score =

mean subscale score (no weighting)

Reliability

Test-retest (1.5 years):

Correlation between factor scores (scores of same factor at two different points in time) for Severity of scores:K = 0.26 p = 0.000

Somatic symptoms:K = 0.25 p = 0.000

Psychological symptoms:K = 0.30 p = 0.000

Urogenital symptoms:K = 0.19 p = 0.000

Validity

By comparison with SF-36

Characteristics of the scalesCharacteristics of the scales

PAM StudyPAM StudyBaseline domain scores by ethnic groupBaseline domain scores by ethnic group

MENQOL (29) domain (mean SD)

Ethnic origin

Number of women Vasomotor Psychosocial Physical Sexual

Chinese 249 3.13 (1.67) 2.84 (1.37) 3.21 (1.15) 4.04 (2.20)

Filipino 199 3.17 (1.60) 3.33 (1.41) 3.20 (1.23) 3.03 (2.03)

Indonesian 60 2.28 (0.87) 2.40 (0.68) 2.66 (0.63) 2.63 (1.18)

Korean 97 2.21 (1.40) 3.06 (1.46) 3.29 (1.24) 3.55 (2.29)

Malay 24 3.02 (1.56) 2.78 (1.11) 2.93 (1.08) 3.14 (1.78)

Pakistani 60 4.96 (2.41) 4.24 (1.64) 4.84 (1.61) 2.90 (1.70)

Taiwanese 81 2.29 (1.39) 2.37 (1.32) 2.84 (1.23) 2.11 (1.32)

Thai 150 2.87 (1.61) 3.10 (1.22) 3.28 (1.08) 2.89 (1.90)

Vietnamese 100 5.71 (1.59) 5.96 (1.48) 5.39 (1.20) 6.55 (1.67)

Limpaphayom, et al. 2006