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PubMed2006

The comparison of different dyspnoea scales in patients with COPD.

OBJECTIVES: (i) To compare the relationship between different dyspnoea scales and physical and clinical parameters of patients with chronic obstructive pulmonary disease (COPD); and (ii) to determine the most suitable scale among these scales for this patient group. METHODS: Forty patients with COPD [mean 1st second forced expiratory volume (FEV(1)), 49.16 +/- 2.33% predicted], aged 53-85 participated in this study. The severity of dyspnoea was assessed with different five scales [Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Medical Research Council Dyspnoea Scale (MRCS), Baseline Dyspnoea Index (BDI) and Oxygen Cost Diagram (OCD)]. As clinical parameters, respiratory function was measured by means of pulmonary function test and arterial blood gas analysis. As physical parameters, age and body mass index was recorded. RESULTS: Patient's dyspnoea severities were 1.59 +/- 2.75, 2.03 +/- 2.82, 2.14 +/- 1.44, 6.81 +/- 4.07, 4.56 +/- 2.47 for MBS, VAS, MRCS, BDI, OCD, respectively (P = 0.08). It was proven that only %FEV(1) had a correlation with MRCS (r = -0.67, P = 0.01) and BDI (r = 0.58, P = 0.02). In addition to these determinations MRCS, MBS and VAS had a strong correlation defining their relationships with each other (P < 0.05). CONCLUSIONS: MRCS and BDI could assess dyspnoea during daily activities, so these scales showed strength correlation with physical and clinical values. Briefly MRCS is the most suitable dyspnoea scale for the patients with COPD, moreover, BDI, as the second suitable scale, is correlated only with MRCS. Based on these findings, we recommended that MRCS and BDI are appropriate scales for evaluation of dyspnoea in the patients with COPD.

Adult↗
PubMed2004

Pollutant dispersion in a large indoor space: Part 1 -- Scaled experiments using a water-filled model with occupants and furniture.

Scale modeling is a useful tool for analyzing complex indoor spaces. Scale model experiments can reduce experimental costs, improve control of flow and temperature conditions, and provide a practical method for pretesting full-scale system modifications. However, changes in physical scale and working fluid (air or water) can complicate interpretation of the equivalent effects in the full-scale structure. This paper presents a detailed scaling analysis of a water tank experiment designed to model a large indoor space, and experimental results obtained with this model to assess the influence of furniture and people in the pollutant concentration field at breathing height. Theoretical calculations are derived for predicting the effects from losses of molecular diffusion, small scale eddies, turbulent kinetic energy, and turbulent mass diffusivity in a scale model, even without Reynolds number matching. Pollutant dispersion experiments were performed in a water-filled 30:1 scale model of a large room, using uranine dye injected continuously from a small point source. Pollutant concentrations were measured in a plane, using laser-induced fluorescence techniques, for three interior configurations: unobstructed, table-like obstructions, and table-like and figure-like obstructions. Concentrations within the measurement plane varied by more than an order of magnitude, even after the concentration field was fully developed. Objects in the model interior had a significant effect on both the concentration field and fluctuation intensity in the measurement plane. PRACTICAL IMPLICATION: This scale model study demonstrates both the utility of scale models for investigating dispersion in indoor environments and the significant impact of turbulence created by furnishings and people on pollutant transport from floor level sources. In a room with no furniture or occupants, the average concentration can vary by about a factor of 3 across the room. Adding furniture and occupants can increase this spatial variation by another factor of 3.

Air Movements↗
PubMed2005

Development and validation of the ABC pain scale for healthy full-term babies.

AIM: We developed and validated a pain scale (ABC scale) for term babies based on acoustic features of crying. METHODS: The scale consisted of three different cry parameters: (a) pitch of the first cry; (b) rhythmicity of the crying bout; (c) constancy of crying intensity. These parameters were previously found to distinguish between medium and high levels of pain measured by spectral analysis of crying. We validated the scale using healthy term babies undergoing routine heel prick. Concurrent validity was assessed comparing pain values obtained with our scale with those obtained with another pain scale; this relationship was also used to assess the sensitivity of the scale. To assess specificity we compared the ABC scores during a painful event (heel prick) with two non-painful events (preliminary phase of prick in the same group of babies, and heel prick with analgesia in another group). RESULTS: Specificity: (a) analgesic/non-analgesic comparison, p < 0.0001; (b) pain/sham comparison, p < 0.0001). Sensitivity: a high correlation between scores of the ABC scale and the Douleur Aigue du Nouveau-Né scale indicates good sensitivity. Concurrent validity: Spearman rho = 0.91. Internal consistency: Cronbach's alpha = 0.76. Inter-rater reliability: Cohen's kappa for multiple raters = 0.83. Intra-rater reliability: Cohen's kappa = 0.85. Practicality: All nurses who used it scored the scale as "good". CONCLUSION: The ABC scale proved to be simple and reliable for assessing pain in healthy, non-intubated term newborns.

Cohort Studies↗
PubMedDate not supplied

Comparison of visual analog and numeric scoring scales for assessing intraoperative mesenteric portovenography.

A visual analog scale and a numeric scoring scale were designed for the assessment of dynamic intraoperative mesenteric portovenography in the dog and cat. Two independent observers evaluated both scoring scales for reproducibility (differences between observers) and repeatability (within-observer differences) in the assessment of 60 trial portovenograms. Agreement (interchangeability) of both scales was evaluated by comparing the scores obtained in the assessment of 200 portovenograms obtained from 100 dogs and cats. There was no statistical difference between the two observers when scoring the same portovenogram for either the visual analog scale (p = .730, reproducibility coefficient = 17.85 units) or the numeric scoring scale (scores identical, reproducibility coefficient = 0). There was no statistical difference, for either of the observers, when the same portovenogram was assessed on two separate occasions using the visual analog scale (observer 1, p = .35, repeatability coefficient = 17.93 units; observer 2, p = .42, repeatability coefficient = 8.27 units) or the numeric scoring scale (scores given by both observers were identical, repeatability coefficient = 0 for both observers). The results of comparison between the visual analog scale and numeric scoring scale confirmed that the two scoring systems were not directly interchangeable. Although both scoring systems demonstrated good reproducibility and repeatability, the numeric scoring scale possessed a number of inherent deficiencies that suggested it was not the method of choice for the assessment of the subjective data obtained from dynamic intraoperative mesenteric portovenography.

Animals↗
PubMedDate not supplied

Getting what you ask for: on the selectivity of depression rating scales.

A large number of rating scales has been developed to assess depression severity and change during antidepressant therapy. When reviewing the literature, the choice of the rating scales used in a particular study often seems arbitrary. The most frequently used observer rating scales, the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), and the most frequently used self-rating scale (the Beck Depression Inventory, or BDI) were developed more than 20 years ago. Their historical background is too often forgotten and they are reflections of their origin: the HDRS and the MADRS reflect antidepressant activity while the BDI reflects psychotherapy. Moreover, the HDRS is at risk of putting 'all depressions in one basket', while the MADRS is at risk of putting 'all antidepressants in one basket'. Therefore, the question whether a particular antidepressant could be more effective in a particular subtype of depression cannot be answered. Observer rating scales are more frequently used than self-rating scales, and when scales are used that do exist in an observer rating and a self-rating version, interesting differences are found. The present paper does not suggest that one scale is better than another, but suggests that a better knowledge of their differential background can help the researcher choose the correct scale for his purposes.

Antidepressive Agents↗
PubMed2000

Review of outcome measurement instruments in Alzheimer's disease drug trials: psychometric properties of behavior and mood scales.

This article reviews the reliability and validity of eight scales for behavior and mood problems that were identified in a comparative analysis of Alzheimer's disease (AD) drug trials. The scales are the Brief Psychiatric Rating Scale, the Alzheimer's Disease Assessment Scale-noncognitive, the Relative's Assessment of Global Symptomatology, the Consortium to Establish a Registry for Alzheimer's Disease-Behavior Rating Scale for Dementia, the Dementia Behavior Disturbance scale, the Neuropsychiatric Inventory, and two scales for depressive symptoms, the Cornell Scale for Depression in Dementia and the Dementia Mood Assessment Scale. This article also examines methodological limitations in the way the published literature has assessed the psychometric properties of these scales. The aim is to help clinicians and potential trial investigators select appropriate measurement instruments with which to assess behavior and mood problems in AD and to assist AD researchers in the evaluation of the psychometric properties of such scales.

Affective Symptoms↗
PubMed2005

Adjusted scaling of FDG positron emission tomography images for statistical evaluation in patients with suspected Alzheimer's disease.

BACKGROUND AND PURPOSE: Statistical parametric mapping (SPM) gained increasing acceptance for the voxel-based statistical evaluation of brain positron emission tomography (PET) with the glucose analog 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) in patients with suspected Alzheimer's disease (AD). To increase the sensitivity for detection of local changes, individual differences of total brain FDG uptake are usually compensated for by proportional scaling. However, in cases of extensive hypometabolic areas, proportional scaling overestimates scaled uptake. This may cause significant underestimation of the extent of hypometabolic areas by the statistical test. METHODS: To detect this problem, the authors tested for hypermetabolism. In patients with no visual evidence of true focal hypermetabolism, significant clusters of hypermetabolism in the presence of extended hypometabolism were interpreted as false-positive findings, indicating relevant overestimation of scaled uptake. In this case, scaled uptake was reduced step by step until there were no more significant clusters of hypermetabolism. RESULTS: In 22 consecutive patients with suspected AD, proportional scaling resulted in relevant overestimation of scaled uptake in 9 patients. Scaled uptake had to be reduced by 11.1% +/- 5.3% in these cases to eliminate the artifacts. Adjusted scaling resulted in extension of existing and appearance of new clusters of hypometabolism. Total volume of the additional voxels with significant hypometabolism depended linearly on the extent of the additional scaling and was 202 +/- 118 mL on average. CONCLUSIONS: Adjusted scaling helps to identify characteristic metabolic patterns in patients with suspected AD. It is expected to increase specificity of FDGPET in this group of patients.

Alzheimer Disease↗
PubMed1996

Quantifying the clinical significance of drug-drug interactions: scaling pharmacists' perceptions of a common interaction classification scheme.

OBJECTIVE: To develop a precise, interval level scale of the clinical significance of drug-drug interactions that reflects the professional judgments of practicing pharmacists. PARTICIPANTS: A convenience sample of 63 practicing pharmacists representing hospital (clinical and staff) and retail (chain and independent) practice settings. METHOD: Pharmacists judged the similarity among 15 interaction categories that have been commonly used to classify drug-drug interactions. A multidimensional scaling technique produced a spatial representation (i.e., a psychological map) of the structure inherent in those similarity judgments. Pharmacists' ratings of clinical significance were projected onto that same spatial representation using a multiple regression procedure, and the resulting information was used to develop a scale of clinical significance. RESULTS: The clinical significance scale developed from pharmacists' judgments was substantially different from a comparison scale published in a popular reference. The new scale was more precise than the comparison scale, and it also approximated an interval level of measurement. The judgments used to produce the new clinical significance scale were not reliably influenced by pertinent demographic characteristics of the sample. CONCLUSIONS: Inconsistencies between published clinical significance scales and the professional judgments of practitioners could affect patient care to the degree that a summary measure of clinical significance affects a practitioner's response to a potential drug-drug interaction. The clinical significance scale developed in this study has good measurement characteristics and reflects the professional judgments of practicing pharmacists. Use of the new scale is recommended on these grounds, although further assessment of its generality is warranted.

Drug Interactions↗
PubMed2006

Quality of life and hormone use: new validation results of MRS scale.

BACKGROUND: The Menopause Rating Scale is a health-related Quality of Life scale developed in the early 1990s and step-by-step validated since then. Recently the MRS scale was validated as outcomes measure for hormone therapy. The suspicion however was expressed that the data were too optimistic due to methodological problems of the study. A new study became available to check how founded this suspicion was. METHOD: An open post-marketing study of 3282 women with pre- and post- treatment data of the self-administered version of the MRS scale was analyzed to evaluate the capacity of the scale to detect hormone treatment related effects with the MRS scale. The main results were then compared with the old study where the interview-based version of the MRS scale was used. RESULTS: The hormone-therapy related improvement of complaints relative to the baseline score was about or less than 30% in total or domain scores, whereas it exceeded 30% improvement in the old study. Similarly, the relative improvement after therapy, stratified by the degree of severity at baseline, was lower in the new than in the old study, but had the same slope. Although we cannot exclude different treatment effects with the study method used, this supports our hypothesis that the individual MRS interviews performed by the physician biased the results towards over-estimation of the treatment effects. This hypothesis is underlined by the degree of concordance of physician's assessment and patient's perception of treatment success (MRS results): Sensitivity (correct prediction of the positive assessment by the treating physician) of the MRS and specificity (correct prediction of a negative assessment by the physician) were lower than the results obtained with the interview-based MRS scale in the previous publication. CONCLUSION: The study confirmed evidence for the capacity of the MRS scale to measure treatment effects on quality of life across the full range of severity of complaints before treatment. The difference of the relative improvement after therapy between the old and current study as well as the observed different sensitivity/specificity is--as a matter of probability--more likely to be caused by a bias introduced by the different application of the MRS scale than by real differences in the efficacy of the therapy. A randomized clinical trial would be needed to test the impact of the latter. The message for future studies is: The MRS scale should be only used as self-administered tool where the suggestive effect of questions raised by health professionals ("therapeutic optimism") can be largely excluded.

Estrogen Replacement Therapy↗
PubMed2004

A comparison of the MCMI-III personality disorder and modifier indices with the MMPI-2 clinical and validity scales.

In this study, we examined the relationship of the MCMI-III (Millon, Davis, & Millon, 1997; Millon, Millon, & Davis, 1994) modifier indices and personality disorder scales to the validity and basic clinical scales of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MCMI-III modifier indices highly correlated with all of the MMPI-2 validity scales except for the F(p) scale. Similarly, the MCMI-III personality disorder scales strongly covaried with the MMPI-2 validity and clinical scales except for the F(p) and 5 (Mf) scales. A factor analysis with Promax rotation revealed substantial relationships between the MMPI-2 and MCMI-III. However, the MMPI-2 F(p) scale did not tend to correlate with MMPI-2 or MCMI-III scales, indicating that F(p) scale variance was largely independent of other scales. The results suggest that clinicians should consider the interrelationship between personality characteristics and dissimulation.

Adolescent↗
PubMed2005

Allometric scaling of mammalian metabolism.

The importance of size as a determinant of metabolic rate (MR) was first suggested by Sarrus and Rameaux over 160 years ago. Max Rubner's finding of a proportionality between MR and body surface area in dogs (in 1883) was consistent with Sarrus and Rameaux's formulation and suggested a proportionality between MR and body mass (Mb) raised to the power of 2/3. However, interspecific analyses compiled during the first half of the 20th century concluded that mammalian basal MR (BMR, ml O2 h(-1)) was proportional to Mb3/4, a viewpoint that persisted for seven decades, even leading to its common application to non-mammalian groups. Beginning in 1997, the field was re-invigorated by three new theoretical explanations for 3/4-power BMR scaling. However, the debate over which theory accurately explains 3/4-power scaling may be premature, because some authors maintain that there is insufficient evidence to adopt an exponent of 3/4 over 2/3. If progress toward understanding the non-isometric scaling of BMR is ever to be made, it is first essential to know what the relationship actually is. We re-examine previous investigations of BMR scaling by standardising units and recalculating regression statistics. The proportion of large herbivores in a data set is positively correlated both with the scaling exponent (b, where BMR=aMb b) and the coefficient of variation (CV: the standard deviation of ln-ln residuals) of the relationship. Inclusion of large herbivores therefore both inflates b and increases variation around the calculated trendline. This is related to the long fast duration required to achieve the postabsorptive conditions required for determination of BMR, and because peak post-feeding resting MR (RMRpp) scales with an exponent of 0.75+/-0.03 (95% CI). Large herbivores are therefore less likely to be postabsorptive when MR is measured, and are likely to have a relatively high MR if not postabsorptive. The 3/4 power scaling of RMRpp is part of a wider trend where, with the notable exception of cold-induced maximum MR (b=0.65+/-0.05), b is positively correlated with the elevation of the relationship (higher MR values scale more steeply). Thus exercise-induced maximum MR (b=0.87+/-0.05) scales more steeply than RMRpp, field MR (b=0.73+/-0.04), thermoneutral resting MR (RMRt, b=0.712+/-0.013) and BMR. The implication of this observation is that contamination of BMR data with non-basal measurements is likely to increase the BMR scaling exponent even if the contamination is randomly distributed with respect to Mb. Artificially elevated scaling exponents can therefore be accounted for by the inclusion of measurements that fail to satisfy the requirements for basal metabolism, which are strictly defined (adult, non-reproductive, postabsorptive animals resting in a thermoneutral environment during the inactive circadian phase). Similarly, a positive correlation between Mb and body temperature (Tb) and between Tb and mass-independent BMR contributes to elevation of b. While not strictly a defined condition for the measurement of BMR, the normalisation of BMR measurements to a common Tb (36.2 degrees C) to achieve standard metabolic rate (SMR) further reduces the CV of the relationship. Clearly the value of the exponent depends on the conditions under which the data are selected. The exponent for true BMR is 0.686 (+/-0.014), Tb normalised SMR is 0.675 (+/-0.013) and RMRt is 0.712 (+/-0.013).

Animals↗
PubMed1990

[Sensory scaling of odor based on mathematical studies of rating words].

Sensory scales are very important indicators for the evaluation of environmental odors, and of the effect of deodorizers. The purpose of this study is to examine reasonable methods of sensory scaling. For this purpose, the psychological values of rating words for odor intensity, odor hedonics and similarity were measured. The interval distances between categories of each scale were estimated in the method of successive categories as well. Results of this study are as follows. 1) The 6-step odor intensity scale, issued by the Environmental Agency, may be regarded as an ordinal scale, but not as an interval scale. The 9-step hedonics scale may be regarded as an interval scale. 2) Psychological values of rating words are not affected by the size and the number of category steps in the graphic scales applied to the judgements of their values. 3) The number of category steps needs to be determined based on the distribution of the psychological values. The meanings and the order of the rating words have to be clear. 4) In the construction of a numerical scale, the category values should accord nearly as possible with the psychological values of rating words. 5) In results from the method of successive categories applied to the measured values of odor intensity and similarity, interval distances between categories are unequal, and the interval distances are wide on both edges of the scale. In these cases, the values must be converted into "category values of stimuli."

Classification↗
PubMed2006

Role of two insect growth regulators in integrated pest management of citrus scales.

Portions of two commercial citrus orchards were treated for two consecutive years with buprofezin or three consecutive years with pyriproxyfen in a replicated plot design to determine the long-term impact of these insect growth regulators (IGRs) on the San Joaquin Valley California integrated pest management program. Pyriproxyfen reduced the target pest, California red scale, Aonidiella aurantii Maskell, to nondetectable levels on leaf samples approximately 4 mo after treatment. Pyriproxyfen treatments reduced the California red scale parasitoid Aphytis melinus DeBach to a greater extent than the parasitoid Comperiella bifasciata Howard collected on sticky cards. Treatments of lemons Citrus limon (L.) Burm. f. infested with scale parasitized by A. melinus showed only 33% direct mortality of the parasitoid, suggesting the population reduction observed on sticky cards was due to low host density. Three years of pyriproxyfen treatments did not maintain citricola scale, Coccus pseudomagnoliarum (Kuwana), below the treatment threshold and cottony cushion scale, Icerya purchasi Maskell, was slowly but incompletely controlled. Buprofezin reduced California red scale to very low but detectable levels approximately 5 mo after treatment. Buprofezin treatments resulted in similar levels of reduction of the two parasitoids A. melinus and C. bifasciata collected on sticky cards. Treatments of lemons infested with scale parasitized by A. melinus showed only 7% mortality of the parasitoids, suggesting the population reduction observed on sticky cards was due to low host density. Citricola scale was not present in this orchard, and cottony cushion scale was slowly and incompletely controlled by buprofezin. These field plots demonstrated that IGRs can act as organophosphate insecticide replacements for California red scale control; however, their narrower spectrum of activity and disruption of coccinellid beetles can allow other scale species to attain primary pest status.

Animals↗
PubMed1999

Scales for teachers' assessment of inhibition and security seeking in kindergarten children.

For young children separation from their primary caregivers can give rise to feelings of emotional insecurity, which are manifested by inhibition of behavior and seeking security from a substitute caregiver. The present study examined the quality of two new scales, the Inhibition Scale and the Security Seeking Scale, developed for teachers' assessment of inhibition and security-seeking behaviors. Participants were 121 kindergarten children. Reliability and short-term stability of both scales proved to be good. Relationships with four major dimensions of personality, Extraversion, Conscientiousness, Agreeableness, and Emotional Stability, were examined by means of teachers' judgements on the School Behavior Checklist Revised. The validity of the Inhibition Scale and the Security Seeking Scale was supported by the findings. Scores on both scales appeared to be negatively related to those on Extraversion and Emotional Stability. The negative association with scores on Extraversion was stronger for scores on the Inhibition Scale than for those on the Security Seeking Scale. Neither scale was related to the nonemotional dimension Conscientiousness. In addition, scores on both the Inhibition and Security Seeking Scale appeared negatively related to the time passed since entry into kindergarten.

Child Behavior↗
PubMed2005

Note on psychometric properties of playfulness scales with adolescents.

105 female and 85 male high school students completed two scales designed to measure playfulness, the Playfulness Scale for Adults and the Adult Playfulness Scale, and two scales designed to measure creativity, the Similes Test and The Franck Drawing Completion Test. The playfulness scales exhibited high internal consistency and good construct validity. Cronbach alpha was .84 for the Playfulness Scale for Adults and .88 for the Adult Playfulness Scale, and split-half reliability was .79 (Spearman-Brown) and .79 (Guttman) for the Adult Playfulness Scale and .87 (Spearman-Brown) and .86 (Guttman) for the Playfulness Scale for Adults. 2-wk. test-retest reliability for the Playfulness Scale for Adults was .89, which compared favorably to the test-retest reliability of .84 previously reported for the Adult Playfulness Scale.

Adolescent↗
PubMed2005

The convergent validity of the Manchester Pain Scale.

OBJECTIVE: To test the convergent validity of the Manchester pain scale when compared to the current 'gold standard' in children's pain assessment, the Oucher pain scale. METHOD: One hundred and fifty two children presenting to the emergency department had pain scale assessments using both the Manchester and Oucher pain scales. The order of presentation of the scales was randomised. The degree of convergence between the scales was assessed using Spearman's rank correlation as well as Bland and Altman plots. RESULTS: One hundred and thirteen children used numerical scales; the correlation coefficient for these was 0.802. Thirty nine children used pictorial scales; the correlation coefficient was 0.820. CONCLUSION: There is strong convergent validity between the scales as demonstrated by a high degree of correlation between the numerical and pictorial scores generated by the Manchester and Oucher pain scales. The Manchester pain scale can be used to assess pain in children presenting to emergency departments.

Adolescent↗
PubMedDate not supplied

[A study of various scales of fatigue and impact on the quality of life among patients with multiple sclerosis].

OBJECTIVES: To explore fatigue in multiple sclerosis and evaluate the specificity of three fatigue scales in this condition: the fatigue severity scale, the specific fatigue scale and the fatigue impact scale. MATERIAL AND METHODS: We sent out 60 questionnaires with the three scales and the quality of life scale, the Nottingham Health Profile, to patients with multiple sclerosis as clinically defined by Poser's criteria. Answers were received to 58 questionnaires and the data correlated by Sperman's correlation and the Student t test, with demographic variables (age, age of onset and sex) and clinical variables (clinical form, time the disease was present, period of time since the previous episode and Kurtzke scale (EDSS). RESULTS: Fatigue was present in 78% of the patients. There was correlation between fatigue severity scale and EDSS, pyramidal function, cerebellar function, the period of time the illness was present and the clinical form. We found that the specific fatigue scale is independent of EDSS. The fatigue impact scale was correlated with the EDSS apart from the questions concerning cognitive function. CONCLUSIONS: Fatigue is a common symptom of multiple sclerosis which has an independent effect on cognitive function. It is also related to involvement of the pyramidal and cerebellar systems, and depends on the degree of disability and time the disease has been present. The specific fatigue scale is a good tool for exploration of this symptom of multiple sclerosis.

Cognition Disorders↗
PubMed2000

[Development of a scale for subjective QOL common to patients with intractable diseases].

OBJECTIVE: We have developed a scale for evaluating subjective quality of life (QOL) common to patients with intractable diseases. SUBJECTS: Two-hundred and forty-seven outpatients of housebound patients from 7 collaborating hospitals or institutions participated in preliminary surveys. The patients were diagnosed with one of 14 diseases targeted by the Ministry of Health and Welfare's Specific Disease Treatment Research Project. Two-hundred and fifty-seven outpatients or housebound patients of 8 collaborating hospitals or institutions participated in a second survey that targeted 15 diseases. METHODS: The concept of subjective QOL was examined, and a favorable subjective QOL score was defied as "a state in which patients accept their current condition and possess a high level of morale with no signs of anxiety, despite the presence of their disease". Sixty-six items were then identified and included in a preliminary survey. Three preliminary surveys and a second survey were then conducted. A final scale for the items was then decided, and the items were assessed for their reliability and validity. RESULTS: Nine items reflecting two factors, "acceptance" and "morale", were selected and assessed for their reliability and validity as follows: 1) The response of subjects who accepted their illness yet possessed a high level of morale showed a good fit with the proposed scale (Adjusted Goodness of Fit Index = 0.925). 2) The confidence coefficient of the re-test method for subjective QOL scale scores was r = 0.78 (95% con idence interval: 0.72-0.83; n = 226) nd the alpha coefficient was 0.822, indicating a high level of reliability. 3) A strong negative correlation (r = -0.76, 95% confidence interval: -0.82 to -0.69; n = 178) was found between the subjective QOL scale scores and self-rating depression scale (SDS) scores, and a moderately positive correlation (r = 0.35, 95% confidence interval: 0.23-0.46; n = 238) was found between the subjective QOL scale scores and activities of daily living (ADL) scores. 4) No statistically significant differences were observed in the distribution of subjective QOL scale scores when analyzed according to sex, age group, disease, or duration of illness. CONCLUSIONS: We have developed a scale consisting of 9 items for determining the subjective QOL of patients with intractable diseases. The scale was confirmed to properly reflect our concept of subjective QOL, which consists of two factors: "acceptance" and "morale" The scale was also confirmed to be stable and highly reliable.

Adolescent↗