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PubMedDate not supplied

A psychometric assessment of the H & H Lactation scale in a sample of thai mothers using a repeated measurement design.

BACKGROUND: The H & H Lactation (H & H) scale is a useful instrument for understanding mothers' perceptions of insufficient milk supply, which is the common reason given for premature cessation of breastfeeding. This instrument may be used to intervene in postbirth dropoff in breastfeeding among mothers. OBJECTIVES: To examine construct and nomological validity and related psychometric evidence for the translated H & H scale using a repeated measurement design in a sample of Thai mothers. METHOD: A repeated measurement design with 196 mother-infant dyads. Data were collected at two time periods. At Time 1, data on the H & H and Index of Breastfeeding Status (IBS) scales were obtained between 36 and 48 hr postbirth. For Time 2, the same mothers completed the same instruments at 1 month postbirth. Psychometricproperties of the H & H scale were examined using convergent, discriminant, and nomological validity principles with instructural equation modeling. RESULTS: Based on judgment/classification task, exploratory/confirmatory factor analysis, and cross-validation using multisample analysis, only nine items of the H & H scale measured at Time 1 and Time 2 were found to be psychometrically sound for measuring insufficient milk supply for Thai mothers. An analysis of the influence of the nine-item of the H & H scale measured at Time 1 and Time 2 on the IBS measured at Time 2 showed that (a) the direct effects of two subscales of the H & H scale measured at Time 2 on the IBS were significant and positive, providing support for the nomological validity of the H & H scale; (b) each H& H factor at Time 1 had a significant influence on its corresponding factor at Time 2, supporting convergent validity; and (c) the crossover effects for each H & H factor for Time 1 and Time 2 data were nonsignificant, indicating discriminant validity. DISCUSSION: Overall, the 20-item H & H scale appears to be unreliable and invalid for measuring the concept of insufficient milk supply in cross-cultural studies. However, the short form of nine items is reliable and valid for Thai mothers. Further testing and development of the H & H scale and the proposed short form in other cultures and contexts is warranted.

Adult↗
PubMed1995

The Quebec Back Pain Disability Scale. Measurement properties.

STUDY DESIGN: The Quebec Back Pain Disability Scale is a 20-item self-administered instrument designed to assess the level of functional disability in individuals with back pain. The scale was administered as part of a larger questionnaire to a group of 242 back pain patients. Follow-up data were obtained after several days and after 2 to 6 months. OBJECTIVES: The goal of this study was to determine whether the Quebec scale is a reliable, valid, and responsive measure of disability in back pain, and to compare it with other disability scales. SUMMARY OF BACKGROUND DATA: A number of functional disability scales for back pain are being used, but their conceptual validity is uncertain. Unlike most published instruments, the Quebec scale was constructed using a conceptual approach to disability assessment and empirical methods of item development, analysis, and selection. METHODS: The authors calculated test-retest and internal consistency coefficients, evaluated construct validity of the scale, and tested its responsiveness against a global index of change. Direct comparisons with the Roland, Oswestry, and SF-36 scales were carried out. RESULTS: Test-retest reliability was 0.92, and Cronbach's alpha coefficient was 0.96. The scale correlated as expected with other measures of disability, pain, medical history, and utilization variables, work-related variables, and socio-demographic characteristics. Significant changes in disability over time, and differences in change scores between patients that were expected to differ in the direction of change, were found. CONCLUSIONS: The Quebec scale can be recommended as an outcome measure in clinical trials, and for monitoring the progress of individual patients participating in treatment or rehabilitation programs.

Adolescent↗
PubMed2005

Do insect metabolic rates at rest and during flight scale with body mass?

Energetically costly behaviours, such as flight, push physiological systems to their limits requiring metabolic rates (MR) that are highly elevated above the resting MR (RMR). Both RMR and MR during exercise (e.g. flight or running) in birds and mammals scale allometrically, although there is little consensus about the underlying mechanisms or the scaling relationships themselves. Even less is known about the allometric scaling of RMR and MR during exercise in insects. We analysed data on the resting and flight MR (FMR) of over 50 insect species that fly to determine whether RMR and FMR scale allometrically. RMR scaled with body mass to the power of 0.66 (M0.66), whereas FMR scaled with M1.10. Further analysis suggested that FMR scaled with two separate relationships; insects weighing less than 10mg had fourfold lower FMR than predicted from the scaling of FMR in insects weighing more than 10mg, although both groups scaled with M0.86. The scaling exponents of RMR and FMR in insects were not significantly different from those of birds and mammals, suggesting that they might be determined by similar factors. We argue that low FMR in small insects suggests these insects may be making considerable energy savings during flight, which could be extremely important for the physiology and evolution of insect flight.

Animals↗
PubMed2000

Generic dynamic scaling in kinetic roughening

We study the dynamic scaling hypothesis in invariant surface growth. We show that the existence of power-law scaling of the correlation functions (scale invariance) does not determine a unique dynamic scaling form of the correlation functions, which leads to the different anomalous forms of scaling recently observed in growth models. We derive all the existing forms of anomalous dynamic scaling from a new generic scaling ansatz. The different scaling forms are subclasses of this generic scaling ansatz associated with bounds on the roughness exponent values. The existence of a new class of anomalous dynamic scaling is predicted and compared with simulations.

Journal Article↗
PubMed2003

A pseudojoint estimation of time delay and scale factor for M-wave analysis.

A pseudojoint estimation of time scale and time delay between an unknown deterministic transient type signal and a reference signal is proposed. The method is based on the separation between the estimations of the two dependent parameters. The time autocorrelation function (TACF) preserves the time scale and is invariant with respect to the time delay between the signals. The time scale factor can, thus, be estimated independently from time delay using the TACFs of the two signals. After estimating the time scale factor, the signal can be scaled by the estimated amount. The time delay is then estimated without bias due to the time scale factor. To obtain high resolution joint estimates, the time scale factor is estimated in the scale domain from the scale transforms of the TACFs of the two signals. The proposed method has low computational cost. Moreover, the results on synthetic signals show good performance of the method with respect to the Cramér-Rao Lower Bound and the joint Maximum Likelihood Estimation. A possible application of the technique to the analysis of electromyogram (EMG) signals detected during electrically elicited contractions is also presented. In a few representative cases, it is shown that the time scale estimate reveals myoelectric manifestations of muscle fatigue and is less affected by M-wave truncation than spectral EMG attributes.

Algorithms↗
PubMed2005

Pressure ulcers: validation of two risk assessment scales.

AIMS AND OBJECTIVES: To compare the predictive value of two pressure ulcer risk assessment scales (Braden and Norton) and of clinical judgement. To evaluate the impact of effective preventive measures on the predictive validity of the two risk assessment scales. METHODS: Of the 1772 participating older patients, 314 were randomly selected and assigned to the 'turning' group; 1458 patients were assigned to the "non-turning" group. Using the Braden and the Norton scale the pressure ulcer risk was scored twice weekly during a four-week period. Clinical assessment was monitored daily. The patients at risk in the "turning" group (Braden score <17 or Norton score <12) were randomly assigned to a two-hour turning schedule or to a four-hour turning schedule in combination with a pressure-reducing mattress. The "non-turning" group received preventive care based on the clinical judgement of the nurses. RESULTS: The diagnostic accuracy was similar for both scales. If nurses act according to risk assessment scales, 80% of the patients would unnecessarily receive preventive measures. The use of effective preventive measures decreased the predictive value of the risk assessment scales. Nurses predicted pressure ulcer development less well than the Braden and the Norton scale. Only activity, sensory perception, skin condition and existence of old pressure ulcers were significant predictors of pressure ulcer lesions. RELEVANCE TO CLINICAL PRACTICE: The effectiveness of the Norton and Braden scales is very low. Much needless work is done and expensive material is wrongly allocated. The use of effective preventive measures decreases the predictive value of the risk assessment scales. Although the performance of the risk assessment scales is poor, using a risk assessment tool seems to be a better alternative than relying on the clinical judgement of the nurses.

Aged↗
PubMed2006

Clinical use of a shortened alcohol withdrawal scale in a general hospital.

BACKGROUND: Multi-item scales for monitoring alcohol withdrawal reactions have been used since the 1970s, and since 1985 we have used a modified version of the Clinical Institute Withdrawal Assessment (CIWA) in our general hospitals. This study was conducted to determine whether a shorter version of the scale would prove easier to use without loss of accuracy. METHODS: A simultaneous 'crossover' clinical audit using two hospitals. The shortened scale was developed from the existing one, and had 10 items as opposed to the previous 18. The patients were followed throughout their course and the incidences of complication, the frequency of sedation, the delay in initiating monitoring and the ease of use were recorded. RESULTS: There were 106 patients managed with the old scale and 96 with the new. The rate of complication was not different, being 16% in patients managed using the old scale and 14.5% using the new scale; the rates of sedation were 49 and 48%, respectively. Patients managed with the new scale had a shorter course with a median duration of 27.6 h compared with 40 h. The time from admission to first recording of a score was 5.4 h for the new scale and 4.8 h for the old, which is not a significant difference. Both scores were used according to instructions, but staff reported that the shortened scale was easier to use. CONCLUSIONS: We conclude that a shortened form of the CIWA alcohol withdrawal scale works as well as the original and is simple to use.

Adult↗
PubMed2000

Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.

The Hill-Bone Compliance to High Blood Pressure Therapy Scale assesses patient behaviors for three important behavioral domains of high blood pressure treatment: 1) reduced sodium intake; 2) appointment keeping; and 3) medication taking. This scale is comprised of 14 items in three subscales. Each item is a four point Likert type scale. The content validity of the scale was assessed by a relevant literature review and an expert panel, which focused on cultural sensitivity and appropriateness of the instrument for low literacy. Internal consistency reliability and predictive validity of the scale were evaluated using two community based samples of hypertensive adults enrolled in clinical trials of high blood pressure care and control. The standardized alpha for the total scale were 0.74 and 0.84, and the average interitem correlations of the 14 items were 0.18 and 0.28, respectively. The construct and predictive validity of the scale was assessed by factor analysis and by testing of theoretically derived hypotheses regarding whether the scale demonstrated consistent and expected relationships with related variables. In this study, high compliance scale scores predicted significantly lower levels of blood pressure and blood pressure control. Moreover, high compliance scale scores at the baseline were significantly associated with blood pressure control at both baseline and at follow up in the two independent samples. This brief instrument provides a simple method for clinicians in various settings to use to assess patients' self reported compliance levels and to plan appropriate interventions.

Adult↗
PubMed2002

Considerations of anthropometric, tissue volume, and tissue mass scaling for improved patient specificity of skeletal S values.

It is generally acknowledged that reference man (70 kg in mass and 170 cm in height) does not adequately represent the stature and physical dimensions of many patients undergoing radionuclide therapy, and thus scaling of radionuclide S values is required for patient specificity. For electron and beta sources uniformly distributed within internal organs, the mean dose from self-irradiation is noted to scale inversely with organ mass, provided no escape of electron energy occurs at the organ boundaries. In the skeleton, this same scaling approach is further assumed to be correct for marrow dosimetry; nevertheless, difficulties in quantitative assessments of marrow mass in specific skeletal regions of the patient make this approach difficult to implement clinically. Instead, scaling of marrow dose is achieved using various anthropometric parameters that presumably scale in the same proportion. In this study, recently developed three-dimensional macrostructural transport models of the femoral head and humeral epiphysis in three individuals (51-year male, 82-year female, and 86-year female) are used to test the abilities of different anthropometric parameters (total body mass, body surface area, etc.) to properly scale radionuclide S values from reference man models. The radionuclides considered are 33P, 177Lu, 153Sm, 186Re, 89Sr, 166Ho, 32P, 188Re, and 90Y localized in either the active marrow or endosteal tissues of the bone trabeculae. S value scaling is additionally conducted in which the 51-year male subject is assigned as the reference individual; scaling parameters are then expanded to include tissue volumes and masses for both active marrow and skeletal spongiosa. The study concludes that, while no single anthropometric parameter emerges as a consistent scaler of reference man S values, lean body mass is indicated as an optimal scaler when the reference S values are based on 3D transport techniques. Furthermore, very exact patient-specific scaling of radionuclide S values can be achieved if measurements of spongiosa volume and marrow volume fraction (high-resolution CT with image segmentation) are known in both the patient and the reference individual at skeletal sites for which dose estimates are sought. However, the study indicates that measurements of the spongiosa volume alone may be sufficient for reasonable patient-specific scaling of S values for the majority of radionuclides of interest in internal-emitter therapy.

Aged↗
PubMed2000

A principle of least complexity for musical scales.

The following properties of equally tempered scales are demonstrated in this Letter: For N semitones and M notes, each distinct scale (interval) structure can be represented by an associated multiplet of N scales. These scales allow themselves to be labeled by a set of integers ¿c¿. Each label c is the difference between the number of sharps and flats in a given scale. The equivalence classes [c] modulo N form a commutative ring with unity. When the ratio N/M cannot be simplified further, then each member of a given multiplet will have a unique label (modulo N), different from the other members of the same multiplet. Because this labeling depends not on the interval structure of the multiplet but only on N and M, different multiplets with the same N and M values will have members carrying the same respective labels. Each equally tempered scale (interval) structure possesses a property which will be referred to as complexity. This Letter proposes a quantitative measure for complexity which distinguishes between different scale (interval) structures. For the particular case where N= 12 and M=7, out of 462 possible different equally tempered scale structures, those with minimum complexity are the major scale and the modes, which suggests a minimum principle in music based on equally tempered scales. This simplicity of structure allows the practical use of key signatures in music.

Models, Theoretical↗
PubMed2005

Critical appraisal and review of the Rankin scale and its derivatives.

BACKGROUND AND PURPOSE: Efforts to reduce stroke burden require accurate assessment of outcomes in order to compare treatments. The Rankin Scale and its derivatives, the Modified Rankin Scale and the Oxford Handicap Scale, taken together, are among the most common outcome measures that have been used in stroke research. The aim of this study was to perform a critical appraisal of the clinimetric properties of these scales. It was also planned to review the use of these scales in a selection of articles to illustrate concerns raised by the critical appraisal. SUMMARY OF REVIEW: A literature search was performed using electronic databases to locate relevant articles about the reviewed scales. The scales were appraised using a structured format regarding the following properties: purpose, development, presentation, language, method of administration, content validity, face validity, feasibility, construct validity, reliability, responsiveness, and generalizability. There are concerns in each of the appraised areas regarding the clinimetric properties of these scales. CONCLUSION: Further work is needed to improve the clinimetric properties of the reviewed scales to ensure that they are more useful tools in determining the outcome of stroke. Alternatively, a newer global outcome scale with improved clinimetric properties may be a better option for future stroke research.

Databases, Factual↗
PubMed2005

A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia.

BACKGROUND AND PURPOSE: One possible mechanism of cognitive decline in individuals with subcortical vascular disease is disruption of cholinergic fibers by ischemic lesions, such as strategically located white matter hyperintensities (WMH). The authors applied a new MRI visual rating scale to assess WMH within cholinergic pathways in patients with Alzheimer Disease (AD) and subcortical ischemic microvascular disease. METHODS: Subjects included 60 AD patients with and without WMH, matched for age, as well as 15 control subjects. A visual rating scale was developed based on published immunohistochemical tracings of the cholinergic pathways in humans. On 4 selected axial images, the severity of WMH in the cholinergic pathways was rated on a 3-point scale for ten regions, identified with major anatomical landmarks. A published, consensus-derived, general WMH scale was also applied. All subjects underwent standardized neuropsychological testing. RESULTS: The Cholinergic Pathways HyperIntensities Scale showed reliability and was validated with volumetry of strategic WMH. After accounting for age and education in a multiple linear regression model, The Cholinergic Pathways HyperIntensities Scale ratings were associated with impaired performance on the Mattis Dementia Rating Scale (r=0.40; P=0.02) and accounted for 12% of the variance (corrected r2). A similar model was not significant for general WMH scores. CONCLUSIONS: The new MRI rating scale for WMH in cholinergic pathways is reliable and shows stronger correlations with cognitive performance than a general WMH rating scale in AD with WMH. This new rating scale provides indirect evidence that localization of WMH within neurotransmitter systems may contribute to cognitive decline.

Age Factors↗
PubMed2006

Development and validation of a muscular dystrophy-specific functional rating scale.

OBJECTIVE: To develop a reliable and valid new rating scale for measuring the functional impact of muscular dystrophy. DESIGN: Prospective and longitudinal investigation. SETTING: Three academic medical centres in Taiwan and the Muscular Dystrophy Association of Taiwan. MEASURES: The Brooke Scale, the Vignos Scale, the Barthel Index, muscular strength, contracture severity, and predicted forced vital capacity (FVC%). METHODS: Scale development was in three stages. In stage I, a preliminary pool of 53 items was generated from patient interviews (n = 25), literature review, existing functional rating scales and expert opinion. In stage II, these items were administered to 85 patients with muscular dystrophy. The resulting data were analysed to construct a rating scale (the Muscular Dystrophy Functional Rating Scale, MDFRS) that encompassed four unidimensional constructs: mobility, basic activities of daily living, arm function and impairment. In stage III, the measurement properties of this rating scale were assessed in 121 muscular dystrophy patients different from those examined with the preliminary instrument. RESULTS: Internal consistency reliability was excellent for all domains of the final 33-item scale, with values of Cronbach's alpha ranging from 0.84 to 0.97. Intraclass correlation coefficients for test-retest and inter-rater reliability were 0.99 for all domains of the MDFRS. The MDFRS showed moderate to high correlations with a range of functional rating scales measuring similar aspects and impairment parameters (Spearman's rho = 0.65-0.91; P < 0.001, each). Confirmatory factor analysis supported a unitary construct of the four-dimensional MDFRS. The MDFRS had small floor and ceiling effects in the study samples. Sensitivity to change was confirmed by large standardized response means for the MDFRS total score. CONCLUSIONS: The MDFRS is a reliable and valid disease-specific measure of functional status for patients with muscular dystrophy.

Activities of Daily Living↗
PubMedDate not supplied

Development and evaluation of an activity rating scale for disorders of the knee.

Reports of clinical studies of patients with knee disorders should routinely include their activity levels to enable comparison of treatment groups and to allow generalizability. The goal of this study was to develop and evaluate a new rating scale to measure activity levels of patients. We assessed reliability by administering the scale to 40 subjects on 2 separate occasions, 1 week apart. Validity was evaluated by comparing the activity rating on the new scale with that from other instruments that use activity level scales (concurrent construct validity) and also by correlating the score on the new scale with age (divergent validity). Patients easily understood the scale and were able to complete it in 1 minute. The reliability was high (intraclass correlation coefficient, 0.97). The scale also correlated well with existing activity rating scales: Spearman correlation coefficient for Cincinnati score, 0.67; for Tegner scale, 0.66; for Daniel scale, 0.52. The activity score was significantly inversely correlated with age (P = 0.002), indicating divergent validity. This instrument will facilitate generalizability of results and allow more accurate comparisons among patient groups in outcomes research in sports medicine.

Adolescent↗
PubMed2003

The Aging Males' Symptoms (AMS) scale: review of its methodological characteristics.

BACKGROUND: The current paper reviews data from different sources to get a closer impression on the psychometric and other methodological characteristics of the Aging Males' Symptoms (AMS) scale gathered recently. The scale was designed and standardized as self-administered scale to (a) to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and post androgen replacement therapy. The scale is in widespread use (14 languages). METHOD: Original data from different studies in many countries were centrally analysed to evaluate reliability and validity of the AMS. RESULTS: Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size was sometimes small. VALIDITY: The internal structure of the AMS in healthy and androgen deficient males, and across countries was sufficiently similar to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8-0.9) but lower among the sub-scales (0.5-0.7). This however suggests that the subscales are not fully independent. The comparison with other scales for aging males or screening instruments for androgen deficiency showed sufficiently good correlations, illustrating a good criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF36 where also high correlation coefficients have been shown. Methodological analyses of a treatment study of symptomatic males with testosterone demonstrated the ability of the AMS scale to measure treatment effect, irrespective of the severity of complaints before therapy. It was also shown that the AMS result can predict the independently generated (physician's) opinion about the individual treatment effect. CONCLUSION: The currently available methodological evidence points towards a high quality of the AMS scale to measure and to compare HRQoL of aging males over time or before/after treatment, it suggests a high reliability and high validity as far as the process of construct validation could be pressed ahead yet. But certainly more data will become available, particularly from ongoing clinical studies.

Adult↗
PubMed2004

Psychometric evaluation of two scales assessing functional status and peripheral neuropathy associated with chemotherapy for ovarian cancer: a gynecologic oncology group study.

PURPOSE/OBJECTIVES: To evaluate the psychometric properties of two adapted scales, one for functional status and one for peripheral neuropathy secondary to neurotoxic chemotherapy. DESIGN: Repeated measures methodologic design conducted within a Gynecologic Oncology Group (GOG) phase III clinical trial that randomly assigned patients with advanced epithelial ovarian cancer to cisplatin and cyclophosphamide or cisplatin and paclitaxel. SETTING: 8 GOG institutions participating in the GOG clinical trial. SAMPLE: 88 evaluable outpatients enrolled in the GOG clinical trial. Sample size at time 1 (T1) was 88 patients and at time 2 (T2) was 67 patients. METHODS: All scales were administered at T1 (prior to initiation of chemotherapy) and T2 (after six cycles of chemotherapy but prior to second-look laparotomy). Internal consistency reliability, criterion validity, and construct validity were evaluated, and clinical application was explored. MAIN RESEARCH VARIABLES: Self-reported peripheral neuropathy and functional status (comprised of physical function and role function subscales), the GOG performance status scale, and the GOG toxicity criteria. FINDINGS: Reliability coefficients at T1 were physical function = 0.83, role function = 0.96, and peripheral neuropathy = 0.91; at T2, they were physical function = 0.83, role function = 0.92, and peripheral neuropathy = 0.89. At T1, physical function and role function correlated positively with performance status. Peripheral neuropathy correlated positively with GOG toxicity criteria used at T2. Principal component factor analysis suggested that the functional status scale had a two-factor structure with factors representing general and specific mobility and that the peripheral neuropathy scale also had a two-factor structure with factors representing foot and hand neuropathy. CONCLUSIONS: The physical function, role function, and peripheral neuropathy scales have internal consistency, reliability, criterion validity, and construct validity. However, revision of the scales should address modification of specific questions and consider increasing the Likert scale from a four-point to a five- or seven-point scale to enhance clinical sensitivity and application. IMPLICATIONS FOR NURSING: With minor modifications, these scales should be useful in assessing physical function, role function, and peripheral neuropathy in patients who receive agents that may cause peripheral neuropathy.

Adult↗
PubMed2003

A fluidity scale for evaluating the motor strategy of the rise-to-walk task after stroke.

OBJECTIVE: (1) To develop an ordinal scale (content validity) for assessing fluidity of the rise-to-walk task (RTW); (2) to examine the concurrent validity of the fluidity scale; (3) to study the inter-rater reliability of the scale. DESIGN: A group of physical therapists participated in the scale development (content validity); a cross-sectional design was used to study the agreement between the fluidity scale and the fluidity index (criterion measure) obtained with the instrumented method (concurrent validity) and to examine the inter-rater reliability of the scale. SETTING: Rehabilitation centre. SUBJECTS: Nineteen persons with a chronic stroke and 19 age- and gender-matched healthy subjects. MAIN OUTCOME MEASURES: For the validation study: the fluidity index (FI) and the scores from the fluidity scale; for the inter-rater reliability study: duration of the RTW task and fluidity scores. RESULTS: The FI values did not overlap across categories of the scale and the relationship between FI values and the fluidity scores was 0.99. The weighted kappa (kappa(w)) indicated a substantial level of agreement between the new raters (kappa(w) = 0.78) and between the new raters and the expert rater (kappa(w) = 0.71). Corresponding mean intraclass correlation coefficients for the RTW duration were 0.95. CONCLUSION: These results indicate that the descriptors of the scale provided a gradation of fluidity comparable to the gold standard measure (FI) and that trained clinicians can use the fluidity scale with a substantial level of reliability. The RTW task is a simple clinical tool for assessing mobility and motor strategies (locomotor co-ordination) in patients presenting varying degrees of motor recovery after stroke.

Case-Control Studies↗
PubMed2003

The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors.

Fatigue is a major complaint among advanced cancer patients. Several instruments are available for measuring fatigue. The EORTC QLQ-C30 is one of the most frequently used health-related quality of life (HRQOL) instruments, and it includes a three-item fatigue subscale. Limited knowledge exists about the validity, performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument. The aim of the present study was to validate the EORTC QLQ-C30 fatigue scale (FA) against the Fatigue Questionnaire (FQ). The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer populations. The FQ measures physical (PF, seven items) and mental fatigue (MF, four items). The study population included two different cohorts: A) patients with advanced metastatic cancer included in a prospective randomized study of palliative radiotherapy (n = 238); B) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy (n = 128). The analysis demonstrated that the FA correlated higher with the PF scale (r = 0.67-0.75) as compared with the MF scale (r = 0.49-0.61). The item scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale. A factor analysis including all the items within the FA and the FQ identified two factors. All FA items loaded on a PF factor (0.70-0.85). A floor/ ceiling effect, indicating a high number of respondents with lowest, respectively, highest scores was observed more frequently in the FA as compared with the FQ. The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did. In conclusion, the EORTC QLQ-C30 fatigue scale is measuring physical fatigue. A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale. The validity of the EORTC QLQ-C30 fatigue scale is to be questioned for use in palliative care patients. In studies with fatigue as a defined end point, a domain-specific instrument should, therefore, be added.

Adult↗