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Cross-cultural validity of four quality of life scales in persons with spinal cord injury.

Geyh S, Fellinghauer BA, Kirchberger I, Post MW - Health Qual Life Outcomes (2010)

Bottom Line: However, comparability of measurement results between countries depends on the cross-cultural validity of the applied instruments.Using differential item functioning (DIF) analyses potential cross-country bias was found in two items of the SWLS and the WHOQoL-5, three items of the LISAT-9 and four items of the PWI.The findings of the current study can be especially helpful to select instruments for international research projects in SCI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Swiss Paraplegic Research SPF, Nottwil, Switzerland. szilvia.geyh@paranet.ch

ABSTRACT

Background: Quality of life (QoL) in persons with spinal cord injury (SCI) has been found to differ across countries. However, comparability of measurement results between countries depends on the cross-cultural validity of the applied instruments. The study examined the metric quality and cross-cultural validity of the Satisfaction with Life Scale (SWLS), the Life Satisfaction Questionnaire (LISAT-9), the Personal Well-Being Index (PWI) and the 5-item World Health Organization Quality of Life Assessment (WHOQoL-5) across six countries in a sample of persons with spinal cord injury (SCI).

Methods: A cross-sectional multi-centre study was conducted and the data of 243 out-patients with SCI from study centers in Australia, Brazil, Canada, Israel, South Africa, and the United States were analyzed using Rasch-based methods.

Results: The analyses showed high reliability for all 4 instruments (person reliability index .78-.92). Unidimensionality of measurement was supported for the WHOQoL-5 (Chi2 = 16.43, df = 10, p = .088), partially supported for the PWI (Chi2 = 15.62, df = 16, p = .480), but rejected for the LISAT-9 (Chi2 = 50.60, df = 18, p = .000) and the SWLS (Chi2 = 78.54, df = 10, p = .000) based on overall and item-wise Chi2 tests, principal components analyses and independent t-tests. The response scales showed the expected ordering for the WHOQoL-5 and the PWI, but not for the other two instruments. Using differential item functioning (DIF) analyses potential cross-country bias was found in two items of the SWLS and the WHOQoL-5, three items of the LISAT-9 and four items of the PWI. However, applying Rasch-based statistical methods, especially subtest analyses, it was possible to identify optimal strategies to enhance the metric properties and the cross-country equivalence of the instruments post-hoc. Following the post-hoc procedures the WHOQOL-5 and the PWI worked in a consistent and expected way in all countries.

Conclusions: QoL assessment using the summary scores of the WHOQOL-5 and the PWI appeared cross-culturally valid in persons with SCI. In contrast, summary scores of the LISAT-9 and the SWLS have to be interpreted with caution. The findings of the current study can be especially helpful to select instruments for international research projects in SCI.

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Overview of the four Rasch-based strategies applied to account for the weaknesses in the metric properties of the four quality of life instruments post-hoc.
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Figure 1: Overview of the four Rasch-based strategies applied to account for the weaknesses in the metric properties of the four quality of life instruments post-hoc.

Mentions: Based on the results of Rasch analyses different approaches can be taken to account for weaknesses in the metric properties of the instruments post-hoc. To come up with suggestions to enhance the measurement properties and cross-cultural validity of the instruments across countries, four alternative strategies of handling the data set were tested and compared. As a result, for each instrument an optimal solution for handling the data could be identified, which allows for acceptable measurement properties with as little change to the instrument as possible. Figure 1 gives an overview of the four strategies implemented in the post-hoc analyses.


Cross-cultural validity of four quality of life scales in persons with spinal cord injury.

Geyh S, Fellinghauer BA, Kirchberger I, Post MW - Health Qual Life Outcomes (2010)

Overview of the four Rasch-based strategies applied to account for the weaknesses in the metric properties of the four quality of life instruments post-hoc.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944343&req=5

Figure 1: Overview of the four Rasch-based strategies applied to account for the weaknesses in the metric properties of the four quality of life instruments post-hoc.
Mentions: Based on the results of Rasch analyses different approaches can be taken to account for weaknesses in the metric properties of the instruments post-hoc. To come up with suggestions to enhance the measurement properties and cross-cultural validity of the instruments across countries, four alternative strategies of handling the data set were tested and compared. As a result, for each instrument an optimal solution for handling the data could be identified, which allows for acceptable measurement properties with as little change to the instrument as possible. Figure 1 gives an overview of the four strategies implemented in the post-hoc analyses.

Bottom Line: However, comparability of measurement results between countries depends on the cross-cultural validity of the applied instruments.Using differential item functioning (DIF) analyses potential cross-country bias was found in two items of the SWLS and the WHOQoL-5, three items of the LISAT-9 and four items of the PWI.The findings of the current study can be especially helpful to select instruments for international research projects in SCI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Swiss Paraplegic Research SPF, Nottwil, Switzerland. szilvia.geyh@paranet.ch

ABSTRACT

Background: Quality of life (QoL) in persons with spinal cord injury (SCI) has been found to differ across countries. However, comparability of measurement results between countries depends on the cross-cultural validity of the applied instruments. The study examined the metric quality and cross-cultural validity of the Satisfaction with Life Scale (SWLS), the Life Satisfaction Questionnaire (LISAT-9), the Personal Well-Being Index (PWI) and the 5-item World Health Organization Quality of Life Assessment (WHOQoL-5) across six countries in a sample of persons with spinal cord injury (SCI).

Methods: A cross-sectional multi-centre study was conducted and the data of 243 out-patients with SCI from study centers in Australia, Brazil, Canada, Israel, South Africa, and the United States were analyzed using Rasch-based methods.

Results: The analyses showed high reliability for all 4 instruments (person reliability index .78-.92). Unidimensionality of measurement was supported for the WHOQoL-5 (Chi2 = 16.43, df = 10, p = .088), partially supported for the PWI (Chi2 = 15.62, df = 16, p = .480), but rejected for the LISAT-9 (Chi2 = 50.60, df = 18, p = .000) and the SWLS (Chi2 = 78.54, df = 10, p = .000) based on overall and item-wise Chi2 tests, principal components analyses and independent t-tests. The response scales showed the expected ordering for the WHOQoL-5 and the PWI, but not for the other two instruments. Using differential item functioning (DIF) analyses potential cross-country bias was found in two items of the SWLS and the WHOQoL-5, three items of the LISAT-9 and four items of the PWI. However, applying Rasch-based statistical methods, especially subtest analyses, it was possible to identify optimal strategies to enhance the metric properties and the cross-country equivalence of the instruments post-hoc. Following the post-hoc procedures the WHOQOL-5 and the PWI worked in a consistent and expected way in all countries.

Conclusions: QoL assessment using the summary scores of the WHOQOL-5 and the PWI appeared cross-culturally valid in persons with SCI. In contrast, summary scores of the LISAT-9 and the SWLS have to be interpreted with caution. The findings of the current study can be especially helpful to select instruments for international research projects in SCI.

Show MeSH
Related in: MedlinePlus