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Published in: Health and Quality of Life Outcomes 1/2018

Open Access 01-12-2018 | Research

CHF-PROM: validation of a patient-reported outcome measure for patients with chronic heart failure

Authors: Jing Tian, Jiangping Xue, Xiaojuan Hu, Qinghua Han, Yanbo Zhang

Published in: Health and Quality of Life Outcomes | Issue 1/2018

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Abstract

Background

Due to a lack of an appropriate disease-specific patient-reported outcome (PRO) instrument for chronic heart failure including its social support and treatment aspects in China, this study was performed to develop a patient-reported outcome measure (PROM) for patients with chronic heart failure and evaluate its reliability, validity, and feasibility.

Methods

According to the standard PROM guidelines established by the Food and Drug Administration, an item pool was formed by reviewing a large amount of relevant literature and interviewing patients with chronic heart failure about their main symptoms. Thus, the primary scale was created after adjusting the items and language with the help of patients and experts in the field. Next, 155 patients from 8 hospitals in different districts were recruited for a pilot survey using questionnaires containing these items. The patients’ responses were analyzed using the classical test theory and item response theory to select high-quality items and determine the subdomains of the scale. This was followed by a formal investigation in the same eight hospitals. In total, 360 patients and 100 healthy subjects were included to evaluate the reliability, validity, and feasibility of the items. Through this process, the final scale was established.

Results

The final scale comprised 12 subdomains with 57 items related to physical, psychological, social, and therapeutic areas. The data analysis results of the formal investigation showed that the PROM for chronic heart failure had good reliability, validity, and feasibility. Reliability was verified by Cronbach’s alpha coefficient, which was 0.913 for the total scale, 0.903 for the physical domain, 0.941 for the psychological domain, 0.827 for the social domain, and 0.839 for the therapeutic domain. The construct validity results met the relative criteria of confirmatory factor analysis. Discriminant validity was represented by score comparisons of nine subdomains. The response rate and the effective rate of return of the CHF-PROM were 98.94% and 98.92%, respectively.

Conclusions

The final scale coincides with the theoretical framework and better reflects the overall quality of life of patients with chronic heart failure. This scale can be used as a valid instrument to evaluate clinical treatment and clinical trials of chronic heart failure.
Appendix
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Literature
1.
go back to reference Heart Failure Society of A, Lindenfeld J, Albert NM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16:e1–194.CrossRef Heart Failure Society of A, Lindenfeld J, Albert NM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16:e1–194.CrossRef
2.
go back to reference Ambrosy AP, Fonarow GC, Butler J, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014;63:1123–33.CrossRefPubMed Ambrosy AP, Fonarow GC, Butler J, et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014;63:1123–33.CrossRefPubMed
3.
go back to reference Blecker S, Paul M, Taksler G, et al. Heart failure-associated hospitalizations in the United States. J Am Coll Cardiol. 2013;61:1259–67.CrossRefPubMed Blecker S, Paul M, Taksler G, et al. Heart failure-associated hospitalizations in the United States. J Am Coll Cardiol. 2013;61:1259–67.CrossRefPubMed
4.
go back to reference Morrissey RP, Czer L, Shah PK. Chronic heart failure: current evidence, challenges to therapy, and future directions. Am J Cardiovasc Drugs. 2011;11:153–71.CrossRefPubMed Morrissey RP, Czer L, Shah PK. Chronic heart failure: current evidence, challenges to therapy, and future directions. Am J Cardiovasc Drugs. 2011;11:153–71.CrossRefPubMed
5.
go back to reference Mariell Jessup, Biykem Bozkurt, Javed Butler, et al. 2013 ACCF/AHA guideline for the Management of Heart Failure. JACC 2013; 62:147–239. Mariell Jessup, Biykem Bozkurt, Javed Butler, et al. 2013 ACCF/AHA guideline for the Management of Heart Failure. JACC 2013; 62:147–239.
6.
go back to reference Nieminen MS, Dickstein K, Fonseca C, et al. The patient perspective: quality of life in advanced heart failure with frequent hospitalisations. Int J Cardiol. 2015;191:256–64.CrossRefPubMed Nieminen MS, Dickstein K, Fonseca C, et al. The patient perspective: quality of life in advanced heart failure with frequent hospitalisations. Int J Cardiol. 2015;191:256–64.CrossRefPubMed
7.
go back to reference Schowalter MG, Gelbrich S, Störk JP, et al. Generic and disease-specific health-related QoL in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol. 2013;102:269–78.CrossRefPubMed Schowalter MG, Gelbrich S, Störk JP, et al. Generic and disease-specific health-related QoL in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol. 2013;102:269–78.CrossRefPubMed
8.
go back to reference Parissis JT, Nikolaou M, Farmakis D, et al. Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. Eur J Heart Fail. 2009;11:163–9.CrossRefPubMedPubMedCentral Parissis JT, Nikolaou M, Farmakis D, et al. Self-assessment of health status is associated with inflammatory activation and predicts long-term outcomes in chronic heart failure. Eur J Heart Fail. 2009;11:163–9.CrossRefPubMedPubMedCentral
9.
go back to reference U.S. Department of Health and Human Services FDA Center for drug evaluation and research, U.S. Department of Health and Human Services FDA Center for biologics evaluation and research, U.S. Department of Health and Human Services FDA Center for devices and radiological health. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes 2006; 4(1):79. U.S. Department of Health and Human Services FDA Center for drug evaluation and research, U.S. Department of Health and Human Services FDA Center for biologics evaluation and research, U.S. Department of Health and Human Services FDA Center for devices and radiological health. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes 2006; 4(1):79.
10.
go back to reference Patrick DL, Chiang YP. Measurement of health outcomes in treatment effectiveness evaluations: conceptual and methodological challenges. MedicalCare. 2000;38(Suppl 9):II14–25. Patrick DL, Chiang YP. Measurement of health outcomes in treatment effectiveness evaluations: conceptual and methodological challenges. MedicalCare. 2000;38(Suppl 9):II14–25.
11.
go back to reference Donaldson MS. Taking stock of health-related quality of life measurement in oncology practice in the United States. J Natl Cancer Inst Monogr. 2004;(33):155–67. Donaldson MS. Taking stock of health-related quality of life measurement in oncology practice in the United States. J Natl Cancer Inst Monogr. 2004;(33):155–67.
12.
go back to reference Ware JE. Conceptualization and Measurement of health- related quality of life: comments on an evolving field. Arch Phys Med Rehabil. 2003;844(Suppl 2):S43–51.CrossRef Ware JE. Conceptualization and Measurement of health- related quality of life: comments on an evolving field. Arch Phys Med Rehabil. 2003;844(Suppl 2):S43–51.CrossRef
13.
go back to reference Emery MP, Perrier LL, Acquadro C. Patient-reported outcome and quality of life instruments database (PROQOLID): frequently asked questions. Health Qual Life Outcomes. 2005;3:12.CrossRefPubMedPubMedCentral Emery MP, Perrier LL, Acquadro C. Patient-reported outcome and quality of life instruments database (PROQOLID): frequently asked questions. Health Qual Life Outcomes. 2005;3:12.CrossRefPubMedPubMedCentral
14.
15.
go back to reference McHorney CA. Generic health measurement: past accomplishments and a measurement paradigm for the 21st century. Annals of Internal Medicine 1997; 127 Part 2:743–750. McHorney CA. Generic health measurement: past accomplishments and a measurement paradigm for the 21st century. Annals of Internal Medicine 1997; 127 Part 2:743–750.
16.
go back to reference White EB. Outcomes: essential information for clinical decision support: an interview with Ellen B. White. Interview by Melinda L. J Health Care Finance 1998; 24(3):71–81. White EB. Outcomes: essential information for clinical decision support: an interview with Ellen B. White. Interview by Melinda L. J Health Care Finance 1998; 24(3):71–81.
17.
go back to reference Dodd BG, De Ayala R, Koch WR. Computerized adaptive testing with polytomous items. Appl Psychol Meas. 1995;19(1):5–22.CrossRef Dodd BG, De Ayala R, Koch WR. Computerized adaptive testing with polytomous items. Appl Psychol Meas. 1995;19(1):5–22.CrossRef
18.
go back to reference Green CP, Porter CB, Bresnahan DR, et al. Development and evaluation of the Kansas City cardiomyopathy questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35(5):1245–55.CrossRefPubMed Green CP, Porter CB, Bresnahan DR, et al. Development and evaluation of the Kansas City cardiomyopathy questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35(5):1245–55.CrossRefPubMed
19.
go back to reference Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota living with heart failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Am Heart J. 1992;124(4):1017–25.CrossRefPubMed Rector TS, Cohn JN. Assessment of patient outcome with the Minnesota living with heart failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Am Heart J. 1992;124(4):1017–25.CrossRefPubMed
20.
go back to reference Bilbao A, Escobar A, García-Perez L, et al. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes. 2016;14(23):1–11. Bilbao A, Escobar A, García-Perez L, et al. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes. 2016;14(23):1–11.
21.
go back to reference Sijtsma K, Emons WHM, Bouwmeester S, et al. Nonparametric IRT analysis of quality-of-life scales and its application to the World Health Organization quality-of-life scale (WHOQOL-Bref). Qual Life Res. 2008;17:275–90.CrossRefPubMedPubMedCentral Sijtsma K, Emons WHM, Bouwmeester S, et al. Nonparametric IRT analysis of quality-of-life scales and its application to the World Health Organization quality-of-life scale (WHOQOL-Bref). Qual Life Res. 2008;17:275–90.CrossRefPubMedPubMedCentral
22.
go back to reference U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research, U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research,U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health.Guidance for industry: patient-reported outcome measures: use in medical productdevelopment to support labeling claims: draft guidance.Health Qual Life Outcomes. 2006;11(4):79. U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research, U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research,U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health.Guidance for industry: patient-reported outcome measures: use in medical productdevelopment to support labeling claims: draft guidance.Health Qual Life Outcomes. 2006;11(4):79.
23.
go back to reference Nunnally JC. Psychometric theory. New York: McGraw-Hill; 1967. Nunnally JC. Psychometric theory. New York: McGraw-Hill; 1967.
24.
go back to reference Anthoine E, Moret L, Regnault A, et al. Sample size used to validate a scale a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014;176:1–10. Anthoine E, Moret L, Regnault A, et al. Sample size used to validate a scale a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014;176:1–10.
25.
go back to reference Paulsen A, Overgaard S, Lauritsen JM. Quality of data entry using single entry, double entry and automated forms processing--an example based on a study of patient-reported outcomes. PLoS One. 2012;7:e35087.CrossRefPubMedPubMedCentral Paulsen A, Overgaard S, Lauritsen JM. Quality of data entry using single entry, double entry and automated forms processing--an example based on a study of patient-reported outcomes. PLoS One. 2012;7:e35087.CrossRefPubMedPubMedCentral
26.
go back to reference Cappelleri JC, Jason LJ, Hays RD. Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clin Ther. 2014;36:648–62.CrossRefPubMedPubMedCentral Cappelleri JC, Jason LJ, Hays RD. Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clin Ther. 2014;36:648–62.CrossRefPubMedPubMedCentral
27.
go back to reference Lai JS, Cook K, Stone A, et al. Classical test theory and item response theory/Rasch model to assess differences between patient-reported fatigue using seven-day and four-week recall periods. J Clin Epidemiol. 2009;62:991–7.CrossRefPubMedPubMedCentral Lai JS, Cook K, Stone A, et al. Classical test theory and item response theory/Rasch model to assess differences between patient-reported fatigue using seven-day and four-week recall periods. J Clin Epidemiol. 2009;62:991–7.CrossRefPubMedPubMedCentral
28.
go back to reference Waller J, Ostini R, Marlow LA, et al. Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Prev Med. 2013;56:35–40.CrossRefPubMed Waller J, Ostini R, Marlow LA, et al. Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Prev Med. 2013;56:35–40.CrossRefPubMed
29.
go back to reference Meads DM, Bentall RP. Rasch analysis and item reduction of the hypomanic personality scale. Personal Individ Differ. 2008;44:1772–83.CrossRef Meads DM, Bentall RP. Rasch analysis and item reduction of the hypomanic personality scale. Personal Individ Differ. 2008;44:1772–83.CrossRef
30.
go back to reference Zhang YB. Latent variable analysis. Beijing: Higher Education Press; 2009. p. 1–5. Zhang YB. Latent variable analysis. Beijing: Higher Education Press; 2009. p. 1–5.
31.
go back to reference Hambleton RK, Swaminathan H. Item response theory: principles and applications. Springer Science & Business Media; 2013. Hambleton RK, Swaminathan H. Item response theory: principles and applications. Springer Science & Business Media; 2013.
32.
go back to reference Meads DM, McKenna SP, Doward LC, et al. Development and validation of the asthma life impact scale (ALIS). Respir Med. 2010;104:633–43.CrossRefPubMed Meads DM, McKenna SP, Doward LC, et al. Development and validation of the asthma life impact scale (ALIS). Respir Med. 2010;104:633–43.CrossRefPubMed
33.
go back to reference Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the functional assessment of Cancer therapy-breast quality-of-life instrument. J Clin Oncol. 1997;15:974–86.CrossRefPubMed Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the functional assessment of Cancer therapy-breast quality-of-life instrument. J Clin Oncol. 1997;15:974–86.CrossRefPubMed
34.
go back to reference Seock-Ho K, Cohen AS. A comparison of linking and concurrent calibrationunder the graded response model. Appl Psychol Meas. 2002;26(1):25–41.CrossRef Seock-Ho K, Cohen AS. A comparison of linking and concurrent calibrationunder the graded response model. Appl Psychol Meas. 2002;26(1):25–41.CrossRef
35.
go back to reference Broekman BF, Niti M, Nyunt MS, et al. Validation of a brief seven-item response bias-free geriatric depression scale. Am J Geriatr Psychiatry. 2011;19:589–96.CrossRefPubMed Broekman BF, Niti M, Nyunt MS, et al. Validation of a brief seven-item response bias-free geriatric depression scale. Am J Geriatr Psychiatry. 2011;19:589–96.CrossRefPubMed
36.
go back to reference Thompson LE, Bekelman DB, Allen LA, et al. Patient-reported outcomes in heart failure: existing measures and future uses. Curr Heart Fail Rep. 2015;12:236–46.CrossRefPubMed Thompson LE, Bekelman DB, Allen LA, et al. Patient-reported outcomes in heart failure: existing measures and future uses. Curr Heart Fail Rep. 2015;12:236–46.CrossRefPubMed
37.
go back to reference Neal DJ, Corbin WR, Fromme K. Measurement of alcohol-related consequences among high school and college students: application of item response models to the Rutgers alcohol problem index. Psychol Assess. 2006;18(4):402–14.CrossRefPubMed Neal DJ, Corbin WR, Fromme K. Measurement of alcohol-related consequences among high school and college students: application of item response models to the Rutgers alcohol problem index. Psychol Assess. 2006;18(4):402–14.CrossRefPubMed
38.
go back to reference Hambieton RK, Jones RW. Comparison of classical test theory and item response theory and their applications to test development. Educational measurement:issues and. Practice. 1993;12(3):38–47. Hambieton RK, Jones RW. Comparison of classical test theory and item response theory and their applications to test development. Educational measurement:issues and. Practice. 1993;12(3):38–47.
39.
go back to reference Hagman BT, Kuerbis AN, Morgenstern J, et al. An item response theory (IRT) analysis of the short inventory of problems-alcohol and drugs (SIP-AD) among non-treatment seeking men-who-have-sex-with-men: evidence for a shortened 10-item SIP-AD. Addict Behav. 2009;34(11):948–54.CrossRefPubMedPubMedCentral Hagman BT, Kuerbis AN, Morgenstern J, et al. An item response theory (IRT) analysis of the short inventory of problems-alcohol and drugs (SIP-AD) among non-treatment seeking men-who-have-sex-with-men: evidence for a shortened 10-item SIP-AD. Addict Behav. 2009;34(11):948–54.CrossRefPubMedPubMedCentral
40.
go back to reference Patoo M, Allahyari AA, Moradi AR, et al. Persian version of functional assessment of Cancer therapy- breast (FACT-B) scale: confirmatory factor analysis and psychometric properties. Asian Pac J Cancer Prev. 2015;16(9):3799–803.CrossRefPubMed Patoo M, Allahyari AA, Moradi AR, et al. Persian version of functional assessment of Cancer therapy- breast (FACT-B) scale: confirmatory factor analysis and psychometric properties. Asian Pac J Cancer Prev. 2015;16(9):3799–803.CrossRefPubMed
41.
go back to reference Fonarow GC. Clinical risk prediction tools in patients hospitalized with heart failure. Rev Cardiovasc Med. 2012;13(1):e14–23.PubMed Fonarow GC. Clinical risk prediction tools in patients hospitalized with heart failure. Rev Cardiovasc Med. 2012;13(1):e14–23.PubMed
42.
go back to reference Kanatas A, Velikova G, Roe B, et al. Patient-reported outcomes in breast oncology: a review of validated outcome instruments. Tumori. 2012;98(6):678–88.CrossRefPubMed Kanatas A, Velikova G, Roe B, et al. Patient-reported outcomes in breast oncology: a review of validated outcome instruments. Tumori. 2012;98(6):678–88.CrossRefPubMed
Metadata
Title
CHF-PROM: validation of a patient-reported outcome measure for patients with chronic heart failure
Authors
Jing Tian
Jiangping Xue
Xiaojuan Hu
Qinghua Han
Yanbo Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2018
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-018-0874-2

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