Development of a Short Version of MSQOL-54 Using Factor Analysis and Item Response Theory

Abstract

BackgroundThe Multiple Sclerosis Quality of Life-54 (MSQOL-54, 52 items grouped in 12 subscales plus two single items) is the most used MS specific health related quality of life inventory.ObjectiveTo develop a shortened version of the MSQOL-54.MethodsMSQOL-54 dimensionality and metric properties were investigated by confirmatory factor analysis (CFA) and Rasch modelling (Partial Credit Model, PCM) on MSQOL-54s completed by 473 MS patients. Their mean age was 41 years, 65% were women, and median Expanded Disability Status Scale (EDSS) score was 2.0 (range 0–9.5). Differential item functioning (DIF) was evaluated for gender, age and EDSS. Dimensionality of the resulting short version was assessed by exploratory factor analysis (EFA) and CFA. Cognitive debriefing of the short instrument (vs. the original) was then performed on 12 MS patients.ResultsCFA of MSQOL-54 subscales showed that the data fitted the overall model well. Two subscales (Role Limitations—Physical, Role Limitations—Emotional) did not fit the PCM, and were removed; two other subscales (Health Perceptions, Social Function) did not fit the model, but were retained as single items. Sexual Satisfaction (single-item subscale) was also removed. The resulting MSQOL-29 consisted of 25 items grouped in 7 subscales, plus 4 single items. PCM fit statistics were within the acceptability range for all MSQOL-29 items except one which had significant DIF by age. EFA and CFA indicated adequate fit to the original two-factor (Physical and Mental Health Composites) hypothesis. Cognitive debriefing confirmed that MSQOL-29 was acceptable and had lost no key items.ConclusionsThe proposed MSQOL-29 is 50% shorter than MSQOL-54, yet preserves key quality of life dimensions. Prospective validation on a large, independent MS patient sample is ongoing.

Reliability and acceptability of the Multiple Sclerosis Quality of Life-29 questionnaire in an English-speaking cohort

“…[14][15][16] As observed by Rosato et al in the Italian speaking population, we noted a strong correlation between scores of MSQoL-54 and MSQoL-29. 8 Our data showed that reliability of MSQoL-29 is as good as that of MSQoL-54 7,15 .The MSQoL-29 is as valid and reliable a tool to evaluate QoL in PwMS as MSQoL-54. , When two different methods are measuring the same outcome, it is expected that there would be a moderate correlation based on the simple fact that the outcome being measured is the same.…”

“…The study received ethical approval from the York Research Ethics Committee. Inclusion criteria were 1) diagnosis of MS according to the 2010 revision of McDonald's criteria 8 2) ability to read and understand written English, 3) consent to participate in the trial, 4) able to attend two appointments 4 to 8 weeks apart. Patients with cognitive issues that would impair understanding of the questionnaires were excluded from the trial.…”

eMSQOL-29: Prospective validation of the abbreviated, electronic version of MSQOL-54

“…Mental Health Composite, MHC) [11]. A filter question ('During the past 4 weeks, have you had an active sexual life?')…”

Development and validation of the Rapid Positive Mental Health Instrument (R-PMHI) for measuring mental health outcomes in the population

“…The technique provides several advantages in the assessment of health outcomes that are not directly measurable by offering a framework for item selection and the benefit of allowing comparisons across diseases and subgroups [28]. A number of outcome measures including the Short WEMWBS [8], Patient-Reported Outcomes Measurement Information System (PROMIS) [29], EUROHIS-QOL 8-item index, a short version of the 26item WHO Quality of Life questionnaire (WHOQOL-BREF) [30] and the Multiple Sclerosis Quality of Life (MSQOL)-54 [31] were developed using Rasch analyses. Such patient reported and preference based outcome measures usually have ordinal scales and are prone to high floor or ceiling effects [32]; Rasch analysis has been particularly useful in reducing these.…”