Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population

N. Kruithof, J.A. Haagsma, M. Karabatzakis, M.C. Cnossen, Leonie de Munter, C.L.P. van de Ree, Mariska de Jongh, S. Polinder

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Introduction
While the number of trauma patients surviving their injury increase, it is important to measure Quality of Life (QoL). The Abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire can be used to assess QoL. However, its psychometric properties in trauma patients are unknown and therefore, we aimed to investigate the validity and reliability of the WHOQOL-BREF for the hospitalized trauma population.

Methods
Data were derived from the Brabant Injury Outcome Surveillance. Floor and ceiling effects and missing values of the WHOQOL-BREF were examined. Confirmatory factor analysis (CFA) was performed to examine the underlying 4 dimensions (i.e. physical, psychological, social and environmental) of the questionnaire. Cronbach’s alpha (CA) was calculated to determine internal consistency. In total, 42 hypotheses were formulated to determine construct validity and 6 hypotheses were created to determine discriminant validity. To determine construct validity, Spearman’s correlations were calculated between the WHOQOL-BREF and the EuroQol-five-dimension-3-level questionnaire, the Health Utility Index Mark 2 and 3, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. Discriminant validity between patients with minor injuries (i.e. Injury Severity Score (ISS)≤8) and moderate/severe injuries (i.e. ISS ≥ 9) was examined by conducting Mann-Whitney-U-tests.

Results
In total, 202 patients (median 63y) participated in this study with a median of 32 days (interquartile range 29–37) post-trauma. The WHOQOL-BREF showed no problematic floor and ceiling effects. The CFA revealed a moderate model fit. The domains showed good internal consistency, with the exception of the social domain. All individual items and domain scores of the WHOQOL-BREF showed nearly symmetrical distributions since mean scores were close to median scores, except of the ‘general health’ item. The highest percentage of missing values was found on the ‘sexual activity’ item (i.e. 19.3%). The WHOQOL-BREF showed moderate construct and discriminant validity since in both cases, 67% of the hypotheses were confirmed.

Conclusion
The present study provides support for using the WHOQOL-BREF for the hospitalized trauma population since the questionnaire appears to be valid and reliable. The WHOQOL-BREF can be used to assess QoL in a heterogeneous group of hospitalized trauma patients accurately.
Original languageEnglish
Pages (from-to)1796-1804
JournalInjury
Volume49
Issue number10
DOIs
Publication statusPublished - 2018

Fingerprint

Wounds and Injuries
Statistical Factor Analysis
Injury Severity Score
Nonparametric Statistics
Depression
Surveys and Questionnaires

Keywords

  • DEPRESSIVE SYMPTOMS
  • INJURY
  • Injury
  • OLDER-PEOPLE
  • PATIENT
  • PSYCHOMETRIC PROPERTIES
  • QUESTIONNAIRE
  • QoL questionnaire
  • Quality of life
  • SCALE
  • SHORT-FORM
  • Trauma
  • VALIDITY
  • Validity
  • WHOQOL-BREF
  • WOMEN

Cite this

Kruithof, N. ; Haagsma, J.A. ; Karabatzakis, M. ; Cnossen, M.C. ; de Munter, Leonie ; van de Ree, C.L.P. ; de Jongh, Mariska ; Polinder, S. / Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population. In: Injury. 2018 ; Vol. 49, No. 10. pp. 1796-1804.
@article{3bace5bf2e1a4213ac6d4c495d4c2111,
title = "Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population",
abstract = "IntroductionWhile the number of trauma patients surviving their injury increase, it is important to measure Quality of Life (QoL). The Abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire can be used to assess QoL. However, its psychometric properties in trauma patients are unknown and therefore, we aimed to investigate the validity and reliability of the WHOQOL-BREF for the hospitalized trauma population.MethodsData were derived from the Brabant Injury Outcome Surveillance. Floor and ceiling effects and missing values of the WHOQOL-BREF were examined. Confirmatory factor analysis (CFA) was performed to examine the underlying 4 dimensions (i.e. physical, psychological, social and environmental) of the questionnaire. Cronbach’s alpha (CA) was calculated to determine internal consistency. In total, 42 hypotheses were formulated to determine construct validity and 6 hypotheses were created to determine discriminant validity. To determine construct validity, Spearman’s correlations were calculated between the WHOQOL-BREF and the EuroQol-five-dimension-3-level questionnaire, the Health Utility Index Mark 2 and 3, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. Discriminant validity between patients with minor injuries (i.e. Injury Severity Score (ISS)≤8) and moderate/severe injuries (i.e. ISS ≥ 9) was examined by conducting Mann-Whitney-U-tests.ResultsIn total, 202 patients (median 63y) participated in this study with a median of 32 days (interquartile range 29–37) post-trauma. The WHOQOL-BREF showed no problematic floor and ceiling effects. The CFA revealed a moderate model fit. The domains showed good internal consistency, with the exception of the social domain. All individual items and domain scores of the WHOQOL-BREF showed nearly symmetrical distributions since mean scores were close to median scores, except of the ‘general health’ item. The highest percentage of missing values was found on the ‘sexual activity’ item (i.e. 19.3{\%}). The WHOQOL-BREF showed moderate construct and discriminant validity since in both cases, 67{\%} of the hypotheses were confirmed.ConclusionThe present study provides support for using the WHOQOL-BREF for the hospitalized trauma population since the questionnaire appears to be valid and reliable. The WHOQOL-BREF can be used to assess QoL in a heterogeneous group of hospitalized trauma patients accurately.",
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author = "N. Kruithof and J.A. Haagsma and M. Karabatzakis and M.C. Cnossen and {de Munter}, Leonie and {van de Ree}, C.L.P. and {de Jongh}, Mariska and S. Polinder",
year = "2018",
doi = "10.1016/j.injury.2018.08.016",
language = "English",
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pages = "1796--1804",
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Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population. / Kruithof, N.; Haagsma, J.A.; Karabatzakis, M.; Cnossen, M.C.; de Munter, Leonie; van de Ree, C.L.P.; de Jongh, Mariska; Polinder, S.

In: Injury, Vol. 49, No. 10, 2018, p. 1796-1804.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population

AU - Kruithof, N.

AU - Haagsma, J.A.

AU - Karabatzakis, M.

AU - Cnossen, M.C.

AU - de Munter, Leonie

AU - van de Ree, C.L.P.

AU - de Jongh, Mariska

AU - Polinder, S.

PY - 2018

Y1 - 2018

N2 - IntroductionWhile the number of trauma patients surviving their injury increase, it is important to measure Quality of Life (QoL). The Abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire can be used to assess QoL. However, its psychometric properties in trauma patients are unknown and therefore, we aimed to investigate the validity and reliability of the WHOQOL-BREF for the hospitalized trauma population.MethodsData were derived from the Brabant Injury Outcome Surveillance. Floor and ceiling effects and missing values of the WHOQOL-BREF were examined. Confirmatory factor analysis (CFA) was performed to examine the underlying 4 dimensions (i.e. physical, psychological, social and environmental) of the questionnaire. Cronbach’s alpha (CA) was calculated to determine internal consistency. In total, 42 hypotheses were formulated to determine construct validity and 6 hypotheses were created to determine discriminant validity. To determine construct validity, Spearman’s correlations were calculated between the WHOQOL-BREF and the EuroQol-five-dimension-3-level questionnaire, the Health Utility Index Mark 2 and 3, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. Discriminant validity between patients with minor injuries (i.e. Injury Severity Score (ISS)≤8) and moderate/severe injuries (i.e. ISS ≥ 9) was examined by conducting Mann-Whitney-U-tests.ResultsIn total, 202 patients (median 63y) participated in this study with a median of 32 days (interquartile range 29–37) post-trauma. The WHOQOL-BREF showed no problematic floor and ceiling effects. The CFA revealed a moderate model fit. The domains showed good internal consistency, with the exception of the social domain. All individual items and domain scores of the WHOQOL-BREF showed nearly symmetrical distributions since mean scores were close to median scores, except of the ‘general health’ item. The highest percentage of missing values was found on the ‘sexual activity’ item (i.e. 19.3%). The WHOQOL-BREF showed moderate construct and discriminant validity since in both cases, 67% of the hypotheses were confirmed.ConclusionThe present study provides support for using the WHOQOL-BREF for the hospitalized trauma population since the questionnaire appears to be valid and reliable. The WHOQOL-BREF can be used to assess QoL in a heterogeneous group of hospitalized trauma patients accurately.

AB - IntroductionWhile the number of trauma patients surviving their injury increase, it is important to measure Quality of Life (QoL). The Abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire can be used to assess QoL. However, its psychometric properties in trauma patients are unknown and therefore, we aimed to investigate the validity and reliability of the WHOQOL-BREF for the hospitalized trauma population.MethodsData were derived from the Brabant Injury Outcome Surveillance. Floor and ceiling effects and missing values of the WHOQOL-BREF were examined. Confirmatory factor analysis (CFA) was performed to examine the underlying 4 dimensions (i.e. physical, psychological, social and environmental) of the questionnaire. Cronbach’s alpha (CA) was calculated to determine internal consistency. In total, 42 hypotheses were formulated to determine construct validity and 6 hypotheses were created to determine discriminant validity. To determine construct validity, Spearman’s correlations were calculated between the WHOQOL-BREF and the EuroQol-five-dimension-3-level questionnaire, the Health Utility Index Mark 2 and 3, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. Discriminant validity between patients with minor injuries (i.e. Injury Severity Score (ISS)≤8) and moderate/severe injuries (i.e. ISS ≥ 9) was examined by conducting Mann-Whitney-U-tests.ResultsIn total, 202 patients (median 63y) participated in this study with a median of 32 days (interquartile range 29–37) post-trauma. The WHOQOL-BREF showed no problematic floor and ceiling effects. The CFA revealed a moderate model fit. The domains showed good internal consistency, with the exception of the social domain. All individual items and domain scores of the WHOQOL-BREF showed nearly symmetrical distributions since mean scores were close to median scores, except of the ‘general health’ item. The highest percentage of missing values was found on the ‘sexual activity’ item (i.e. 19.3%). The WHOQOL-BREF showed moderate construct and discriminant validity since in both cases, 67% of the hypotheses were confirmed.ConclusionThe present study provides support for using the WHOQOL-BREF for the hospitalized trauma population since the questionnaire appears to be valid and reliable. The WHOQOL-BREF can be used to assess QoL in a heterogeneous group of hospitalized trauma patients accurately.

KW - DEPRESSIVE SYMPTOMS

KW - INJURY

KW - Injury

KW - OLDER-PEOPLE

KW - PATIENT

KW - PSYCHOMETRIC PROPERTIES

KW - QUESTIONNAIRE

KW - QoL questionnaire

KW - Quality of life

KW - SCALE

KW - SHORT-FORM

KW - Trauma

KW - VALIDITY

KW - Validity

KW - WHOQOL-BREF

KW - WOMEN

U2 - 10.1016/j.injury.2018.08.016

DO - 10.1016/j.injury.2018.08.016

M3 - Article

VL - 49

SP - 1796

EP - 1804

JO - Injury

JF - Injury

SN - 0020-1383

IS - 10

ER -