Christensen J.1,2, Doherty P.3, Bjorner J.B.4,5, Langberg H.2
1Copenhagen University Hospital, Rigshospitalet, Dept of Occupational- and Physiotherapy, Copenhagen, Denmark, 2University of Copenhagen, CopenRehab, Faculty of Health, Dept of Social Medicine, Copenhagen, Denmark, 3University of York, Department of Health Sciences, York, United Kingdom, 4University of Copenhagen, Section of Social Medicine, Dept. of Public Health, Faculty of Health, Copenhagen, Denmark, 5Optum Patient Insights, Lincoln, Rhodes Island, United States
Background: While the in-hospital mortality rate for major lower limb amputation is relatively high 16.8%, most amputees live with prostheses for a long time. Therefore, quality of life is an important outcome for lower limb amputees. The prosthesis evaluation questionnaire (PEQ) was developed for investigation of prosthesis related quality of life in lower limb amputees and is widely used in the evaluation of prosthetic care.
Purpose: The purpose of this study are to
(1) translate and culturally adapt the Prosthesis Evaluation Questionnaire into Danish
(2) evaluate test-retest reliability
(3) evaluate internal consistency reliability and
(4) evaluate construct validity by testing hypotheses regarding the associations between subscales in the Prosthesis Evaluation Questionnaire and the Short Form-36 Health Survey.
(1) translate and culturally adapt the Prosthesis Evaluation Questionnaire into Danish
(2) evaluate test-retest reliability
(3) evaluate internal consistency reliability and
(4) evaluate construct validity by testing hypotheses regarding the associations between subscales in the Prosthesis Evaluation Questionnaire and the Short Form-36 Health Survey.
Methods: The PEQ was tested in a group of lower limb amputees that responded to electronic versions of the PEQ and SF-36v2 at baseline (n=64), after two weeks (n=51), and after 12 weeks (n=50). In addition to descriptive statistics, reliability was assessed using Cronbachs alpha and intraclass correlation (ICC) analyses of the baseline and two weeks test-retest data. Estimates for standard error of measurement (SEM) were calculated based on reliability estimates. Construct validity was evaluated by testing prespecified hypotheses regarding the correlation between PEQ and SF-36 subscales.
Results: Reliability estimates (ICC/Cronbachs alpha) for the nine subscales were: Social Burden (0.85/0.76), Appearance (0.85/0.72), Residual Limb Health (0.80/0.69), Well-Being (0.78/0.90), Utility (0.76/0.89), Frustration (0.74/0.90), Perceived Response (0.62/0.80), Ambulation (0.61/0.94), Sounds (0.51/0.65). Construct validity was supported in three out of four scales evaluated (Social Burden, and Wellbeing), but contrary to expectations, the Residual Limb Health scale had fairly low correlation (0.36) with the SF-36 Bodily Pain scale.
Conclusion(s): In conclusion, the findings of the present study indicate that the PEQ subscales Social Burden, Appearance, Well-Being, Utility and Frustration are reliable and can be used in assessing the prosthesis related quality of life in lower limb amputees. However, our findings also indicate conflicting results concerning the subscales: Residual Limb Health, Ambulation, and Perceived R. The reliability and validity of these scales should be evaluated in larger samples. The Sound subscale showed poor test-retest and internal consistency reliability.
Implications: This is the first prosthesis related quality of life questionnaire that is available in Danish for testing of patients with lower limb amputation. Health providers in clinical practice can now through a patient reported outcome measure identify patients with reduced quality of life and measure treatment and rehabilitation effects over time. However the health care providers should be aware of the psychometric challenges related to the subscales: Residual Limb Health, Ambulation, Perceived Responses, and Sounds.
Funding acknowledgements: This study was funded by a strategic grant from the Danish Defense Agreement and by the Danish Association of Physiotherapists.
Topic: Disability & rehabilitation
Ethics approval: The study complied with ethical principles presented in the Helsinki Declaration. The Danish data protection agency approved the study (RH#35-3561).
All authors, affiliations and abstracts have been published as submitted.
