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Multicenter Study
. 2017 Nov;26(11):2931-2947.
doi: 10.1007/s11136-017-1660-z. Epub 2017 Jul 27.

Longitudinal validity and reliability of the Myeloma Patient Outcome Scale (MyPOS) was established using traditional, generalizability and Rasch psychometric methods

Christina Ramsenthaler  1 , Wei Gao  2 , Richard J Siegert  2   3 , Steve A Schey  4 , Poly M Edmonds  5 , Irene J Higginson  2
Affiliations
Multicenter Study

Longitudinal validity and reliability of the Myeloma Patient Outcome Scale (MyPOS) was established using traditional, generalizability and Rasch psychometric methods

Christina Ramsenthaler et al. Qual Life Res. 2017 Nov.

Abstract

Purpose: The Myeloma Patient Outcome Scale (MyPOS) was developed to measure quality of life in routine clinical care. The aim of this study was to determine its longitudinal validity, reliability, responsiveness to change and its acceptability.

Methods: This 14-centre study recruited patients with multiple myeloma. At baseline and then every two months for 5 assessments, patients completed the MyPOS. Psychometric properties evaluated were as follows: (a) confirmatory factor analysis and scaling assumptions (b) reliability: Generalizability theory and Rasch analysis, (c) responsiveness and minimally important difference (MID) relating changes in scores between baseline and subsequent assessments to an external criterion, (d) determining the acceptability of self-monitoring.

Results: 238 patients with multiple myeloma were recruited. Confirmatory factor analysis found three subscales; criteria for scaling assumptions were satisfied except for gastrointestinal items and the Healthcare support scale. Rasch analysis identified limitations of suboptimal scale-to-sample targeting, resulting in floor effects. Test-retest reliability indices were good (R = > 0.97). Responsiveness analysis yielded an MID of +2.5 for improvement and -4.5 for deterioration.

Conclusions: The MyPOS demonstrated good longitudinal measurement properties, with potential areas for revision being the Healthcare Support subscale and the rating scale. The new psychometric approaches should be used for testing validity of monitoring in clinical settings.

Keywords: Health status; Multiple myeloma; Quality of life; Rasch analysis; Responsiveness.

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Conflict of interest statement

Conflicts of interest

All authors declare that they have no conflicts of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical and research governance approvals were obtained from the Central London Research Ethics Committee (reference number: 13/LO/1140) with further local Research and Development approvals obtained from all participating NHS hospital trusts. These collaborating centres were Bradford Teaching Hospitals NHS Foundation Trust, Burton Hospitals NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust, East Cheshire NHS Trust, Epsom and St Helier University Hospitals NHS Trust, Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, Medway NHS Foundation Trust, Mid Yorkshire Hospitals NHS Trust, Royal Free London NHS Foundation Trust, Surrey and Sussex Healthcare NHS Trust, and the University Hospital Coventry and Warwickshire NHS Trust. These collaborating and supporting organisations were not involved in planning the study or preparing the manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Targeting of the sample (person-item location distribution maps) for the three subscales Symptoms (first panel), Emotional response (second panel), and Healthcare Support (third panel) Note the figure shows the distribution of person measurements (upper histogram) against the distribution of item locations (lower histogram). People are located along a continuum of low quality of life (left-hand side) to better quality of life (right-hand side). Items are located relative to their difficulty: easier items (representing lesser impact on quality of life) on the right-hand side, and the most difficult items (required for a better quality of life) on the left-hand side. People outside the scales measurement range (−2 to +2 logits) indicate suboptimal scale-to-scale targeting. A ceiling effect is seen when the person locations on the left-hand side do not cover the item locations below, meaning items not discriminating in the portion of the sample with high quality of life
Fig. 2
Fig. 2
Responsiveness of the total MyPOS change score over 8 months post baseline. Note a negative change score on the total MyPOS denotes an improvement in quality of life
See this image and copyright information in PMC

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