Health Constructs and Measurement
I. Health Outcomes
Mental Health-
(Depression, Anxiety, etc.)
Secondary and Chronic Conditions
General
Health/ Perceived Health
Role
limitations (physical and emotional)
Sleeping
Problems/ Disturbance
Mental Health- (Depression, Anxiety, etc.)
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Instrument Name and Original
Reference |
Instrument Description &
Construct Measured |
Dimensions/ subscales |
Indicator (Timing + Source of
Data) |
Variables (Number of Items, Scale,
& Range) |
Test Population |
Instrument Reliability |
Psychometric Review of Instrument
Validity |
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Center for
Epidemiologic Studies Depression Scale- 10 item version CES-D 10 Andresen,
Malmgren, |
10-item
screening questionnaire for “depressive symptoms”. Measures severity of
depression. Shortened version of 20-item CES-D). Does not
diagnose depression. |
No subscales; no
established cutoff scores, although ≥ 8 and ≥ 10 have been used. Generally a cutoff of ≥ 10 is used for screening purposes. (Cutoff of ≥ 16
indicates depressive symptoms in the original CES-D, which was validated
using DSM-III criteria) |
Past week; Self-administered
questionnaire. Header:
“How often have you felt this way during the last week” |
10 items, Ordinal scale; Range of scale: 0-3 (0= rarely
or none of time, 1= some or
little (1-2 days) 2=occas/
mod (3-4 days) 3= most of
time (5-7 days) Two items
(#5, 8) are positive and therefore reverse-scored Only two
sets of variables, (positive and negative affect) in CESD-10; original CES-D
had 4 factors (depressed affect, positive affect, somatic, and
interpersonal). Scores
range from 0 to 30, with higher scores indicating higher degree of depressive
symptoms. |
N= 1,206 ≥65 yrs, x= 72, from random sample of 4,250 GHC insurance
enrollees who were ≥ 65 yrs; individuals with
significant disabilities or major physical or psychosocial problems were
excluded before study. Slightly higher SES than avg in King Co., |
Compared
baseline & retest responses with 10 items common to both instruments.
Test-retest item correlation ranged from r=.21 to r=.84, with overall score
correlation of r=.71 (comparable to 20-item CES-D). Also, looked at changes
in classification btw 2 administrations. Of CESD-10: at ≥8, 1 disag.
Btw admins, at ≥10, 1 disag. Tested stability by comparing baseline
& 12-mth scores; r=.59 (p<.01) for n=1,006 |
Using cutoff of ≥8 results in 10 false pos, ĸ=.75, using cutoff of ≥10 results in one false negative, ĸ=.97, compared to
20-item CES-D. Using a cutoff of
≥ 8 resulted in estimate of overall prevalence of 19.3% (similar to
retest pts’ prevalence of 19.8% for 20-item CES-D); however, using ≥10
yielded prevalence estimate of only 11.7%. PTs were
also asked the original CES-D and questions that assessed self-reported
health status, physical pain, & stress. Found correlt. btw CESD-10 and
other measures varied as predicted; stress strongly assoc with depress
(r=.43), positive affect inverse related (r=.63). Correl. of 10 items to
total scores ranged from r=.45 to r=.71 for retest, and r=.46 to r=.68 for
baseline sample of 1,206. 5 item accounted for 89% of variance. Factor
analysis yielded 2 sets of variables (positive affect & negative affect). |
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Disability populations used: |
The CES-D 10 is
used extensively with disabled populations. Researchers at the Center for Research
on Women with Disabilities (CROWD) used this scale in several studies,
including Healthy Aging (testing a health promotion intervention for women
with disabilities over the age of 45, and Stress Self-Management (used in
screen as part of criteria for establishing stress level). Stuifbergen,
Seraphine, and Roberts (2000) also have used this scale in a sample of
persons with multiple sclerosis in a study titled Health Promotion and
Quality of Life in Chronic Illness.
Harrison and Stuifbergen (2001) used this scale in a study of
disability, social support, and depressive symptoms in 201 mothers with
multiple sclerosis; they reported the reliability of the CES-D 10 as .85 for
this study. Mean scores in this sample were reported as 10.83 with a standard
deviation of 6.4. Ward (1994) used the CES-D-20 in a longitudinal study of
patients with rheumatoid arthritis, but excluded 4 items that might have been
more related to the impact of RA than to depression. Harrison, T.,
Stuifbergen, A., (2001). Disability, social support, and concern for
children: Depression in mothers with multiple sclerosis. Journal of
Obstetric, Gynecologic, and Neonatal Nursing, 31 (4), 444-453. Stuifbergen, A.,
Seraphine, A., & Roberts, G., (2000). An explanatory model of health
promotion and quality of life in chronic illness. Nursing Research, 49
(3), 122-129. Ward, M.M.
(1994). Are patient self-report measures of arthritis activity confounded by
mood? A longitudinal study of patients with rheumatoid arthritis. The
Journal of Rheumatology, 21 (6), 1046-1050. |
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Beck
Depression Inventory (BDI-IA) (Original
Scale) |
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Past week,
self-administered |
21-item
measure of depressive severity. Respondents rate depressive symptoms
experienced during the past two weeks on a 4-point scale from 0 to 3. Scores
are summated (range: 0 to 63). |
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Coefficient
alphas for psychiatric patients has been reported as ranging from .76 to .95.
The alphas for non-psychiatric populations is between (.73 and .92).
Test-retest reliability is reported as adequate but variable. Coefficient
alpha =.86. |
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Beck
Depression Inventory - Revised (BDI-II) Beck, Dozois,
D.J., Dobson, K.S., & Ahnberg, J.L., (1998). A psychometric evaluation of
the Beck Depression Inventory-II. Psychological Assessment, 10 (2),
83-89. |
Measures
presence and severity of depression in psychiatric patients and normal
populations. Revised the BDI-IA to reflect the diagnostic criteria for major
depressive disorders in the DSM-IV. |
Cognitive,
Affective, and neurovegetative symptoms of depression. It has been
suggested that the Cognitive subscale may be especially useful in populations
in which somatic complaints may be attributable to medical conditions rather
than to depression. |
Past two
weeks, interviewer administered or self-report. |
21-item
scale that measures the severity of self-reported depression Respondents rate
depressive symptoms experienced during the past two weeks on a 4-point scale
from 0 to 3. Scores are summated (range: 0 to 63). |
1,022
undergraduate psychology students (67% female, average age = 21 years). |
The BDI-II
has demonstrated high internal consistency among college students (alpha =
.93), and among outpatients (alpha = .92). Two subscales, Cognitive and
Noncognitive, have shown adequate internal consistency (alphas > .80). |
The BDI-II
has been shown to have adequate content and factorial validity and diagnostic
discrimination. Factor analyses revealed that a 2-factor solution accounted
for a cumulative 41% and 46% of the common variance in BDI and BDI-II
responses, respectively. |
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Disability populations used |
The
Original BDI has been validated in people with chronic pain and multiple sclerosis (Aikens, et al.,
1998). The BDI-II has been used with women with physical disabilities in
studies conducted by researchers at the Center for Research on Women with
Disabilities (CROWD), in studies of the outcome of a self-management program
for people with chronic arthritis (Holman, Mazonson, and Lorig, 1989, Lorig
et al., 1989), and in women with fibromyalgia (Hassett, Cone, Patella, &
Sigal, 2000) . Hassett, Holman, H.,
Mazonson, P., and Lorig, K., (1989). Health education for self-management has
significant early and sustained benefits in chronic arthritis. Transactions
of the Association of American Physicians, 102, 204-298. Lorig, K., Chastain,
R.L., Ung, E., Shoor, S., and Holman, H., (1989). Development and evaluation
of a scale to measure perceived self-efficacy in people with arthritis.
Arthritis and Rheumatism, 32 (1), 37-44. |
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Patient
Health Questionnaire-9 (PHQ-9) |
Diagnostic
measure of the presence and severity of depression |
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Shown to
be sensitive to change over time, a 50% reduction in the baseline of high
PHQ-9 scores or an outcome score of less than 10 has been proposed as a good
treatment response. |
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Has been
found to show strong correlations with other measures of depression
severity. Criterion validity,
construct validity, and external validity have been established. A single cutpoint of 12 or greater has been
found to best discriminate the likelihood of major depression. |
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Disability populations used: |
The Center for
Research on Women with Disabilities (CROWD) has used the PHQ-9 in studies of
stress and depression in women with physical disabilities. |
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Brief Symptom
Inventory (BSI) Boulet,
J., and Boss, M.W. (1991). Reliability and validity of the Brief Symptom
Inventory. Psychological Assessment: A Journal of Consulting and Clinical
Psychology, 3 (3), 433-437. |
Measures
levels of psychopathology. A shortened version of the Symptom Checklist-90
(SCL-90-R). Items describe a variety of problems and complaints associated
with psychopathology. Three global indexes can be calculated from the raw
scores: General Severity Index (GSI), Positive Symptom Total (PST), and
Positive Symptom Distress Index (PSDI). |
Nine dimensions: Somatization
(SOM), 7 items Obsessive-Compulsive
(OC), 6 items Interpersonal
Sensitivity (INT), 4 items Depression
(DEP), 6 items Anxiety (ANX), 6
items Phobic Anxiety
(PHOB), 5 items Paranoid
Ideation (PAR), 5 items Psychoticism
(PSY), 5 items |
Self-administered
or interviewer-administered, past week. Header: “How much have you been
bothered or distressed by the following in the past 7 days including today”. |
53 items
rated on a 5-point Likert scale (0= not at all to 4= extremely). |
501 male
psychiatric inpatients and outpatients; all subjects had reportedly been
involved with some form of deviant sexual activity that required clinical
assessment or intervention (57% was diagnosed with paraphilic disorders).
Mean age was 34 years, mean number of years of education was 10.22. No data
on ethnicity was collected. |
Test-retest
values ranged from low of .68 (SOM) to a high of .91 (PHOB). Stability
coefficient of the Global Severity Index (GSI) was .90. Cronbach’s alpha used
to establish internal reliability (in a separate study using sample of 1,002
psychiatric outpatients); alpha ranged from low of .71 (PSY) to high of .85
(DEP). Using the 501 male psychiatric patient sample, coefficients alpha
ranged from .75 (PSY) to .89 (DEP). Reliability
for parent scales (SCL-90 and SCL-90-R) has also been documented in several
studies. |
The MMPI
was used to assess convergent validity of the BSI. Some BSI scales correlated
with the MMPI (e.g. DEP and the MMPI Depression Scale, PAR and MMPI Paranoia
Scale, PSY and MMPI Schizophrenia, and SOM and MMPI Hypochondriasis Scale).
However, the BSI had poor discriminant validity. Each of the BSI scales also
correlated with almost all of the MMPI scales (including those that would
assumedly be unrelated), and there were high intercorrelations among the nine
BSI scales (ranging from .55 to .80). Each of the nine subscales also
correlated with the total score for the test (r=.73 to .91). Furthermore,
some items of a scale correlated more highly with another dimension (e.g. INT
and PSY). DEP scale demonstrated construct validity, with all items for DEP
correlated most highly with the total score for DEP. Validity
for SCL-90 and SCL-90-R has been documented in other studies, and BSI is
reported to highly correlate with the SCL-90. |
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Disability populations used: |
The BSI has been
used in research of various disability populations, including with
individuals with spinal cord injury (Tate, Forcheimer, Maynard, Dikjers,
1994), people with post-polio syndrome (Tate, Forcheimer, Kirsch, et al.,
1993, Tate, Kirsch, Maynard, et al., 1994), and patients with traumatic brain
injury (Slaughter, Johnstone, Petroski, and Flax, 1999); the scale has also
been tested in patients with chronic pain (Geisser, Perna, Kirsch, and
Bachman, 1998) and in cancer survivors (Cella and Tross, 1986). Cella, D.E., and
Tross, S., (1986). Psychological adjustment to survival from Hodgkin’s disease.
Journal of Consulting and Clinical Psychology, 54, 616-622. Slaughter, J.,
Johnstone, G., Petroski, G., and Flax, J., (1999). The usefulness of the
Brief Symptom Inventory in the neuropsychological evaluation of traumatic
brain injury. Brain Injury, 13 (2), 125-130. Tate, D.G.,
Forchheimer, M., Kirsch, N., et al., (1993). Prevalence and associated
features of depression and psychological distress in polio survivors. Archives
of Physical Medicine and Rehabilitation, 74(10), 1056-60. Tate, D.,
Forchheimer, M., Maynard, F., Dijkers, M., (1994). Predicting depression and
psychological distress in persons with spinal cord injury based on indicators
of handicap. American Journal of Physical Medicine and Rehabilitation, 73
(3), 175-183. Tate, D., Kirsch,
N., Maynard, F., et al., (1994). Coping with the late effects: Differences
between depressed and nondepressed polio survivors. American Journal of
Physical Medicine Rehabilitation, 73(1), 27-35. |
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Medical
Outcomes Study 36-item Short Form Healthy Survey (SF-36), Mental Health Index
subscale Ware, J.E.
& Sherbourne, C.D. (1992). The MOS 36-Item Short Form Health Survey
(SF-36): Conceptual framework and item selection. Medical Care, 30
(6), 473-483. |
Measures
general mental health (psychological distress and well-being). Designed for
clinical practice & research, health policy eval, and general population
surveys. |
One
subscale of the SF-36. Mental Health Index (MHI) (5 items, 26 levels). Uses the
uncut from the MOS long-form study or the SF-20. |
Self-administration
by persons 14 years of age and older or for administration by a trained
interviewer in person or by phone (different forms are required for each).
Timing is present or current health. |
Ordinal
scales (Likert), summated ratings. Lower scores indicates greater
limitations, interference, pain, fatigue, and health. E.g. High score on
physical functioning indicates “able to perform all types of physical
activities including the most vigorous without limitations due to
health”. |
Tested on
a variety of patient populations. |
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Used
corresponding full-length MOS scale as the criterion in testing. MHI- full
scale of the Mental Health Index used in SF-21 retained; includes items from
each of the 4 major mental health dimensions (anxiety, depression, loss of
behavioral or emotional control, and psychological well-being). Simple sum of
5 items correlates 0.95 with full-length 38 item MHI used in MOS-LF, and 0.93
on cross-validation with data on Health Insurance Experiment (most
widely-tested of the 8 subscales). |
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Disability populations used: |
Used extensively
with a variety of populations with disabilities. The Center for Research on
Women with Disabilities (CROWD) has used the SF-36 Mental Health Subscale in studies
of stress and depression in women with physical disabilities. |
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General
Health Questionnaire (GHQ-28) Goldberg,
D. & Williams, P. (1988). A User’s Guide to the General Health
Questionnaire. |
Measures symptoms
of anxiety and depression |
Subscales
include: Anxiety Depression |
Self-administered |
28-items,
Likert scoring (1-4). Summated scores by subscales. |
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Disability populations used: |
Smedstad, Kvien, Moum,
and Vaglum (1995) used the Life Event Interview in a study of how life
events, psychosocial factors, and demographic variables are related to
changes in functional disability in people with early rheumatoid arthritis. Smedstad, L.M.,
Kvien, T.K., Moum, T., and Vaglum, P. (1995). Life events, psychosocial
factors, and demographic variables in early rheumatoid arthritis: Relations
to one-year changes in functional disability. The Journal of Rheumatology,
22 (12), 2218-2225. |
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Mental Health
Inventory (MHI) Veit,
C.T., and Ware, J.E. Jr. (1983). The structure of psychological distress and
well-being in general populations. Journal of Consulting Clinical
Psychology (51), 730-742. |
Measures
psychological distress. |
Subscales
include: Depression (10
items) Anxiety (9
items) |
Self-report. |
6 point
scales for all items but one (5 point scale). |
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Disability populations used: |
Zautra, Zautra, Zautra, A., Okun,
M., Zautra, A.,
Burleson, M., Manne, S.L. &
Zautra, |
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Self-Control
Questionnaire (SCQ) Fuchs, C.Z.,
Rehm, L.P., (1977). A self-control behavior therapy program for depression. Journal
of Consulting and Clinical Psychology, 45,-206. |
40 items
assessing attitudes and beliefs about self-control and cognitions related to
depression. |
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40 items
scored on a 5-point scale. |
People
with chronic illnesses and nondisabled women. |
Good internal consistency with alphas ranging from
.82-.88, and test-retest correlation of .86. |
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Disability populations used: |
The SCQ has been
used by researchers at the Center for Research on Women with Disabilities in
studies of depression in women with physical disabilities. |
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Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
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Perceived Stress Scale (PSS) Cohen, S., Kamarck, T., & Mermelstein, R.
(1983). A global measure of perceived stress. Journal of Health and Social
Behavior, 24 (December), 385 -396. |
Measures a global level of perceived stress, not
merely the presence of stressful life events. Measures the degree to which respondents find their
lives to be unpredictable, uncontrollable, and overloading over the previous
week. |
none |
Timing: Past week Self-administered |
14-item scale. Respondents rate items on a 5-point scale (0=never
to 4=very often), and scores range from 0 to 40. Summated scores; items 4, 5,
6, 7, 9,10, and 13 are positively-stated, and reverse scored. A 10-item and
4-item version of the PSS have also been validated. |
Three samples used for validation: two college
student samples and one more heterogenous sample enrolled in an
smoking-cessation program. Mean scores were 23.18 (S.D. = 7.31, range 6-50),
23.67 (S.D. = 7.79, range 5-44), and 25.0 (S.D.= 8.00, range 7-47),
respectively. |
Coefficient alpha reliability was .84, .85, and .86
in each of the samples, respectively. Test-retest for a two-day period was
.85 for a student sample. |
A small to moderate correlation between number of
life events and the PSS was found with all three samples. This association
was found to increase when the scale score took into account the respondent’s
perception of the impact of the life event. The PSS and the CES-D were found
to correlate, yet both scales still independently predicted physical
symptomatology. The PSS is also predictive of changes in health care
utilization. |
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Perceived Stress Scale (PSS-10) Cohen, S., Kamarck, T., & Mermelstein, R.
(1983). A global measure of perceived stress. Journal of Health and Social
Behavior, 24 (December), 385 -396. |
Measures a global level of perceived stress, not
merely the presence of stressful life events. Measures the degree to which respondents find their
lives to be unpredictable, uncontrollable, and overloading over the previous
week. |
none |
Timing: Past week Self-administered |
10-item scale. Respondents rate items on a 5-point scale (0=never
to 4=very often), and scores range from 0 to 40. Summated scores; items 4, 5,
6, 7, 9,10, and 13 are positively-stated, and reverse scored. A 10-item and
4-item version of the PSS have also been validated. |
Three samples used for validation: two college
student samples and one more heterogenous sample enrolled in an
smoking-cessation program. |
high internal reliability (alpha coefficient =.78) |
acceptable evidence of validity |
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Perceived Stress Scale- 4 item version (PSS-4) |
Measures the degree to which respondents find their
lives to be unpredictable, uncontrollable, and overloading over the previous
month. |
none |
Timing: Past month Self-administered |
4-item scale. Respondents rate items on a 5-point scale (0=never
to 4=very often), and scores range from 0 to 20. |
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Coefficient alpha reliability of .72, the 4-item PSS
has demonstrated test-retest reliability of .55 over a 2-month interval. |
Longer forms of the PSS have demonstrated moderate
correlations with other measures of appraised stress. |
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Disability
populations used: |
The Center for Research on Women with Disabilities (CROWD)
has used both the PSS-4 and PSS-10 in studies of stress and depression in
women with physical disabilities. Tate and colleagues have used the PSS in a
health promotion study of people with spinal cord injury. Tate, D.G., Chiodo, A., Nelson, V., et al., (2002). The
effect of a holistic health promotion program on individuals with spinal cord
injury. Final Report of Study Findings. University of Michigan Health
System: Department of Physical Medicine and Rehabilitation. |
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Perceived Stress Zautra, A.J., Hoffman, J.M., Matt, K.S., et al.,
(1998). An examination of individual differences in the relationship between
interpersonal stress and disease activity among women with rheumatoid
arthritis. |
Four items assessing the following domains of
interpersonal perceived stress (adapted from the Inventory of Small Life
Events): Spouse or significant other, family members, friends
and acquaintances, and employers/coworkers. |
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Past week, as compared with the week before. |
Four questions for each domain: “Compared to the week before, how would you describe
your relations with (domain) this past week?” Participants could respond: Less stressful (0) About the same (1) More stressful (2) Much more stressful (3) |
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Disability
populations used: |
Zautra, Hoffman, Matt, et al.,(1998) developed four
questions to measure perceived stress in a study of stress in women with
rheumatoid arthritis. Zautra, A.J., Hoffman, J.M., Matt, K.S., et al., (1998).
An examination of individual differences in the relationship between
interpersonal stress and disease activity among women with rheumatoid
arthritis. |
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Mood
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Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
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Profile of Mood States-B (POM-B). |
Measures their mood that day based upon 9 negative
indicators of depression, anxiety, hostility) and 9 positive indicators of
happiness, calmness, and agreeableness. |
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Self-report |
18 items (degree descriptors matched mood), 4-point
scale; Scores range from -27 to +27;higher scores indicate more negative
mood. |
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Disability
populations used: |
Ward (1994) used the Profile of Mood States-B in a
longitudinal study of patients with rheumatoid arthritis. Ward, M.M. (1994). Are patient self-report measures of
arthritis activity confounded by mood? A longitudinal study of patients with
rheumatoid arthritis. The Journal of Rheumatology, 21 (6), 1046-1050. |
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Secondary and Chronic Conditions
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Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
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Seekins’
Secondary Conditions Scale (SCS) Seekins, T., Smith, N., McCleary, T., Clay, J.,
Walsh, J., (1990). Secondary disability prevention: Involving consumers in the development of a
public health surveillance instrument.
Journal of Disability Policy Studies, 1 (3), 21-36. |
List of 40 secondary conditions that can be used in
surveillance studies and to assess the physical, psychological, and social health
of the individual and barriers in the environment. Measures new health
problems since onset of primary disability. |
None. |
Self-administered, asks about extent of problems per
week. |
Asks respondents to rate the severity of each
secondary condition on a scale of 0 to 3. “0” means the condition does not limit activity, “1”
means it limits activity 1-5 hours per week (mild problem), “2” means it
limits activity 6-10 hours per week (moderate problem), and “3” means that it
limits activity 11 or more hours per week (significant/chronic problem). |
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Disability
populations used: |
Seekins, Clay, and Ravesloot, (1994) used this scale in a
population of adults with physical disabilities living in rural areas. Used extensively with disabled populations; this scale has
also been modified for use by researchers in other studies and with a variety
of populations. Researchers at the Center for Research on Women with
Disabilities have adapted this scale for use in samples of women with
physical disabilities. Tate and colleagues (2002) used this scale in a health
promotion study of people with spinal cord injury. Turk and colleagues used a
variation of this scale to reflect secondary health conditions experienced by
adults with cerebral palsy. Seekins, T., Clay, J., & Ravesloot, C. (1994). A
descriptive study of secondary conditions reported by a population of adults
with physical disabilities served by three independent living centers in a
rural state. Journal of
Rehabilitation, April/May/June, 47-51. Tate, D.G., Chiodo, A., Nelson, V., et al., (2002).
The effect of a holistic health promotion program on
individuals with spinal cord injury. Final Report of Study Findings.
University of Michigan Health System: Department of Physical Medicine and
Rehabilitation. Turk, M.A., Geremski, C.A., Rosenbaum, P.F., Weber, R.J., (1997). The health status of women with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 78, S10-S17. |
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Health Conditions Checklist (HCC) |
Measures secondary health conditions for women with
a primary physical disability. |
None. |
Self-administered or interviewer-administered; How
much have the following conditions affected your activity and independence in
the past two months. |
44 items, Likert scale (with never as an additional
categorical possible response); Range: 0= no problem in past 2 months, 1=mild or infrequent problem, 2= moderate/ occasional, 3= significant/ chronic, 4= never had this problem in my life |
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Disability
populations used: |
Researchers at the Center for Research on Women with
Disabilities (CROWD) used this scale in several studies of women with
disabilities, including the evaluation of a health promotion intervention for
women with disabilities over the age of 45, a stress self-management
intervention, and depression self-management interventions. |
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Secondary Health Conditions Campbell, M.L., Sheets, D., and Strong, P.S.,
(1999). Secondary health conditions among middle-aged individuals with
chronic physical disabilities: Implications for unmet needs for services. Assistive
Technology, 11, 105-122. |
List of 14 common chronic health conditions
experienced by middle-aged persons with disabilities. |
Items include osteoarthritis, glaucoma, diabetes, heart
disease, high blood pressure, stroke, and emphysema. |
Self-reported since onset of primary disability. |
24 items. Dichotomous variable (yes = 1). Total
disease burden was calculated by summing the 24 diagnoses. 17 items summed as
morbidity diagnoses (e.g. asthma, skin breakdown, osteoarthritis), and 7
items summed as mortality diagnoses (e.g. coronary heart disease, stroke, diabetes,
cancer). |
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Disability
populations used: |
Campbell, Sheets, and Strong administered this list of
health conditions to middle-aged persons living with polio, rheumatoid
arthritis, and stroke. Campbell, M.L., Sheets, D., and Strong, P.S., (1999).
Secondary health conditions among middle-aged individuals with chronic
physical disabilities: Implications for unmet needs for services. Assistive
Technology, 11, 105-122. |
||||||
|
|
|||||||
|
Secondary Conditions Questionnaire Tate, D., (1996). Secondary Conditions
Questionnaire. Pages 1-10. Wellness for Women with Polio Program, University
of |
Measures secondary conditions and comorbid
conditions reportedly experienced by polio survivors. |
No subsets, but the list is divided
into: secondary conditions (any physical condition that is the result of
poliomyelitis), and comorbid conditions (diagnosed disease processes that
coincide with polio). |
|
21 items. Respondents indicate whether they have ever been diagnosed with the
condition (dichotomous yes/no). The number of “yes” responses is added to
provide a total score of secondary condtions. |
Persons living with post-polio. |
|
Content validity was established by expert review. |
|
Disability
populations used: |
This questionnaire has been used in samples of polio
survivors in studies conducted by Tate and colleagues (authors of the
instrument) at University of Michigan Medical Center and by Harrison and
Stuifbergen (2001), with the authors’ permission. Harrison, T., and Stuifbergen, A., (2001). Barriers
that further disablement: A study of survivors of polio. Journal of
Neuroscience Nursing, 33 (3), 160-166. |
||||||
|
|
|||||||
General
Health/ Perceived Health
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Medical
Outcomes Study 36-item Short Form Healthy Survey (SF-36), General Health Perceptions
subscale Ware,
J.E. & Sherbourne, C.D. (1992). The MOS 36-Item Short Form Health Survey
(SF-36): Conceptual framework and item selection. Medical Care, 30
(6), 473-483. |
The SF-36 is supposed to address general health
concepts not specific to any age, disease, or treatment group (basic human
values). The General Health Perceptions subscale assesses general health
perceptions. Designed for clinical practice & research, health policy
eval, and general population surveys. |
One subscale of the SF-36: General health perceptions (GHP) (5 items, 21 levels). |
Self-administration by persons 14 years of age and
older or for administration by a trained interviewer in person or by phone
(different forms are required for each). Timing is present or current health. |
Five items, ordinal scales (Likert), summated
ratings. Lower score indicates less perception of general health. |
Tested on a variety of patient populations. |
|
Used corresponding full-length MOS scale as the
criterion in testing. GHP: correlates (r=0.96) with 22-item GHRI constructed
from Health Perspectives Questionnaire. Balances between favorably and
unfavorably worded items to control for response set effects. A sixth item
was added but is not used to score any of the 8 multi-item scales. It should
probably be analyzed as a categorical variable or as an ordinal level scale. |
|
Disability
populations used: |
Used extensively with a variety of populations with
disabilities. The Center for Research on Women with Disabilities (CROWD) uses
the SF-36 General Health subscale in studies of women with physical
disabilities. |
||||||
|
|
|||||||
|
Health Self-Rating Scale/ Self-Rated Health (SRH) |
A subindex of the Multilevel Assessment Instrument;
measures perceived current health status |
None. |
Current timing. Self-report. |
4 items, including a global subjective health item
(“How would you rate your overall health at the present time?”). Scores range
from 4-13. |
|
|
|
|
Disability
populations used: |
Used by Becker, Stuifbergen, Ingalsbe, and Sands in a
study of health promoting attitudes and behaviors among people with
disabilities. Roberts and Stuifbergen (1998) used this scale in a study of
persons with multiple sclerosis. They reported an alpha coefficient of 0.76
in this sample. Becker, H.A., Stuifbergen, A.K., Ingalsbe, K., and Sands,
D., (1989). International Journal of Rehabilitation Research, 12 (3),
235-250. Roberts, G., & Stuifbergen, A.K., (1998). Health
appraisal models in multiple sclerosis. Social Science in Medicine, 47
(2), 243-253. |
||||||
|
|
|||||||
|
Health Conception Scale |
Measures four dimensions of health as conceptualized
by Smith (1983). |
Four subscales: Clinical Health Conception (absence
of disease), Functional/Role Performance Health Conception (ability to
perform life roles and tasks), Adaptive Health Conception (ability to adapt
to environmental changes), and Eudaimonistic Health Conception
(self-actualization or living life to the fullest) |
Self-report, current/present timing. |
28 items 6-point Likert (1=strongly disagree,
6=strongly agree). Summated scores into four 7-item subscales. |
|
Cronbach alpha coefficients range from .87 to .88. |
Construct validity is supported by factor analysis. |
|
Disability
populations used: |
Used by Becker, Stuifbergen, Ingalsbe, and Sands in a
study of health promoting attitudes and behaviors among people with
disabilities. Stuifbergen and Becker (1994) report intercorrelations between
three of the subscales (Functional/Role Performance, Adaptive, and
Eudaimonistic) as ranging from .70 to .78, and therefore combined these
scales to form a Wellness Subscale. They reported coefficient alphas for this
sample as .95 for the Wellness subscale and .84 for the Clinical subscale. Becker, H.A., Stuifbergen, A.K., Ingalsbe, K., and Sands,
D., (1989). Health promoting attitudes and behaviors among persons with
disabilities. International Journal of Rehabilitation Research, 12
(3), 235-250. Stuifbergen, A.K., and Becker, H.A., (1994). Predictors of
health promoting lifestyles in persons with disabilities. Research in
Nursing and Health, 17, 3-13. |
||||||
|
|
|||||||
Pain
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
|
Stanford Health Assessment Questionnaire Functional-
Pain Scale (Stanford HAQ) Fries, J.F., Spitz, P., Kraines, R.G., and Holman,
H.R. (1980). Measurement of patient outcome in arthritis. Arthritis and
Rheum., 23, 137-145. |
|
|
Self-report |
Responses for each area are scored 0 (no pain) to
3.0 (very severe pain). A summated score for each of the 8 dimensions is
averaged to derive the total pain index (range: 0.0 to 3.0). |
|
|
|
|
|
Disability
populations used: |
Holman, H., Mazonson, P., and Lorig, K., (1989). Health
education for self-management has significant early and sustained benefits in
chronic arthritis. Transactions of the Association of American Physicians,
102, 204-298. Ward, M.M. (1994). Are patient self-report measures of
arthritis activity confounded by mood? A longitudinal study of patients with
rheumatoid arthritis. The Journal of Rheumatology, 21 (6), 1046-1050. |
|||||||
|
|
||||||||
|
Medical Outcomes Study 36-item Short Form Healthy
Survey (SF-36), Pain
subscale Ware, J.E. & Sherbourne, C.D. (1992). The MOS
36-Item Short Form Health Survey (SF-36): Conceptual framework and item
selection. Medical Care, 30 (6), 473-483. |
Subscale is used to assess the health concept of
bodily pain. |
(2 item, 9 lev), Bodily pain (BP) |
Self-administration by persons 14 yrs and older or
for administration by a trained interviewer in person or by phone (different
forms are required for each). Timing is present or current health. |
Ordinal scales (Likert), summated ratings. Lower
score indicates greater limitations pain. |
Tested on a variety of patient populations. |
|
BP: one question concerns frequency of pain, 2nd
question measures extent of interference with normal activities because of
pain (latter item is best predictor, r=0.84, or total score for Behavioral
Effects of Pain used in MOS-LF, the parent instrument). |
|
|
Disability
populations used: |
Used extensively with a variety of populations with
disabilities. The Center for Research on Women with Disabilities (CROWD) uses
the SF-36 pain subscale in studies of women with physical disabilities. |
|||||||
|
|
||||||||
|
Multidimensional Pain Inventory (MPI) Kerns, Turk,
and Rudy, 1985 |
|
|
|
|
|
|
|
|
|
Disability
populations used: |
|
|||||||
|
|
||||||||
|
McGill Pain Questionnaire (MPQ) Melzack, R., (1975). The McGill Questionnaire: major
properties and scoring methods. Pain, 1, 277-299. Melnack, R., Katz, J., (1992). The McGill Pain
Questionnaire: appraisal and current status. In: Turk DC, Melzack R, editors.
Handbook of Pain Assessment. |
An adjective checklist that measures multiple
dimensions of pain, based upon gate control theory. |
3 dimensions of pain (sensory, evaluative, and
affective). |
Self-report |
20 items representing single-word pain descriptors.
Respondents select one word from each group that best describes their
experiences and leave out any word group that is not applicable. A total pain
score can be derived by summing scores for all 3 dimensions, including the
score from the miscellaneous category. |
|
Good test-retest reliability. |
Content and construct validity have been
established. |
|
|
Disability
populations used: |
The MPQ has been used in a study of women with
fibromyalgia (Hassett, et al., 2000). Hassett, A.L., Cone, J.D., Patella, S.J., and Sigal,
L.H., (2000). The role of catastrophizing in the pain and depression of women
with fibromyalgia syndrome. Arthritis and Rheumatism, 42 (11),
2493-2500. |
|||||||
|
|
||||||||
|
Pain Visual Analog Scale (VAS) Downie, |
Measures absolute pain, assumes a linear variable. |
N/A |
Self-report, current or present timing. |
10-cm (100 mm) visual analog scale. Range is 0 (no
pain) to 100 (worst possible pain). |
|
|
|
|
|
Disability
populations used: |
The VAS is widely used in a variety of populations,
including people with osteoarthritis and rheumatoid arthritis (Sarzi-Puttini,
et al., 2002). Lorig et al., (1996, 1985) used a pain visual analog
scale in an outcome study of persons with chronic arthritis participating in
a self-management program. Lorig, K., Chastain, R.L., Ung, E., Shoor, S., and
Holman, H., (1989). Development and evaluation of a scale to measure
perceived self-efficacy in people with arthritis. Arthritis and Rheumatism,
32 (1), 37-44. Lorig, K., Sarzi-Puttini,
P., Fiorini, T., Panni, B., et al., (2002). Correlation
of the score for subjective pain with physical disability, clinical and radiographic
scores in recent onset rheumatoid arthritis. BMC Musculoskeletal
Disorders, 3 (1), 18. |
|||||||
|
|
||||||||
|
Pain Ordinal Scale |
Asks participants to measure pain as mild, moderate,
or severe. |
N/A |
Self-report, current or present timing. |
Asks participants to measure pain as mild, moderate,
or severe. |
|
|
|
|
|
Disability
populations used: |
An ordinal assessment of pain, in conjunction with a
visual analog scale, was used in a study of health outcomes for a
self-management intervention in persons with arthritis (Lorig et al., 1985). Lorig, K., |
|||||||
Mobility
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|||
|
Craig Handicap Assessment & Reporting Technique
original- (CHART), Mobility subscale Whiteneck, Charlifue, Gerhart, Overholser, &
Richardson (1992). Quantifying Handicap: A New Measure of Long-Term
Rehabilitation Outcomes. Archives of Physical Medicine & Rehabilitation
73 (June), 519-526. |
Measures mobility, or difficulty getting around in
environment, but not necessarily disability. See full CHART description. |
Mobility (M), (9
items) |
Interview tool (face-to-face or phone). Instrument
can be mailed but data may be lost in absence of interaction with interviewer
providing consistent prompts. No set time period but multiple measurements
should be taken over course of person’s lifetime. |
37 items measuring “handicap”, with 100-point
subscale for each dimension of handicap, which can be interpreted
individually or totaled to give overall index of handicap. It is possible to
earn >100 points for each subset, but max of 100 points is allowed, as 100
points indicates no handicap in that domain. Scores below 100 indicate some
level of handicap. |
n=135 patients with SCI, avg age 33 (range 16-74)
with injuries >2 years to assess psychometrics. Only 16% women, n=41
complete quads, n= 38 incomplete quads, n=42 complete paras, n=14 incomplete
paras. Norms established using n=88 able-bodied friends or associates of same
age and gender; 23% were women and 77% male. Initial application done with n = 342 former
patients at Craig who have spinal cord injuries for > 1 year. avg age = 34
yrs, range (15-80). Only 15% were women. 60% had cervical injuries. |
High test-retest reliability; r= .93 for total
instrument. M subscale: r=.95 Family members or other proxy for each SCI subject
also asked CHART; subject-proxy correlations were .83 for total CHART; good
agreement betw ratings of subjects & proxies achieved on all dimensions
except SI, in which degree of agreement found to be related to how closely
the proxy knew the subject. M subscale: r=.84 |
Validity was determined by performance in
differentiating groups of subjects globally evaluated by rehab professionals
as having high or low levels of handicap.; signif dif found between 2 group’s
(low or hi) mean total CHART scores (high handicap x = 333, low-handicap x =
438, t=6.36, p<.001. The M subscale was also significantly different (M:
t=3.89, p<.001) Rasch demonstrated CHART is a well-calibrated linear
scale, with good fit of both items and persons to data. Items in each subscale analyzed separately; all
items fit in subscale cluster, (no item had t-value for fit >1.2).
Person-fit analysis also good match (fit-statistic x =0.0, SD=1.2). |
|||
|
Other Disability
Populations: |
Analysis for the original CHART was conducted on
various disability populations, including SCI (Whiteneck, Tate, Charlifue,
1999, Boninger et al., 1998, Vogel, 1998, Waters, 1998, Whiteneck, 1996) TBI
(Corrigan, et al., 1998, Brooks, Gabella, Hoffman, Sosin, & Whiteneck,
1997), stroke (Segal & Schall, 1995), MS, burn, and amputee populations.
These additional analyses indicate that the CHART can be generalized to other
disability populations. |
|||||||||
|
|
||||||||||
|
Craig Handicap Assessment & Reporting Technique
Short Form (CHART-SF) Craig Handicap Assessment & Reporting Technique-
Short Form (CHART-SF), Craig Hospital Research Department, 3425 S Clarkson
St. Englewood, CO 80110. Introduction to the CHART Short Form. Center for
Outcome Measurement in Brain Injury (COMBI); http://www.tbims.org/combi/chartsf |
The CHART-SF
is a shortened version of the CHART. The Mobility subscale of CHART-SF retains
three items from the parent scale. |
Mobility (M), (3
items) |
Same as CHART: Interview tool (face-to-face or phone). Instrument
can be mailed but data may be lost in absence of interaction with interviewer
providing consistent prompts. No set time period but multiple measurements
should be taken over course of person’s lifetime. |
19 items
total summation of scores. 100-point subscale for each dimension of handicap,
which can be interpreted individually or totaled to give overall index of
handicap. It is possible to earn >100 points for each subset, but max of
100 points is allowed, as 100 points indicates no handicap in that domain.
Scores below 100 indicate some level of handicap. |
|
Could not find original article analyzing
psychometrics for CHART-SF. |
With 2 exceptions, the only variables that were
selected to be in a subscale were those that entered into a stepwise
regression model together explaining over 90% of the variance. Items were
re-scored so that each subscale still would have a max of 100, but efforts
were made to keep all the score weightings of the variables proportionate to
the original weightings. |
|||
|
Other Disability
Populations: |
The main analysis used data for participants in the
CHART validation, n=1,110 with various disabilities. SCI: n=236; BI: n=242; MS: n=248; Stroke: n=223;
Amputation: n=91; Burn: n=70. The CHART-SF was then tested on 1800 persons in the
BRFSS survey of CHART-SF has also been used with disability
populations in other countries. For example, Dijkers et al., (2002) compared
SCI populations in |
|||||||||
|
Lower Body Mobility Scale |
Reports of any difficulty in performing three mobility
tasks: walking one block, walking several blocks, and climbing one flight of
stairs without resting. |
None |
Self-response, current timing |
Header: “How difficult is it for you to…” or “Do you
have any difficulty with…” 5 point Likert scale: Responses ranged from not at all, a little,
somewhat, very, and don’t do. “A little”, “somewhat”, and “very” were coded as 1s,
indicating difficulty. Possible scores range from 0 (no difficulty on any
item) to 3 (difficulty on every item). |
Adults 51-61 years, both with and without mobility
problems, administered to participants in the Health and Retirement Survey. |
Cronbach’s alpha was 0.71 at a baseline
administration and 0.72 at 2-year follow-up. |
Exploratory factor analysis models yielded minimum
factor loadings of 0.79. |
|||
|
Other Disability
Populations: |
|
|||||||||
|
|
||||||||||
|
Mobility Assessment Turk, M.A., |
Observational assessment. |
|
Trained observer. |
Timed test of walking and/or wheelchair propulsion. |
|
|
|
|||
|
Disability
populations used: |
Turk and colleagues describe this procedure to assess
mobility as used in a sample of women with cerebral palsy. Turk, M.A., |
|||||||||
|
|
||||||||||
See also IV: Personal/Social/Environmental Status Measures- Physical
Functioning, Disability, and Functional Limitations
Role
limitations (physical and emotional)
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Medical
Outcomes Study 36-item Short Form Healthy Survey (SF-36), Role Functioning subscale Ware,
J.E. & Sherbourne, C.D. (1992). The MOS 36-Item Short Form Health Survey
(SF-36): Conceptual framework and item selection. Medical Care, 30
(6), 473-483. |
Assesses health concept of limitations in usual role
activities because of physical health problems and limitations in usual role
activities because of emotional problems. Designed for clinical practice
& research, health policy eval, and general population surveys. |
Subscale assesses role limits due to phys prob (RF) , (4 item, 5 levels);This scale
is a subset of the MOS long-form study or the SF-20. |
Self-administration by persons 14 years of age and
older or for administration by a trained interviewer in person or by phone
(different forms are required for each). Timing is present or current health. |
Ordinal scales (Likert), summated ratings. Lower
scores indicates greater limitations or interference due to health. |
Tested on a variety of patient populations. |
|
Used corresponding full-length MOS scale as the
criterion in testing. RF: subset of MOS-LF |
|
Disability
populations used: |
Used extensively with a variety of populations with
disabilities. The Center for Research on Women with Disabilities (CROWD) uses
the SF-36 role functioning subscale in studies of women with physical
disabilities. |
||||||
See also IV: Personal/Social/Environmental Status Measures- Physical
Functioning, Disability, Functional Limitations, and Handicap
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Medical
Outcomes Study 36-item Short Form Healthy Survey (SF-36, Vitality subscale Ware,
J.E. & Sherbourne, C.D. (1992). The MOS 36-Item Short Form Health Survey
(SF-36): Conceptual framework and item selection. Medical Care, 30
(6), 473-483. |
Assesses health concept of vitality, defined in
terms of energy and fatigue. Designed for clinical practice & research,
health policy eval, and general population surveys. |
One of eight subscales. Vitality (V) (4 item, 21 levels) Scale was constructed by adding four items adapted
from the 38-item MHI to the MOS long-form study or the SF-20. |
Self-administration by persons 14 years of age and
older or for administration by a trained interviewer in person or by phone
(different forms are required for each). Timing is present or current health. |
Ordinal scales (Likert), summated ratings. Lower
scores indicates lower vitality. |
Tested on a variety of patient populations. |
|
Used corresponding full-length MOS scale as the
criterion in testing. V: tested with patients with hypertension, prostate
disease, and AIDS. |
|
Disability
populations used: |
Used extensively with a variety of populations with
disabilities. The Center for Research on Women with Disabilities (CROWD) uses
the SF-36 Vitality subscale in studies of women with physical disabilities. |
||||||
Physical
Functioning
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Medical
Outcomes Study 36-item Short Form Healthy Survey (SF-36), Physical Functioning
subscale Ware,
J.E. & Sherbourne, C.D. (1992). The MOS 36-Item Short Form Health Survey
(SF-36): Conceptual framework and item selection. Medical Care, 30
(6), 473-483. |
Assesses
health concept of physical functioning, defined as limitations in
physical activities because of health problems. Designed for clinical practice & research,
health policy eval, and general population surveys. |
Physical functioning (PFS) (10 items, 21
levels) is one of eight subscales. |
Self-administration by persons 14 years of age and
older or for administration by a trained interviewer in person or by phone
(different forms are required for each). Timing is present or current health. |
Ordinal scales (Likert), summated ratings. Lower
scores indicates greater limitations. High score on physical functioning
indicates “able to perform all types of physical activities including the
most vigorous without limitations due to health”. |
Tested on a variety of patient populations. |
|
Used corresponding full-length MOS scale as the
criterion in testing. PFS: 3-level response continuum of presence and
extent of physical limitations. This subscale was retained uncut from MOS-LF,
the parent scale. |
|
Disability
populations used: |
Used extensively with a variety of populations with
disabilities. The Center for Research on Women with Disabilities (CROWD) uses
the SF-36 physical functioning scale in studies of women with physical
disabilities. |
||||||
|
|
|||||||
|
Functional
(FIM) The functional independence measure: a new
tool for rehabilitation. |
|
|
|
|
|
|
|
|
|
|||||||
See also IV: Personal/Social/Environmental Status Measures- Physical
Functioning, Disability, and Functional Limitations
Social
Functioning
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Medical
Outcomes Study 36-item Short Form Healthy Survey (SF-36), Social Functioning
subscale Ware,
J.E. & Sherbourne, C.D. (1992). The MOS 36-Item Short Form Health Survey
(SF-36): Conceptual framework and item selection. Medical Care, 30
(6), 473-483. |
Measures limitations in social activities because of
physical or emotional problems. Designed for clinical practice &
research, health policy eval, and general population surveys. |
One of eight subscales: Social Functioning (SF) (2 item, 9 lev). Some scales were retained uncut from the MOS
long-form study or the SF-20. |
Self-administration by persons 14 years of age and
older or for administration by a trained interviewer in person or by phone
(different forms are required for each). Timing is present or current health. |
Ordinal scales (Likert), summated ratings. Lower
scores indicates greater limitations or interference due to health. |
Tested on a variety of patient populations. |
|
Used corresponding full-length MOS scale as the
criterion in testing. SF: asks about impact of phys OR emotional health on
social activities. |
|
Disability
populations used: |
Used extensively with a variety of populations with
disabilities. The Center for Research on Women with Disabilities (CROWD) uses
the SF-36 Social Functioning subscale in studies of women with physical
disabilities. |
||||||
|
|
|||||||
Use
of Health Care
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Health and Social Service Utilization Questionnaire Veterans Administration. Health services research
and development: Resource utilization
and costs of HIV care in the VA: VA
resource use: Form D. 2000. Wray NP. VA Medical Research Grant 0001: Arthroscopic treatment of osteoarthritis of
the knee. |
Includes questions concerning social services use
related to medical conditions. Can be used to survey health care utilization
in populations with high rates of utilization. |
|
|
|
This questionnaire was developed and successfully
implemented to survey Resource Utilization and Costs of HIV Care in the VA. A
survey of health status and
utilization by patients undergoing arthroscopic knee surgery was also
developed. |
|
|
|
Disability
populations used: |
Questions concerning utilization
from this survey were incorporated and modified for use in a study of the
cost of depression and secondary conditions in women with physical
disabilities conducted by the Center for Research on Women with Disabilities
(CROWD). |
||||||
|
|
|||||||
|
CROWD- Modified Version of the Health and Social
Service Utilization Questionnaire |
Includes questions adapted from the Health and
Social Service Utilization Questionnaire. This questionnaire asks
participants about frequency of utilization of various health care, and
estimates out-of-pocket cost. |
Sections/ Domains: A.
Visits
to physicians. B.
Visits
to other health care providers. C.
Hospitalizations
and Procedures. D.
Emergency
Care. E.
Personal
Assistance Care. F.
Medical
Equipment. G.
Medications. H.
Medical
Tests. I.
Costs. |
Interviewer-administered. Past two months. |
Requires determination of a Medicare Diagnosis
Related Group (DRG) to be used in scoring when a participant has been
hospitalized. The DRG code will provide critical and informative
additional information on the resource intensity of the hospitalization. |
Developed for use in a study of women with physical
disabilities to explore cost of depression and secondary conditions. |
|
|
|
Disability
populations used: |
The Center for Research on Women
with Disabilities (CROWD) modified this scale in collaboration with the
survey’s original authors for a study of the cost of depression and secondary
conditions in women with physical disabilities. |
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Medical Services Utilization (UTIL) CROWD – no citation |
Assessment of number
of visits to medical doctor, emergency room, hospital, or to mental health
professional |
N/A |
Past two months, self-administered |
6 items, number of visits. |
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Disability
populations used: |
The Center for Research on Women with Disabilities (CROWD)
developed this scale for use in a study of women with physical disabilities
over the age of 45. |
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Number of visits to physicians Lorig, K., |
Self-reported estimate of number of visits to
physicians during the previous four months. |
N/A |
Past four months, self-report. |
Estimate provided by participant. |
286 persons with chronic arthritis participating in
a self-management study. |
A chart check on an independent sample of 29
arthritis patients yielded a correlation of 0.79. |
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Disability
populations used: |
Lorig et al., used this count in a study of persons with
arthritis. Lorig, K., |
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Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
Body Mass Index (BMI) |
Widely-used measure of overweight. Requires
assumptions to be made about norms in the population being assessed. Requires
height and weight measurements. |
None. |
Self-report or measurements by interviewer. |
According to the National Institutes of Health and
World Health Organization, overweight is defined as a BMI or 25-29.9, and
obesity as a BMI equal to or greater than 30. A person with a BMI of 30
is about 30 pounds overweight/overfat. A BMI of 18 or lower indicates
that a person is underweight/underfat. |
Persons in the general population. |
|
Current guidelines do not differentiate for gender,
ethnicity or age, and do not distinguish obesity or leanness for individuals
who are extremely muscular. It is, however, more precise than
height/weight tables and allows comparisons of population groups.
Studies have confirmed that obesity-related health risks start in the BMI
range of 25-30. Self-reported weight and height are problematic because
evidence has shown that overweight individuals are more likely to
underestimate weight and overestimate height than thinner individuals
(Rowland, (1990). |
|
Disability
populations used: |
BMI is widely used in research of
people with physical disabilities (e.g., The National Health Interview
Survey). However, it should be used with caution in some populations, because
normative standards are not usually available for people with physical
disabilities. BMI fails to consider lower weights due to muscle atrophy or
missing limbs, and is unable to attribute lost weight due to body fat loss or
due to muscle loss associated with conditions such as muscle wasting
(Pessolano et al., 2003, Gibson, 1990, Weil et al., 2002). BMI calculations
also require a height measurement, and women who have been unable to walk for
years may be unable to provide an accurate height (calculations taken while
sitting may be inaccurate due to spine compression, and muscle contractures
may make measurements in a supine position difficult); additionally, women
with altered skeletal musculature due to scoliosis, bone deformities, or
severe osteoporosis may have a misrepresented height. In patients who have
muscle contractures, technicians may segmentally measure the contracted limb
in order to get a more accurate measure of height (Rimmer, 2003). Buchholz et
al., (2003) used BMI in a study of paraplegic patients. A Plexiglas length board
to measure height was designed specifically for the study. Participants had
to transfer from their wheelchairs, and lie flat on the board. Self-reported
heights and weights for people with mobility problems may be particularly
problematic in reporting BMI, as there is some evidence that people who are
unable to stand on a scale are more likely to report imprecise height and
weight (Nawaz, et al., 2001). BMI has been used by The Center for Research on
Women with Disabilities (CROWD) in studies of women with physical
disabilities. Buchholz, A.C., McGillivray, C.F., Pencharz, P.B.,
(2003). Differences in resting metabolic rate between paraplegic and
able-bodied subjects are explained by differences in body composition. American
Journal of Clinical Nutrition, 77(2),371-8. Gibson, R.S., (1990).
Anthropometric and other reference data. Principles of nutritional
assessment. Nawaz, H., Chan, W., Abdulrahman,
M., Pessolano, Rimmer J. 4-13-2003. Personal Communication. Rowland, M.L., (1990).
Self-reported weight and height. American Journal of Clinical Nutrition,
52, 1125-1133. |
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Bioelectric Impedance Analysis |
A scale that measures the opposition of different
bodily tissues to an electrical current, and calculates percent body fat, fat
free mass, and estimate total body water. |
Three generalizable equations from this test can be
used to calculate percent body fat, fat free mass, and estimate total body
water. |
N/A |
Uses electrodes on arms and feet. This technique
would require laboratory analysis, and for subjects to come to the lab about
4 hours early. They would also have to avoid strenuous exercise, alcohol, and
caffeine for 12 hours before the test, and at least 64 fluid oz of water in
the 24 hour period before test (dehydration can influence test results). |
Persons in the general population. |
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Disability
populations used: |
May be used with caution in studies
of persons with physical disabilities. Some scales require one to stand,
others to lie supine. Pessalano and colleagues (2003) argue that this method
is inappropriate for people with certain conditions or disabilities as it
does not take into account significant loss in muscle mass due to
neuromuscular problems or atrophy. Proposed for use by researchers at the
Center for Research on Women with Disabilities (CROWD) in a weight-management
intervention study among women with physical disabilities. Pessolano,
F.A., Suarez, A.A., Monteiro, S.G., Mesa, L., Dubrovsky, A., et al., (2003). Nutritional
assessment of patients with neuromuscular diseases. American Journal of
Physical Medicine & Rehabilitation, 82 (3), 182-185. |
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Zero Muscle Mass (ZMM) |
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N/A |
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Persons in the general population. |
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Disability
populations used: |
Pessolano and colleagues (2003) favor the Zero
Muscle Mass technique based upon their study findings that the test was able
to take into account muscle atrophy for patients with muscular dystrophy or
ALS. Their study found that in a sample of 34 patients with muscular
dystrophy and ALS, only five were classified as overweight by the BMI,
whereas 30 were overweight according to the Zero Muscle Mass (ZMM); no
patients showed normal body muscle mass. However, this test requires that
participants go on a creatinine-free diet for 6 days, and requires body
height and weight measurements. Pessolano,
F.A., Suarez, A.A., Monteiro, S.G., Mesa, L., Dubrovsky, A., et al., (2003). Nutritional
assessment of patients with neuromuscular diseases. American Journal of
Physical Medicine & Rehabilitation, 82 (3), 182-185. |
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Skin-fold calipers |
Uses a skin-fold caliper to measure skinfold
thickness at various sites, including triceps, subscrapular, suprailiac, and
anterior thigh. |
N/A |
|
Measurements at several sites should be taken for
greater accuracy. |
Persons in the general population. |
Requires trained technician to ensure greater
reliability, and each site must be measured several times. This test is
considered much more unreliable if the technician is not adequately trained.
Also, this test is not reliable in persons with severe obesity. According to Himes, (2001), up to ¼ of
women over 50 may have skinfold thickness too large to measure with standard
calipers. Although larger calipers are available, there is question regarding
the reliability (and logistics) of using larger calipers with skinfolds this
large. |
Requires a specially trained technician to
accurately measure body fat folds. |
|
Disability
populations used: |
May be used in studies of people
with physical disabilities. Skin fold
measurements may be taken at sites that do not require the person to stand.
Proposed for use by researchers at the Center for Research on Women with
Disabilities (CROWD) in a weight-management intervention study among women
with physical disabilities. Himes, J.H., (2001). Prevalence of
individuals with skinfolds too large to measure. American Journal of
Public Health, 91 (1), 154-155. |
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Bod-Pod (Air Displacement) |
Based on the same principle as underwater weighing,
the BOD POD uses computerized sensors to measure how much air is displaced
while a person sits for 20 seconds in a capsule. |
Body density and percent body fat. |
N/A |
It uses a calculation to determine body density,
then estimates body fat. Person must sit for 20 seconds in a capsule. |
Persons in the general population. |
Highly reliable. |
Highly accurate. |
|
Disability
populations used: |
As it is very accurate, this may be a good
alternative to underwater (hydrostatic weighing), which is a gold-standard
technique in the general population, but has several disadvantages for use in
persons with severe physical disabilities. However, Bod-Pod equipment is very
expensive and limited in availability. |
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Dual Energy X-Ray Absorptiometry (DEXA) |
DEXA uses a whole body scanner that has two low-dose
x-rays at different sources that read bone and soft tissue mass
simultaneously. The sources are mounted beneath a table with a detector
overhead. tissue mass. |
Reads bone and soft tissue mass, then divides the
body into multiple compartments- total body mineral, fat-free soft mass
(lean), and fat |
N/A |
Requires a person to lay supine or reclining; data
is collected at 0.5 cm intervals. The scan takes between 10-25 minutes.
Person must lie still throughout the procedure. |
Persons in the general population. |
Very reliable. |
Considered a “gold standard”; accurately provides a
variety of information about body composition. Considered to be less accurate
for people who are extremely obese. |
|
Disability
populations used: |
Used in studies of people with physical
disabilities. Considered to be the most accurate measurement of body
composition in persons with spinal cord injury (Jones, Goulding, and Gerrard,
1998). However, it is extremely expensive, the method is not as accurate for
people who are extremely obese, and the table has weight limits. Jones, L.M., Goulding, A., and Gerrard, D.F.,
(1998). DEXA: A practical and accurate tool to demonstrate total and regional
bone loss, lean tissue loss and fat mass gain in paraplegia. Spinal Cord,
36, 637-640. |
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Wheelchair-Accessible Platform Scales |
Wheelchair scales come in various sizes and weight
capacities. Some can be used with power wheelchairs. Some also have handles
that support a person who is able to stand. |
N/A |
N/A |
|
|
Varies. |
Varies. |
|
Disability
populations used: |
Commonly used in studies of people with severe
mobility impairments. Buchholz et al., (2003) used a digital wheelchair scale
for weight measurement, and a specially designed Plexiglas length board to
measure height for the paraplegic participants (this board was designed
specifically for the study). Participants had to transfer from their
wheelchairs, and lie flat on the board. Wheelchair scales have been proposed
for use by researchers at the Center for Research on Women with Disabilities
(CROWD) in a weight-management intervention study among women with physical
disabilities. Buchholz, A.C., McGillivray, C.F., Pencharz, P.B.,
(2003). Differences in resting metabolic rate between paraplegic and
able-bodied subjects are explained by differences in body composition. American
Journal of Clinical Nutrition, 77(2),371-8. |
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Quality
of Life
|
Instrument
Name and Original Reference |
Instrument
Description & Construct Measured |
Dimensions/ subscales |
Indicator
(Timing + Source of Data) |
Variables
(Number of Items, Scale, & Range) |
Test
Population |
Instrument
Reliability |
Psychometric
Review of Instrument Validity |
|
|
Quality of Life Index (QLI), Spinal Cord Injury Version May, |
Adapted from the original QLI: Ferrans, C., &
Powers, M., (1985). Quality of life index: Development and psychometric
properties. ANS: Advances in Nursing Science, 8 (1), 15-24. |
Four domains: Health and functioning, psychological and
spiritual, social and economic, and family. |
Self-report, current or present timing. |
35 items. Six-point scale. Each question is weighted
by the relative importance or value of the aspect of life represented by that
item to the respondent. Scores are calculated by weighting the satisfaction
item with its corresponding importance item. |
A qualitative analysis of the QLI-SCI was conducted
with 11 participants (nine men and two women), with spinal cord injury for at
least one year. |
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Disability
populations used: |
The QLI-SCI has been used in studies of persons with
spinal cord injury. |
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Quality of Life Index (QLI), Multiple Sclerosis Version Ferrans, C., & Powers, M., (1985). Quality of
life index: Development and psychometric properties. ANS: Advances in Nursing
Science, 8 (1), 15-24. |
Measures general satisfaction with various aspects
of quality of life. Respondents rate the relative importance of each aspect. |
Four domains: Health and functioning, psychological and
spiritual, social and economic, and family. 2 parts: Part 1 measures satisfaction with various QOL
domains, Part 2 measures the importance of each domain. |
Self-report, current or present timing. |
72 items. Six-point scale. Each question is weighted
by the relative importance or value of the aspect of life represented by that
item to the respondent. Scores are calculated by weighting the satisfaction
item with its corresponding importance item. |
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Disability
populations used: |
Stuifbergen, Seraphine, and Roberts (2000) have used this
scale in a sample of persons with multiple sclerosis in a study titled Health
Promotion and Quality of Life in Chronic Illness. Stuifbergen, A., Seraphine, A., & Roberts, G.,
(2000). An explanatory model of health promotion and quality of life in
chronic illness. Nursing Research, 49 (3), 122-129. |
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Osteoporosis Functional Disability Questionnaire (OFDQ) Helmes, E., (2000). Function and disability or
quality of life? Issues illustrated by the Osteoporosis Functional Disability
Questionnaire (OFDQ). Quality of Life Research, 9, 755-761. |
Measures major areas of function important to
persons with osteoporosis. Also measures quality of life. |
Five
domains: pain (severity, impact, and frequency or pattern, 8 items),
depression (20 items from CES-D), function in performing activities of daily
living (ADLs) (26 items), socialization and financial situation (2 items),
and confidence in exercise program (3 items). |
Self-report. |
59 items. Scoring is based upon scores for each
domain. Scale does not provide a total score. |
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