Contributions for the Validation of the European Portuguese Version of the Vascular Quality of Life-6 Questionnaire for Peripheral Artery Disease
DOI:
https://doi.org/10.20344/amp.20760Keywords:
Peripheral Arterial Disease, Portugal, Quality of Life, Reproducibility of Results, Surveys and Questionnaires, TranslatingAbstract
Introduction: Peripheral arterial disease (PAD) is an occlusive atherosclerotic disease of the arteries of the extremities of the body that affects more than 230 million people worldwide. The most common symptom is intermittent claudication, described as leg pain which occurs mainly while walking. The symptoms impair the ambulation and functional capacity of patients, leading to loss of mobility, disease deterioration, increased risk of other cardiovascular
diseases, and lower quality of life (QoL). Therefore, the aim of this study was to perform a cross-cultural adaptation and validation of the VascuQol-6 questionnaire for the Portuguese population to obtain a quick, sensitive, and easy-to-use way to assess the QoL of Portuguese patients diagnosed with PAD.
Methods: The Vascular Quality of Life-6 Questionnaire (VascuQoL-6) was adapted and translated into European Portuguese using standard validation methodology, including 115 patients with a mean age of 64.67 (7.23) years, with PAD with IC stable for more than three months; and ABI < 0.9 at rest. VascuQoL-6, SF-36, International Physical Activity Questionnaire (IPAQ), and the PAD Knowledge Questionnaire (PADKQ) were used. Reliability, construct validity analysis through convergent and discriminant validity, known-group validity, and responsiveness analysis were tested.
Results: The Cronbach’s alpha was 0.64 and the average inter-item correlation was 0.27, indicating acceptable internal consistency. VascuQoL-6 was positively associated with SF-36 Physical Component Summary and Mental Component Summary scores (r = 0.64, p < 0.01 and r = 0.42, p < 0.01, respectively). In turn, there was no significant correlation between VascuQoL-6 scores and the PADKQ or IPAQ. A statistically significant difference between groups according to IC severity [F(2.47) = 8.35, p < 0.001] was found. A paired samples t-test showed differences between VascuQol-6 scores before a walking program (M = 15.65, SD = 3.09), and after a walking program (M = 17.41, SD = 2.71), t(67) = 3.94, p ≤ 0.001.
Conclusion: The VascuQoL-6 is a six-item instrument to assess the QoL associated with PAD with good psychometric properties, convergent and discriminant validity with SF-36, PADKQ and IPAQ. The instrument proved to have known group validity and responsiveness.
Downloads
References
Shu J, Santulli G. Update on peripheral artery disease: epidemiology and evidence-based facts. Atherosclerosis. 2018;275:379-81.
Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res. 2021;128:1818-32.
Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ. 2018;27:427-32.
Van Den Houten MM, Gommans LN, Van Der Wees PJ, Teijink JA. Minimally important difference of the absolute and functional claudication distance in patients with intermittent claudication. Eur J Vasc Endovasc Surg. 2016;51:404-9.
Henni S, Ammi M, Semporé Y, Hersant J, Zegar G, Gourdier A, et al. Treadmill measured vs. questionnaire estimated changes in walking ability in patients with peripheral artery disease. Eur J Vasc Endovasc Surg. 2019;57:676-84.
Frans FA, Van Wijngaarden SE, Met R, Koelemay MJ. Validation of the Dutch version of the VascuQol questionnaire and the Amsterdam linear disability score in patients with intermittent claudication. Qual Life Res. 2012;21:1487-93.
Nicolaï SP, Kruidenier LM, Rouwet EV, Graffius K, Prins MH, Teijink JA. The walking impairment questionnaire: an effective tool to assess the effect of treatment in patients with intermittent claudication. J Vasc Surg. 2009;50:89-94.
Nordanstig J, Karlsson J, Pettersson M, Wann-Hansson C. Psychometric properties of the disease-specific health-related quality of life instrument VascuQoL in a Swedish setting. Health Qual Life Out. 2012;10:1-8.
Soria-juan B, Llanos L, Moral LR, Aparicio C, Gonzalez A, Shaw O, et al. Cross cultural adaptation and validation of a Spanish version of vascuqol-6 questionnaire. Res Sq. 2021:1-17.
Poku E, Duncan R, Keetharuth A, Essat M, Phillips P, Woods H, et al. Patient-reported outcome measures in patients with peripheral arterial disease: a systematic review of psychometric properties. Health Qual Life Outcomes. 2016;14:161.
Kumlien C, Nordanstig J, Lundström M, Pettersson M. Validity and test retest reliability of the vascular quality of life questionnaire-6: A short form of a disease-specific health-related quality of life instrument for patients with peripheral arterial disease. Health Qual Life Outcomes. 2017;15:1-12.
Nordanstig J, Wann-Hansson C, Karlsson J, Lundström M, Pettersson M, Morgan MB. Vascular quality of life questionnaire-6 facilitates healthrelated quality of life assessment in peripheral arterial disease. J Vasc Surg. 2014;59:700-7.
Larsen AS, Reiersen AT, Jacobsen MB, Kløw NE, Nordanstig J, Morgan M, et al. Validation of the vascular quality of life questionnaire-6 for clinical use in patients with lower limb peripheral arterial disease. Health Qual Life Outcomes. 2017;15:184.
Correia M, Andrade-Lima A, Oliveira PL, Domiciano RM, Domingues WJ, Wolosker N, et al. Translation and validation of the Brazilian-Portuguese short version of vascular quality of life questionnaire in peripheral artery disease patients with intermittent claudication symptoms. Ann Vasc Surg. 2018;51:48-54.
Gjersing L, Caplehorn JR, Clausen T. Cross-cultural adaptation of research instruments: Language, setting, time and statistical considerations. BMC Med Res Methodol. 2010;10:13.
Wild D, Grove A, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health. 2005;8:94-104.
Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth. 2017;11:S80-9.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation. 2017;135:e686-75.
Kruidenier LM, Nicolaï SP, Willigendael EM, de Bie RA, Prins MH, Teijink JA. Functional claudication distance: a reliable and valid measurement to assess functional limitation in patients with intermittent claudication. BMC Cardiovasc Disord. 2009;9:1-7.
Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, et al. Optimal exercise programs for patients with peripheral artery disease. Circulation. 2019;139:10-33.
Gardner A, Skiner J. Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc. 1991;23:402-8.
Ferreira PL. Development of the portuguese version of MOS SF-36. Part II - Validation tests. Acta Med Port. 2000;13:119-27.
Hurtig-Wennlf A, Hagstrmer M, Olsson LA. The international physical activity questionnaire modified for the elderly: aspects of validity and feasibility. Public Health Nutr. 2010;13:1847-54.
Pedras S, Oliveira R, Veiga C, Silva I. What do patients know about peripheral arterial disease? a knowledge questionnaire. Rev Port Cir Cardiotorac Vasc. 2023;29:31-41.
Hamed Taherdoost A, Lumpur K. Validity and reliability of the research instrument; how to test the validation of a questionnaire/survey in a research. Int J Academ Res Manag. 2016;5:28-36.
DeVellis RF. Scale development: theory and applications. Vol 26. 5th ed. Newbury Park: SAGE Publications; 1991.
Maroco J, Garcia-Marques T. Qual a fiabilidade do alfa de Cronbach? Questões antigas e soluções modernas? Laboratório de Psicologia. 2006;4:65-90.
Stensen K, Lydersen S. Internal consistency: from alpha to omega? Tidsskr Nor Laegeforen. 2022;142.
Pallant J. SPSS survival manual: a step by step guide to data analysis using SPSS Program. 6th edition. London: McGraw-Hill Education; 2016.
Rattray J, Jones MC. Essential elements of questionnaire design and development. J Clin Nurs. 2007;16:234-43.
Davidson M. Known-groups validity. In: Michalos AC, editor. Encyclopedia of quality of life and well-being research. Dordrecht: Springer; 2014. p.3481-2.
Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral artery disease. Semin Intervent Radiol. 2014;31:378-88.
Mokkink L, Terwee C, de Vet H. Key concepts in clinical epidemiology: responsiveness, the longitudinal aspect of validity. J Clin Epidemiol. 2021;140:159-62.
Sullivan GM, Feinn R. Using effect size—or why the p value is not enough. J Grad Med Educ. 2012;4:279-82.
McHorney C, Ware J, Lu J, Sherbourne C. The MOS 36-item short-form healthy survey (sf-36): iii. test of data quality, scaling assumptions and reliability across diverse patient groups. Med Care. 1994;32:40-66.
Hair J, Back W, Aderson R. Multivariate data analysis. 7th ed. London: Pearson Prentice Hall; 2010.
Bland JM, Altman D. Statistics notes: Cronbach’s alpha. BJM. 1997;314:572.
Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80:99-103.
Piedmont R. Encyclopedia of quality of life and well-being research. 1st ed. Dordrecht: Springer; 2014.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.