Adapting the Nottingham Health Profile for use in people with severe physical disabilities

The Nottingham Health Profile (NHP) is a well-known quality of life questionnaire. However, wheelchair-bound patients might obtain misleading scores on the scales Physical mobility, Pain and Emotional reactions. We tested three possible adaptations of the Dutch NHP to overcome this problem.

Respondents were 111 wheelchair-using people (walking ability maximum 5 m) with spinal cord injury, rheumatic diseases and other diagnoses. Adaptation methods were formulation of new questions (Q-NHP), a recoding procedure (R-NHP) and deleting items (D-NHP). Internal consistency, correlations between original and adapted scales and correlations with upper and lower extremity function and social functioning (NHP part II) were computed.

All adapted Pain and Emotional reactions scales were close to the original ones. The original Physical mobility scale proved invalid, resulting in better median scores for those patients who could not walk at all (38.7) than for patients who could walk a bit (50.0). The Q-NHP performed little better than the original one and suffered from greater complexity. The R-NHP showed better internal consistency (0.69 versus 0.49) and construct validity than the D-NHP.

An uncomplicated recoding procedure, scoring five questions about walking problems as 'yes' if respondents confirmed the question 'I cannot walk at all', improved reliability and validity of the Dutch NHP. Use of this recoding procedure in future research using the NHP is recommended, although its applicability in other language versions has to be proven in future research.