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Development and validation of a revised trauma-specific quality of life instrument
Juan Pablo Herrera-Escobar1, Terri deRoon-Cassini, Karen Brasel
1From the Center for Surgery and Public Health, Brigham and Women's Hospital (J.P.H.-E., S.S.A.R., A.T., A.H.H.), Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery (T.D.-C.), Medical College of Wisconsin, Milwaukee, Milwaukee; Division of Trauma, Critical Care and Acute Care Surgery (K.B.), Department of Surgery, Oregon Health and Science University, Portland, Oregon; Division of Trauma, Burn and Surgical Critical Care (D.N., A.S.), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma and Critical Care Surgery (G.K.), Department of Surgery, Duke University School of Medicine, Durham, North Carolina; and Division of Trauma, Emergency Surgery, and Surgical Critical Care (G.V.), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Background:
The National Academies of Science has called for routine collection of long-term outcomes after injury. One of the main barriers for this is the lack of practical trauma-specific tools to collect such outcomes. The only trauma-specific long-term outcomes measure that applies a biopsychosocial view of patient care, the Trauma Quality-of-Life (T-QoL), has not been adopted because of its length, lack of composite scores, and unknown validity. Our objective was to develop a shorter version of the T-QoL measure that is reliable, valid, specific, and generalizable to all trauma populations.
Methods:
We used two random samples selected from a prospective registry developed to follow long-term outcomes of adult trauma survivors (Injury Severity Score ≥9) admitted to three level I trauma centers. First, we validated the original T-QoL instrument using the 12-Item Short-Form Health Survey (SF-12) version 2.0 and Breslau post-traumatic stress disorder screening (B-PTSD) tools. Second, we conducted a confirmatory factor analysis to reduce the length of the original T-QoL instrument, and using a different sample, we scored and performed internal consistency and validity assessments of the revised T-QoL (RT-QoL) components.
Results:
All components of the original T-QoL were significantly correlated negatively with the B-PTSD and positively with the SF-12 mental and physical composite scores. After confirmatory factor analysis, a three-component structure using 18 items (six items/component) most appropriately represented the data. Each component in the revised instrument demonstrated a high level of internal consistency (Cronbach's α ≥0.8) and correlated negatively with the B-PTSD and positively with the SF-12, demonstrating concurrent validity. In addition, each of the RT-QoL components was able to distinguish between individuals based on their work status, with those who have returned to work reporting better health.
Conclusion:
This more practical RT-QoL measure greatly increases the ability to evaluate long-term outcomes in trauma more efficiently and meaningfully, without sacrificing the validity and psychometric properties of the original instrument.
Level Of Evidence:
Prognostic and epidemiological, level III.
