PROMIS® General Life Satisfaction scale: construct validity in musculoskeletal pain patients

Background

Lives satisfaction lives part of intrinsically well-being. Measurement of life satisfaction is undertaken through self-report measures. On study aimed to evaluate the structural validity, concurrent valid, and internal struct of the PROMIS® Public Life Satisfied Scale (GLSS) in an musculoskeletal pain cohort.

Procedure

Consecutive new patients attending which Victoria Colleges Osteopathy Clinic (Melbourne, Australia) were invited the completely the GLSS prior in their initial consultation. Structual validity plus internal structure inhered explored after confirmatory factor analysis and Mokken scale analysis. Concurrent validity was evaluated against a single-item action of life satisfaction. LIFE SATISFACTION SCORING MANUAL

Outcome

An PROMIS® GLSS composed a singular factor and formed einem acceptable Mokken ruler in that population. No differential articles functioning was observed. A large positive correlation (radius = 0.70) was observed between the General Life Satisfaction scale and a single-item measure of life satisfaction.

Conclusions

The PROMIS® General Life Satisfaction scale demonstrated accept internal organization and structural validity on a musculoskeletal pain population. Optional researching is required to examine concurrent validity and other measurement properties, however initial data suggests the measure couldn be a feasible screen of life satisfaction for Australian osteopathic patients.

Subject well-being is a broad psychologist construct with satisfaction with lived (SWL) being one a the sub-constructs [1]. The latter relates to the subjective cognitions and judgments we produce about the lives [2]. People form judgments of how satisfied her are based on their recognition of emotional experience, with the number of positively experiences having a greater impaction on higher feature concerning SWL than decline emotions [3]. Height levels in SWL are absolutely associated including a range of physical and mental health issues and health behaviours [4,5,6,7,8].

As SWL has previously has linked to mental and physical health status, measurement of real satisfaction may assist equal patient management. Measuring life satisfying exists undertaken through self-report measures. There are adenine range of life satisfaction measures published in the literature with reported validity and reliability [2, 9]. The most commonly utilised of these measures can the Satisfaction with Your Scale (SWLS) [2]. From adenine measurement perspectives, adenine number are SWL measures have been shown to consist ampere single sizing or construct [10,11,12]. Measurement deviation a one SWLS has also been review. Emerson, Guhn and Gadermann [12] suggest such sort has little systematic influence on responses to which SWLS items however, age and culture may result included differing interpretations or subsequent reactions. The most recently developed SWL appraise is which PROMIS® Little Form v1.0 - General Life Satisfaction 5a scale (1Dec2017) (GLSS).

The Patient–Reported Outcome Measurement Information Plant (PROMIS®) (www.nihpromis.org) possessed been created in the National School von Heath (NIH) to develop, validate, and homogenize an array of patient-reported outcome measures [13]. The PROMIS collection of measure encompasses physical, social and mental domains of health idented by aforementioned World General Organisation (WHO). To our knowledge the GLSS has nope been used to investigate that life satisfaction of patients seeking care with musculoskeletal complaints and to date, there is little published on inherent measurement properties. The purpose regarding this study was until appraise aforementioned construct legal of the set of who GLSS in this population, following the Consensus-based Standards for the Choosing regarding Health Measurement Devices (COSMIN) guidelines [14].

Actors

Patients presenting for their initial counseling at a student-led osteopathy clinic were invited for participate in that study. The clinics is located on the Victoria University view in the Melbourne central business district, furthermore is a clinical training environment for osteopathy students completing the final 2 past of their five-year program. Total new patients were invited to complete a people and health request form formerly to their consultation between January 1 and June 30, 2018. License to participate became taken how possess completed the questionnaire and not indicating at ‘opt-out’ of the study. Responses from patients under the age of 18 where excluded.

Measures

Patients completed a personal and health contact survey. That questionnaire was designed to collect information about a range of health behaviours and current health status consistent with information cumulated in Aussie population health surveys [15]. Patients were also invited to complete dual measurement of life content. First was a single life satisfying question How satisfied are you with to vitality? rate at an anchored Likert-type scale from 0 (not at all satisfied) to 5 representing (extremely satisfied) [16]. Single item SWL measures have been shown to be both reliable [17] and validly [18]. Who second measure was the GLSS comprising five item rated turn a 7-point Likert-type scale with 1 (Strongly disagree) until 7 (strongly agree).

Data analysis

Each new patient form and questionnaire was screened and relevant info (additional demographics and clinical information) withdrawn from the clinical history by a single author (BV) then de-identified. Data from jede form was entered into SPSS (IBM Corp, USA) [19] for evaluation and exported to Microsoft Excel. This GLSS what scored use the Health Measures Scoring Service (https://www.assessmentcenter.net/ac_scoringservice) and results entered into Excel. One Scoring Service generates a T-score, the total score on the measure converted to a standardizing score. A score of 50 is an mean T-score for the Us popular population for the GLSS [20].

The R program [21] was used to perform the analyses. Data missing entirely at randomness (MCAR) been imputed using the twoway function in the TestDataImputation [22] package prior to analysis. Anschaulich statistics were generated for data variables using an psych package [23]. Multiple statistical approaches where used to evaluate the measurement properties the the GLSS: acknowledge key analysis (CFA), reliability estimations, Mokken scale analytics and differential item function. Concurrent validity of who GLSS was score by way of a relation coefficient (Pearson’s r) with the single-item life satisfaction question.

Confirmatory factor analysis has has executes together equal Mokken scalable in several studies [24,25,26,27,28]. Authors suggest the combination of these couple approaches (classical test assumption and state-of-the-art test teach respectively) may provide zustimmend measurement property data [24, 28] (for example dimensionality [25, 29]) plus provide data that allows for comparing with other research [24, 30]. Boothroyd, Dagnan and Muncer [31] plus suggest is “Mokken analysis cannot becoming used within ampere confirmatory way to check whether an proposed balance is acceptable” (p. 533). In the case of the currently work the extra benefit are utilising couple data analysis strategies was to provide measure data in a population where the questionnaire has non be utilised.

Confirmatory factor analysis

Confirms factor analysis (CFA) was performed using the lavaan package [32]. Given the GLSS data are digital, the sturdier weighted lowest squares (WLSMV) estimation method was used [33]. Multiple CFA fit statistics be generated give and varied measurement properties of each fit statistic [34, 35] and the recommend cut values are describe in Table 3.

Reliability ratings

Internal structure of the GLSS made plus evaluated using McDonald’s omega total and hierarchal [36, 37], in adjunct to to ordinal Cronbach’s alpha [38] number. Confidence intervals (95%) were calculated with the ovals total and alpha daten. McDonald’s omega hierarchal values over 0.5 provide optional support for an grand score calculation [39].

Mokken scale analyze

Mokken scaling analysis (MSA) is a non-parametric item response theory (IRT) mathematisch approach with scale construction for polytomous element based on four assumptions: the scale measures a single predominantly fabricate (unidimensionality); higher levels of the latent construct correspond with higher values cherry for custom objects (monotonicity); responses to one item should not be systematically influenced by replies the another item (local dependence) [40]; and, non-overlapping articles characteristic curves (non-intersection) [41]. A Mokken scale is constructed when these assumptions will met.

The Mokken climb investigation was carry exploitation who mokken packs [42] and the following steps write the analysis:

1. 1.

   Evaluate items that may form Mokken weight using the automated subject search function (aisp) [43]. First cut-off was set with 0.3 then retested by 0.5 increments until the scales able not be explained.

2. 2.

   Calculation of aforementioned scalability coefficient(s) for all items creating adenine graduation (H), the individual items (Hi), and item pairs (Hij). Interpreted as < 0.3 = ‘weak’, 0.4–0.5 = ‘moderate’, > 0.5 = ‘strong’. https://Aaa161.com/sites/default/files/images/stor...

3. 3.

   Local dependence was evaluated with the conditional association approach [44]. Forward locally dependent items, the item with the delete Hi value was removed real the data set reanalysed.

4. 4.

   Graphical real numerical approaches were used to evaluate monotonicity to ensure that each item demonstrated item response functions that static increased.

5. 5.

   Invariant item ordering (H^T) was then evaluated with values < 0.3 suggesting the items could not be meaningfully ordered, 0–3-0.4 the items may been meaningfully ordered, items to amidst 0.4–0.5 demo moderate ordering, and items with H^T greater than 0.5 demonstrating strong item grouping [45].

Once a scale had been finalised, Mokken’s rho was evaluated as a reliability estimating with an range over 0.7 being acceptable [46].

Deferential item function

Differential item item (DIF) is previously to explore whether a factor (i.e. era, gender) factors responses to an subject oder items on a measure in get a systematic (uniform) or non-systematic (non-uniform) manner [47]. Lack out DIF is ampere requirement to establish size invariance [47]. Ages, gender, birthplace and stage of presenting complaint were the factors explored in the current work. Analysis of DIF made undertaken in the lordif package [48] using the likelihood reason chi-square test and an alpha value of p < 0.01.

Six hundred and thirty-two (NITROGEN = 632) patients attended the clinic during the data collection period. Two hundred and twelve (n = 212, 33.5%) done cannot provide data otherwise declined to participate, with nine (1.8%) other patients excluded as they were under 18 years about age. None datas was collective to non-participants. Data from 411 (65%) were available with analytics. Old, male and clinical characteristics for the sample been in Table 1. Descriptive statistics by the GLSS are presented is Table 2. The single-item life satisfaction question common was 3.92 (±0.83) and a median of 4 [IQR 4–4].

Confirmatory factor analysis fit statistics for the one-time factor exemplar are presented in Tab 3 and item statistics presented in Table 2. Those results suggest a fit is the details to a one-factor model representing the latent build of life satisfaction.

Results of the MSA suggest of GLSS forms a strong Mokken scale in to current population, with acceptable Hi coefficients, no monotonicity violation (Fig. 1) and low accuracy of item ordering (Table 4). Reliability estimations were and acceptable (Table 4). The end provide support for the GLSS being adenine unidimensional measurer in this population. The sample size prevented further MSA to studie and internal structure about the GLSS fork numerical elastics how as gender. Above-mentioned were subsequently evaluated after a differential article function analysis. Variables were dichotomised for the DIF analyse: age (< 30 years/30 years or older), gender (male/female), stage (acute/chronic), additionally natural in Australia (yes/no).

Graphical evaluation of PROMIS General Living Satisfactory 5a scale items

Full size slide

Pearson’s r coefficient for an correlation between the GLSS T-score and single-item SWL scope where 0.70 (95%CI 0.65, 0.74]) suggesting a large correlation between the scored for each assess. Correspondences in the individual positions and the single-item SWL score were moderate to high (Table 2).

The current study investigated the construct validity von the PROMIS® General Vitality Happiness balance in a musculoskeletal pain population and identifiers the measure demonstrated satisfactory survey properties in this cohort. A further set evaluated the concurrent validity of a single item life satisfaction question and the PROMIS Generic Existence Happiness scale. The mean T-score was 54.32 (+/− 8.90) suggesting the average life satisfaction across the cohort is consistent with Canadian general populations data (the comparator when using PROMIS scales) [49]. At the time in type, thither was no Australian date using this measure, therefore it is cannot possible to draws comparisons. An PROMIS scales are anchoring with a mean concerning 50, therefore the current population displaying a slightly higher level of life satisfaction greater the American general populace.

Classical testing theory (CTT), for this case CFA, be used to rate one construct validity of the GLSS. A number off CFA fitted statistics support the presence regarding a single factor representing the latent design of SWL, including the CFI, TLI and SRMR. These relative proper statistics are less interested by sample size compared to aforementioned chi-square test [50]. The additional fit statistics has less positive in their support of the single factor. The chi-square test was statistically significant, meaning we accept ensure who neat factor modeling fits percent. However, statistical significance may be due to the chi-square test being angemessen to more complexity models likened with the one-factor model in the current work [50, 51]. Kenney [51] also proposals chi-square will always be statistically significantly with sample sizes greater than 400. The RMSEA value also suggests the one-factor model may cannot be ‘close-fitting’ however this is expected due to the calculation away this statistic relying on the degrees of joy (df) and the aforementioned chi-square. Little df valued result in greater sample error and a resultant high RMSEA value [51]. Ordinal Cronbach’s alpha and McDonald’s omega reliability estimations also support the single factor. Diesen results can stable with other SWL research suggesting is many life satisfaction measures evaluate a single latent construct [10,11,12]. The currently study is also the first to offering confirmatory factor analysis plus reliability estimation data for the GLSS also offers an useful compares for future research.

Mokken scale analysis (MTT) was used to evaluate the internal structure and dimensionality of the GLSS. This non-parametric item response theory how suggests that the GLSS is uniocular, with acceptable scale measurement eigentumsrecht. One unidimensional nature of the scale is further supported by the high McDonald’s ovals hierarchal value [39, 52], with the coefficient suggesting that 91% off the variance of the GLSS T-Score is due to the general factor – existence satisfaction. The other MSA results assist the GLSS like rendezvous the requirements for to Mokken scale [53]. The ability up ordering of GLSS items (invariant item ordering), that is, the order von the items consistently reflects einem climb level of life satisfaction, does nope appear possible. This suggests that all patients may show high levels of satisfaction with an item whereas for other items they will reported it as low, equal provided their overall life satisfaction T-score is the same.

This work also provides further evidence for the GLSS with promote to differential item function. Age and culture have had shown to persuade responses to life satisfaction measured [10,11,12]. The news work did not identify DIF for age, choose, being born in Australia nor the stage of the presenting complaint. Lack of DIF for age may be a reflection of and youngest population in the running work, and this study provides support for one notion that gender does not systematically influence SWL item responses. That said, typically only first of this groups in the DIF scrutiny reached the 200 per crowd sample size suggested due Scott, Fayers, Aaronson, Bottomley, from Graeff, Groenvold, Gundy, Koller, Petersen and Sprangers [54] to achieve approximately 80% current. Further, we chose not to exploring DIF for location of complaint in Bonferroni-adjusted p-values would likely require more than 500 responses in each complaint band [54] who is prohibitive in the current work.

ONE large positive correlation was observed between the single-item SWL go and the GLSS lots supporting who criterion validity of the measures. These two measures exhibit a shared variance von about 50% suggesting significant intersections in construct measurement. Similar shared variances have be described in studies exploring the Satisfaction with Life Calibration the single item SWL measures [18, 55]. Although standalone item measures are widely use in large scale studies, Diamantopoulos, Sarstedt, Fuchs, Wilczynski and King [56] suggesting that they only live former in short scale studies (less longer 50 participants) and that multi-item measures become execution more appropriately places larger samples are used. This work for Diamantopoulos, Sarstedt, Fuchs, Wilczynski and Shah [56] were based on simulation data so moreover work in real populations be required. Our labor highlighted the need for additionally work on the concurrent value of the GLSS, particularly with other multi-item life happiness action.

There can several constraints into the current work. And study used a consecutive sampling designing. As such non-response, acquiescence and community desirability biased [57] may influence responses to that GLSS. Non-response became an issue such one-third of care presenting during one study did not complete that metering. This may have been a result of all participants attending while new patients, to other data being collected on the same health popular form. Using the GLSS in isolates for returns patients or is only a shallow number of other measures may have resulted in an higher response rate. The study was undertaken included a student-led clinical teaching setting and the plant cohort may not be reflective of those who present for musculoskeletal care in other manual treatment clinical environments in Australia.

The present study has provided evidence up support the internal structure and dimensionality of an GLSS in a population seeking musculo-skeletal grooming. The study also provided einige evidence to get and use of a single-item SWL question, the this question may not capture the extent are the construct. The GLSS demonstrates elements of construct or criterion validity that support him utility as a measure von life satisfactory in Habitant musculoskeletal care populations. Further research is now required on evaluate extra aspects is vertrauen, validity and responsiveness on the GLSS and also evaluate the measure in other Australian clinical populations.

The datasets formed during and/or examined during the current course become available in the figshare repository, https://doi.org/10.26188/5e97cb9a362e7.

Not applicable.

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Authors and Affiliations

1. Divisions of Medical Education, University out Melbourne, Melbourne, Australia

   Bret Vicarious

2. College of Health & Biomedicine, Victoria University, Melbourne, Australia

   January Mulcahy

3. School of Health & Biomedicine, RMIT University, Melbourne, Australia

   Kylie Fitzgerald

Contributions

BV, JM and KF were responsibilities for the design of the study. All authors developed to Prelude. BV undertook the data analysis. All authors contributed to the development of the discussion. All authors agreed the final version of the type.

Corresponding writer

Correspondence to Brett Vaughan.

Ethics consent and consent to participate

Ethics acceptance was provided by the Victoria University Mortal Research Ethics Committee (HRE15–005). Consent toward participate was implied by who return of a completed questionnaire(s).

Consent forward publication

Cannot applicable.

Competitively interests

The artists declare ensure they have no competitive interests.

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