Summary:
Introduction
Distal radius fractures, are of the most common fractures of the upper
extremity. They are also, one of the major osteoporotic fractures. This kind of
fracture, causes pain and acute loss of physical function and has an impact on
social and emotional function. Distal radius fracture, occurs early in the
course of osteoporosis and many patients are still employed. This fracture
often, is a predictor of other fractures.
Osteoporotic fractures, cause a considerable loss of quality of life, both
acute loss, immediately after the fracture, and chronic loss, because of
recurrent fractures and disability, due to incomplete recovery.
Development of the Questionnaire
Several instruments have been developed for the assessment of quality of life,
after vertebral fractures. The European Foundation for Osteoporosis, now merged
with the International Osteoporosis Foundation, developed a specific
questionnaire for quality of life, in patients with vertebral fractures. This
questionnaire Qualeffo-41, has been validated and translated into many
languages. It showed, that quality of life decreased with increasing number of
vertebral fractures and that lumbar fractures, had more impact on quality of
life than thoracic fractures. A shorter version has also been developed.
The Working Group for Quality of Life of the International Osteoporosis
Foundation, has developed a questionnaire for quality of life specific for
patients, with wrist fracture. This questionnaire can be used, as a supplement
to the Qualaffo-41. The aim of the study, is to test the validity of the Greek
version of the International Osteoporosis Foundation (IOF) quality of life
questionnaire, in postmenopausal women with a recent wrist fracture.
Study
The study included 125 post-menopausal women, with a recent distal radius
fracture. The questionnaire was administered as soon as possible after the
fracture, at 6 weeks, 3 months, 6 months and 1 year after the fracture.
The validation study, of the Greek version of the quality of life
questionnaire, examined internal consistency, concurrent validity, test –
retest reliability, sensitivity and specificity.
Internal consistency was assessed using the Cronbach’s a coefficient. The
Cronbach’s a value should be greater than 0.7 for a scale of good consistency.
Pearson’s correlation coefficient, was calculated between all the items and
their domain score, to check item’s convergent validity. The correlation
coefficient should be moderate to large (>0.4). A discriminant validity checks,
if the item measures other concept that it is not supposed to measure. A degree
of item’s discriminant validity, was calculated as a correlation between items
and scores of other domains. The discriminant validity of each item, should be
lower than the convergence one.
Reproducibility was estimated through a test-retest after one month. The
strength of agreement between the repeated measures, was examined using the
intraclass correlation coefficient.
Concurrent validity was explored by correlations between the scores of the
QUALEFFO and SF-36 questionnaires.
The sensitivity was assessed by the receiver operating characteristics curve.
This analysis can describe discrimination ability of a questionnaire. The curve
is defined by the values of sensitivity (true positive rate) and specificity
(true negative rate) of the questionnaire. Sensitivity is an ability of a
questionnaire, to detect a patient with the observed disease versus
specificity, that is the ability to detect a patient without the
disease.
Conclusions
The Greek QUALEFFO version is reliable, valid, sensitive and predictive for
examinations of health related quality of life, in post- menopausal women, with
a recent distal radius fracture and can be used in further studies. It appears
to be a reliable and responsive quality of life questionnaire, showing
sufficient repeatability, high internal consistency and adequate sensitivity to
change. It is ready for use in patients with wrist fracture, for evaluation of
quality of life with regard to osteoporosis.
Keywords:
Validation, Greek questionnaire, Quality of life, Patients, Forearm fracture
