**2.2 Nottingham Health Profile (NHP)**

(1) Part I: 38 questions in 6 subareas, with each question assigned a weighted value; the sum of all weighted values in a given subarea adds up to 100, (Hunt, 1985),


160 Liver Transplantation – Basic Issues

There is some doubt as to what differentiates HRQOL and QOL. Some concepts that can be encapsulated under the term QOL include social functioning, emotional well-being, role functioning, cognitive functioning, sleep problems, sexual functioning, vitality/energy, pain, life satisfaction, body image and general perceptions of health (Table 1) (Borgaonkar, 2000; van den Plas, 2003). In this chapter we will discuss HRQOL because in clinical practice both concepts HRQOL and QOL are used as equivalents, especially for patients with severe

Due to the multidimensionality of HRQOL, it is not possible to measure every dimension simultaneously, therefore a more limited and focused assessment should be undertaken. In patients with chronic diseases such as advanced liver disease, QOL is based on health parameters, and not on more general factors such as socioeconomic status or housing conditions since these are often considered as not having any relevance to their medical concerns. However, some problems related to finances, corporal image or specific architectural needs are contemplated in relation to some medical conditions as it is done for the study of QOL in oncological patients using specific tools (Roila & Cortesi, 2001; Gangeri,

**Leisure and recreation**, **Mobility and self-care,** Travel, Walking, Food/drink, Running, Visit friends' homes, Climbing, Vacation, Eating, Nearnes sto toilet facilities, Grooming, Hobbies and sports, Physical endurance, Relationships, **Emotional,** Intimacy and sexual function, Anger, Body image, Embarrassment, Understanding from others, Anxiety, Coping and support, Irritability, Relations with children and extended family, Happiness, Friendships, Worries or fears, Pain and discomfort, Ability to relax, Chest pain, Frustration, Abdominal pain, Depression/sadness, Abdominal cramps, Satisfaction, Abdominal discomfort, **Job-education,** Rectal pain, Satisfaction, Back pain, Attendance, Headaches, Concentration, Extra intestinal pain, Task completion, Joint pain, Achievement/promotion, **Well being**, Financial reward, Energy, **Treatment,** Fatigue, Efficacy, Sleep, Adverse effects,

Table 1. Problems, issues and domains of health related quality of ife (HRQOL) studied by

In practice most research has measured HRQOL as a multi-dimensional construct, instruments used to measure it must have at least three core domains: physical, psychological and social (Unal, 2001; Drent, 2009). Broadly speaking QOL measures can be divided into two categories: generic or condition-specific (Patrick, 1989; van den Plas, 2003):

Generic questionnaires are comprehensive and they can apply to different patient populations, allowing comparisons between different diseases. These generic measures have the advantage that the obtained scores can be compared with the scores of other patient populations or with a healthy control group, stratified by age and gender. A recognized disadvantage is that generic instruments are not designed to identify disease specific

disease.

2007).

Self-control

questionnaires (Borgaonkar, 2000*.*)

**2. Methods for studying QOL** 

**2.1 Generic questionnaires** 


(2) Part II: Seven daily life areas that can cause problems in your present state of health:



IC: Internal consistency; TRT: Test Re-test reliability; CV: Construct validity; Conv. V: Convergent validity; DV: Discriminant validity.

\*All reported validities have been established

\*\* Mental component score and physical component score

Table 2. Most commonly used generic HRQOL instruments

(2) Part II: Seven daily life areas that can cause problems in your present state of health:

• Looking after the home (cleaning & cooking, repairs, odd jobs around the home, etc.);

**Form (SF-36)** 

Brazier et al. 1992 (Validation)


TRT.r: 0.60-0.81

NHP were high

non comparable

NHP were low



IC: Internal consistency; TRT: Test Re-test reliability; CV: Construct validity; Conv. V: Convergent

IC: Cronbach *alpha* > 0.84

DV: Correlations between

dimensions of SF-36 and


Conv. V: correlations between four comparable dimensions of SF-36 and

**Medical Outcomes Study** 

**Sickness Impact Profile** 

IC:Cronbach *alpha*: 0.94

Conv. V: E.g. Activity of

TRT.r: 0.87-0.97

daily living. Index:r:0.55-0.61 DV: E.g. explained variance of Speech Pathology Ratings Clinical and Descriptive

validity

Bergner et al. 1981

**(SIP)** 

Yes

• Social life (going out, seeing friends, going to the movies, etc.); • Home life (i.e. relationships with other people in your home);

• Interests and hobbies (sports, arts and crafts, do-it-yourself, etc.);

• Vacations (summer or winter vacations, weekends away, etc.) (Hunt,1980).

38 36 136

6 8 12

• Work (i.e. paid employment);

**Nottingham Health Profile (NHP)** 

*Reliability* IC:Cronbach *alpha*: 0.70- 0.85

*Validity\** CV: Ill vs healthy people

statuses



validity; DV: Discriminant validity.

\*All reported validities have been established

\*\* Mental component score and physical component score

Table 2. Most commonly used generic HRQOL instruments

TRT.r: 0.75-0.88

DV: Between groups with various health



*Authors* Hunt et al. 1980, 1985 Ware et al. 1992

*Total score* No Yes, -Emotional role\*\*

• Sex life;

**Generic Tests** 

*Number of items* 

*Number of subscales* 

*Subscales/ domains* 

#### **2.3 Disease-specific questionnaires have been developed to be valid only for one specific condition**

A review of QOL instruments used in liver transplantation has been published recently (Jay, 2009). In this article, among others, authors discussed existing QOL instruments with its individual strengths and limitations.

In this chapter we will discuss four specific questionnaires, that have been designed for CLD: (Table 3.) (Gutteling, 2007). In table 3 we present the two more frequently used questionnaires.


IC: Internal consistency; TRT: Test Re-test reliability; CV: Construct validity; Conv. V: Convergent validity; DV: Discriminant validity; CLD: Chronic Liver Disease.

\*All reported validities have been established

\*\*A prospectively validated Short Version of LDQOL has been published (Kanwal, 2008)

Table 3. The two most commonly used specific HRQOL instruments for candidates or recipients of liver transplantation (Jay, 2009)
