A Web-Based Adaptation of the Quality of Life in Bipolar Disorder Questionnaire: Psychometric Evaluation Study.

Steven Barnes,Oonagh Fogarty,Colin Depp,Erin Michalak,Emma Morton,Sharon Hj Hou,Greg Murray

doi:10.2196/17497

Abstract

BackgroundQuality of life (QoL) is considered a key treatment outcome in bipolar disorder (BD) across research, clinical, and self-management contexts. Web-based assessment of patient-reported outcomes offer numerous pragmatic benefits but require validation to ensure measurement equivalency. A web-based version of the Quality of Life in Bipolar Disorder (QoL.BD) questionnaire was developed (QoL Tool).ObjectiveThis study aimed to evaluate the psychometric properties of a web-based QoL self-report questionnaire for BD (QoL Tool). Key aims were to (1) characterize the QoL of the sample using the QoL Tool, (2) evaluate the internal consistency of the web-based measure, and (3) determine whether the factor structure of the original version of the QoL.BD instrument was replicated in the web-based instrument.MethodsCommunity-based participatory research methods were used to inform the development of a web-based adaptation of the QoL.BD instrument. Individuals with BD who registered for an account with the QoL Tool were able to opt in to sharing their data for research purposes. The distribution of scores and internal consistency estimates, as indicated by Cronbach alpha, were inspected. An exploratory factor analysis using maximum likelihood and oblique rotation was conducted. Inspection of the scree plot, eigenvalues, and minimum average partial correlation were used to determine the optimal factor structure to extract.ResultsA total of 498 people with BD (349/498, 70.1% female; mean age 39.64, SD 12.54 years; 181/498, 36.3% BD type I; 195/498, 39.2% BD type II) consented to sharing their QoL Tool data for the present study. Mean scores across the 14 QoL Tool domains were, in general, significantly lower than that of the original QoL.BD validation sample. Reliability estimates for QoL Tool domains were comparable with that observed for the QoL.BD instrument (Cronbach alpha=.70-.93). Exploratory factor analysis supported the extraction of an 11-factor model, with item loadings consistent with the factor structure suggested by the original study. Findings for the sleep and physical domains differed from the original study, with this analysis suggesting one shared latent construct.ConclusionsThe psychometric properties of the web-based QoL Tool are largely concordant with the original pen-and-paper QoL.BD, although some minor differences in the structure of the sleep and physical domains were observed. Despite this small variation from the factor structure identified in the QoL.BD instrument, the latent factor structure of the QoL Tool largely reproduced the original findings and theoretical structure of QoL areas relevant to people with BD. These findings underscore the research and clinical utility of this instrument, but further comparison of the psychometric properties of the QoL Tool relative to the QoL.BD instrument is warranted. Future adaptations of the QoL Tool, including the production of an app-based version of the QoL Tool, are also discussed.

Highlights

BackgroundApplications of quality of life (QoL) assessment instruments in bipolar disorder (BD) research have grown substantially [1,2] since the introduction of the concept in psychiatric research more generally in the 1980s [3]
The psychometric properties of the web-based Quality of life (QoL) Tool are largely concordant with the original pen-and-paper QoL.BD, some minor differences in the structure of the sleep and physical domains were observed
Despite this small variation from the factor structure identified in the QoL.BD instrument, the latent factor structure of the QoL Tool largely reproduced the original findings and theoretical structure of QoL areas relevant to people with BD

Summary

Introduction

BackgroundApplications of quality of life (QoL) assessment instruments in bipolar disorder (BD) research have grown substantially [1,2] since the introduction of the concept in psychiatric research more generally in the 1980s [3]. Generic measures assess areas of life, which may be considered fundamentally important [5], patient groups may have unique priorities that are best assessed with disorder-specific instruments [6] To address this gap, the first condition-specific QoL instrument for BD was developed: the Quality of Life in Bipolar Disorder (QoL.BD) [7]. A decade since its development, the QoL.BD instrument has seen international adoption: it has undergone formal adaptation and validation in Iranian, Chinese, and Chilean populations [8,9,10] and has been translated into over 20 languages [11] It has seen application in diverse research contexts, including clinical trials of psychotherapy [12,13,14,15,16] and pharmacological interventions [17,18]. A web-based version of the Quality of Life in Bipolar Disorder (QoL.BD) questionnaire was developed (QoL Tool)

Methods

Results

Discussion

Conclusion