Validation of the RAND 36-Item Health Survey questionnaire in Brazil

Health-related quality of life is frequently used as an outcome measure that improves the quality of care. The SF-36 and RAND-36 were derived from the Medical Outcomes Study.

Objective

The present study aimed to validate the RAND-36 in Brazil, in healthy individuals and patients with liver disease.

Methods:

Confirmatory factor analysis (CFA) was conducted by using JASP Software. The parameters of the items were estimated using the Robust Diagonally Weighted Least Squares (RDWLS) approach. Comparative fit index (CFI), Goodness-of-fit index (GFI), Tucker-Lewis Index (TLI) and the root mean square error of approximation (RMSEA) were evaluated. Internal consistency was measured using the Composite reliability index. Convergent validity between RAND-36 domains and Work Ability Index (WAI) was conducted.

Results:

This validation study included 763 individuals, 400 (52.4%) with chronic liver disease. The most prevalent liver diseases were hepatitis C (13.9%), alcoholic liver disease (11.8%), and steatosis (12.1%). The measurement model tested using the CFA obtained the following adjustment indicators: X² (df): 599.65 (498); CFI: 0.998; GFI: 0.998; TLI: 0.998; RMSEA: 0.016 (90%CI: 0.011-.021). Convergent validity of RAND-36 and total WAI ranged from medium to large correlation.

Conclusion:

The RAND-36 is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. The results of our study support the developer’s claims for the reliability of the RAND-36 version 1 as a measure of health-related quality of life. The evidence for the construct validity of the RAND-36 was substantial.

Keywords:
Quality of life; health-related quality of life; validation study

Demographic and clinical characteristic	N=763
Age, mean (SD^a)	50.3 (9.9)
Sex N (%)
Male	408 (53.5)
Female	355 (46.5)
Ethnicity N (%)
Caucasian	156 (20.4)
Racially Mixed	417 (54.7)
Black	190 (24.9)
Marital status N (%)
Stable relationship	475 (62.3)
No stable relationship	288 (37.3)
Educational status N (%)
<8 years	648 (84.9)
>8 years	115 (15.1)
Family income (minimal wages)^b N (%)
<2 MW	587 (76.9)
>2 MW	176 (23.1)
Liver diseases
Autoimmune liver diseases	21 (2.8)
Alcoholic liver disease	90 (11.8)
Nonalcoholic fatty liver disease	15 (2.0)
Hepatitis C virus	106 (13.9)
Hepatitis B virus	19 (2.5)
Primary biliary cirrhosis	2 (0.3)
Secondary biliary cirrhosis	2 (0.3)
Hepatocellular carcinoma	9 (1.2)
Steatosis	92 (12.1)
Other liver diseases	44 (5.8)
Without liver disease	363 (47.6)

RAND- 36 domains	M±SD	1	2	3	4	5	6	7	8
1-Physical functioning	75.30±26.81	(0.94)
2-Role limitations due to physical health	65.43±43.26	0.56^a	(0.92)
3-Pain	72.95±27.39	-0.54^a	-0.47^a	(0.84)
4-General Health	66.27±22.47	-0.63^a	-0.56^a	0.59^a	(0.80)
5-Energy fatigue	67.48±23.85	-0.74^a	-0.60^a	0.70^a	0.80^a	(0.81)
6-Social functioning	82.75±23.17	-0.62^a	-0.67^a	0.52^a	0.67^a	0.73^a	(0.71)
7-Role limitations due to emotional problems	71.42±41.56	0.37^a	0.82^a	-0.39^a	-0.47^a	-0.49^a	-0.48^a	(0.92)
8-Emotional well-being	78.20±19.64	0.57^a	0.46^a	-0.67^a	-0.76^a	-0.88^a	-0.70^a	0.52^a	(0.80)

RAND- 36 domains	WAI^a	P ^b
Physical functioning	0.676	0.001
Role limitations due to physical health	0.592	0.001
Pain	0.454	0.001
General Health	0.601	0.001
Energy fatigue	0.585	0.001
Social functioning	0.490	0.001
Role limitations due to emotional problems	0.500	0.001
Emotional well-being	0.512	0.001

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] Corresponding author: Liliane Lins-Kusterer. E-mail: lkusterer@gmail.com