Validity, responsiveness, and minimal important difference for the SF-6D health utility scale in a spinal cord injured population

Value Health. 2008 Jul-Aug;11(4):680-8. doi: 10.1111/j.1524-4733.2007.00311.x. Epub 2008 Jan 11.

Abstract

Objective: To determine the feasibility, acceptability, discriminative validity, responsiveness, and minimal important difference (MID) of the SF-6D for people with spinal cord injury (SCI).

Methods: A total of 305 people with SCI completed the SF-36 health status questionnaire at baseline and at subsequent occurrence of a urinary tract infection (UTI) or 6-month follow-up. Normative SF-36 data were obtained from the Australian Bureau of Statistics. SF-36 scores were transformed to SF-6D utility values using Brazier's algorithm. We used UTI as the external criterion of clinically important change to determine responsiveness and two categories of the SF-36 transition question ("somewhat worse" and "somewhat better") as the external criterion to determine the MID. Derived SF-12 responsiveness was also assessed.

Results: The mean SF-6D values were: 0.68 (SD 0.21, n = 305) all patients; 0.66 (SD 0.19, n = 167) tetraplegia; 0.72 (SD 0.26, n = 138) paraplegia; 0.57 (SD 0.15, n = 138) with UTI. The Australian normative SF-6D mean value was 0.80 (SD 0.14, n = 18,005). The SF-6D was able to discriminate between SCI and the Australian normative sample (effect size [ES] = 0.86), tetraplegia-paraplegia (ES = 0.23), and it was responsive to UTI (ES = 0.86 SF-36 variant, ES = 0.92 SF-12 variant). The MID for respondents who reported being somewhat worse or somewhat better at follow-up was 0.03 (SD 0.17, n = 108/305), while the MID for only those who were somewhat worse was 0.10 (SD 0.14, n = 58).

Conclusions: The content of the SF-6D is more appropriate than that of the SF-36 for this physically impaired population. The SF-6D has discriminative power and is responsive to clinically important change because of UTI. The MID is consistent with published estimates for other disease groups.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Cross-Sectional Studies
  • Discriminant Analysis
  • Feasibility Studies
  • Female
  • Health Status Indicators*
  • Humans
  • Male
  • Middle Aged
  • New South Wales
  • Psychometrics / instrumentation*
  • Quality of Life
  • Reproducibility of Results
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / psychology*
  • Surveys and Questionnaires
  • Urinary Tract Infections / etiology*
  • Urinary Tract Infections / psychology*