Cumplimiento

Conclusion:- The MHIQ needs more validation especially for emotional and social scales. It may not be as sensitive as other available instruments to changes in physical function and there is little information regarding its sensitivity to change for emotional and social scores. Additionally its use in older people has been queried and it takes 20 minutes to complete.

8. Affect balance scale

The Affect Balance Scale was developed as a measure o f happiness or general psychological well-being (McDowell & Newell, 1996). It consists o f 10 items, 5 positive responses and 5 negative.

Reliability - Internal consistency is reasonable with values o f 0.55 to 0.73 reported for

the positive scale and 0.61 to 0.73 for the negative scale. Test-retest coefficients after 3 days are reported to be high, exceeding 0.9 for 9 o f the items and 0.86 for 1 question (Bradbum, 1969).

Validity - Bradbum (1969) showed agreement between the questions and other indices

o f reported well-being and also reported good discriminant validity, for example the instrument can distinguish between employed and unemployed and between rich and poor.

Sensitivity and sensitivity to change - Some evidence o f sensitivity to change has been

reported (Bradbum, 1969).

Has it been used with older people? - The Affect Balance Scale has been used in large

numbers o f surveys o f elderly people (Fletcher et al. 1992).

Is the instrument suitable fo r self-administration? - The Affect Balance Scale is self

administered with completion time taking less than 5 minutes.

Is it easy to score? - The instrument can be scored in two ways. First it can be used

simply with a ‘Yes’ or ‘N o ’ reply or second it can be used with a scale o f responses (3,4 or 5 points) which represent the frequency o f experiencing the feeling e.g. when using the 3 point scale the respondent can choose from three responses, "often"

"sometimes" or "never" in answer to each question.

Is the instrument comprehensive but not too longl - The Affect Balance Scale is brief

but broad in scale. Because o f this it may suffers some resulting psychometric weaknesses (McDowell & Newell, 1996).

Conclusion:- The Affect Balance Scale has been widely used and therefore results can

be compared to other studies. However it has been criticised as some o f the items appear to measure accomplishments (Bowling, 1991; Fletcher et al. 1992) and because the positive items may measure transient change whilst the negative items have a more stable state.

9. Nottingham health profile (NHP)

The NHP was designed to give a brief indication o f perceived physical, social and emotional health problems. It is composed o f two parts, although part I can be used on its own. Part I consists o f 38 items, each item referring to departures from "normal" functioning. It splits into 6 sections (physical ability, pain, sleep, social isolation, emotional reactions and energy levels). Part II gives a brief indication of handicap and is composed o f 7 items which record the effect o f health problems on occupation, jobs around the house, personal relationships, social life, sex life, hobbies and holidays. The following information concerns part I only.

Reliability - The NHP does not meet the requirements for carrying out tests for split-

half reliability as it is too short and the items are not homogeneous (Bowling, 1991). Test-retest reliability is reported to be good for part I with coefficients for the 6 sections ranging from 0.75 to 0.88 (McDowell & Newell, 1996).

Validity - The NHP is reported to have good content validity and also is able to

discriminate between different types of patient. It also has shown good correlation with other instruments and reasonable correlation with physiotherapy ratings (McDowell & Newell, 1996)

Sensitivity to change - Although some studies have shown changes in response to

interventions the NHP is designed to pick up rather severe problems therefore many healthy people may give scores with little room for improvement i.e. ceiling effect.

Has it been used with older people? - The NHP has been used in studies with older

people (Borgquist et al. 1992; Ebrahim & Williams, 1992; Johansson et al. 1993;

Grimby et al. 1992; Rowland et al. 1994)

Is the instrument suitable fo r self-administration? - The NHP is self administered and

takes around 10 to 15 minutes to complete

Is it easy to scorel - The NHP can be scored in different ways, the simplest o f which

is to count the number o f positive responses in each section.

Is the instrument comprehensive but not too longl - Comprehensive instrument which

is quick and simple to complete.

Conclusion:- The NHP is a well used questionnaire. It’s major disadvantage, for it’s

proposed use in our study, is that it is designed to identify rather severe problems. This makes responses to interventions in ‘healthy’ individuals difficult to see.

FINAL SELECTION

The final selection o f instruments was the Profile o f Mood States, the General Health Questionnaire, the SF-36 and the Philadelphia Geriatric Centre Morale Scale. These were considered to be best in terms of performance and covered a wide range of components which make up Quality of Life. The Geriatric Depression Scale was also

chosen because it has been recommended by the Royal College o f Physicians o f London and we wished to gain further information on its use.