Quality of Life Research

, Volume 14, Issue 5, pp 1375–1386 | Cite as

Development and validation of a new health-related quality of life instrument for patients with sinusitis

  • Steven J. Atlas
  • Patricia M. Gallagher
  • Yen A. Wu
  • Daniel E. Singer
  • Richard E. Gliklich
  • Ralph B. Metson
  • Floyd J. FowlerJr


Background and Objective: There are few validated measures of sinusitis-specific health-related quality of life (HRQL). This study used patient focus and pretesting groups followed by a prospective cohort study to develop and validate a HRQL instrument for patients with sinusitis. Methods: Instrument development involved a systematic literature review, use of expert input, and patient focus and pretesting groups. Patients were recruited from the practices of primary care providers and otolaryngologists. The derived survey instrument then underwent prospective testing in patients with acute sinusitis, chronic sinusitis, allergic rhinitis, and asymptomatic controls. Reduced item scales of the original instrument were developed for symptom frequency and bothersomeness. The psychometric properties of the survey instrument were evaluated for reliability, construct validity, responsiveness, and interpretability. Results: In the prospective study, 47 patients with acute sinusitis and 50 patients with chronic sinusitis were compared to 18 patients with allergic rhinitis and 60 patients without nasal symptoms. Forty-three (91.5) patients with acute sinusitis completed the questionnaire at baseline and at 1-month follow-up. Internal consistency was high for the symptom impact scale for acute and chronic sinusitis patients. The symptom frequency and especially bothersomeness scales had lower internal consistency particularly for acute sinusitis patients. Reproducibility among surgical patients retested prior to their procedure was good for each scale. A high degree of disciminant validity was demonstrated when comparing sinusitis patients to other groups, and a high degree of convergent validity was seen when the new measures were compared to other HRQL measures at baseline. Among patients with acute sinusitis, the responsiveness and interpretability of the symptom frequency, bothersomeness and impact scales were excellent. Conclusions: This study developed and validated a new sinusitis-specific HRQL instrument. The instrument included symptom frequency, bothersomeness and impact scales. It was shown to be valid in patients with acute and chronic sinusitis, and highly responsive and interpretable in acute sinusitis patients managed in the primary care setting.


Health-related quality of life Instrument Sinusitis Validation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cherry DK, Burt CW, Woodwell DA. (2001). National Ambulatory Medical Care Survey: 1999 Summary. Advance Data from Vital and Health Statistics; No. 322. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  2. 2.
    Gonzales, R, Steiner, JF, Sande, MA. 1997Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physiciansJAMA278901904CrossRefPubMedGoogle Scholar
  3. 3.
    Schappert, SM. 1998Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1996National Center for Health Statistics. Vital Health Stat13137Google Scholar
  4. 4.
    Woodwell DA. (2000). National Ambulatory Medical Care Survey: 1998 Summary. Advance Data from Vital and Health Statistics. Hyattsville, Md: National Center for Health Statistics.Google Scholar
  5. 5.
    Kennedy, DW, Shaman, P, Han, W, Selman, H, Deems, DA, Lanza, DC. 1994Complications of ethmoidectomy: A survey of fellows of the American Academy of Otolaryngology – Head and Neck SurgeryOtolaryngol Head Neck Surg111589599CrossRefPubMedGoogle Scholar
  6. 6.
    Juniper, EF. 1997Quality of life in adults and children with asthma and rhinitisAllergy52971977CrossRefPubMedGoogle Scholar
  7. 7.
    Stewart, MG, Donovan, DT, Parke, RB,Jr, Bautista, MH. 2000Does the severity of sinus computed tomography findings predict outcome in chronic sinusitis?Otolaryngol Head Neck Surg1238184CrossRefPubMedGoogle Scholar
  8. 8.
    Linder JA, Atlas SJ. Health-related quality of life in patients with sinusitis. Current Allergy Asthma Rep 2004: in press.Google Scholar
  9. 9.
    Linder, JA, Singer, DE, Ancker, M, Atlas, SJ. 2003Measures of health-related quality of life for adults with sinusitis: A systematic reviewJ Gen Int Med18390401CrossRefGoogle Scholar
  10. 10.
    Fowler, FJ,Jr. 1993Survey Research Methods2CA: SAGE PublicationsNewbury ParkGoogle Scholar
  11. 11.
    Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. (2002). How to Score Version 2 of the SF-12 Health Survey (With a Supplement Documenting Version 1). Lincoln, RI: Quality Metric Incorporated.Google Scholar
  12. 12.
    Anderberg, MR. 1973Cluster Analysis for ApplicationsAcademic Press IncNew YorkGoogle Scholar
  13. 13.
    Cronbach, LJ. 1951Coefficient alpha and the internal structure of testsPsychometrika16297334CrossRefGoogle Scholar
  14. 14.
    Deyo, RA, Diehr, P, Patrick, DL. 1991Reproducibility and responsiveness of health status measures: Statistics and strategies for evaluationControl Clin Trials12142S58SCrossRefPubMedGoogle Scholar
  15. 15.
    Fleiss, JL, Cohen, J. 1973The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliabilityEdu Psychol Measure33613619CrossRefGoogle Scholar
  16. 16.
    Durr, DG, Desrosiers, MY, Dassa, C. 2001Impact of rhinosinusitis in health care delivery: The Quebec experienceJ Otolaryngol309397CrossRefPubMedGoogle Scholar
  17. 17.
    Gliklich, RE, Metson, R. 1997Effect of sinus surgery on quality of lifeOtolaryngol Head Neck Surg1171217CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson, ER, Murphy, MP, Weymuller, EA,Jr. 1999Clinimetric evaluation of the Sinonasal Outcome Test-16Otolaryngol Head Neck Surg121702707CrossRefPubMedGoogle Scholar
  19. 19.
    Gliklich, RE, Hilinski, JM. 1995Longitudinal sensitivity of generic and specific health measures in chronic sinusitisQual Life Res42732CrossRefPubMedGoogle Scholar
  20. 20.
    Piccirillo, JF, Edwards, D, Haiduk, A, Yonan, C, Thawley, SE. 1995Psychometric and clinimetric validity of the 31-item rhinosinusitis outcome measure (RSOM-31)Am J Rhinology9297306CrossRefGoogle Scholar
  21. 21.
    Cronbach, LJ, Shavelson, RJ. 2004My current thoughts on coefficient alpha and successor proceduresEducat Psychol Measure64391418CrossRefGoogle Scholar
  22. 22.
    Juniper, EF, Thompson, AK, Ferrie, PJ, Roberts, JN. 2000Development and validation of the Mini Rhinoconjunctivitis Quality of Life QuestionnaireClin Exp Allergy30132140CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Steven J. Atlas
    • 1
  • Patricia M. Gallagher
    • 2
  • Yen A. Wu
    • 1
  • Daniel E. Singer
    • 1
  • Richard E. Gliklich
    • 3
  • Ralph B. Metson
    • 3
  • Floyd J. FowlerJr
    • 2
  1. 1.General Medicine Division and the Clinical Epidemiology Unit, Medical ServicesMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Center for Survey ResearchUniversity of MassachusettsBostonUSA
  3. 3.Department of Otolaryngology, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonUSA

Personalised recommendations