An evaluation of the Minnesota Living with Heart Failure Questionnaire using Rasch analysis

Munyombwe, Theresa, Höfer, Stefan, Fitzsimons, Donna, Thompson, David R., Lane, Deidre, Smith, Karen and Astin, Felicity (2014) An evaluation of the Minnesota Living with Heart Failure Questionnaire using Rasch analysis. Quality of Life Research, 23 6: 1753-1765. doi:10.1007/s11136-013-0617-0

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Author Munyombwe, Theresa
Höfer, Stefan
Fitzsimons, Donna
Thompson, David R.
Lane, Deidre
Smith, Karen
Astin, Felicity
Title An evaluation of the Minnesota Living with Heart Failure Questionnaire using Rasch analysis
Journal name Quality of Life Research   Check publisher's open access policy
ISSN 0962-9343
Publication date 2014-08
Year available 2014
Sub-type Article (original research)
DOI 10.1007/s11136-013-0617-0
Open Access Status
Volume 23
Issue 6
Start page 1753
End page 1765
Total pages 13
Place of publication Dordrecht, Netherlands
Publisher Springer
Collection year 2015
Language eng
Formatted abstract
Purpose: The symptom burden of heart failure is significant and impacts upon health-related quality of life. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is widely used in clinical practice to measure self-reported health-related quality of life, but the psychometric properties of the instrument are not fully elucidated. To address this gap, we investigated item and person fit, differential item functioning, item thresholds ordering, targeting and dimensionality of the MLHFQ.

Methods: Three approaches were used, exploratory factor analysis, Mokken analysis and Rasch analysis, on a convenience sample of 109 participants with a diagnosis of HF from the UK. Participants were typically male (67 %) with a mean age of 68 years (range 41–88).

Results: Findings from the exploratory factor analysis of the MLHFQ revealed three factors (physical, emotional and social) that explained 72 % of the total variance. Mokken analysis confirmed the MLHFQ total scale, and the three subscales, as valid ordinal scales: the total MLHFQ scale [overall Loevinger coefficient (H) = 0.61], physical scale (H = 0.75), emotional scale (H = 0.79) and social scale (H = 0.552). Rasch analysis confirmed the physical scale as a unidimensional scale, but this was not consistent for the total MLHFQ scale which showed poor fit to the Rasch model (χ 2 = 162), df = 42, p < 0.0001). Six items of the total scale were misfitting (7, 8, 10, 14–16) and removing them improved the fit of the total scale. The physical subscale showed fit to the Rasch model (χ 2 = 20.24, df = 16, p = 0.21), and there was evidence of unidimensionality (t tests = 0.09, lower bound 95 % CI 0.04). There was evidence of disordered thresholds for the MLHFQ total and physical scale, and targeting was poor for both the total scale and its subscales.

Conclusion: We confirmed the MLHFQ subscales to be valid ordinal scales supporting the use of sum scores to assess quality of life in people diagnosed with HF. Floor effects were evident indicating that the ability of the instrument to identify differences across populations with mild HF may be suboptimal. The psychometric properties of the MLHFQ total scale may be improved by excluding problematic items from the total scale. Further research is warranted to verify findings from this study.

Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
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Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 16 Jan 2014, 12:48:29 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work