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Different Questionnaires Lead to Different Interpretations

Marco Scarpa, MD; Cesare Ruffolo, MD; Lino Polese, MD; Alessandro Martin, MD; Renata D’Incà, MD; Giacomo C. Sturniolo, MD; Davide F. D’Amico, MD; Imerio Angriman, MD

Arch Surg. 2007;142(2):158-165.

Background  According to some researchers, health-related quality-of-life scores for patients who undergo restorative proctocolectomy (RPC) for ulcerative colitis (UC) are comparable to those of healthy control subjects. Other studies show evidence that patients who undergo RPC experience a health-related quality of life similar to patients with mild UC or UC in remission.

Hypothesis  The discrepancy in health-related quality-of-life scores among studies may be due to different health-related quality-of-life analyses.

Design  Cross-sectional study.

Setting  Outpatient clinic of a tertiary care center.

Patients  In the first phase of the study, we consecutively enrolled 24 patients with UC, 24 patients with Crohn disease, and 24 healthy controls. In the second phase of the study, 40 patients who underwent RPC, 43 patients with UC, and 44 controls were consecutively enrolled.

Interventions  We administered an Italian version of the Cleveland Global Quality of Life (CGQL) instrument, the Padova Inflammatory Bowel Disease Quality of Life instrument, and the Italian 36-Item Short-Form Health Survey.

Main Outcome Measures  We evaluated the construct validity, internal consistency, test-retest reliability, sensitivity to change, and discriminant ability of the Italian CGQL instrument. We compared its discriminative ability with that of the Padova Inflammatory Bowel Disease Quality of Life instrument.

Results  The Italian CGQL instrument obtained good construct validity, internal consistency, test-retest reliability, and sensitivity to change. The Italian CGQL score did not distinguish patients who underwent RPC from healthy controls and those with mild UC or UC in remission, while the Padova Inflammatory Bowel Disease Quality of Life instrument reported similar scores for patients who underwent RPC and those with mild UC or UC in remission, and showed a difference vs healthy controls.

Conclusions  We validated an Italian version of the CGQL score. The different results obtained with the CGQL and the Padova Inflammatory Bowel Disease Quality of Life instruments can be attributed to the different discriminative ability of the 2 questionnaires.

Author Affiliations: Department of Surgical and Gastroenterological Science, Clinica Chirurgica I (Drs Scarpa, Ruffolo, Polese, D’Amico, and Angriman), and Gastroenterologia Units (Drs Martin, D’Incà, and Sturniolo), University of Padova, Padova, Italy.