Development and psychometric evaluation of a chronic liver disease-specific quality of life questionnaire

Background and Aims: There has been no reliable and valid instrument to measure health-related quality of life for Asian patients with chronic liver disease. The aim of the present study was to develop and evaluate a chronic liver disease-specific quality of life (CLD-QOL) questionnaire for Korean patients with chronic liver disease. Methods: Content-validated items were evaluated psychometrically in 271 patients with chronic liver disease recruited from seven university hospitals in Korea. The participants were asked to complete a preliminary questionnaire comprising the content-validated items and the Short Form-36 Health Survey. The Child-Pugh classification was used to classify the severity of liver cirrhosis. Results: Factor analysis extracted a five-factor solution from 27 preliminary items, which were generated by an expert panel and a pilot study, but factor and a multidimensional scaling analysis revealed that four items were not loaded significantly on any factor, suggesting that the four items might be heterogeneous. After deletion of these four items, a multiscaling analysis strongly supported item convergence and discriminant validity. The CLD-QOL was associated significantly with the Child-Pugh classification and the type of patient status (inpatient/outpatient) and was moderately correlated with the subscales of the Short Form-36 Health Survey. The values of Cronbach's alpha for the subscales of the novel CLD-QOL questionnaire were all greater than 0.70. Conclusions: The novel CLD-QOL questionnaire we developed is an easily applicable tool that exhibits excellent psychometric properties for Korean patients with chronic liver disease. It is recommended for the CLD-QOL to apply for Asian patients with chronic liver disease.