Cross - Cultural Adjustment And Preliminary Application Of Questionnaire On Life Quality Of Liver Transplant Receptor

Objective1. To evaluate the practicability of the Chinese version of post-Liver Transplant Quality of Life Questionnaire (pLTQ) used in Chinese liver transplant recipients, and to test the reliability and validity.2. To investigate the quality of life (QOL) in Chinese liver transplant patient. Methods1. Obtaining the consent of the author, the English version pLTQ was carried forward translation, cross-cultural adaptation, synthesis, back translation and expert consultation. Thirty cases of liver transplant recipients were selected to complete the pre-survey, to test the feasibility of the questionnaire.2. The reliability and validity of the Chinese version of pLTQ were tested among 230 liver transplant recipients in a transplant follow-up clinic of Beijing. Convenience sampling method was used; patients who met the inclusion criteria were investigated. A general information questionnaire, the initial Chinese version of the pLTQ and SF-36 were used to collect data. Item analysis and exploratory factor analysis were used to analyze the clinical data, and test the reliability and validity of the pLTQ. Data were analyzed by SPSS20.0 software. Item distribution method, critical value, correlation coefficient between item and total scale, and homogeneity test were conducted for item analysis and screening. S-CVI/Ave was used to evaluate the content validity; Exploratory factor analysis was used to test construct validity of the questionnaire; SF-36 as the reference standard, to test criterion-related validity of the pLTQ. Cronbach’a coefficient and test-retest reliability were used to evaluate the reliability. The Chinese version pLTQ was formed.3. Total of 97 liver transplant recipients were investigated by Chinese version pLTQ and a general information questionnaire. The QOL of Chinese liver transplant recepients with different characteristics were ananlyzed.Results1. The differences of translation were mainly in the guidance, questions sentences, certain words and some sentence related to different culture. Then the initial Chinese translation of pLTQ was formed.2. In the first stage, total of 250 were investigated, and finally obtained 230 valid questionnaires. All answer choices of pLTQ were less than 80%, did not show a skewed distribution. CR values were all greater than 3.0, indicated that all items had a better discrimination. The correlation coefficient between the scores of items and scale were 0.392-0.731; all were greater than 0.4, except for item19. Four items were excluded according to item analysis and factor analysis. Six factors were extracted by principal components analysis, which contributed 63.732% of the variance. Six-factor named Worry, Physical Function, Emotional Function, Financial, Healthcare and Complication. Internal consistency by Cronbach’s alpha was 0.895,0.763,0.810,0.879,0.725, and 0.708 for each domain respectively; Cronbach’s alpha for total questionnaire was 0.939. Pearson correlation coefficients of test-retest reliability was 0.713 (P<0.01). S-CVI/Ave of the Chinese version of pLTQ was 0.93; it indicated that pLTQ had a good content validity. The correlation of pLTQ and SF-36 were analyzed, the scores of Mental Component Summary (MCS) were strongly positively correlated with "Worry"" Physical Function" and "emotional function" scores (P< 0.01), and showed moderate positive correlation with the scores of "economy" " healthcare" and "complications" (P<0.01). The score of Physical Component Summary (PCS) showed moderate positive correlation with the scores of "Worry" "Physical Function " and "Complication" (P<0.01), and showed weakly positive correlation with the scores of "Emotional Function" "Economy" and "Healthcare" (P<0.01).3. In the second stage,97 valid questionnaires were collected. More than 80% of the participants were Male, median age was 53 year old. They mainly lived in the towns (91.8%). The median time after liver transplantation was 3.9 years. The domains with lowest score and highest score were "Economic" and "Worry" respectively. The QOL of liver transplant recipients were correlated to gender, domicile, degree of education, income, marital status, medical payment and the postoperative time.ConclusionThe Chinese version of pLTQ is well accepted with good psychometric properties, and represents a valid and reliable instrument in Chinese liver transplant recipients. It needs to be verified in future studies with large sample and in multiple centers.