淋巴水肿生活质量问卷（LYMQOL）信效度研究

doi:10.24920/003918

Abstract

Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire (LYMQOL) in lymphedema patients.
Methods LYMQOL was translated into Chinese. The Chinese version of the LYMQOL was distributed with the official Wechat account “Lymphedema Channel” to lymphedema patients who were recruited from October 28 ^th, 2020 to February 23^rd, 2021. Patients with upper limb lymphedema and lower limb lymphedema completed the LYMQOL-ARM subscale and the LYMQOL-LEG subscale separately, at enrollment, 1 week later, and 1 month later. Reliability, validity, feasibility, responsiveness and average time required for completing the questionnaire were assessed.
Results A total of 195 patients participated in the study. The Chinese questionnaire showed high reliability with Cronbach’s α coefficients of 0.849-0.902 for the LYMQOL-ARM and intraclass correlation coefficient (ICC) of 0.848-0.884 and Cronbach’s α coefficients of 0.726-0.902 for the LYMQOL-LEG and ICC of 0.863-0.900. The LYMQOL showed moderate to good correlations with the EQ-5D (0.4<r<0.6, P<0.01; for the LYMQOL-ARM, n=95, for the LYMQOL-LEG, n=102). Responsiveness analysis suggested that quality of life of upper limb lymphedema patients decreased after 1 month (P<0.05). The average time of patients to finish the questionnaire was approximately 12 minutes.
Conclusions The Chinese version of the LYMQOL is easy to answer, comprehensive and appropriate in length, and has good reliability and validity. It may be utilized to assist treatment decision-making and track changes in clinical setting or research for lymphedema.

Key words: lymphedema quality of life questionnaire, reliability, validity

Zhengyun Liang, Xiao Long, Elan Yang, Yunzhu Li, Zhujun Li, Min Xu, Bifen Zhang, Nanze Yu, Jiuzuo Huang. Reliability and Validity of the Chinese Version of the Lymphedema Quality of Life Questionnaire[J].Chinese Medical Sciences Journal, 2021, 36(4): 295-306.

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Items	Results
Gender [n (%)]
Male	4 (2.05)
Female	191 (97.95)
Age [yrs, mean±SD (range)]	52±9 (23-81)
BMI [kg/m², mean±SD (range)]	24.2±3.1 (17.5-33.5)
Causes [n (%)]
Endometrium cancer	24 (12.30)
Ovary cancer	14 (7.18)
Cervical cancer	52 (26.67)
Breast cancer	94 (48.21)
Other cancer	2 (1.03)
Lymphatics abnormality	2 (1.03)
Trauma	2 (1.03)
Others	5 (2.55)
Lymphedema site [n (%)]
Upper limb	93 (47.69)
Lower Limb	100 (51.28)
Upper & lower limb	2 (1.03)
Affected site [n (%)]
Left	96 (49.23)
Right	77 (39.49)
Bilateral	22 (11.28)
Duration [yrs, mean±SD (range)]	3.7±4.9 (0.1-37.6)
<1 [n (%)]	62 (31.79)
1-5 [including 1 yrs, n (%)]	90 (46.15)
5-10 [including 5 yrs, n (%)]	26 (13.33)
10-20 [including 10 yrs, n (%)]	12 (6.15)
≥20 [n (%)]	5 (2.56)
ISL staging [n (%)]
StageⅠ	116 (59.49)
StageⅡ	35 (17.95)
StageⅢ	44 (22.56)
Treatment [n (%)]
No previous treatment	68 (34.87)
Conservative therapy	114 (58.46)
Surgery	2 (1.05)
Both treatment	11 (5.64)

Domains	The LYMQOL-ARM (n=95)			The LYMQOL-LEG (n=102)
	α	Spearman-Brown coefficient		α	Spearman-Brown coefficient
	α	1^st/2^nd half	Odd/Even	α	1^st/2^nd half	Odd/Even
Function	0.902	0.925	0.948	0.861	0.840	0.866
Appearance	0.889	0.843	0.910	0.902	0.882	0.935
Symptoms	0.849	0.811	0.888	0.726	0.638	0.733
Mood	0.877	0.849	0.904	0.834	0.777	0.879

Domains	The LYMQOL-ARM (n=74)		The LYMQOL-LEG (n=83)
Domains	ICC	P	ICC	P
Function	0.848	<0.001	0.900	<0.001
Appearance	0.884	<0.001	0.886	<0.001
Symptoms	0.866	<0.001	0.863	<0.001
Mood	0.874	<0.001	0.894	<0.001
Overall QoL	0.871	<0.001	0.868	<0.001

Items	The LYMQOL-ARM (n=77)		The LYMQOL-LEG (n=83)
Items	Yes (%)	No (%)	Yes (%)	No (%)
Is it easy to complete?	94.8	5.2	96.4	3.6
Is it too long?	14.3	85.7	7.2	92.8
Are all the questions clear?	92.2	7.8	91.6	8.4
Are there any important areas not covered?	15.6	84.4	26.5	73.5
Are there any questions redundant?	3.9	96.1	4.8	95.2

The EQ-5D	The LYMQOL-ARM (n=95)					The LYMQOL-LEG (n=102)
The EQ-5D	Function	Appearance	Symptoms	Mood	Overall QoL	Function	Appearance	Symptoms	Mood	Overall QoL
Mobility	0.198					0.471^**
Self-Care		0.333^**					-0.002
Usual activities	0.498^**					0.630^**
Discomfort			0.626^**					0.508^**
Depression				0.680^**					0.438^**
EQ-5D index	-0.617^**	-0.377^**	-0.727^**	-0.633^**	0.552^**	-0.662^**	-0.267^**	-0.511^**	-0.507^**	0.555^**

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References 56.

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Metrics

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Items	LYMQOL-ARM				LYMQOL-LEG
Items	Factor 1	Factor 2	Factor 3	Factor 4	Factor 1	Factor 2	Factor 3	Factor 4
1a	0.527	0.452	0.296	0.163	0.061	0.024	0.822	0.307
1b	0.545	0.497	0.130	0.176	0.063	0.127	0.279	0.658
1c	0.183	0.215	0.120	0.789	0.004	0.089	0.592	0.477
1d	0.475	0.302	0.076	0.420	0.065	0.197	0.458	0.447
1e	0.285	0.158	0.161	0.793	0.330	0.000	0.424	0.554
1f	0.021	0.154	0.108	0.906	0.179	-0.016	0.677	0.429
1g	0.414	0.506	0.155	0.272
1h	0.100	0.194	0.281	0.839
2	0.618	0.406	0.227	0.215	0.368	0.431	0.565	0.002
3	0.549	0.419	0.201	0.207	0.531	0.166	0.196	0.324
4	0.758	0.111	0.269	0.138	0.324	0.786	0.217	-0.074
5	0.873	0.039	-0.003	0.044	0.216	0.841	-0.013	0.092
6	0.883	-0.031	0.013	0.124	0.186	0.885	0.017	0.096
7	0.775	0.025	0.381	0.071	0.020	0.729	0.109	0.196
8	0.525	0.356	0.387	0.059	0.203	0.767	0.075	0.178
9	-0.020	0.681	0.176	0.043	0.579	0.548	0.083	0.087
10	0.137	0.659	0.154	0.166	0.547	0.459	0.201	0.004
11	0.047	0.768	0.088	0.019	0.152	0.102	0.082	0.721
12	0.184	0.725	0.043	0.375	0.288	-0.001	0.472	0.228
13	0.357	0.589	0.142	0.309	0.076	0.096	0.238	0.657
14	0.139	0.658	0.301	0.186	0.349	-0.018	0.551	0.317
15	0.044	0.515	0.497	0.146	0.204	0.332	0.669	-0.067
16	0.223	0.405	0.583	0.260	0.499	0.065	0.019	0.419
17	0.342	0.107	0.742	0.150	0.649	0.153	-0.015	0.320
18	0.423	0.197	0.717	0.140	0.740	0.083	0.257	0.125
19	0.052	0.172	0.819	0.078	0.728	0.236	0.299	0.017
20	0.099	0.179	0.793	0.189	0.682	0.278	0.027	0.057
21					0.742	0.191	0.312	-0.013

Domains	LYMQOL-ARM		LYMQOL-LEG
Domains	t value	P value	t value	P value
Function	-5.071	0.000	-1.901	0.063
Appearance	-3.302	0.002	0.348	0.729
Symptoms	-4.000	0.000	-1.378	0.175
Mood	-2.694	0.010	-0.898	0.374
Overall QoL	1.480	0.145	1.600	0.116

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