Validation of a short form Wisconsin Upper Respiratory Symptom Survey WURSS-21Report as inadecuate

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Health and Quality of Life Outcomes

, 7:76

First Online: 12 August 2009Received: 23 December 2008Accepted: 12 August 2009


BackgroundThe Wisconsin Upper Respiratory Symptom Survey WURSS is an illness-specific health-related quality-of-life questionnaire outcomes instrument.

ObjectivesResearch questions were: 1 How well does the WURSS-21 assess the symptoms and functional impairments associated with common cold? 2 How well can this instrument measure change over time responsiveness? 3 What is the minimal important difference MID that can be detected by the WURSS-21? 4 What are the descriptive statistics for area under the time severity curve AUC? 5 What sample sizes would trials require to detect MID or AUC criteria? 6 What does factor analysis tell us about the underlying dimensional structure of the common cold? 7 How reliable are items, domains, and summary scores represented in WURSS? 8 For each of these considerations, how well does the WURSS-21 compare to the WURSS-44, Jackson, and SF-8?

Study Design and SettingPeople with Jackson-defined colds were recruited from the community in and around Madison, Wisconsin. Participants were enrolled within 48 hours of first cold symptom and monitored for up to 14 days of illness. Half the sample filled out the WURSS-21 in the morning and the WURSS-44 in the evening, with the other half reversing the daily order. External comparators were the SF-8, a 24-hour recall general health measure yielding separate physical and mental health scores, and the eight-item Jackson cold index, which assesses symptoms, but not functional impairment or quality of life.

ResultsIn all, 230 participants were monitored for 2,457 person-days. Participants were aged 14 to 83 years mean 34.1, SD 13.6, majority female 66.5%, mostly white 86.0%, and represented substantive education and income diversity. WURSS-21 items demonstrated similar performance when embedded within the WURSS-44 or in the stand-alone WURSS-21. Minimal important difference MID and Guyatt-s responsiveness index were 10.3, 0.71 for the WURSS-21 and 18.5, 0.75 for the WURSS-44. Factorial analysis suggested an eight dimension structure for the WURSS-44 and a three dimension structure for the WURSS-21, with composite reliability coefficients ranging from 0.87 to 0.97, and Cronbach-s alpha ranging from 0.76 to 0.96. Both WURSS versions correlated significantly with the Jackson scale W-21 R = 0.85; W-44 R = 0.88, with the SF-8 physical health W-21 R = -0.79; W-44 R = -0.80 and SF-8 mental health W-21 R = -0.55; W-44 R = -0.60.

ConclusionThe WURSS-44 and WURSS-21 perform well as illness-specific quality-of-life evaluative outcome instruments. Construct validity is supported by the data presented here. While the WURSS-44 covers more symptoms, the WURSS-21 exhibits similar performance in terms of reliability, responsiveness, importance-to-patients, and convergence with other measures.

Electronic supplementary materialThe online version of this article doi:10.1186-1477-7525-7-76 contains supplementary material, which is available to authorized users.

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Author: Bruce Barrett - Roger L Brown - Marlon P Mundt - Gay R Thomas - Shari K Barlow - Alex D Highstrom - Mozhdeh Bahrainian


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