CSF circulation disorders: measuring progress in patients through quality of life and hope.
BACKGROUND
Cerebrospinal fluid circulation disorders are complex and multifaceted conditions making reliable assessment of progress problematic.


OBJECTIVE
It is the aim of this paper to explore how efficient measures of quality of life and hope might be used to assess clinical progress for patients with disorders of cerebrospinal fluid circulation. It will be argued that a single-item 10-point quality of life scale and the Herth Hope Index are as effective at measuring progress as the more widely used, but considerably more complex, Short-Form 36.


METHODS
Patients attending a cerebrospinal fluid clinic were sent a questionnaire containing the three measures of progress. Questionnaires were returned in a stamp-addressed envelope to allow initial analysis before the clinic appointment and to enable discussion of results during the clinic appointment. Patients were also assessed using the Mini-Mental State Examination during the clinic appointment.


METHODS
The relationship between the three measures of progress was calculated using Spearman's rank order correlation. Correlations of 0.40-0.70 are considered modest and correlations of 0.70 are considered strong; 5% levels of significance are considered significant and 1% levels are highly significant. Internal consistency of the Short-Form 36 was assessed using Cronbach's alpha coefficient. Reliability was considered acceptable for dimension comparisons when alpha > 0.70.


RESULTS
All patients were diagnosed with benign intracranial hypertension (n = 74), congenital hydrocephalus (n = 35) or normal pressure hydrocephalus (n = 171). There was a modest to strong correlation between the quality of life-10 and all eight dimensions of the Short-Form 36 for benign intracranial hypertension and congenital hydrocephalus patients. A slightly weaker correlation was demonstrated in seven of the eight Short-Form 36 dimensions for normal pressure hydrocephalus patients. Normal pressure hydrocephalus patients scored significantly lower on the Mini-Mental State Examination, which may contribute to explaining the weaker correlation between the three measures and the weaker internal consistency between the dimensions with the Short-Form 36. Conclusions. This paper demonstrates that efficient indicators of progress (quality of life-10 and Herth Hope Index) can be as effective at assessing clinical progress as more complex indicators (Short-Form 36) in patients who do not demonstrate cognitive deficit.


CONCLUSIONS
For clinical application, the Short-Form 36 is too long, difficult to complete, score and analyse for these patient groups. Quality of life-10 and Herth Hope Index could provide efficient and effective measures of clinical progress but this requires further psychometric examination.
Gelling
Leslie
L
School of Community Health and Social Studies, Anglia Polytechnic University, East Road, Cambridge CB1 1PT, UK. l.gelling@apu.ac.uk
Iddon
Joanna
J
McVicar
Andrew
A
Pickard
John D
JD
D000203:Activities of Daily Living; D001294:Attitude to Health; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D006849:Hydrocephalus / Q000523:psychology* / Q000628:therapy; D006850:Hydrocephalus, Normal Pressure / Q000523:psychology* / Q000628:therapy; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009013:Morale; D011559:Pseudotumor Cerebri / Q000523:psychology* / Q000628:therapy; D011594:Psychometrics; D011788:Quality of Life; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome