title: Methodology and measurement properties of health-related quality of life instruments: a prospective study of patients undergoing breast reduction surgery.
abstract: BACKGROUND
  Breast hypertrophy is associated with clinically important morbidity. A prospective study was conducted to assess the change in health-related quality of life (HRQL) following breast reduction mammoplasty. This paper describes the measurement properties of each of the HRQL questionnaires used.
  
  
  METHODS
  The reliability, responsiveness, and the construct validity of each HRQL instrument (the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) and the Breast Reduction Assessment Value and Outcomes (BRAVO) instruments) were assessed. The BRAVO instruments are a set of separate instruments including the Short Form-36 (SF-36), the Multidimensional Body Self Relations Questionnaire Appearance Assessment (MBSRQ-AS), and the Breast Related Symptoms Questionnaire (BRSQ).
  
  
  RESULTS
  The HUI2, the HUI3, the MBSRQ-AS, and the breast severity symptom (BSS) score from the BRSQ all demonstrated good test-retest reliability. The SF-36 physical component summary, the MBSRQ-AS, and the BSS score demonstrated high responsiveness. The SF-36 mental component summary and the HUI3 had a moderate effect size and the HUI2 had a small effect size. All of the changes in scales are correlated in the same direction except for the SF-36 physical component summary and the SF-36 mental component summary.
  
  
  CONCLUSIONS
  All four instruments were found to be reliable and responsive. These instruments can be used in similar clinical settings to evaluate the change in patients' HRQL.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, St, Joseph's Healthcare, Hamilton, Ontario, Canada. athoma@mcmaster.ca
authors.forename: Achilleas
authors.initials: A
authors.lastname: Thoma
authors.forename: Sheila
authors.initials: S
authors.lastname: Sprague
authors.forename: Karen
authors.initials: K
authors.lastname: Veltri
authors.forename: Eric
authors.initials: E
authors.lastname: Duku
authors.forename: William
authors.initials: W
authors.lastname: Furlong
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001941:Breast Diseases / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D016462:Mammaplasty / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome