Construct validity of the interview time trade-off and computer time trade-off in patients with rheumatoid arthritis: a cross-sectional observational pilot study.
BACKGROUND
The Time Trade-Off (TTO) is a widely used instrument for valuing preference-based health-related quality of life (HRQoL). The TTO reveals preferences for own current health ('utilities') on a scale anchored between death (0) and perfect health (1). Limited information on the external validity of the TTO is available. Aim of this pilot study was to examine the construct validity of both an interview TTO and a computer-based TTO in patients with rheumatoid arthritis (RA).


METHODS
Thirty patients visiting the outpatient rheumatology clinic participated. Construct validity was assessed by measuring convergent and discriminative validity. Convergent validity was assessed by calculating Spearman's correlations between the utilities obtained from the TTOs and pain, general health (rating scales), health-related quality of life (SF-36 and SF-6D) and functional status (HAQ-DI). Discriminative power of both TTO measures was determined by comparing median utilities between worse and better health outcomes.


RESULTS
Correlations of both TTO measures with HRQoL, general health, pain and functional status were poor (absolute values ranging from .05 to .26). Both TTOs appeared to have no discriminative value among groups of RA patients who had a worse or better health status defined by six health outcome measures. About one-third of respondents were zero-traders on each of the TTO measures. After excluding zero-traders from analysis, the correlations improved considerably.


CONCLUSIONS
Both the interview TTO and computer TTO showed poor construct validity in RA patients when using measures of HRQol, general health, pain and functional status as reference measures. Possibly, the validity of the TTO improves when using an anchor that is more realistic to RA patients than the anchor 'death'.
Department of Psychology, Health and Technology, Institute for Innovation and Governance Studies, University of Twente, Enschede, The Netherlands. l.buitinga@utwente.nl
Laurien
L
Buitinga
Louise Ma
LM
Braakman-Jansen
Erik
E
Taal
Mart Afj
MA
van de Laar
D000203:Activities of Daily Living; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D003936:Diagnosis, Computer-Assisted; D016002:Discriminant Analysis; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007407:Interviews as Topic; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D026712:Value of Life