title: Using subscales when scoring the Cushing's quality of life questionnaire.
abstract: BACKGROUND
  Patients in long-term remission of Cushing's syndrome (CS) commonly report impaired quality of life (QoL). The CushingQoL questionnaire is a disease-specific QoL questionnaire for patients diagnosed with CS. The developers of the CushingQoL recommend using a global (total) score to assess QoL. However, the global score does not capture all aspects of QoL as outlined by the World Health Organization (WHO).
  
  
  OBJECTIVE
  The aim of the study was to compare the performance of different scoring options to determine the optimal method for the CushingQoL.
  
  
  METHODS
  Patients in remission from CS (n=341) were recruited from the Cushing's Syndrome Research Foundation's email listserv and Facebook page, and asked to complete the CushingQoL and a short demographics survey.
  
  
  RESULTS
  Using an exploratory analysis, adequate model fit was obtained for the global score, as well as a 2-subscale (psychosocial issues and physical problems) scoring solution. Confirmatory methods were performed to identify the optimal scoring solution. Both the global score and the 2-subscale scoring solution showed adequate model fit. However, a χ(2) difference test indicated that the 2-subscale scoring solution was a significantly better fit than the global score (P<0.05).
  
  
  CONCLUSIONS
  If doctors or researchers would like to tease apart physical and psychosocial issues, the 2-subscale scoring solution would be recommended, since this solution showed to be optimal in scoring the CushingQoL. Regardless of the scoring solution used, the CushingQoL has proven to be a valuable resource for assessing health-related QoL in patients with CS.
authors.affiliation: Psychological SciencesUniversity of California, Merced, 5200 North Lake Road, Merced, California 95343, USA jtiemensma@ucmerced.edu.
authors.forename: Jitske
authors.initials: J
authors.lastname: Tiemensma
authors.affiliation: Psychological SciencesUniversity of California, Merced, 5200 North Lake Road, Merced, California 95343, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Depaoli
authors.affiliation: Psychological SciencesUniversity of California, Merced, 5200 North Lake Road, Merced, California 95343, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Felt
mesh_terms: D000328:Adult; D003480:Cushing Syndrome / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D003710:Demography; D005260:Female; D006304:Health Status; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D011584:Psychology; D011788:Quality of Life; D012074:Remission Induction; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone