Another explanation could be that the patients were a

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Unformatted text preview: group before treatment, with similar problems which affected the quality of life, but one year postoperatively they have become more heterogeneous and represent different states of recovery [13]. Both instruments meet the reliability standards for group-level application in most respects, although none of them achieved the degree of reliability that be would be desirable in individual-based assessment. The result in this study showed significant convergent correlation coefficients between scores of the comparable dimensions except for physical activity and social activity, indicating a considerable convergence of the NHP and SF36 scale. Prieto et al [39] and Meyer-Rosberg et al [40] demonstrated similar results with an average convergent validity. Thus the NHP and SF-36 are relatively equal in the validity and corroborate that the subscales probably reflect similar impacts of chronic lower limb ischaemia. However, social isolation in the NHP showed a higher correlation with mental health in the SF-36 and might measure more psychological aspects of social life, whilst social functioning in the SF-36 tends to assess social activities according to the higher correlation with energy in NHP. Similarly the physical functioning in the SF-36 showed a higher correlation with energy and may reflect physical activities of daily living rather than physical mobility. This suggests that the SF-36 and NHP measure different aspects of physical and social activities. Validity in terms of the instruments' relative ability to discriminate among different levels of the ischaemia could only demonstrate that patients with CLI had significantly more problems with pain and physical mobility before treatment than patients with IC measured by the NHP. Klevsgård et al [1] showed similar results, that the NHP was more sensitive in discriminating deterioration in pain and physical mobility than the SF-36. In contrast, Brown et al [37] demonstrated that the SF-36 was more sensitive than the NHP for identifying people still troubled with angina or breathlessness after a myocardial infarction. Despite the lack of significant differences between patients with IC and patients with CLI, the NHP scale tends to be more sensitive in explaining the quality of life in this group of patients with regard to the dimension of pain and physical mobility. The important issue thus is to consider how well the measurement method explains health-related phenomena which are significant for the particular targeted disease or group of patients. The SF-36 was the more responsive instrument in detecting changes in quality of life over time in patients with IC, including bodily pain and physical functioning one year postoperatively. However, in patients with CLI, the NHP was the more responsive instrument, with significant changes in pain and physical mobility, while the SF-36 showed a significant change only in bodily pain. Falcoz et al [38] also demonstrated that the SF-36 was more responsive...
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This document was uploaded on 11/24/2013.

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