Measurement Validity of the Seattle Angina Questionnaire in Coronary Artery Disease
Date
2023-04-06
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Abstract
Patient-reported outcome measures (PROMs), such as the Seattle angina questionnaire (SAQ), are widely used to directly elicit perceptions of health status and quality of life (QOL) in individuals with coronary artery disease (CAD). The SAQ has been used in clinical and epidemiological studies to evaluate the effectiveness of treatment interventions, compare population groups, and inform quality improvement for CAD management. However, there is limited investigation of its measurement validity between groups and over time.
The overarching goal of this research is to evaluate the validity of the SAQ in individuals with CAD between groups and over time. Specifically, the objectives are to (1) examine the factorial validity of the SAQ in a Canadian population of patients with CAD, (2) assess if the SAQ construct is equivalent across subgroups and over time and (3) test and adjust for response shift (RS) effect in the SAQ subscales over time. Data for this research were obtained from the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry, a comprehensive, longitudinal inception cohort of all adult Canadians who received cardiac catheterization in Alberta, Canada. Exploratory and Confirmatory factor analysis (CFA) was used to investigate the underlying factor structure of the SAQ. CFA revealed that the factorial structure of the original 19-item SAQ, with five subscales, was inconsistent in this cohort. Instead, a 16-item Canadian version of this SAQ (SAQ-CAN), which includes four subscales, was found to be a better fit for the data and was a more valid and reliable instrument to measure QOL in CAD patients. Multigroup-CFA of the SAQ-CAN provides evidence supporting the equivalence of the underlying latent construct across sex, age, angina type, and treatment groups cross-sectionally and longitudinally in a sample of patients with CAD. Finally, the longitudinal structural equation model revealed the presence of small RS effects in the treatment-related experience subscale of the SAQ-CAN, which attenuated longitudinal changes on the SAQ-CAN subscales when not accounted for. In conclusion, this study proposes the use of SAQ-CAN as a valid and reliable instrument for assessing differences and temporal measures of QOL in individuals with CAD.
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Keywords
Measurement Invariance, Response shift, Longitudinal Measurement Invariance, Differential item functioning, Coronary artery disease, Seattle Angina Questionnaire, Measurement Validity, Patient reported outcome measures, patient reported outcomes, Psychometric Evaluation, Exploratory factor analysis, confirmatory factor analysis
Citation
Lawal, O. A. (2023). Measurement validity of the Seattle angina questionnaire in coronary artery disease (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.