Adaptation and Validation of a German Version of the Multimorbidity Treatment Burden Questionnaire

Overview

Journal Health Qual Life Outcomes

Publisher Biomed Central

Specialty Public Health

Date 2022 Jun 6

PMID 35658972

Authors

Josefine Schulze

Amanda Breckner

Polly Duncan

Martin Scherer

Nadine Janis Pohontsch

Dagmar Luhmann

Affiliations

Soon will be listed here.

Abstract

Background: Patients with multiple long-term conditions often face a variety of challenges arising from the requirements of their health care. Knowledge of perceived treatment burden is crucial for optimizing treatment. In this study, we aimed to create a German version of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and to evaluate its validity.

Methods: The steps to translate the MTBQ included forward/back translation, cognitive interviews (n = 6) and a pilot test (n = 7). Psychometric properties of the scale were assessed in a cross-sectional survey with primary care patients aged 65 and older with at least 3 long-term conditions (n = 344). We examined the distribution of responses, dimensionality, internal reliability and construct validity.

Results: Cognitive interviewing and piloting led to minor modifications and showed overall good face validity and acceptability. As expected, we observed a positively skewed response distribution for all items. Reliability was acceptable with McDonald's omega = 0.71. Factor analysis suggested one common factor while model fit indices were inconclusive. Predefined hypotheses regarding the construct validity were supported by negative associations between treatment burden and health-related quality of life, self-rated health, social support, patient activation and medication adherence, and positive associations between treatment burden and number of comorbidities. Treatment burden was found to be higher in female participants (Mdn = 6.82, Mdn = 4.55; U = 11,729, p = 0.001) and participants with mental health diagnoses (Mdn = 9.10, Mdn = 4.55; U = 3172, p = 0.024).

Conclusions: The German MTBQ exhibited good psychometric properties and can be used to assess the perceived treatment burden of patients with multimorbidity.

Citing Articles

Treatment burden in multimorbidity: an integrative review.

Lee J, Lee J, Shin R, Oh O, Lee K BMC Prim Care. 2024; 25(1):352.

PMID: 39342121 PMC: 11438421. DOI: 10.1186/s12875-024-02586-z.

Further development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ).

Duncan P, Scott L, Dawson S, Munas M, Pyne Y, Chaplin K BMJ Open. 2024; 14(4):e080096.

PMID: 38604632 PMC: 11015253. DOI: 10.1136/bmjopen-2023-080096.

Validation of the Lithuanian multimorbidity treatment burden questionnaire (MTBQ) and its association with primary care patient characteristics.

Vasiliauskiene O, Vasiliauskas D, Duncan P, Kontrimiene A, Jaruseviciene L, Cesnuleviciene A Eur J Gen Pract. 2023; 29(1):2284257.

PMID: 38010870 PMC: 10990257. DOI: 10.1080/13814788.2023.2284257.

Measurement of treatment burden in patients with multimorbidity in the Netherlands: translation and validation of the Multimorbidity Treatment Burden Questionnaire (NL-MTBQ).

Engels L, van Merode T, Heijmans M, Menting J, Duncan P, Rademakers J Fam Pract. 2023; 41(6):901-908.

PMID: 37878729 PMC: 11636562. DOI: 10.1093/fampra/cmad100.

Treatment burden and health-related quality of life of patients with multimorbidity: a cross-sectional study.

Gebreyohannes E, Gebresillassie B, Mulugeta F, Dessu E, Abebe T Qual Life Res. 2023; 32(11):3269-3277.

PMID: 37405663 PMC: 10522511. DOI: 10.1007/s11136-023-03473-3.

References

Kelley K . Methods for the behavioral, educational, and social sciences: an R package. Behav Res Methods. 2008; 39(4):979-84. DOI: 10.3758/bf03192993. View

Schulze J, Glassen K, Pohontsch N, Blozik E, Eissing T, Breckner A . Measuring the Quality of Care for Older Adults With Multimorbidity: Results of the MULTIqual Project. Gerontologist. 2022; 62(8):1135-1146. PMC: 9451020. DOI: 10.1093/geront/gnac013. View

Boyd C, Wolff J, Giovannetti E, Reider L, Weiss C, Xue Q . Healthcare task difficulty among older adults with multimorbidity. Med Care. 2014; 52 Suppl 3:S118-25. PMC: 3937858. DOI: 10.1097/MLR.0b013e3182a977da. View

Kone Pefoyo A, Bronskill S, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y . The increasing burden and complexity of multimorbidity. BMC Public Health. 2015; 15:415. PMC: 4415224. DOI: 10.1186/s12889-015-1733-2. View

Mahler C, Hermann K, Horne R, Ludt S, Haefeli W, Szecsenyi J . Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany. J Eval Clin Pract. 2010; 16(3):574-9. DOI: 10.1111/j.1365-2753.2009.01169.x. View

Duncan P, Murphy M, Man M, Chaplin K, Gaunt D, Salisbury C . Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ). BMJ Open. 2018; 8(4):e019413. PMC: 5900423. DOI: 10.1136/bmjopen-2017-019413. View

Tran V, Montori V, Ravaud P . Is My Patient Overwhelmed?: Determining Thresholds for Acceptable Burden of Treatment Using Data From the ComPaRe e-Cohort. Mayo Clin Proc. 2019; 95(3):504-512. DOI: 10.1016/j.mayocp.2019.09.004. View

Gallacher K, May C, Langhorne P, Mair F . A conceptual model of treatment burden and patient capacity in stroke. BMC Fam Pract. 2018; 19(1):9. PMC: 5759246. DOI: 10.1186/s12875-017-0691-4. View

Lesage A, Leclere B, Moret L, Le Glatin C . Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies. PLoS One. 2021; 16(1):e0245112. PMC: 7802949. DOI: 10.1371/journal.pone.0245112. View

10.

. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208. DOI: 10.1016/0168-8510(90)90421-9. View

11.

Herzig L, Zeller A, Pasquier J, Streit S, Neuner-Jehle S, Excoffier S . Factors associated with patients' and GPs' assessment of the burden of treatment in multimorbid patients: a cross-sectional study in primary care. BMC Fam Pract. 2019; 20(1):88. PMC: 6598361. DOI: 10.1186/s12875-019-0974-z. View

12.

Salisbury C, Man M, Bower P, Guthrie B, Chaplin K, Gaunt D . Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach. Lancet. 2018; 392(10141):41-50. PMC: 6041724. DOI: 10.1016/S0140-6736(18)31308-4. View

13.

Friis K, Lasgaard M, Pedersen M, Duncan P, Maindal H . Health literacy, multimorbidity, and patient-perceived treatment burden in individuals with cardiovascular disease. A Danish population-based study. Patient Educ Couns. 2019; 102(10):1932-1938. DOI: 10.1016/j.pec.2019.05.013. View

14.

Eton D, Oliveira D, Egginton J, Ridgeway J, Odell L, May C . Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Relat Outcome Meas. 2012; 3:39-49. PMC: 3506008. DOI: 10.2147/PROM.S34681. View

15.

Spencer-Bonilla G, Quinones A, Montori V . Assessing the Burden of Treatment. J Gen Intern Med. 2017; 32(10):1141-1145. PMC: 5602768. DOI: 10.1007/s11606-017-4117-8. View

16.

Ridgeway J, Egginton J, Tiedje K, Linzer M, Boehm D, Poplau S . Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Prefer Adherence. 2014; 8:339-51. PMC: 3964167. DOI: 10.2147/PPA.S58014. View

17.

Rosbach M, Andersen J . Patient-experienced burden of treatment in patients with multimorbidity - A systematic review of qualitative data. PLoS One. 2017; 12(6):e0179916. PMC: 5482482. DOI: 10.1371/journal.pone.0179916. View

18.

Pedersen M, Duncan P, Lasgaard M, Friis K, Salisbury C, Breinholt Larsen F . Danish validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and findings from a population health survey: a mixed-methods study. BMJ Open. 2022; 12(1):e055276. PMC: 8724706. DOI: 10.1136/bmjopen-2021-055276. View

19.

Eton D, Yost K, Lai J, Ridgeway J, Egginton J, Rosedahl J . Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden. Qual Life Res. 2016; 26(2):489-503. PMC: 5753596. DOI: 10.1007/s11136-016-1397-0. View

20.

Eton D, Linzer M, Boehm D, Vanderboom C, Rogers E, Frost M . Deriving and validating a brief measure of treatment burden to assess person-centered healthcare quality in primary care: a multi-method study. BMC Fam Pract. 2020; 21(1):221. PMC: 7594460. DOI: 10.1186/s12875-020-01291-x. View