American Inventory Unusable for European Patients With MS

In a recently published multicenter clinimetric study, researchers determined the extent to which the American Life Balance Inventory (LBI) is successful in measuring the same factors in several European countries.

The inventory, which determines “a satisfying pattern of daily activity that is healthful, meaningful, and sustainable to an individual within the context of his or her current life circumstances,” was distributed to patients with multiple sclerosis (MS) in 4 countries.

By translating LBI according to the principles of forward/backward translation, researchers evaluated cross-cultural validity, construct validity, and test-retest reliability of LBI in Flemish, Dutch, Slovenian, and Spanish patients.

MS is a chronic disease of inflammation, demyelination, and axonal loss in the central nervous system. These factors can lead to a reduced quality of life among patients. The American LBI is “one of the few instruments specifically assessing the construct of life balance and assesses the perceived congruence between desired and actual time use in various activity categories.” For this reason, researchers wished to test its global applicability.

Researchers hypothesized that LBI would be “moderately to highly” correlated to patients’ quality of life and self-efficacy (correlation coefficients ≥0.5). They also hypothesized LBI would be negatively correlated to the influence of fatigue and depression (correlation coefficients between 0.3 and 0.7).

When distributing LBI to patients in these countries using predetermined translation processes, researchers found limited support for the reliability of test-retest, along with limited support for cross-cultural and construct validity. “Although LBI may serve as a supportive tool in goalsetting in rehabilitation, the current version of LBI is not recommended for (international) research purposes,” authors concluded.

Researchers carried out the study by registering LBI twice, 7 days apart, among patients to measure test-retest reliability. Intraclass correlation coefficients and Bland Altman analyses were used to determine outcomes. In addition, “to evaluate construct validity, Pearson correlations of the LBI with quality of life, fatigue, depression, and self-efficacy were explored,” authors said.

Of the total sample of 313 patients, the following cultural breakdowns were present:

• Dutch (n = 81; 74% women; mean [SD] age of 54 [9.6] years)
• Flemish 1 (n = 42; 57% women; 49 [12] years) and Flemish 2 (n = 105; 63% women; 50 [10.6] years)
• Slovenian (n = 48; 79% women; 44 [1.2] years)
• Spanish (n = 37; 62% women; 47 [9.0] years)

After assessing the results of the inventories, researchers determined their hypothesis was not fully supported. “Correlations ranged from 0.05 to 0.55 for quality of life and self-efficacy, from —0.50 to 0.05 for fatigue and from –0.44 to –0.28 for depression.” Additionally, systematic error was present in 1 sample.

Researchers put forth several possible explanations for the mixed results. Cognitive functioning, education level, or reduced self-awareness of participants may have contributed to the findings.

No conclusions can be drawn regarding life balance equivalence from the research, authors said. Future studies may want to explore different means of scoring congruence between desired and actual time spent in activity categories to ensure more accurate results. However, LBI and similar measures may be used to support rehabilitation teams striving to optimize patients’ overall activity and participation.

Reference

Kos D, Ferdinand S, Duportail M, et al; Assessing life balance of European people with multiple sclerosis: a multicenter clinimetric study within the RIMS network [published online December 4, 2019]. Mult Scler Relat Disord. doi: 10.1016/j.msard.2019.101879.