Psychometric Validation of a Japanese Version of the emPHasis-10 Questionnaire, a Patient-Reported Outcome Measure for Pulmonary Hypertension　― Multicenter Study in Japan ―

Abstract

Background: The emPHasis-10 questionnaire is a disease-specific patient-reported outcome assessment of quality of life (QOL) in pulmonary hypertension (PH). The aim of this study was to psychometrically validate a linguistically validated Japanese version of the emPHasis-10. Methods and Results: Japanese patients with PH (age ≥18 years) and no change in functional status, or initiation or change in PH-specific treatment during the past 3 months were recruited from 5 institutions from August 2018 to July 2019. A set of questionnaires was administered twice. The validity and reliability of the emPHasis-10 were assessed using the data of 76 patients. On concurrent validity analysis, a moderate-to-strong correlation was seen with the total score of all 5 external criteria (the Minnesota Living with Heart Failure modified for PH [MLHFQ-PH], Hospital Anxiety and Depression Scale, Dyspnea-12 questionnaire, European Quality of Life-5 Dimensions questionnaire [EQ-5D], and 6-min walk test), with a notably strong correlation with the MLHFQ-PH (0.77) and EQ-5D (–0.64). On known-group validity, a linear increasing trend of the emPHasis-10 score was observed across 4 World Health Organization functional status groups (Jonckheere-Terpstra test, 1-sided, P<0.001). Intraclass correlation coefficient for test-retest reliability was 0.86, and the Cronbach’s α for internal consistency was 0.89. Conclusions: The Japanese emPHasis-10 questionnaire is psychometrically valid to evaluate QOL in Japanese PH patients in a clinical setting.

How COVID-19 Affected the Introduction of Telemedicine and Patient Reported Outcomes Among Patients With Pulmonary Hypertension ― A Report From a Referral Center in Japan ―

“…It was previously reported that the emPHasis-10 evaluation among Japanese patients with PH was poorly correlated with HADS. 4 The analysis of HADS scores in the present study revealed that the spread of COVID-19 affected patients in terms of increasing anxiety, which was not represented by symptoms or the comprehensive PRO.…”

“…3 The Japanese version of emPHasis-10 has been examined for both linguistic and psychometric validation. 4 The total emPHasis-10 score is the sum of scores for each item (between 0 and 5) and ranges from 0 to 50. Higher scores indicate impaired conditions associated with PH.…”

“…1,2 Thus, it has become increasingly important to assess patients' long-term quality of life using indicators for patient-reported outcomes (PRO) as well as prognostic assessment. 3,4 In addition to frequently causing pneumonia, COVID-19 infection causes thrombosis and pulmonary circulatory disorders. 5 Thus, COVID-19 is considered to present a high risk of mortality if a patient with PH is infected.…”

EmPHasis-10 Health-Related Quality of Life and Exercise Capacity in Chronic Thromboembolic Pulmonary Hypertension After Balloon Angioplasty: A Cross-Sectional Study

“…The nal version was approved by the developers of the original English version and published in 2018. 12…”

“…EmPHasis-10 scores have been correlated with exercise capacity and haemodynamics in the PH patient population, including those with CTEPH. 12,13 A part of its utility in clinical care stems from its strong association with long-term prognosis. Despite the recent proposal to rede ne PH by lowering the mean pulmonary artery pressure (PAP) threshold from 25 mmHg to 20 mmHg, it remains unknown whether pulmonary haemodynamic parameters and/or functional capacity are associated with QoL among CTEPH patients with a mean PAP of less than 25 mmHg.…”