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. 2006;15(2):217–231. doi: 10.1007/s11136-005-1463-5

The Validity and Reliability of the Functional Impairment Checklist (FIC) in the Evaluation of Functional Consequences of Severe Acute Respiratory Distress Syndrome (SARS)

Siu Pui Lam 1,5,✉, Eva Tsui 2, Kin Sang Chan 3, Cindy LK Lam 4, Ho Pui So 1
PMCID: PMC7088534  PMID: 16468078

Abstract

Severe acute respiratory distress syndrome (SARS) contributed to significant mortality and morbidity worldwide. We aimed to establish the validity, reliability and responsiveness of the functional impairment checklist (FIC) as a measurement tool for physical dysfunction in SARS survivors. One hundred and sixteeen (65 females and 51 males, mean age 45.6) patients who joined the SARS rehabilitation programme were analysed. The factor analysis yielded two latent factors. The mean FIC-symptom and FIC-disability score were 24.12 (SD ± 20.2) and 26.11 (SD ± 27.32), respectively. Based on the item-scale correlation coefficients, the Cronbach’s alpha coefficients reflecting the internal consistency reliability of scale score were 0.75 for FIC-symptom and 0.86 for FIC-disability. Test–retest reliability in 23 patients showed no statistical significant difference in the FIC scores between tests with intraclass correlation coefficient (ICC) 0.49–0.57. The FIC scales correlated both with 6 munute walking test (6MWT) distance (−0.26 and −0.38) and handgrip strength (HGS) (−0.20 and −0.27). Moreover, the FIC scales correlated with St. George’s respiratory questionnaire (SGRQ) (0.19 to 0.52) and short form 36 Hong Kong (SF-36) domains (−0.19 to −0.59). Both FIC scales correlated stronger with physical component summary (PCS) (−0.41 and −0.55) than with mental component summary (MCS) (−0.30 and −0.23). FIC reduced significantly at 6 months while the SF-36 PCS and MCS did not show any change. In conclusion, the study results indicate the FIC is reliable, valid and responsive to change in symptom and disability as a consequence of SARS, suggesting it may provide a means of assessing health related quality of life (HRQOL) outcomes in a longitudinal follow up.

Keywords: Function impairment checklist, HRQOL, Physical dysfunction, SARS

Abbreviations

FIC

function impairment checklist

HRQOL

health related quality of life

ICC

intraclass correlation coefficients

MCS

SF-36 mental component summary

6MWT

6 minute walking test

PCS

SF-36 physical component summary

SARS

severe acute respiratory syndrome

SF-36

short form 36 Hong Kong

SGRQ

St. George’s respiratory questionnaire

References

  • 1.World Health Organization. Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS). WHO/CDS/CSR/GAR/2003.11.
  • 2.Department of Health. Latest Figures on Severe Acute Respiratory Syndrome (SARS). 19 January 2004. http://www.info.gov.hk/dh/diseases/ap/eng/infected.htm.
  • 3.Report of the SARS Expert Committee. SARS in Hong Kong: From Experience to Action. October 2003. http://www.sars-expertcom.gov.hk/english/reports/reports.html.
  • 4.Chan-Yeung M, Xu RH. SARS: epidemiology. Respirology. 2003;8:S9–S14. doi: 10.1046/j.1440-1843.2003.00453.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Chan KS, Zheng JP, Mok YW. SARS: Prognosis, outcome and sequelae. Respirology. 2003;8:S36–S40. doi: 10.1046/j.1440-1843.2003.00522.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Lam SP, So HP, Tang I, Chong S, Tang E. Evaluation of Physical Consequences of SARS Pulmonary Rehabilitation Screening (SPRS). Proceedings in New Challenges in Healthcare Hong Kong Academy of Medicine; November 2003: 94.
  • 7.Lam SP, So HP, Tang E, Tang I, Woo D, Chong S, Yeung A. The First Comprehensive SARS Pulmonary Rehabilitation Programme in Hong Kong. Proceedings in Hong Kong SARS Forum and Hospital Authority Convention; May 2004: 128.
  • 8.Cella D, Nowinski CJ. Measuring quality of life in chronic illness: The functional assessment of chronic illness therapy measurement system. Arch Phys Med Rehabil. 2002 Dec;83(12 Suppl 2):S10–S17. doi: 10.1053/apmr.2002.36959. [DOI] [PubMed] [Google Scholar]
  • 9.Kaplan RM, Ries AL, Reilly J, Mohsenifar Z. Measurement of health-related quality of life in the national emphysema treatment trial. Chest. 2004;126(3):781–789. doi: 10.1378/chest.126.3.781. [DOI] [PubMed] [Google Scholar]
  • 10.Engstrom CP, Persson LO, Larsson S, Sullivan M, et al. Health-related quality of life in COPD: Why both disease-specific and generic measures should be used. Respir J. 2001;18(1):69–76. doi: 10.1183/09031936.01.00044901. [DOI] [PubMed] [Google Scholar]
  • 11.Testa MA, Simonson DC. Assessment of quality-of-life outcomes. New Engl J Med. 1996;334(13):835–840. doi: 10.1056/NEJM199603283341306. [DOI] [PubMed] [Google Scholar]
  • 12.Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. Am Rev Respir Dis. 1992;145:1321–1327. doi: 10.1164/ajrccm/145.6.1321. [DOI] [PubMed] [Google Scholar]
  • 13.Ware JE, Kosinski M, Gandek B. SF-36 Health Survey: Manual & Interpretation Guide. Lincoln, RI: Quality Metric Incorporated; 2000. [Google Scholar]
  • 14.American Thoracic Society (ATS) Official statement of ATS on pulmonary rehabilitation. Am J Respir Crit Care Med. 1999;159:1666–1682. doi: 10.1164/ajrccm.159.5.ats2-99. [DOI] [PubMed] [Google Scholar]
  • 15.Hodgkin JE, Bartolome RC. Pulmonary Rehabilitation Guidelines to Success. 3. Philadelphia: Lippincott Williams & Wilkins; 2000. [Google Scholar]
  • 16.Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiat Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]
  • 17.Weiss D, Marmar C. The impact of event scale—revised. In: Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York: Guilford; 1997. [Google Scholar]
  • 18.American Thoracic Society ATS Statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117. doi: 10.1164/ajrccm.166.1.at1102. [DOI] [PubMed] [Google Scholar]
  • 19.Innes E. Handgrip strength testing: A review of the literature. Aust Occup Ther J. 1999;46:120–140. [Google Scholar]
  • 20.Bohannon RW. Hand-grip dynamometry provides a valid indication of upper extremity strength impairment in home care patients. J Hand Ther. 1998;11:258–260. doi: 10.1016/s0894-1130(98)80021-5. [DOI] [PubMed] [Google Scholar]
  • 21.Lam C, Gandek B, Ren XS, Chan MS. Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 health survey. J Clin Epideminol. 1998;51:1139–1147. doi: 10.1016/s0895-4356(98)00105-x. [DOI] [PubMed] [Google Scholar]
  • 22.Lam CLK, Lauder IJ, Lam TP, Gandek B, et al. Population based norming of the Chinese (HK) version of the SF-36 health survey. Hong Kong Practitioner. 1999;21(10):460–470. [Google Scholar]
  • 23.Ware JE, Kosinski M. SF-36 Physical & Mental Health Summary Scales: A Maunal for Users of Version 1. 2. Lincoln, RI: QualityMetric Incorporated; 2001. [Google Scholar]
  • 24.Chan SL, Chan-Yeung M, Ooi GC, Lam CL, Cheung TF, Lam WK, Tsang KW, et al. Validation of the Hong Kong Chinese version of the St. George respiratory questionnaire in patients with bronchiectasis. Chest. 2002;122:2030–2037. doi: 10.1378/chest.122.6.2030. [DOI] [PubMed] [Google Scholar]
  • 25.Yu TWD, Scudds RJ, Scudds RA. Reliability and validity of a Chinese version of the St. George’s respiratory questionnaire. Hong Kong Physiotherapy Journal. 2004;22:33–39. [Google Scholar]
  • 26.Spilker B. Quality of Life and Pharmacoeconomics in Clinical Trials. 2. Philadelphia: Lippincott-Raven Publishers; 1996. [Google Scholar]
  • 27.Swinscow TDV. Statistics at Square One. 9. London: BMJ Publishing Group; 1996. [Google Scholar]
  • 28.McHorney CA, Ware JE, Lu JFR. The MOS 36-item short-form health status survey (SF-36): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Care. 1994;32:40–66. doi: 10.1097/00005650-199401000-00004. [DOI] [PubMed] [Google Scholar]
  • 29.Nunnally JC, Bernstein IH. Psychometric Theory. 3. New York: McGraw-Hill; 1994. [Google Scholar]
  • 30.Fleiss JL. The Design and Analysis of Clinical Experiments. New York: John Wiley & Sons, Inc.; 1999. [Google Scholar]
  • 31.Bellamy N. Musculosceletal Clinical Metrology. Dordrecht: Kluwer Academic Publishers Group; 1993. [Google Scholar]
  • 32.Au A, Chan I, Li P, Chan YH, Chan J, Ng F. Correlates of psychological distress in discharged patients recovering from SARS in Hong Kong. Int J Psychosoc Rehabil. 2004;8:41–51. [Google Scholar]
  • 33.Tsang K, Zhong NS. SARS: Pharmacotherapy. Respirology. 2003;8:S25–S30. doi: 10.1046/j.1440-1843.2003.00525.x. [DOI] [PubMed] [Google Scholar]
  • 34.Ding Y, He L, Zhang Q, et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol. 2004;203(2):622–630. doi: 10.1002/path.1560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Ding Y, Wang H, Shen H, et al. The clinical pathology of severe acute respiratory syndrome (SARS): A report from China. J Pathol. 2003;200(3):282–299. doi: 10.1002/path.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Sung JJ, Wu A, Joynt GM, et al. Severe acute respiratory syndrome: Report of treatment and outcome after a major outbreak. Thorax. 2004;59(5):414–420. doi: 10.1136/thx.2003.014076. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Lau AC, So LK, Miu FP, et al. Outcome of coronavirus-associated severe acute respiratory syndrome using a standard treatment protocol. Respirology. 2004;9(2):173–183. doi: 10.1111/j.1440-1843.2004.00588.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Ng CK, Chan JW, Kwan TL, et al. Six month radiological and physiological outcomes in severe acute respiratory syndrome (SARS) survivors. Thorax. 2004;59(10):889–891. doi: 10.1136/thx.2004.023762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Ong KC, Ng AWK, Lee LS, et al. Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome. Eur Respir J. 2004;24:436–462. doi: 10.1183/09031936.04.00007104. [DOI] [PubMed] [Google Scholar]
  • 40.Cheng SK, Tsang JS, Ku KH, Wong CW, Ng YK. Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: A series of 10 cases. Brit J Psychiat. 2004;184:359–360. doi: 10.1192/bjp.184.4.359. [DOI] [PubMed] [Google Scholar]
  • 41.Lam Cindy LK, Tse EYY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research. 2005;14(2):539–547. doi: 10.1007/s11136-004-0704-3. [DOI] [PubMed] [Google Scholar]

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