IS YOUR PRESENT STATE OF HEALTH CAUSING PROBLEMS WITH YOUR 1 JOB OF WORK

(That is, paid employment) 2. LOOKING AFTER THE HOME

(Examples: cleaning & cooking, repairs, odd jobs around the home etc.)

3. SOCIAL LIFE

(Examples: going out, seeing friends, going to the pub etc.)

4. HOME LIFE

(That is, relationships with other people in your home)

5. SEX LIFE

6. INTERESTS & HOBBIES

(Examples: sports, arts and crafts, do-it-yourself etc.)

7. HOLIDAYS

(Examples: summer or winter holidays, weekends away etc)

consulters and non-consulters (n=252), firemen (158), patients with peripheral vascular disease (n=93), patients with fractures (141 fractures, 141 controls; comparison of 2 assessments made 8 weeks apart), non-acute out-patients (n=157, 41 tested before and after minor surgery) (Hunt et al., 1980, McEwen, 1988). The NHP successfully discriminated between 'well' and 'ill' populations and was shown to be sensitive to changes in perceived health status following treatment.

Test-retest reliability was assessed in two groups of patients: 58 patients with osteoarthritis and 93 with peripheral vascular disease. The test-retest interval was 4 weeks for the osteoarthritis group and 8 weeks in the peripheral vascular disease group. Correlation coefficients for Part I ranged from 0.75 to 0.88 (Spearmans r) with a larger range evident for Part II statements (Cramers C, 0.44 to 0.89).

In addition, two studies have been conducted to establish population norms for this instrument: one conducted among 2192 patients randomly drawn from a GP population and the second based on 1753 employees in a large manufacturing organisation. These studies looked specifically at differences in NHP scores attributable to sex, age and social class.

In summary this is a brief, well-conceptualised and well- researched measurement tool with a number of advantages. It is acceptable, inexpensive, and easy to use and understand. There are, however, a number of drawbacks. Part I statements represent severe situations and may miss less severe, but nonetheless distressing, disabilities; zero scores cannot register improvement even if noticed by the patient; there is a heavy reliance on physical symptoms; it concentrates on negative aspects of health and; the weighted scoring of Part I can be cumbersome.

The main drawback to its use in patients with epilepsy is the large proportion of statements relating to physical problems (mobility, pain e t c ) . Such concerns are not usually considered to predominate the life of the patient with epilepsy, who is more likely to experience difficulties with social and emotional aspects of functioning.

3.3.f Sickness Impact Profile (Bergner et al., 1981) This scale was used in the current study and in reviewed in detail in Chapter 4 (Materials and Methods) . A copy of the full scale can be found in the Appendix (Appendix 6).

In brief, this is a comprehensive, generic, 136-item scale covering 12 areas of functioning; sleep and rest, eating, work, home management, recreation and pastimes, ambulation, mobility, bodycare and movement, social interaction, alertness behaviour, emotional behaviour and communication. Patients are asked to check any item which describes them today and is related to their health. Scores are weighted then summed and transformed to a percentage score to provide individual category scores. In addition, composite scores of physical, psychosocial and overall functioning can be computed. The higher the score on the SIP, the more dysfunctional the patient.

This scale has been widely used in a variety of patient populations including chronic obstructive pulmonary disease (McSweeney et al., 1982), renal disease (Hart and Evans, 1987), arthritis (Bergner et al., 1981), low back pain (Deyo et al., 1986) and has been used to evaluate changes in health care delivery (Bergner, 1988). In addition it is well researched with a wealth of published data relating to reliability and validity (Bergner et al., 1976; Pollard et al., 1976; Carter et al., 1976. McDowell and Newell (1987) state: 'The SIP has been developed with exemplary care and thoroughness... The reliability results are good, the validity findings promising and this scale is likely to become a standard against which to judge other methods. We have no hesitation in recommending its use in clinical and survey research.'

The extensive psychometric testing which has been conducted on this measure was one of the factors influencing the choice of this measure for inclusion in the current study. In addition, it provides a good coverage of cognitive, emotional and social aspects of functioning, areas likely to be of concern for the person with epilepsy.

3. 3.g McMaster Health Index Questionnaire (Chêunbers, 1982) The McMaster Health Index Questionnaire (MHIQ) is a 59 item questionnaire covering the three components of health outlined in the World Health Organisation definition of health - physical function, emotional function and social function. Item selection was based on 'experts' and adaptations of existing measures (for example, the Katz Activities of Daily Living scale and the Social Readjustment Rating Scales). Physical function is assessed by 24-items covering physical activities, mobility, self-care activities, communication (sight/hearing) and global physical function; the 25-item social function scale covers general well-being, work, social role performance, material welfare, family support and participation, friends support and participation and global social function; the emotional function scale comprises of 25- items assessing feelings of self-esteem, attitudes to personal relationships, thoughts about the future, critical life events and global emotional function. The MHIQ only contains 59 items as some items address both social and emotional function

(Chambers, 1988).

The self-administered version of the test takes approximately 20 minutes to complete. Items are scored such that a 'good function' response is given a score of 1, while a 'poor function' response is given a score of 0. Index scores are calculated by summing the responses given to items within that category (Table 3.9 gives some examples of the scoring system for the M H I Q ) .

Two studies were conducted to establish the test-retest reliability of the 3 MHIQ indexes (physical function, emotional function, social function). The first, carried out on 30 physiotherapy outpatients, and using a 1 week test- retest interval reported correlations of 0.53 (physical index), 0.70 (emotional index) and 0.48 (social index). Higher correlations were seen in the second study involving 40 psychiatry outpatients (1 week test-retest correlations: physical index, 0.95; emotional index, 0.77; social index,

Table 3.9: Example of items and scoring system used in MHIQ

ITEM ITEM SCORING

Physical function items

Today, do you (or would you) have any difficulty at all with

walking as far as a mile?

Today, do you (or would you) have any physical difficulty at all with undressing?

Do you have trouble hearing the radio or television?

Social function items

What is your occupational status?

How long has it been since you last had a holiday?

Has a friend visited you in the last week? GOOD function Score = 1 NO NO NO, NEVER WORK F/T, WORK P/T, ON VACATION, STUDENT, HOUSEWIFE LESS THAN OR EQUAL TO 12 MONTHS YES POOR function Score= 0 YES, NO ANSWER YES, NO ANSWER YES, SOMETIMES YES ALWAYS, NO ANSWER RETIRED, ON SICK LEAVE NO ANSWER GREATER THAN 12 MONTHS NO, NO ANSWER Emotional function items

I sometimes feel that my life is not very useful.

During the last year have you separated from your spouse? During the last year have you retired from work?

STRONGLY