DOI 10.26773/smj.200609
Spo Mon 18 (2020) 2: Ahead o P in 1
Assessing Heal h-Rela ed Quali y o Li e in Olde
Adul s: Eu oQol Fi e-Dimensional Ques ionnai e
s he Sho Fo m Heal h Su ey
Pablo Mon eagudo
1,2
, Ana Co della
1,3
, Ainoa Roldán
1,3
, Ca e ina Pesce4 and C is ina Blasco-La a ga
1,3
1Uni e si y o Valencia, Spo Pe o mance and Physical Fi ness Resea ch G oup (UIRFIDE), Valencia, Spain, 2Jaume I Uni e si y, Educa ion and
Speci ic Didac ics Depa men , Cas ellon, Spain, 3Uni e si y o Valencia, Physical Educa ion and Spo s Depa men , Valencia, Spain, 4Uni e si y o
Rome Fo o I alico, Depa men o Mo emen , Human and Heal h Sciences, Rome, I aly
Abs ac
This s udy analyses he associa ion be ween Eu oQol i e-dimensional ques ionnai e indexes (u ili y index and
isual analogue scale) and he physical and men al componen s o he Sho Fo m Heal h Su ey, conside ing
he impac o some a iables ha may in luence bo h ques ionnai es (i.e., age, BMI, physical i ness and cogni i e
unc ion). Bi a ia e and pa ial co ela ion analysis be ween Eu oQol i e-dimensional ques ionnai e indexes and
summa y componen s o he Sho Fo m Heal h Su ey, including he men ioned co a ia es, we e conduc ed in
58 olde adul s (71.03±4.32 yea s). The la ge o small co ela ions ound be ween u ili y index and he physical
componen (0.647), as well as he u ili y index and he isual analogue scale (0.441), pe sis ed by adjus ing physical
condi ion, cogni i e unc ion, BMI and age, while men al componen s showed no associa ion a all. The u ili y
index and physical componen we e con i med o co ela e wi h physical i ness, al hough mode a ely (0.294;
0.284). BMI was nega i ely associa ed, bu only o he u ili y index (-0.322). These esul s ein o ce he concu en
alidi y only o he u ili y index and physical componen s and highligh he impo ance o physical i ness in
a comp ehensi e ge ia ic assessmen . The indexes o he Sho Fo m Heal h Su ey seem o p o ide di e se
in o ma ion ega ding hose o he Eu oQol i e-dimensional ques ionnai e in e ms o he HRQL cons uc .
Keywo ds: aging, body mass index, execu i e unc ion; heal h s a us; pe cei ed quali y o li e; physical i ness
In oduc ion
The s udy o Heal h-Rela ed Quali y o Li e (HRQL)
eme ges as an impo an objec i e o heal h p omo ion and
disease p e en ion policies o olde adul s (OA) (Buchcik,
Wes enhö e , Fleming, & Ma in, 2017) a ousing g ea in e -
es o adminis a ions and p o essionals in his ield (Lu hy,
Ced aschi, Allaz, He mann, & Ludwig, 2015). As an example,
he de elopmen o wo common ques ionnai es: The Sho
Fo m Heal h Su ey (SF-36) and he Eu oQol i e-dimension-
al ques ionnai e (EQ-5D); o mo e ecen ly, he sho e sion
o he o me (SF-12) and he subsequen upda e o he la e
(EQ-5D-5L). These wo ques ionnai es, designed o measu e
HRQL ega dless o he p esence o absence o diseases¸ ha e
become popula in OA s udies (Ha , Kang, Wea he by, Lee,
& B in haup , 2015). In addi ion, hey ha e shown good e-
liabili y and alidi y in his popula ion (Haywood, Ga a , &
Fi zpa ick, 2005), despi e i s high he e ogenei y and he many
a iables ha in luence he HRQL.
In ecen yea s, i has been obse ed ha people wi h be -
e physical i ness (PF) a e usually in highe pe cen iles in
e ms o pe cei ed HRQL as assessed employing he EQ-5D
(Wande ley e al., 2011), gi ing inc easing impo ance o his
domain. O he s udies ha e con i med ha HRQL dec eases
as he Body Mass Index (BMI) and/o age inc eases (König e
Co espondence:
P. Mon eagudo
Jaume I Uni e si y, Physical Educa ion and Spo s Depa men , Ca e de Gascó Oliag, 3, 46010 València (España)
Email: [email p o ec ed]
SHORT REPORT
2 Spo Mon 18 (2020) 2
ASSOCIATIONS BETWEEN TWO QUALITY OF LIFE MEASURES | P. MONTEAGUDO ET AL.
al., 2010; Ko honen, Seppälä, Jä enpää, & Kau iainen, 2014),
using bo h he EQ-5D and he SF-12. I has e en been ound
ha cogni i e unc ion (CF), and mo e speci ically execu i e
unc ions, such as inhibi ion and cogni i e lexibili y, also in-
luence he esponses ob ained in hese ques ionnai es (Fo e,
Bo eham, De Vi o, & Pesce, 2015).
In his con ex , i PF, CF, age, and BMI con i m o modi y
he HRQL sco es (u ili y index; isual analogue scale, physi-
cal componen s, and men al componen s), i seems use ul o
deepen in he concu en analysis o hese sco es con olling
he in luence o each o he abo e-ci ed co a ia es. To he bes
o ou knowledge, no s udies ha e pe o med his ype o anal-
ysis be ween he SF-12 and he EQ-5D-5L among a popula ion
o olde adul s. Thus, he aim o his s udy is o analyse he as-
socia ion be ween EQ-5D-5L and SF-12, conside ing he im-
pac o some a iables ha may in luence bo h ques ionnai es
(i.e. age, BMI, physical i ness and cogni i e unc ion).
Me hods
Pa icipan s
Fi y-eigh elde ly people (30 women) pa icipa ed in his
c oss-sec ional s udy. Inclusion c i e ia we e: 1) o be o e 60
yea s o age; 2) e e a sco e less han o equal o 2 in he agil-
i y ques ionnai e o F ied e al. (2001); 3) no o pa icipa e in
any supe ised physical ac i i y p io o he e alua ion.
HRQL Ques ionnai es
The EQ-5D-5L ques ionnai e (He dman e al., 2011) has
wo pa s: he EQindex (u ili y index), a desc ip i e p o ile
ha can be con e ed in o an index-summa y which de ines
heal h in e ms o i e dimensions (Mobili y, Sel -ca e, Daily
Ac i i ies, Pain/Discom o , and Anxie y/Dep ession); and
he EQVAS, in which esponden s a e hei o e all heal h us-
ing a e ical isual analogue scale om 0 o 100.
The SF-12 (Wa e, 2002) is a educed and upda ed e sion
o he SF-36 ques ionnai e, designed o quick adminis a ion.
I answe s 12 ques ions (on a Like scale o 2 o 6 poin s) ha
add up o eigh dimensions, in which wo summa y compo-
nen s a e ob ained: he physical componen (PCS) and he
men al componen (MCS) (Wa e, 2002).
Co a ia es
PF was ob ained om he a e age o he s anda dized
alues o h ee well-known es s: he Fi e-Times-Si - o-S and
Tes (5STS), as a measu e o lowe -limb s eng h (Whi ney e
al., 2005); he 6-minu e walk (6MWT), as a measu e o he ca -
dio ascula i ness; he six-me e Gai -Speed (GS_6m), o as-
sess he o e all unc ional capaci y. The 6MWT was conduc -
ed ollowing he ecommenda ions o he Ame ican Tho acic
Socie y (2002). The GS_6m was e alua ed using C onojump
Bosco Sys em elec ic pho ocells (Velleman PEM10D pho o-
cells, 5-100ms esponse ime) and he Ch onojump So wa e.
In con as , a e assessing weigh (BC-545 scale; TANITA;
Tokyo, Japan) and heigh (SECA 222 s adiome e ), BMI was
calcula ed as body weigh di ided by he squa ed alue o
body heigh (kg/m²). CF was assessed wi h he S oop Tes , in
which he in e e ence sco e was calcula ed as a ep esen a i e
alue o he Execu i e Func ion (Ri e a e al., 2015).
Expe imen al p ocedu e and e hical aspec s
Da a collec ion was ca ied ou on wo al e na e days o
con ol he con amina ing e ec o some es s. On he i s day,
we assessed body composi ion, SF-12, EQ-5D-5L, and he 5STS
es ; on he second day, S oop Tes , 6-me e Gai -Speed, and he
6MWT we e assessed. Food in ake was hal ed wo hou s p io o
he assessmen s. All indi iduals we e p e iously in o med and
signed hei w i en consen o pa icipa e in his s udy app o ed
by he e hic commi ee o he Uni e si y o Valencia.
S a is ical analysis
Da a we e analyzed wi h he S a is ical Package o he
Social Sciences, SPSS 24 o Windows (IBM Inc. Chicago,
USA). A e es ing o no mali y, non-pa ame ic co ela ion
analysis (Spea man's Rho) we e conduc ed be ween he main
HRQL indices (EQindex, EQVAS ( isual analogue scale), PCS
(physical componen s) and MCS (men al componen s), ol-
lowed by pa ial co ela ion analysis con olling he co a ia es
PF, EF, Age and BMI. I was conside ed: <0.1, i ial; 0.1–0.3,
small; 0.3–.5, mode a e; 0.5–0.7, la ge; 0.7–0.9, e y la ge;
>0.9, almos pe ec ; and 1 pe ec .
Resul s
The sample was ela i ely homogeneous in e ms o age
(71.03±4.32 yea s; 6.1% CV), wi h a la ge coe icien o a i-
a ion in weigh (71.15±14.27 kg, 20% CV), BMI (29.10±4.21;
14.5% CV) and he in e e ence sco e o execu i e unc ion
(-6.02±7.90; CV=130.8%).
Bi a ia e co ela ions
Ou esul s con i m a posi i e and mode a e co ela-
ion be ween he componen s o he EQ-5D-5L (EQindex s
EQVAS; =0.441, p<0.05), no ound be ween he summa-
y componen s o he SF-12 (PCS s MCS; =0.036; p>0.10).
Mo eo e , when analysing he concu ence be ween ques-
ionnai es ( igu e 1), he PCS con i med a la ge and posi i e
concu ence wi h EQindex, and a end ega ding he EQVAS
(small), while he MCS ailed o associa e wi h any index o
he EQ-5D-5L.
Pa ial co ela ions
Rega ding he in luence o PF, CF, age, and BMI on hese
ela ionships, once checked whe he he e we e changes in
pa ial co ela ions o each co a ia e o g oups o co a ia es,
Figu e 1 shows hese esul s bo h independen ly as when con-
olling he ou co a ia es oge he . PF co ela es signi ican ly
and posi i ely wi h EQindex and PCS, while BMI only a ec s
EQindex. Pa ial co ela ion coe icien dec eases sligh ly in
compa ison o he p e ious analysis, wi h no di e ence in le -
els o signi icance. Signi ican ly, MCS again ailed o ela e wi h
any co a ia e. Nei he age no CF showed any associa ion a all.
Discussion
The p esen s udy aimed o highligh simila i ies and di -
e ences be ween wo ques ionnai es widely used in he as-
sessmen o he heal h- ela ed quali y o li e among he elde ly,
so ing ou he in luence o physical and men al condi ions
ela ed o age. As he main inding, bo h ques ionnai es sha e
and p ope ly highligh he impo ance o he PF in elde -
ly people’s HRQL. PF is highly associa ed wi h he EQIndex
and PCS, which a e also la gely associa ed wi h each o he .
Con e sely, EQVAS and MCS ail in hese associa ions, which
indica es hei complemen a i y and need in he assessmen o
his cons uc (HRQL).
Simila o p e ious s udies (D i saki, Pe ou, Williams, &
ASSOCIATIONS BETWEEN TWO QUALITY OF LIFE MEASURES | P. MONTEAGUDO ET AL.
Spo Mon 18 (2020) 2 3
Lamb, 2017), ou esul s ein o ce he concu en alidi y o
bo h ques ionnai es in e ms o pe cei ed physical heal h and
i s in luence on he quali y o li e (EQindex and PCS), quali y-
ing hem in ela ion o a popula ion o olde adul s. Howe e ,
da a also con i m he need o bo h ins umen s and he in lu-
ence o o he ac o s di e en om he physical heal h in he
HRQL. The summa y componen s o he SF-12 do no co -
ela e be ween each o he , and he wi hin co ela ion in he
wo EQ-5D-5L indexes dec eases. In addi ion, he EQVAS-
PCS co ela ion is only a end, and he MCS does no co -
ela e wi h any o he EQ-5D-5L indices. Indeed MCS seems
o p o ide in o ma ion abou a di e en heo ic cons uc o
which he es o he indices, no e en a ec ed by he age and
Execu e Func ion o he pa icipan s.
On he one hand, he associa ion o PF and he compo-
nen s EQindex and PCS in bo h ques ionnai es ein o ces he
idea o a highe i ness leading o highe HRQL, as p e ious-
ly epo ed in olde adul s (Taka a e al., 2010), PF should be
included in he comp ehensi e ge ia ic assessmen (Sánchez,
Fo miga, & C uz-Jen o , 2018) and aken in o accoun in he
assessmen o HRQL. On he o he hand, ou da a sugges ha
PF migh in luence his HRQL mo e han o he ac o s such as
BMI, age o he cogni i e unc ion in heal hy olde adul s, a
leas in a sample qui e homogeneous in e ms o age.
Wi h ega d o BMI, only he EQIndex has been sensi-
i e o his ac o , epo ing a small and nega i e associa ion
(Figu e 1). Signi ican ly, he use o he BMI may no ully
e lec changes in body composi ion wi h ageing, as i does
no dis inguish be ween muscle mass and a mass (Kahn &
Cheng, 2018). Ne e heless, he EQindex may o e addi ion-
al in o ma ion ela ed o been o e weigh by including some
emo ional issues (i.e., pain and anxie y), becoming a mo e
comp ehensi e HRQL index.
Sample size and homogeneous age can be he majo lim-
i a ions o his s udy. Simila ly, u u e s udies should epli-
ca e his analysis by using, o example, he wais /hip a io
index, o mo e accu a e es s o he cogni i e domain. They
should also in es iga e whe he PF is bes exp essed by a
uni ied se o a iables unde a single indica o , o by he iso-
la ed s udy o he di e en capaci ies o he OA, since he use
o a single indica o could be hiding he ele ance o some
speci ic capaci y.
In conclusion, ou esul s indica e ha only EQindex and
PCS ha e mode a e concu en alidi y. Howe e , con olling
ce ain aspec s such as PF, age o BMI is impo an due o hei
possible in luence on ce ain indexes and hei ela ionship.
FIGURE 1. Bi a ia e and pa ial co ela ions (Spea man) be ween he di e en HRQL indices when con olling physical i ness,
cogni i e unc ion, body mass index and age oge he , **p<0.010; *p<0.050; †p=0.100.
Acknowledgemen s
To he “Asociación En enamien o Con Mayo es” o he help in da a collec-
ion and o all pa icipan s in he s udy o hei coope a ion.
Con lic o in e es
The au ho s decla e ha he e is no con lic o in e es .
Recei ed: 27 Decembe 2019 | Accep ed: 09 Ma ch 2020 | Published: 01
June 2020
Re e ences
Buchcik, J., Wes enhö e , J., Fleming, M., & Ma in, C.R. (2017). Heal h- ela ed
quali y o li e (HRQoL) among elde ly Tu kish and Polish mig an s and
Ge man na i es: The ole o age, gende , income, disc imina ion and
social suppo . People’s mo emen s in he 21s cen u y- isks, challenges
bene i s, 55-75. doi.o g/10.5772/66931
Lu hy, C., Ced aschi, C., Allaz, A.-F., He mann, F.R., & Ludwig, C. (2015). Heal h
s a us and quali y o li e: esul s om a na ional su ey in a communi y-
dwelling sample o elde ly people. Quali y o Li e Resea ch, 24(7), 1687-
1696. doi.o g/10.1007/s11136-014-0894-2.
Ha , P.D., Kang, M., Wea he by, N.L., Lee, Y.S., & B in haup , T.M. (2015).
Sys ema ic e iew o heal h- ela ed quali y o li e assessmen s in
physical ac i i y esea ch. Wo ld J P e Med, 3(2), 28-39. doi: 10.12691/
jpm-3-2-3.
Haywood, K., Ga a , A., & Fi zpa ick, R. (2005). Quali y o li e in olde people:
a s uc u ed e iew o gene ic sel -assessed heal h ins umen s. Quali y
o li e Resea ch, 14(7), 1651-1668. doi.o g/10.1007/s11136-005-1743-0.
Wande ley, F.A., Sil a, G., Ma ques, E., Oli ei a, J., Mo a, J., & Ca alho, J.
(2011). Associa ions be ween objec i ely assessed physical ac i i y
le els and i ness and sel - epo ed heal h- ela ed quali y o li e in
communi y-dwelling olde adul s. Quali y o Li e Resea ch, 20(9), 1371-
1378. doi.o g/10.1007/s11136-011-9875-x.
König, H.-H., Heide , D., Lehne , T., Riedel-Helle , S.G., Ange meye , M.C.,
Ma schinge , H., ... de Gi olamo, G. (2010). Heal h s a us o he ad anced
elde ly in six Eu opean coun ies: esul s om a ep esen a i e su ey
using EQ-5D and SF-12. Heal h quali y o li e ou comes, 8(1), 143. doi.
o g/10.1186/1477-7525-8-143.
Ko honen, P.E., Seppälä, T., Jä enpää, S., & Kau iainen, H. (2014). Body mass
index and heal h- ela ed quali y o li e in appa en ly heal hy indi iduals.
Quali y o li e esea ch, 23(1), 67-74. doi.o g/10.1007/s11136-013-0433-6.
4 Spo Mon 18 (2020) 2
ASSOCIATIONS BETWEEN TWO QUALITY OF LIFE MEASURES | P. MONTEAGUDO ET AL.
Fo e, R., Bo eham, C., De Vi o, G., & Pesce, C. (2015). Heal h and quali y o
li e pe cep ion in olde adul s: he join ole o cogni i e e iciency
and unc ional mobili y. In e na ional jou nal o en i onmen al esea ch
public heal h, 12(9), 11328-11344. doi.o g/10.3390/ije ph120911328
F ied, L. P., Tangen, C. M., Wals on, J., Newman, A. B., Hi sch, C., Go diene ,
J.,... Bu ke, G. (2001). F ail y in olde adul s: e idence o a pheno ype.
The Jou nals o Ge on ology Se ies A: Biological Sciences Medical Sciences,
56(3), M146-M157. doi.o g/10.1093/ge ona/56.3.M146.
He dman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Pa kin, D.,... Badia,
X. (2011). De elopmen and p elimina y es ing o he new i e-le el
e sion o EQ-5D (EQ-5D-5L). Quali y o li e esea ch, 20(10), 1727-1736.
doi.o g/10.1007/s11136-011-9903-x.
Wa e, J.E. (2002). The SF-12 2TM how o sco e e sion 2 o he SF-12® heal h
su ey: (wi h a supplemen documen ing e sion 1): Quali y Me ic.
Whi ney, S.L., W isley, D.M., Ma che i, G.F., Gee, M.A., Red e n, M.S., &
Fu man, J.M. (2005). Clinical measu emen o si - o-s and pe o mance
in people wi h balance diso de s: alidi y o da a o he Fi e-Times-
Si - o-S and Tes . Physical he apy, 85(10), 1034-1045. doi.o g/10.1093/
p j/85.10.1034.
Ame ican Tho acic Socie y. (2002). Ame ican Tho acic Socie y s a emen :
guidelines o he six-minu e walk es . Commi ee on P o iciency
S anda ds o Clinical Pulmona y Func ion Labo a o ies. Am J Respi C i
Ca e Med, 166(1), 111-117.
Ri e a, D., Pe in, P., S e ens, L., Ga za, M., Weil, C., Sa acho, C.,... Weile , G.
(2015). S oop colo -wo d in e e ence es : no ma i e da a o he La in
Ame ican Spanish speaking adul popula ion. Neu oRehabili a ion,
37(4), 591-624. doi: 10.3233/NRE-151281.
D i saki, M., Pe ou, S., Williams, M., & Lamb, S.E. (2017). An empi ical
e alua ion o he SF-12, SF-6D, EQ-5D and Michigan Hand Ou come
Ques ionnai e in pa ien s wi h heuma oid a h i is o he hand. Heal h
quali y o li e ou comes, 15(1), 20. doi.o g/10.1186/s12955-016-0584-6
Taka a, Y., Ansai, T., Soh, I., Awano, S., Yoshi ake, Y., Kimu a, Y., ... Nakamichi, I.
(2010). Quali y o li e and physical i ness in an 85-yea -old popula ion.
A chi es o ge on ology ge ia ics, 50(3), 272-276. doi.o g/10.1016/j.
a chge .2009.04.005.
Sánchez, E., Fo miga, F., & C uz-Jen o , A. (2018). La c ecien e impo ancia
del endimien o ísico en la alo ación ge iá ica in eg al. Re is a
Española de Ge ia ía y Ge on ología, 53(5), 243-244. doi: 10.1016/j.
egg.2018.06.002.
Kahn, H.S., & Cheng, Y.J. (2018). Compa ison o adiposi y indica o s
associa ed wi h as ing-s a e insulinemia, iglyce idemia, and ela ed
isk bioma ke s in a na ionally ep esen a i e, adul popula ion.
Diabe es esea ch and clinical p ac ice, 136, 7-15.