After nearly 6 years in development, a new health-related satisfaction and recovery scale is now available for use. The manuscript describing its development and preliminary validation studies is currently under review with the Health and Quality of Life Outcomes open-access journal, which does mean that the tool has yet to be formally scrutinized through peer review so until the reviews come back we must consider the rest of what I’m about to say pilot work.
The SRI contains 9 condition- and region-agnostic (generic) items that ask respondents to provide two scores for each item: the first is an importance score, the second is a satisfaction score in relation to the interference due to the respondent’s health condition. It sounds a little complex, but in practice it seems that patients are able to understand what they’re being asked to do. It does mean that the scoring is a little more complex and is probably easiest with a calculator (but not overly difficult). An importance-weighted satisfaction score is calculated for each item by multiplying the importance and satisfaction scores together then dividing by 10. So, for example, if a patient rates the item about future potential as being extremely important to them (10/10) and rates their current satisfaction in that area at a 5, the weighted score is 5 x 10 / 10, or 5 which is added to all other items. If a different patient rates the importance of that item at a 7, then the weighted score is 5 x 7 /10, or 3.5 in the final summed score. This is done for each item, so all 9 items get a weighted score. To get the final SRI score, you then use the following formula:
SIRI score = [(Sum of weighted scores)/(Sum of importance scores only)] x 100
What this means is that you end up with a percentage ‘importance-weighted health-related satisfaction’ score that is more heavily influenced by those items that the patient feels are important to their own sense of satisfaction, while those areas less important are weighted lower. The added benefit here is that change in those items that are rated as important leads to a greater overall score change than does change in less important items. Here’s a concrete example of that:
Let’s say on day 1, your patient provides the following scores for the SRI items:
The total SRI score would be the sum of the weighted scores (33.8) divided by the sum of the importance scores (79) x 100, or in this case, 42.8% health-related satisfaction. Two weeks later that same patient completes the SRI again. As the first example, let’s say that they improved by 2 points in the area of positive emotions (from 3 to 5). This item being weighted a full ‘10’ on importance, the sum of the weighted scores is now 35.8, and the percent satisfaction is 45.3%, and increase of 2.5%. To draw the contrast, let’s instead say that the same patient improved by 2 points in the area of intimate relationships (from 4 to 6), no doubt due to your excellent physiotherapeutic interventions. The sum of the weighted scores is now 34.8, and the percent satisfaction is now 44.1%, an increase of only 1.3% for the same 2 point satisfaction increase. You can play with this a little yourself and see how it pans out in practice.
It’s worth noting that each of the items represent areas of importance that were gleaned from focus groups with people with pain (mostly neck pain) and from existing theories on health, happiness, and human potential. You can read the ‘companion’ paper to this one, from which many of the items were drawn, here for free: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793580/
Another interesting potential for this tool is in the area of response shift, or shifting priorities in the presence of chronic conditions. Over time, some people will change in what is important to them, and the SRI allows for that change to occur, meaning that people can feel ‘satisfactorily recovered’, even if they haven’t completely achieved satisfaction in areas that used to be important to them.
So far our preliminary data indicates that a score over 80% is likely indicative of someone adequately satisfied to be considered recovered in most cases (likely to be back at work, not requiring further treatment), and a score over 90% is highly indicative of a recovered status. Keep in mind that these numbers come from a ‘normal’ adult population, elite athletes or other such people outside of the norm may have different expectations. It also bears mentioning that the tool includes a single ‘validation’ check item, which asks people to indicate a ‘4’ in item 6. Interestingly, nearly 10% of our respondents in the validation study did this incorrectly, so keep an eye open.
So, feel free to give this a try. It appears to be as responsive as region-specific scales (like the NDI, Roland-Morris, UEFI or LEFS) and more responsive than other generic tools like the SF-12. We’re still working on MCID, but so far it looks like 5-7% change indicates meaningful change. If you do decide to give this a spin, I’d love to hear your thoughts and experiences.