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Evaluation of the Psychometric Properties of the Swiss French Version of Older People’s Quality Of Life Questionnaire (OPQOL-35-SF)

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Background: The proportion of older people aged more than 65 years old is continuously increasing in the world population. The quality of life is an important factor in their biopsychosocial handling. The questionnaire “Older People’s Quality of Life-35” (OPQOL-35) has been specially developed for the assessment of the senior’s quality of life. The aim of this study is to translate and evaluate the psychometric properties of the transcultural Swiss French version of the OPQOL-35 questionnaire (OPQOL-35-SF). Method: Forward-backward procedure was applied to translate the original questionnaire from English into Swiss French. Then, a sample of older people completed the questionnaire. The construct validity was evaluated by comparing the results of the OPQOL-35-SF with the scores of three other questionnaires (WHOQOL-OLD, CASP-12 and EQ-5D-5L) and two visual analogue scales (health and quality of life). The questionnaire’s structure has been assessed through exploratory and confirmatory factor analysis. The OPQOL-35-SF questionnaire was submitted a second time after 7 to 23 days to evaluate the reliability. Results: 264 older people completed all the questionnaires once and 262 the OPQOL-35-SF a second time. The mean age of participants was 76.8 (SD = 7.1). Most of them were women (73,9%). KMO is of 0.86 and the Bartlett’s test of sphericity is significant (p<0.001). The result of EFA shows 8 factors with eigenvalues greater than one, which explained 58% of the observed variance. All the items have a significant impact (<0.30) in at least one factor. The convergent validity presents low to moderate correlations (rho: 0.384-0.663). Internal consistency is good with a Cronbach’s alpha at 0.875 for test and at 0.902 for retest. Test-retest reliability presents an ICC2.1 at 0.83 (IC 0.78 to 0.87). Conclusion: The Swiss French version of the questionnaire OPQOL-35 shows psychometric properties which permit its use in the clinical practice or for research purposes. A supplementary sample would be necessary for a better repartition of the items in the different factors.
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Evaluation of the Psychometric Properties of the
Swiss French Version of Older Peoples Quality Of
Life Questionnaire (OPQOL-35-SF)
Sophie Carrard ( sophie.carrard@hevs.ch )
HES-SO Valais-Wallis Haute Ecole de Sante https://orcid.org/0000-0002-3147-5848
Claudia Mooser
Institut Notre-Dame de Lourdes
Roger Hilker
HES-SO Valais-Wallis Haute Ecole de Sante
Anne-Gabrielle Mittaz Hager
HES-SO Valais-Wallis Haute Ecole de Sante
Research
Keywords: older people, quality of life, questionnaire, psychometric properties
Posted Date: November 9th, 2021
DOI: https://doi.org/10.21203/rs.3.rs-1030056/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License. 
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Manuscript_OPQOL-35-fr_for BMC Springer Nature_20.10.21
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Title page 1
2
Evaluation of the psychometric properties of the Swiss French version of Older People’s 3
Quality Of Life questionnaire (OPQOL-35-SF) 4
5
6
Sophie Carrard, HES-SO Valais-Wallis, School of Health Sciences, Physiotherapy, 7
Rathausstrasse 25, 3954 Leukerbad (VS-Switzerland), sophie.carrard@hevs.ch 8
9
Claudia Mooser, Institut Notre-Dame de Lourdes, 3960 Sierre, (VS-Switzerland), 10
claudia.mooser@hotmail.ch 11
12
Hilfiker Roger, HES-SO Valais-Wallis, School of Health Sciences, Physiotherapy, 13
Rathausstrasse 25, 3954 Leukerbad (VS-Switzerland), roger.hilfiker@hevs.ch 14
15
Anne-Gabrielle Mittaz Hager, Caphri-Care and Public Health Research Institute and HES-SO 16
Valais-Wallis, School of Health Sciences, Physiotherapy, Rathaustrasse 25, 3954 Leukerbad 17
(VS-Switzerland), gaby.mittaz@hevs.ch 18
19
Corresponding Author: 20
Sophie Carrard, HES-SO Valais-Wallis, School of Health Sciences, Physiotherapy, 21
Rathausstrasse 25, 3954 Leukerbad (VS-Switzerland), sophie.carrard@hevs.ch 22
23
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Abstract (max 350 words) 1
2
Background: The proportion of older people aged more than 65 years old is continuously 3
increasing in the world population. The quality of life is an important factor in their 4
biopsychosocial handling. The questionnaire “Older People’s Quality of Life-35” (OPQOL-35) 5
has been specially developed for the assessment of the senior’s quality of life. The aim of this 6
study is to translate and evaluate the psychometric properties of the transcultural Swiss 7
French version of the OPQOL-35 questionnaire (OPQOL-35-SF). 8
9
Method: Forward-backward procedure was applied to translate the original questionnaire 10
from English into Swiss French. Then, a sample of older people completed the questionnaire. 11
The construct validity was evaluated by comparing the results of the OPQOL-35-SF with the 12
scores of three other questionnaires (WHOQOL-OLD, CASP-12 and EQ-5D-5L) and two visual 13
analogue scales (health and quality of life). The questionnaire’s structure has been assessed 14
through exploratory and confirmatory factor analysis. The OPQOL-35-SF questionnaire was 15
submitted a second time after 7 to 23 days to evaluate the reliability. 16
17
Results: 264 older people completed all the questionnaires once and 262 the OPQOL-35-SF a 18
second time. The mean age of participants was 76.8 (SD = 7.1). Most of them were women 19
(73,9%). KMO is of 0.86 and the Bartlett’s test of sphericity is significant (p<0.001). The result 20
of EFA shows 8 factors with eigenvalues greater than one, which explained 58% of the 21
observed variance. All the items have a significant impact (<0.30) in at least one factor. The 22
convergent validity presents low to moderate correlations (rho: 0.384-0.663). Internal 23
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consistency is good with a Cronbach’s alpha at 0.875 for test and at 0.902 for retest. Test-24
retest reliability presents an ICC2.1 at 0.83 (IC 0.78 to 0.87). 25
26
Conclusion: The Swiss French version of the questionnaire OPQOL-35 shows psychometric 27
properties which permit its use in the clinical practice or for research purposes. A 28
supplementary sample would be necessary for a better repartition of the items in the different 29
factors. 30
31
Keyword: older people, quality of life, questionnaire, psychometric properties 32
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Background 1
2
As the world population is ageing faster than in the past, the World Health Assembly endorsed, 3
in August 2020, the “Decade of healthy ageing” (2020-2030). This acceleration in ageing will 4
have an impact on almost all aspects of the society.(1) Between 2015 and 2050, the proportion 5
of the world’s population over 60 years is expected to nearly double from 12% to 22%.(2) In 6
the European Union, people over 60 represented around 15% in 2014 and could reach 30% by 7
2050.(3) 8
9
Ageing is associated with the decline of health (4) and often related to multiple chronic and 10
acute diseases.(5) This overloads the health care system, both in hospitals and in community 11
care. (6) Due to the ever-increasing costs of health care, older people leave the hospital earlier 12
than before.(7) Therefore home-based cares are increasingly required to provide assistance 13
for daily tasks and enable older adults to age at home.(8, 9) In 2018, 1,5% of Swiss people aged 14
between 65 and 79 years were living in a health care institution and there were 15,3% of the 15
over 80.(10) In the future, most of the older people, healthy or not, will live at home as long 16
as possible. In addition to their care role, one goal for caregivers is to enhance quality of life 17
(QoL).(11) Maintaining QoL is one of the most important outcomes of care services for older 18
adults.(8) Measuring QoL could help to predict adverse health outcome, such as death and 19
nursing home placement in older people, even after adjustment for frailty.(12) However, it is 20
not evident how QoL should be defined and how it should be assessed in older people still 21
living at home. 22
23
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Quality of life can inherently be defined as a dynamic, multi-level and complex concepts, 24
reflecting objective, subjective, macro-societal, and micro-individual, positive and negative 25
influences which interact together”.(13) Quality of life is also a network of objectives and 26
subjective factors, that includes relationships between psychological and social indicators, 27
objectives living conditions and the subjective well-being.(14) In their recent thematic 28
synthesis, Van Leeuwen et al. categorized and described the QoL aspects into nine domains 29
and thirty-eight subthemes.(8) 30
31
There is a multitude of questionnaires permitting the evaluation of quality of life. Some of 32
them have been developed specifically for older adults.(15) The most used questionnaires in 33
this field differ in the number of dimensions analyzed as well as in the number of items. The 34
questionnaire WHOQOL-OLD contains 24 items distributed in six dimensions.(16) The CASP 35
questionnaires evaluate four dimensions (Control, Autonomy, Self-realization and Pleasure) 36
standing for the acronym. It exists with 19 (CASP-19) (17) or 12 (CASP-12) items.(18) The 37
WHOQOL-AGE, two dimensions and 30 items (19), was constructed with five items of 38
WHOQOL-OLD and the eight items from the EUROHIS-QOL.(20) The OPQOL-35 questionnaire 39
(21) is composed of 35 items in eight dimensions. It exists in a brief version of it with 13 40
items.(22) 41
42
Most of these questionnaires have been conceptualized and validated in English. Some of 43
them have been translated into different languages. To our knowledge, the OPQOL-35 has 44
been translated and validated to be used in Iran (23), Czech Republic (24), China (25) and 45
Uganda (26). It was also used in several studies in Albania (27), India (28), Sri Lanka (29), 46
Pakistan (30), Malesia (31) and Indonesia (32). Some countries, such as Turkey (33), Iran (34) 47
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and Norway (35), translated and used the OPQOL-brief with thirteen items. Although French 48
is spoken by about 300 millions of people in the world, making it the fifth most widely used 49
language in the world (36), the OPQOL-35 is not yet available in French. The aim of this study 50
was to evaluate the psychometric properties of the Swiss French version of Older People’s 51
Quality of Life questionnaire (OPQOL-35-SF). 52
Methods 53
The original version of the OPQOL questionnaire 54
The OPQOL-35 was developed by Ann Bowling.(21, 37, 38) It consists of 35 statements for 55
which older people must select their agreement between “strongly agree”, “agree”, “neither 56
agree nor disagree”, disagree”, “strongly disagree” or with a score ranking from 1 to 5. 57
Scoring needs reverse coding of positive items. Higher score represents better quality of life. 58
The total score ranges from 35 (worst possible QoL) to 175 (best possible QoL). This 59
questionnaire covers eight domains: a. Life overall (4 items), b. Health (4 items), c. Social 60
relationships and participation (8 items), d. Independence, control over life and freedom (5 61
items), e. Home and neighborhood (4 items), f. Psychological and emotional well-being (4 62
items), g. Financial circumstances (4 items) and h. Culture and religion (2 items.) 63
Psychometrics proprieties of the original English version of the OPQOL-35 were analyzed by 64
Bowling. (21) Cronbach’s alpha statistic ranged between 0.70 and 0.90 for internal consistency 65
without item redundancy. Test-retest correlations (four weeks) ranged from moderate to high 66
(r 0.403-0.782). Convergent construct validity was tested with CASP-19 (17) and WHOQOL-67
OLD (16). OPQOL-35 showed moderate to high correlations (rho 0.380-0.732, p<.01) for total 68
scores. 69
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There is no consensus for the factorial structure of this questionnaire. Although the English 70
version includes eight dimensions, principle components analysis (PCA) identify mainly two or 71
four dimensions (21) but also nine (38). Chinese and Persian authors of the both translated 72
versions of OPQOL-35 identified eight dimensions (23, 25) while Czech authors of the Czech 73
translation estimate seven dimensions as optimal (24). 74
75
The Swiss French version of the OPQOL questionnaire 76
With the consent of Ms. Ann Bowling, the author of the original version, a research team 77
translated the OPQOL-35 questionnaire into French according to the current guidelines.(39) A 78
health professional and a naive translator translated forward the English version into Swiss 79
French (resp. translation 1 (T1) and translation 2 (T2)). Both translators and a recording 80
observer produced a synthesis of the translation, resulting into a first Swiss French version of 81
the questionnaire (T-12). Two persons translated T-12 back. Both were native English speakers 82
and not informed of the concept explored. Both back translations (BT1 and BT2), both forward 83
translations (T1 and T2), T-12 and the original English version of the questionnaire were 84
submitted to an expert committee to consolidate all the versions and develop the prefinal 85
version of the Swiss French OPQOL-35. This prefinal version was then submitted to 19 older 86
adults which gave comments and remarks. These feedbacks were included in the second 87
prefinal version. Bütikofer & Rausis (40) submitted the second prefinal version to 37 older 88
people. As no comprehension issues were pointed out, this version is effective as the final 89
Swiss French version. 90
91
Participants 92
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We recruited older adults, aged 65 years or more, living in their own home and able to 93
understand and write French language in two French speaking cantons of Switzerland (Vaud 94
and Valais) during two periods: from April 2017 to May 2017 and from June 2018 to December 95
2018. They were recruited from medical-social centers, physiotherapy practices, associations 96
of elderly people and personal contacts. 97
Recommendations for sample size for exploratory factor analysis (EFA) differs widely in the 98
literature: from 50 to 1’000 subjects (41) ; or between five and ten subjects per items (42, 43); 99
or more than 100 (44). Two hundred subjects seems to be necessary for a confirmatory factor 100
analysis (42). Considering a minimum of 50 subjects (45) and between three and ten subjects 101
pro items (23), we opted for seven to eight subjects per item, i.e. between 245 subjects and 102
280 subjects. 103
104
Measures 105
To evaluate the construct validity of the Swiss French version of the OPQOL-35, total scores 106
have been correlated with the French versions of the Visual Analogue Scale (VAS), WHOQOL-107
OLD (46), CASP-12 (18) and EQ-5D-5L (47). Authorizations have been received by the World 108
Health Organization (WHO) for the use of the WHOQOL-OLD and by EuroQol for the EQ-5D-109
5L. CASP-12 was free of use. 110
111
VASs are single-item self-reported measurement tools. They are often used in health care 112
practice to assess pain (48), patient satisfaction (49), anxiety (50) and health related quality of 113
life (51). The scientific literature does not permit us to attribute one or more authors to it, but 114
it seems to have been developed and then used empirically by physicians and caregivers.(52) 115
VAS global quality of life shows a good validity and an excellent reliability. It is recommended 116
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to measure global quality of life in clinical trials.(53) It was represented by a horizontal line of 117
100-mm ranging from 0 “worst imaginable quality of life” to 100 “perfect quality of life”. 118
119
The WHOQOL-OLD was developed from WHOQOL-100, which is a questionnaire of the 120
WHOQoL Group within the World Health Organization.(16) It measures QoL with 24 items in 121
seven subscales: sensory abilities; autonomy; past, present and future activities; social 122
participation; death and dying; and intimacy (four items per subscale). Items are scored with 123
reverse coding of positive responses, so that higher score means higher QoL between 24 124
(lowest possible QoL) to 120 (highest possible QoL). Response scales are all 5-point but vary 125
in their wording (“Not at all” to An extreme amount/ Completely/ Extremely”; Very 126
poor” to Very good”; “Very dissatisfied” to “Very satisfied”; “Very unhappyto “Very happy”). 127
128
CASP questionnaires were developed on the theories of Maslow and Giddens about the 129
satisfaction of the human needs.(17) Quality of life is evaluated in four domains: control, 130
autonomy, self-realization, and pleasure. The original version contains 19 items and two short 131
versions with twelve items have been developed: one in 2005, specifically for the Survey of 132
Health, Aging and retirement in Europe (54) and a second one in 2008 (55). Items are scored 133
on a 4-point Likert response scale “Often”, Sometimes”, Not often” and “Never”, with 134
reverse coding of positive responses, so that higher scores mean higher QoL. The scale of the 135
CASP-12 ranges from 0 (complete absence of QoL) to 36 (total satisfaction in all four domains). 136
137
EuroQol Group developed in the 90’s the EQ-5D to evaluate the quality of life related to health. 138
Later the questionnaire was added three levels (3L) and in 2009, EuroQol Group introduced 139
five levels (5L) to improve the instrument’s sensitivity and to reduce the ceiling effects. The 140
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tool consists of two parts: one for the descriptive system and the second for the visual 141
analogue scale (EQ VAS). The descriptive system comprises five dimensions: mobility, self-care, 142
usual activities, pain/discomfort, and anxiety/depression. Each dimension has five levels: “no 143
problems”, slight problems”, moderate problems”, severe problems and extreme 144
problems”. The EQ VAS records the patient’s self-rated health on a vertical visual analogue 145
scale, where the Endpoints are labelled The best health you can imagineand The worst 146
health you can imagine”.(56) Scoring is calculated with an algorithm specific to each country. 147
148
Data collection 149
The questionnaires were self-administrated under the supervision of a research assistant (SC 150
or CM), sometimes individually and sometimes in group. There were completed on electronic 151
tablets, laptops or in paper format, at the subjects' homes or in another location of their 152
convenience. To analyze the test-retest reliability, the OPQOL-35-SF was administrated twice 153
within a time interval of 6 to 23 days. There is no significant difference, clinical or statistical, 154
with an interval of two days or two weeks between two administrations.(57) In some 155
exceptional situations, and for logistical reasons, the questionnaire for the retest was handed 156
out at the end of the first meeting with a pre-stamped and pre-addressed envelope. 157
Instructions were to complete the questionnaire in seven days and send it back. 158
During the first meeting, the research assistant explained in detail the course of the study. The 159
participants completed, in this order, their personal data and general information about 160
health status, the questionnaires WHOQOL-OLD, CASP-12, EQ-5D-5L and OPQOL-35-SF. The 161
first meeting lasted between 30 minutes (individual meeting) and two hours (group meeting). 162
During the second meeting, the participants completed only the OPQOL-35-SF and answered 163
to the question: Since our first meeting, have you experienced any events that could have 164
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influenced your quality of life?”. If the answer was “Yes”, it was asked: Does this event 165
influence your quality of life positively or negatively?” and the participant was asked to 166
describe this event. The second meeting lasted between 10 and 30 minutes. 167
168
Data have been collected online on the software REDCap (Research Electronic Data Capture) 169
(58) and have been saved on a secure server in the University of Applied Sciences in Fribourg. 170
All data have been exported in EXCEL to be cleaned before analysis with the software R, 171
version 3.5.2 (within R-Studio), and Stata version 15.1. 172
173
Data analysis 174
Construct validity: The factor structure of the OPQOL-35-SF was evaluated by performing EFA 175
with varimax rotation.(59) It permits to group the variables by factors and eliminate those that 176
are not related to the construct.(44, 60) In brief, it permits to measure the coefficient of 177
variance of items between two populations. A large variance shows a difference in the 178
meaning of the question which may be due either to the translation or to cultural 179
variation.(61) Factor analysis could be exploratory or confirmatory; both could be 180
complementary.(44) For factor analysis, the Kaiser-Meyer-Olkin Measure of Sampling 181
Adequacy (KMO) should exceed the threshold of 0.8 (62, 63) and the correlation matrix must 182
contain correlations = 0 (p<0.05) with the Bartlett’s Test of Sphericity (41, 64). EFA permits the 183
identification of the different factors that define the construct.(60) There is no expectation as 184
to the nature and number of factors and this helps to purify questionnaires by grouping inter-185
correlated questions.(41, 42, 44) It is measured using Principal Component Analysis (PCA) and 186
Varimax rotation. It is expressed by eigenvalues >1.0 and variance coefficients >0.40 from the 187
correlation matrix.(23, 25, 42) The weight of the variables represents the correlation between 188
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the original variable and the factor. The weight should be greater than 0.35 for a sample of 189
250 to 350 individuals. Our analysis is based on a threshold of 0.30, as in the study by Bowling 190
et al.(38) Scree plots permit the identification of the ideal number of factors, either the one 191
before the inflection point of the curve, or the one at the level of the ideal eigenvalue, equal 192
to 1.(64) 193
194
Convergence validity was evaluated using Spearman’s rank correlations between scores of 195
VAS for QoL, the OPQOL-35-SF, WHOQOL-OLD, CASP-12 and EQ-5D-5L, including its VAS for 196
health.(65) Because the scoring scales of these questionnaires aren’t similar, they all were 197
converted on the scale used for the OPQOL-35 (Additional material I) for the analysis. 198
Cronbach’s alpha tests the strength of the association between each scale item and the full 199
scale. It was used to evaluate the internal consistency.(65) The closer the Cronbach alpha is 200
to 1, the more reliable it is. It should be between 0.7 and 0.9.(21, 45, 66) 201
Intra-class correlation coefficient, two-way random effects, absolute agreement, single rater 202
(ICC2.1) has been used for the test-retest reliability.(67) Terwee et al. (45) and De Vet et al.(61) 203
consider an ICC of 0.70 as acceptable to demonstrate good reliability. Koo and Li (68) suggest 204
that ICC values less than 0.5 are indicative of poor reliability, values between 0.5 and 0.75 205
indicate moderate reliability, values between 0.75 and 0.9 indicate good reliability, and values 206
greater than 0.90 indicate excellent reliability. Agreement was analyzed in percentage, with 207
weighted Cohen's kappa coefficient and with prevalence-adjusted bias-adjusted kappa 208
(PABAK). The use of PABAK minimizes the influence of a response difference of 1, as the 209
responses to the items range from 1 to 5.(69, 70) Landis and Koch consider a score >0.80 as 210
almost perfect, and for Fleiss, a score >0.75 is excellent.(61) 211
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Results 212
Sample characteristics 213
The characteristics of the participants are presented in Table 1. 264 older people completed 214
the questionnaires at the first meeting, 262 at the second one. The average age of the 215
participants was 76.8 years +/- 7.1 years ranging from 65 to 96 years old. 87.1% were native 216
French speakers. The remaining elderly (n=34) had been speaking French for an average of 217
55 years. Most of the participants were women (73.9%), rural residents (67%), practiced 218
physical activity (87.1%) and took medication (73.5%). 219
220
Title: Table 1: Characteristics of participants (n= 264) 221
Legend: SD=standard deviation; n=number of participants 222
223
Twenty-four participants reported events that have strongly influenced their quality of life 224
between the first and the second meeting. Their scores were excluded for the Principal 225
Component Analysis of the OPQOL-35-SF retest (n=238). 226
227
Construct validity 228
EFA was performed to test the structure of the OPQOL-35-SF. The ratio of participants to items 229
was 7.54:1. The KMO value of sampling adequacy was 0.86 for OPQOL-35-SF test and 0.88 for 230
OPQOL-35 retest, exceeding the recommended value of 0.8. (62, 63) Bartlett’s Test of 231
Sphericity was statistically significant for OPQOL-35-SF test (Chi-square 3424.096, 595 degrees 232
of freedom, P<.001) and for OPQOL-35-SF retest (Chi-square 4117.709, 595 degrees of 233
freedom, p<.001), supporting the factorability of the correlation matrix. (62) Eight factors 234
were extracted and identified using a minimal eigenvalue of 1 as the factor criterion. The eight 235
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factors explained 58% of the variance observed. Scree plots of OPQOL-35-SF test and retest 236
show an ideal number of eight factors (Figure 1a and 1b). This is more explicit in the test than 237
in the retest. 238
Title: Figure 1: Scree plot of eigenvalues from the exploratory factor analysis. 239
Legend: 1a: OPQOL-35-SF test; 1b: OPQOL-35-SF retest 240
241
PCA and Varimax rotation for OPQOL-35-SF test and retest (Additional material II and III) 242
present the repartition of the items with a significative weight (<0.30) in eight factors. 243
Component 1 explained the largest explained proportion of the variance for the test (0.21) 244
and component 1 and 8 for the retest (0.19). In the Swiss French version of the questionnaire, 245
the distribution of items in the dimensions (Figure 2) differs from the original English version 246
of Bowling.(21) The dimension “Life overall” disappears and its four items (Q1-Q4) are 247
integrated into the dimension “Psychological and emotional well-being” with items Q26-Q28. 248
Item Q19 “The cost of the things compared to my pension/income restricts my life” joins the 249
dimension "Financial circumstances" with items Q30-Q33. A new dimension, entitled “Physical 250
condition” appears. It includes three items (Q5-Q7) from the original “Health” dimension, 251
three items (Q14-Q16) from the original “Social relationships/leisure and social activities” 252
dimension, and three items (Q17, Q18 and Q20) from the original “Independence, control over 253
life, freedom” dimension. The original dimension “Social relations/leisure and social activities” 254
is divided into two new separate dimensions: a dimension “Social relationship” which includes 255
items Q10, Q12 and Q21 and a dimension “Family context” which includes items Q9, Q11 and 256
Q13. Item Q22 “I feel safe where I live” disappears from the dimension "Home and 257
neighborhood". The dimension “Religion/culture” stay unchanged. Finally, three items do not 258
fit any of the identified dimensions: Q8 “I am healthy enough to get out and about”, Q22 “I 259
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feel safe where I live” and Q29 “If my health limits social/leisure activities, then I will 260
compensate and find something else I can do”. 261
262
Title: Figure 2: Factors’ structure of the OPQOL derived form PCA 263
264
Table 2 presents the scores of the different questionnaires measuring the quality of life, in 265
original scoring and in transformed values (TV) to be compared to OPQOL-35. The average 266
scores of the questionnaires, scaled to OPQOL-35, ranged from 142.2 +/- 17.2 for CASP-12 to 267
155.4 +/- 19.6 for EQ-5D-5L. The maximum score was reached in all the questionnaires except 268
in the WHOQOL-OLD (118 out of 120). 269
270
Title: Table 2: Scores of QoL questionnaires 271
Legend: n= number of participants; SD= standard deviation; TV= transformed values 272
273
Convergent validity 274
Table 3 shows that OPQOL-35-SF (test), EQ-5D-5L, WHOQOL-OLD, CASP-12, VAS QoL and VAS 275
health total score all correlated lowly to moderately with each other (r = 0.384-0.663; all 276
P<.001).(71) 277
278
Title: Table 3: Correlations between total scores of QoL questionnaires (Spearman’s rho) 279
Legend: OPQOL-35-SF: Older People’s Quality of Live Questionnaire Swiss French; VAS QoL: 280
Visual Analogue Scale for Quality of Life; WHOQOL-OLD: World Health Organization Quality of 281
Life in older people questionnaire; CASP-12: Control, Autonomy, Self-realization, Pleasure in 12 282
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questions; EQ-5D-5L: EuroQol-5-dimensions-5- levels; VAS health: Visual Analogue Scale for 283
health, **p<.001 284
285
Internal consistency 286
Cronbach’s alpha coefficient for the total scale was 0.875 for the test and 0.902 for the retest. 287
This shows a good internal consistency (45) and could mean that the items evaluate the same 288
construct (72). 289
290
Test-retest reliability 291
262 older people completed within a time interval from 6 to 23 days the OPQOL-35-SF a 292
second time. The mean score of the total scale for the first and the second test was 147.91 293
(SD 13.43) and 146.03 (SD 14.28), respectively. ICC2.1 for the total sample (N=262) was 0.83 294
(CI 0.78-0.87), and for the sample that didn’t reported events that have strongly influenced 295
their quality of life between the first and the second meeting (N=238) was 0.83 (CI 0.77-0.87). 296
These results show a good reliability.(45, 61) The ICC2.1 of the subscales ranged between 0.58 297
to 0.84 for the older people without life changes, and between 0.59 to 0.82 for those that 298
reported events having influenced their quality of life (Table 4). 299
300
Title: Table 4: OPQOL-35-SF Subscales test-retest reliability (ICC2.1) 301
Legend: ICC: Intraclass Correlation Coefficient; CI: Confidence Interval 302
303
Agreement between test and retest was between 81.6% and 92.6% for the total sample and 304
between 81.6% and 93.3% for the reduced sample (sample without extra events between test 305
and retest). Weighted Cohen’s kappa coefficients were between 0.25 and 0.7 in the total 306
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sample and between 0.22 and 0.67 in the reduced sample. 30 items were rated as moderate 307
in the total sample and 29 items in the reduced sample. PABAK was higher in the total sample 308
than in the reduced one: between 0.63 and 0.85 and between 0.63 and 0.87, respectively 309
(Additional material IV). 310
Discussion 311
The aim of this study was to evaluate the psychometric properties of the Swiss French version 312
of OPQOL-35 in older people in the French speaking part of Switzerland. Political leaders as 313
well as social and health professionals need effective and validated tools to assess the quality 314
of life in older people.(73, 74) The results of this study demonstrate the good to very good 315
psychometric quality of the Swiss French version of the OPQOL-35 questionnaire. It also 316
showed the complexity of the repartition of the quality of life-items in pre-defined categories. 317
318
With 264 participants, the sample of this study was smaller than the sample of the studies 319
evaluating the psychometric properties in Czech (24), in Persian (23) and in Chinese (25). 320
However, this sample is sufficient to meet the requirements and recommendations to conduct 321
a factor analysis.(42) 322
323
EFA extracted and identified eight factors using a minimal eigenvalue of 1 as the factor 324
criterion and explained 58% of the variance observed. As the original version of Bowling, the 325
Persian version and the Chinese version, the Swiss French version of OPQOL-35 has eight 326
dimensions, unlike the Czech version, which has seven. Based on cross-cultural aspects that 327
are reflected with the items, some dimensions of the original version have been renamed, 328
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some have fewer or more items, some dimensions have been integrated into others, and new 329
dimensions have been created in the translated versions. 330
Bowling's "Life overall" dimension is still present in the Iranian version, but it is completed by 331
two items “I take life as it comes and make the best of things” and “I feel lucky compared to 332
most peoplefrom the original "Psychological and emotional well-being" dimension. In the 333
Swiss French version, the dimension "Life overall" disappears and its four items are integrated 334
into the dimension "Psychological and emotional well-being". 335
The Czechs created a new dimension entitled "Positive Approach", which includes the items 336
I take life as it comes and try to make the best of it”, “I feel happy compared to most people337
and “I tend to look on the bright side of the life”. 338
The "Health" dimension of the original version also disappeared in the Swiss French version. 339
Three of its items integrate a new dimension "Physical condition" which also includes three 340
items from the original dimension "Social relationship/leisure and social activities": I have 341
social or leisure activities/hobbies that I enjoy doing”, “I try to stay involved with things” and 342
I do paid or unpaid work or activities that gives me a role in life”. Similarly, three items from 343
the original "Independence, control over life, freedom" dimension, namely I am healthy 344
enough to have my own independence”, I can please myself what I do” and I have a lot of 345
control over the important things in my lifeare incorporated into the "Physical condition" 346
dimension. In the Chinese version, Chen et al. (25) created a new dimension entitled "Health 347
and Independence". It seems that, for the Swiss French population 65 years old and over, the 348
aspects of physical condition, or health, are closely related to independence, as they are for 349
the Chinese population. This is similar to the Czech population, as, in their version, Mares et 350
al. (24) created a dimension entitled "Health, independence, active life" which groups some 351
items included in the "Physical condition" dimension of the Swiss French version. 352
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353
The original version of Bowling has a dimension entitled "Social Relationships/Leisure and 354
Social Activities". This dimension has been modified in all translated versions of the OPQOL-355
35, both in its title and in the items that are attached to it. The Czech version has divided the 356
items of this dimension into two new dimensions, a "Family and Safe Environment" dimension 357
and a "Loneliness" dimension. In the Swiss French version, the items of the original Bowling 358
dimension are divided into a dimension "Social Relations" and a new dimension entitled 359
"Family Context" which includes the three items “My family, friends or neighbors will help me 360
if necessary”, “I have someone who gives me love and affectionand I have my children 361
around which is important”. The notion of "Family" appears explicitly in the Czech version 362
(Family and Safe Environment) and in the Swiss French version (Family context) while in the 363
English, Iranian and Chinese versions, the items referring to it are distributed in different 364
dimensions. In the Persian version, the item “My family, friends or neighborhood will help me 365
if necessary” is not included in any of the questionnaire dimensions. The fact that the Chinese 366
sample consisted exclusively of older people living alone could explain why the notion of 367
"Family" was not highlighted in the Chinese version of OPQOL. 368
The three items “I am healthy enough to get out and about”, “I feel safe where I live” and “If 369
my health limits social/leisure activities, then I will compensate and find something else I can 370
do”, couldn’t be attributed in any identified dimensions in the Swiss French OPQOL-35. 371
Similarly, in the Persian version, Nikkhah et al. (23) were unable to include four items in the 372
identified dimensions, namely “My family, friends or neighbors would help me if needed”, “I 373
can please myself what I do”, “The cost of things compared to my pension/income restricts my 374
life”, and “I cannot afford to do things I would enjoy”. 375
376
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20
OPQOL-35-SF correlated lowly with EQ-5D-5L (r = 0.42, P < .001) and its VAS for health (r 377
=0.425, P < .001), and moderately with VAS for QoL (r = 0.561, P < .001), WHOQOL-OLD (r = 378
0.656, P < .001) and CASP-12 (r = 0.663, P<.001). Quality of life is a multidimensional concept, 379
so the low correlation with the EQ-5D-5L and its VAS could be explained by the fact that EQ-380
5D-5L is health centered and do not explore any other dimensions as suggested in the 381
literature.(75) The correlation between the Swiss French version of the OPQOL and the 382
WHOQOL-OLD is relatively similar to that of the original version (r = 0.698) assessed in a 383
population of English origin (ONS Omnibus) from Bowling.(21) The correlation between the 384
Swiss French version of the OPQOL and the CASP-12 is slightly lower than the one 385
demonstrated by Prof. Bowling in her study with the CASP-19 (r = 0.732). Whatsoever, the 386
overall OPQOL score was statistically significant in correlation with validated questionnaires 387
measuring quality of life. This supports the convergent validity of the Swiss French OPQOL. 388
389
Cronbach’s alpha’s coefficient for the total scale was 0.875 for the test and 0.902 for the 390
retest. That shows a good internal consistency as to the original English version (0.876 in the 391
ONS Omnibus and 0.901 in the Follow-up).(21) The internationally used OPQOL questionnaire 392
has also demonstrated very good internal consistency: 0.78 in Italy(12), 0.81 in Ghana(76), 393
0.834 in Sri Lanka(77), 0.90 in China(25) and 0.92 in Iran(23). Considering the literature on the 394
internal reliability of a questionnaire, the Swiss French version has a very acceptable reliability, 395
neither too low nor too high.(45, 61, 65) 396
397
The ICC2.1 of the Swiss French OPQOL total score indicates a good test-retest reliability for a 398
use for research purposes with values over 0.75 (total sample : 0.83, CI 0.78-0.87; reduced 399
sample : 0.83, CI 0.77-0.87) (68). Because ICC2.1 is not over 0.9, it cannot be used 400
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21
individually.(78) The results of the Swiss French OPQOL are slightly lower than those obtained 401
in the Chinese (ICC 0.87) and the Persian (ICC 0.92) versions. The test-retest reliability of the 402
original English version showed Spearman’s rho between 0.403 and 0.782. Subscales’ test-403
retest reliability of the Swiss French OPQOL can be compared to the results of the Chinese and 404
Persian version. In the Swiss French version, two subscales show an ICC2.1 between 0.75 and 405
0.9 and six an ICC2.1 between 0.5 and 0.75; in the Chinese version, four subscales had an ICC
406
between 0.75 and 0.9 and four an ICC between 0.5 and 0.75. However, the Persian version 407
showed better results with four subscales having an ICC >0.9, and four subscales with an ICC 408
between 0.75 and 0.9. The difference in these results could be explained by the difference in 409
the length of time between filling out the questionnaires, 1 to 3 weeks in the Swiss French 410
version, 4 weeks in the English version and 2 weeks in the Chinese and Persian version. The 411
time between the administration of two questionnaires should be long enough to prevent 412
subjects from remembering what they had written, but short enough to prevent a change in 413
the situation.(45) It seems that with older people, a short duration would be more 414
appropriate.(21) The statistical methods used in these studies are also different: ICC2.1 for the 415
Swiss French version, Spearman’s rho for the English version and ICC for the Chinese and 416
Persian versions. It is possible that ICC2.1 might show smaller reliability than ICC.(68) For a 417
positive rating for reliability, weighted Kappa should be at least 0.70 (45). Following the ratings 418
of Landis and Koch(79), PABAK results between 0.80 to 1.00 means a “near-perfect 419
agreement”; between 0.60 to 0.79 a “substantial agreement” and between 0.40 to 0.59 a 420
“moderate agreement”. In the Swiss French version of OPQOL, 17 items reach a “near-perfect 421
agreement”, and 18 items can be interpreted as “substantial agreement”. Six items have a 422
PABAK <0.70: Q6 “I look forward to things”, Q12 “I’d like more people to enjoy life with”, Q16 423
I do paid or unpaid work or activities that give me a role in life”, Q19 “The cost of the things 424
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22
compared to my pension/income restricts my life”, Q21 “I have responsibilities to others that 425
restrict my social or leisure activitiesand Q33 “I cannot afford to do things I would enjoy”. 426
This may be explained by the reactions of the participants. Q6 was not easily understood, the 427
participants did not know if the item was for the present moment or in general. Participants 428
took long time to answer Q12 because coding is reversed. Q19 and Q21 often needed 429
clarifications. Q33, at the end of the questionnaire, follows a similar item but expressed in 430
positive terms. Participants took more time, certainly because of the loss of the concentration. 431
The original version of OPQOL contains voluntarily eight items with reversed scoring, to avoid 432
automatisms.(80) The relevance of reversal coding is discussed.(81, 82) In their translation of 433
the questionnaire, the Czechs decided to invert the rating in order to respond to their local 434
and socio-cultural practice, i.e. the "best rating" is 1 and the "worst rating" is 5.(24) 435
436
For this study, SC and CM were trained to conduct “one-to-one” and “in-group” interviews. 437
This permitted to informally record the participants' experiences when filling out the 438
questionnaires. Some of them would have liked "memory" to be the subject of an item. 439
Memory loss is a concern for older adults. For many of them, religion and culture are two 440
themes to be differentiated in the items. Most participants wished they could have answered 441
"yes" or "no." The choice of 5 answers offered by the Likert scale was not easy to integrate. 442
Perhaps a 3-level scale should be considered for the elderly population. In addition, some of 443
them would have liked to complete their answers with qualitative information. 444
445
The assessment of the quality of life of our seniors could complete their evaluation during 446
physiotherapy care, either in a practice or at their home. Although the ICC test-retest 447
reliability of the Swiss French version of the OPQOL-35 is not above 0.90, this tool could inspire 448
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23
physiotherapists to learn about the quality of life of their older patients. The bio-psycho-social 449
care would be even more complete. 450
451
It would be interesting to continue this study by recruiting 200 additional subjects to perform 452
a confirmatory factor analysis. The authors of this study translated and assessed the 453
psychometric properties of the Swiss French version of the OPQOL-35 for Switzerland, which 454
represents 25% of the Swiss population. Switzerland has four national languages and German 455
is spoken by over 64% of the population. To our knowledge, the OPQOL-35 has not been 456
translated or validated in German. This could be the subject of future research. 457
458
459
List of abbreviation: 460
CASP: Control, Autonomy, Self-realization and Pleasure 461
EFA: Explanatory Factor Analysis 462
EQ: EuroQol 463
ICC2.1: Intra-class Correlation Coefficient, two-way random effects, absolute agreement, 464
single rater 465
KMO: Kaiser-Meyer-Olkin measure of sampling adequacy 466
OPQOL: Older People’s Quality Of Life questionnaire 467
PABAK: Prevalence-Adjusted Bias-Adjusted Kappa 468
PCA: Principal Component Analysis 469
QoL: Quality of Life 470
REDCap: Research Electronic Data Capture 471
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VAS: Visual Analogue Scale 472
WHO: World Health Organization 473
Declarations 474
Ethics approval and consent to participate 475
This study was approved by the Swissethics committee (project 38/14). All participants 476
received an information letter and signed an informed consent. 477
Consent for publication 478
Not applicable 479
Availability of data and materials 480
The datasets used and/or analyzed during the current study are available from the 481
corresponding author on reasonable request. 482
Competing interests 483
The authors declare that they have no competing interests. 484
Funding 485
Not applicable 486
Author’s contributions 487
AGMH: conception and design, interpretation, drafting the article, critical revision, and final 488
approval 489
CM: collection and interpretation of the data and final approval 490
RH: statistical analysis and final approval 491
SC: collection and interpretation of the data, statistical analysis, critical revision of the article 492
and final approval 493
Manuscript_OPQOL-35-fr_for BMC Springer Nature_20.10.21
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494
495
Additional material 496
497
Additional material I: 498
File name: Additional material I.pdf 499
Title: Score’s conversions 500
Description of data: Table displaying the equation of the conversion of the score of the 501
questionnaires to meet the range of scores of the OPQOL. 502
503
504
Additional material II: 505
File name: Additional material II.pdf 506
Title: Principal Component Analysis (test) 507
Description of data: Table displaying the detailed results of the PCA for the test 508
509
510
Additional material III: 511
File name: Additional material III.pdf 512
Title: Principal Component Analysis (retest) 513
Description of data: Table displaying the detailed results of the PCA for the retest 514
515
516
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Additional material IV: 517
File name: Additional material IV.pdf 518
Title: Cohen’s kappa and PABAK 519
Description of data: Table displaying the detailed results of the Cohen’s kappa and PABAK 520
separated for the total sample and the reduced sample 521
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Figures
Figure 1
Scree plot of eigenvalues from the exploratory factor analysis. 1a: OPQOL-35-SF test; 1b: OPQOL-35-SF
retest
Figure 2
Factors’ structure of the OPQOL derived form PCA
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