We have developed a new, simply-worded, concise questionnaire – the Multimorbidity Treatment Burden Questionnaire (MTBQ) – to measure treatment burden in patients with multimorbidity (multiple long-term conditions).
Treatment burden is the perceived effort of looking after one’s health and the impact this has on day-to-day life. It includes everything that the patient has to do to look after their health including: ordering, collecting and taking medicines; coordinating and arranging transport for, and attending, health appointments with multiple health professionals; monitoring blood sugar or blood pressure levels; learning about own health conditions; and taking on lifestyle advice.
To understand how new health care interventions impact on treatment burden, we need to be able to measure it. A recent study published in the Annals of Family Medicine highlighted treatment burden as one of the core outcome measures for research studies involving patients with multimorbidity.
The MTBQ was developed as part of a large research study called the 3D Study. We identified and reviewed three existing measures of treatment burden that were not specific to a medical condition. A further measure has since been published. We found that the existing measures had limitations. For example, they did not cover all the areas of treatment burden or they required good literacy levels, or were not otherwise suitable for our study population (of mainly older people). We therefore decided to develop and validate a new measure.
We discussed the concept of treatment burden and an existing framework of treatment burden that had been developed in the United States with members of a patient and public involvement group. Using this framework as a guide, we developed a questionnaire to include all the important areas of treatment burden. We interviewed patients with multimorbidity and asked them to comment on the layout and wording of questions. We asked them how easy the questions were to understand and to ‘think aloud’ as they answered the questionnaire – what did the questions mean to them and what answer would they give if they were completing the questionnaire?
The MTBQ was then completed by over 1,500 mostly elderly (average age 71) patients with three or more long-term conditions who took part in the 3D Study. We assessed the questionnaire against the International Society for Quality of Life (ISOQOL) standards for developing and validating questionnaires and found that it performed well. It demonstrated good face validity (measured what it set out to measure), construct validity (for example, patients with high disease burden and poor quality of life reported higher treatment burden), reliability and responsiveness to change (for example, as expected, patients who reported reduced quality of life over time also reported higher treatment burden over time).
Strengths of the MTBQ include:
- simple wording
- a concise measure with ten questions
- all the important aspects of treatment burden are included
- it was tested in patients for whom it was intended – elderly patients (mean age 71) with three or more long-term conditions
This blog post was originally published on the International Research Community on Multimorbidity website.
Further information about the MTBQ and registering to use it.
Further information about the 3D Study.
Videos explaining the 3D Study.