Abstract
Objective or purpose
To develop and test a patient-reported outcome measure for assessing health-related quality of life (HRQOL) in surgically amenable epiphora.
Design
Questionnaire development and validation study.
Participants
201 patients with a cause of epiphora amenable to surgical intervention, recruited across three independent centres.
Methods, intervention or testing
The watery eye quality of life (WEQOL) questionnaire was developed and refined according to defined psychometric standards. Both surgical and non-surgical participants completed WEQOL at baseline and follow-up (>3 months), along with the Lacrimal Symptom Questionnaire (Lac-Q), RAND Short Form Health Survey (SF-36) and Glasgow Benefit Inventory (GBI). Convergent validity of WEQOL was evaluated according to correlation (R > 0.40) with each of these additional tests. Responsiveness of WEQOL to intervention was evaluated according to patient-reported success. Test-retest reliability was assessed by the Bland–Altman method and intraclass correlation (ICC) in a subset of 64 participants at baseline.
Main outcome measures
WEQOL construct validity, responsiveness and test-retest reliability.
Results
WEQOL was moderately correlated (R > 0.4) with the Lac-Q and several subscales of the SF-36 (physical role limitation, social, emotional role limitation and emotional well-being). A stronger correlation was found between the change in WEQOL at follow-up and GBI (R = 0.61). An appropriate graded response was found with a significant change in WEQOL score being observed in patients reporting successful (−28%, p < 0.0001) and partially successful surgery (−6%, p = 0.04), but not in those reporting unsuccessful surgery (+2%, p = 0.9). High test-retest reliability was observed (ICC = 0.93).
Conclusions
The WEQOL questionnaire has been developed systematically according to modern psychometric standards and has been designed to evaluate the quality of life in patients with epiphora that is of a surgically amenable cause. In this study, it has demonstrated appropriate test-retest reliability, responsiveness and construct validity.
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Change history
16 August 2021
A Correction to this paper has been published: https://doi.org/10.1038/s41433-021-01733-5
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CBS and TF were responsible for overall study conceptualisation, questionnaire development, methodology, analysis and manuscript preparation. PF supported the methodology, statistical analysis as well as manuscript review. PR, JJH, LA, EY, SR and RM supported the study with data collection, questionnaire refinement and manuscript review.
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Schulz, C.B., Rainsbury, P., Hoffman, J.J. et al. The watery eye quality of life (WEQOL) questionnaire: a patient-reported outcome measure for surgically amenable epiphora. Eye 36, 1468–1475 (2022). https://doi.org/10.1038/s41433-021-01674-z
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DOI: https://doi.org/10.1038/s41433-021-01674-z
