Health-related quality of life (HRQOL) measurement MCQs With Answer

Health-related quality of life (HRQOL) measurement MCQs With Answer

This collection of MCQs is designed for M.Pharm students to deepen understanding of health-related quality of life (HRQOL) measurement in pharmacoepidemiology and pharmacoeconomics. Questions cover conceptual foundations, instrument selection (generic vs disease-specific), psychometric properties (reliability, validity, responsiveness), utility measurement and QALYs, administration issues, cross-cultural adaptation, and modern measurement theories (CTT, IRT/Rasch). Each item focuses on applied knowledge needed to evaluate, select, interpret, and use HRQOL instruments in clinical trials, observational studies, and economic evaluations. Answers are provided to facilitate self-assessment and exam preparation.

Q1. Which statement best describes health-related quality of life (HRQOL) measurement?

• Objective clinical indices such as blood pressure and lab values that summarize health
• Measures of the economic burden of disease including direct and indirect costs
• Subjective assessment of the impact of disease and its treatment on physical, mental and social well-being
• Global mortality rates adjusted for age and sex

Correct Answer: Subjective assessment of the impact of disease and its treatment on physical, mental and social well-being

Q2. Which is a correct distinction between generic and disease-specific HRQOL instruments?

• Generic instruments are developed only for a single disease while disease-specific instruments cover many conditions
• Generic instruments are more sensitive to small changes in a particular disease than disease-specific instruments
• Generic instruments allow cross-disease comparisons whereas disease-specific instruments provide greater clinical sensitivity for one condition
• There is no practical difference; both provide identical information in all contexts

Correct Answer: Generic instruments allow cross-disease comparisons whereas disease-specific instruments provide greater clinical sensitivity for one condition

Q3. Which psychometric property is assessed by Cronbach’s alpha?

• Test–retest reliability over time
• Internal consistency of items within a scale
• Construct validity compared to a gold standard
• Responsiveness to clinical change

Correct Answer: Internal consistency of items within a scale

Q4. Which approach estimates health state utilities directly from patient preferences?

• Standard gamble and time trade-off
• SF-36 domain scoring
• Principal component analysis
• Internal consistency analysis

Correct Answer: Standard gamble and time trade-off

Q5. Which instrument is a commonly used generic HRQOL questionnaire with 36 items?

• EQ-5D
• SF-36
• AQLQ (Asthma Quality of Life Questionnaire)
• KDQOL (Kidney Disease Quality of Life)

Correct Answer: SF-36

Q6. Which characteristic describes a ceiling effect in HRQOL measurement?

• Many respondents score at the lower extreme limiting ability to detect deterioration
• Many respondents score at the upper extreme limiting ability to detect improvement
• Random response patterns across items producing low reliability
• Systematic bias introduced by interviewer administration

Correct Answer: Many respondents score at the upper extreme limiting ability to detect improvement

Q7. Which validity type is demonstrated when an HRQOL instrument correlates as expected with related clinical measures?

• Content validity
• Face validity
• Construct validity
• Criterion validity

Correct Answer: Construct validity

Q8. What does minimal clinically important difference (MCID) represent?

• The smallest statistically significant change detectable by an instrument
• The smallest change in score perceived as beneficial or harmful by patients that would lead to a change in management
• The maximum possible score difference between two populations
• The average baseline score in a healthy reference sample

Correct Answer: The smallest change in score perceived as beneficial or harmful by patients that would lead to a change in management

Q9. Which metric is commonly used to quantify responsiveness of an HRQOL instrument?

• Internal consistency coefficient (Cronbach’s alpha)
• Effect size or standardized response mean (SRM)
• Cross-sectional correlation with demographic variables
• Number of missing items per respondent

Correct Answer: Effect size or standardized response mean (SRM)

Q10. Which step is essential in cross-cultural adaptation of an HRQOL questionnaire?

• Translation only by a single translator
• Back-translation and cognitive debriefing with target population
• Replacing items with local clinical measures without testing
• Administering the original language version regardless of literacy

Correct Answer: Back-translation and cognitive debriefing with target population

Q11. Which statement about preference-based measures like EQ-5D is true?

• They do not produce utility weights and cannot be used to compute QALYs
• They generate a health state profile that can be converted into a single index utility value
• They are disease-specific and unsuitable for economic evaluations
• They always require direct elicitation from each study participant using time trade-off

Correct Answer: They generate a health state profile that can be converted into a single index utility value

Q12. Which administration mode may introduce interviewer bias but can improve completion in low-literacy populations?

• Self-administered postal questionnaire
• Computer adaptive testing only
• Interviewer-administered face-to-face questionnaire
• Automated telephone IVR without assistance

Correct Answer: Interviewer-administered face-to-face questionnaire

Q13. What is the primary advantage of item response theory (IRT) or Rasch analysis over classical test theory (CTT) in HRQOL measurement?

• IRT assumes equal item difficulty and so simplifies scoring
• IRT provides item-level parameters and supports cross-sample invariant measurement and computerized adaptive testing
• CTT allows for shorter instruments with fewer items than IRT
• IRT eliminates the need for validation studies

Correct Answer: IRT provides item-level parameters and supports cross-sample invariant measurement and computerized adaptive testing

Q14. Which problem is best addressed by using proxy respondents for HRQOL?

• When patients are fully literate and can self-report
• When the instrument has demonstrated perfect reliability
• When patients are too young or too cognitively impaired to self-report
• When interviewer cost must be minimized

Correct Answer: When patients are too young or too cognitively impaired to self-report

Q15. Which approach is appropriate for handling occasional missing item responses within a validated multi-item HRQOL domain?

• Exclude the entire study from analysis
• Use single imputation with the item mean only when missingness is extensive
• Follow instrument-specific scoring rules, e.g., prorate domain scores if allowed
• Replace missing items with the worst possible score to be conservative

Correct Answer: Follow instrument-specific scoring rules, e.g., prorate domain scores if allowed

Q16. Which concept describes the smallest change beyond measurement error, often estimated using the standard error of measurement?

• Minimal clinically important difference (MCID)
• Minimal detectable change (MDC) or smallest real difference
• Responsiveness coefficient
• Cross-cultural equivalence

Correct Answer: Minimal detectable change (MDC) or smallest real difference

Q17. In cost-utility analysis, how is a QALY calculated?

• Sum of direct medical costs and indirect costs per year
• Health utility value multiplied by duration spent in that health state
• Difference in HRQOL score divided by sample size
• Number of disease-free days per month

Correct Answer: Health utility value multiplied by duration spent in that health state

Q18. Which recall period choice might reduce recall bias for symptoms that fluctuate daily?

• Lifetime recall
• One-month recall for daily symptoms
• 24-hour or past-week recall
• No recall period specified

Correct Answer: 24-hour or past-week recall

Q19. What is mapping in the context of HRQOL and economic evaluation?

• Translating a questionnaire into another language
• Converting disease-specific HRQOL scores into generic utility values using statistical algorithms
• Mapping patients’ residential addresses to health outcomes
• Designing an item bank for computerized adaptive testing

Correct Answer: Converting disease-specific HRQOL scores into generic utility values using statistical algorithms

Q20. Which practice improves interpretability of HRQOL change scores in clinical trials?

• Reporting only p-values without effect sizes
• Using both anchor-based estimates (e.g., patient global impression) and distribution-based metrics to triangulate MCID
• Relying solely on baseline-to-endpoint mean differences without context
• Suppressing confidence intervals to avoid confusion

Correct Answer: Using both anchor-based estimates (e.g., patient global impression) and distribution-based metrics to triangulate MCID

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