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Monthly Archives: May 2018

‘Multimorbidity Treatment Burden Questionnaire’ (MTBQ) – a new measure of treatment burden

By Polly Duncan and Chris Salisbury
A group of researchers from the University of Bristol, UK, have developed a new simply worded, concise questionnaire, named the ‘Multimorbidity Treatment Burden Questionnaire’ (MTBQ) to measure treatment burden (the perceived effort of looking after one’s health and the impact that this has on day to day life) in patients with multimorbidity (multiple long-term conditions).  The study has been published in the BMJ Open [1].
Treatment burden includes everything that the patient has to do to look after their health – from ordering, collecting and taking medicines; to co-ordinating, arranging transport for and attending health appointments with multiple different health professionals; to monitoring blood sugar or blood pressure levels; to learning about your 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, and 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 [2].
The MTBQ was developed as part of a large research study called the 3D Study [3].  The research team 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 (e.g. they did not cover all of the areas of treatment burden or they required good literacy levels and so were not suitable for our study population of mainly older people) and so we 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, 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 1500 mostly elderly patients (average age 71 years) with three or more long-term conditions who took part in the 3D Study.  The research team assessed the questionnaire against the ISOQOL international standards for developing and validating questionnaires and found that it performed well, demonstrating good face validity (e.g. it measured what it set out to measure), construct validity (e.g. patients with high disease burden and poor quality of life reported higher treatment burden), reliability and responsiveness to change  (e.g. as expected, patients who reported reduce quality of life over time also reported higher treatment burden over time) [1].
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 (means age 71 years) with three or more long-term conditions
Further information about the MTBQ can be found here:
1. Duncan P, Murphy M, Man MS, et al. Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ). BMJ Open 2018;8(4):e019413. doi: 10.1136/bmjopen-2017-019413 [published Online First: 2018/04/12]
2. Smith SM, Wallace E, Salisbury C, et al. A Core Outcome Set for Multimorbidity Research (COSmm). Ann Fam Med 2018;16(2):132-38.
3. Man MS, Chaplin K, Mann C, et al. Improving the management of multimorbidity in general practice: protocol of a cluster randomised controlled trial (The 3D Study). BMJ Open 2016;6(4):e011261. doi: 10.1136/bmjopen-2016-011261