By Marie-Eve Poitras, RN. M.Sc.
Studies on multimorbidity should rely on valid and robust measurement to assess the disease burden experienced by patients with chronic diseases. There are many instruments designed to measure multimorbidity, however, most of them have to be administered by professionals because of the medical background required to complete them. This is a limitation to using these instruments in large samples of patients either in primary care settings or the general population.
Previous studies have shown that a measure that includes a weighting for severity is a better predictor of patient-related outcomes than a measure based on a simple disease count [1-2]. Severity can be judged on purely clinical grounds by health professionals or on the basis of the illness experienced by patients themselves. However, impact on daily living seems to be best evaluated by the patient because self-reported disease burden correlates with quality of life outcomes more strongly than measures of comorbidity based on other methods of data collection [3].
The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire that seems promising because: 1) it can be administered to large samples of patients and 2) it judges severity on the basis of the illness experienced by patients themselves [3].
We conducted a study to test and to measure the properties of the French translation of the DBMA (DBMA-Fv). The DBMA-Fv’s properties were similar to its English counterpart as to its median sensitivity and specificity compared to chart reviews. It correlated moderately with an established index of multimorbidity, the Cumulative Illness Rating Scale (CIRS). A high percentage of patients were able to complete the test correctly as a mail questionnaire and it showed high test-retest reliability.
The article describing the study can be accessed freely on line [4], where the readers can also find both the English and French versions of the DBMA questionnaire as appendices to the paper.
1. Fortin, M., et al., Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes, 2005. 3:74.
2.Fortin, M., et al., Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res, 2006. 15:83-91.
3. Bayliss, E.A., J.L. Ellis, and J.F. Steiner, Subjective assessments of comorbidity correlate with quality of life health outcomes: Initial validation of a comorbidity assessment instrument. Health and Quality of life Outcomes, 2005. 3:51.
4. Poitras, M.-E., et al., Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Service Research, 2012. 12:35.
One comment
Thank you for this report. It is impossible to find a website or link that addresses all of my fathers multimorbidities at one time; much less 2 or 3 of them at the same time.
Born November 25,1935, he had to retire suddenly during July of 2010, due to Sinus Sickness Syndrome; from that point forward this health has declined rapidly.
I printed off and answered your English questionairre, taking all of his medications (33 of them) and his daily activities of life. His quality of life isn’t good either.
He has been diagnosed with the following:
-High cholesterol – medically and diet controlled
-High Blood Pressure – “”””
-Double Cataracts – Surgically repaired and currently his lens are turning opaque
-Hearing deficit – fitting for hearing aids soon
-Diabeties ll – Insulin dependent – currently on 2 types of insulin and 6 medications
-Thickening of the left ventrical- found during a bout of pneumonia that turned into congestive heart failure
-Colon Cancer – he now has a permanent non-reverisable ostomy, due to the severity and incontinence. No chemo or radiation was performed afterwards. The stoma is severly herniated, but due to condition, they will not perform surgery. We are trying to get him to wear a hernia belt with little success.
-Pacemaker – due to Sinus Sickness Syndrome – pauses as long as 4.5 seconds hundreds of times w/in an hour.
-Gout – medically and diet controlled
-Polymiagia Rhumatica – 10 mg of prednisone daily. Anything less causes severe spasms and swelling bi-laterally.
-Multi infarct dementia/ ALZ – he is currently somewhere between stages 5/6 – zoloft, zanax, depakote 250 mg 2x daily. Aricipet made no difference and the Depakote helps dearly with the volitile mood. He shuffles his feet, repeats himself constantly, changes the story, angers when he doesn’t understand something immediately and gets lost very easily. He cannot remember what day it is, even with a calendar. He has confused the day so badly that he has taken 2 days worth of pills in one day when we had to go out for the day.
-GERD – medically and diet treated
-CAD- Coronary Artery Disease – thickening of the arteries – shows clearly in his neck.
-Degenrative Disk Disease – severe, not medically treated
-COPD/Emphasema – 2 different inhalers
-Sleep Apnea – not treated. He has not had a sleep studey performed, but my husband has it and my fathers hesitant breathing is much worse.
You never know what you may wake up from one day to another. He sees a Geriatrician once every 3 months and acute care as needed.
We are currently treating him symptomatically and due to what is causing him the most harm and we can gain the most benefit from the fastest.
His HBP is lower, but does spike occasionally, as we cannot control everything that goes into his mouth when he sneaks food and we cannot see what he adds to his daily lunch when he is at the Senior Center during the day.
Currently we are trying to keep him hyop and hyperglycimia. Yesterday it was up to 380, this morning is was down to 59, after taking 10 units of Lantus last night.
We chart his daily readings and it looks like a syzmograph gone terribly wrong.
He is unable to prepare his daily medications; we took over that about a year ago. His short term memory is gone and we must remind him to take a bath. He can no longer drive, but still hopes to. He gets lost and was a cross country truck driver when he had to retire and already getting lost, but now he can’t remember how to get 1/2 mile away from the house.
I answered most of your questions “yes” and “a lot” simply because I know the burden that it puts upon us on a daily basis.
I hope this information helps you with your study. If there are any other questions that I can answer, I’d be happy to do so.
Very Respectfully,
Suzanne Hill