Adaptation and multicentre validation of a patient-centred outcome scale for people severely ill with COVID (IPOS-COV)

Mevhibe Hocaoglu*, Fliss Murtagh, Catherine Walshe, Rachel Chambers, Matthew Maddocks, Katherine Sleeman, Adejoke Oluyase, Lesley Dunleavy, Andy Bradshaw, Sabrina Bajwah, Lorna Fraser, Nancy Preston, Irene Higginson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Patient-centred measures to capture symptoms and concerns have rarely been reported in severe COVID. We adapted and tested the measurement properties of the proxy version of the Integrated Palliative care Outcome Scale – IPOS-COV for severe COVID using psychometric approach.
We consulted experts and followed consensus-based standards for the selection of health status measurement instruments and United States Food and Drug Administration guidance for adaptation and analysis. Exploratory Factor Analysis and clinical perspective informed subscales. We tested the internal consistency reliability, calculated item total correlations, examined re-test reliability in stable patients, and also evaluated inter-rater reproducibility. We examined convergent and divergent validity of IPOS-COV with AKPS and evaluated known-groups validity. Ability to detect change were examined.
In the adaptation phase, 6 new items were added, 7 items were removed from the original measure. The recall period was revised to be the last 12-24 hours to capture fast deterioration in COVID. General format and response options of the original Integrated Palliative Outcome Scale was preserved. Data from 572 patients with COVID from across England and Wales seen by palliative care services were included. Four subscales were supported by the 4-factor solution explaining 53.5% of total variance. Breathlessness-Agitation and Gastro-intestinal subscales demonstrated good reliability with high to moderate (a=0.70 and a=0.67) internal consistency, and item–total correlations (0.62 - 0.21). All except the Flu subscale discriminated well between patients with differing disease severity. Inter-rater reliability was fair with ICC 0.40 (0.3 - 0.5, 95%CI, n=324). Correlations between the subscales and AKPS as predicted were weak (r=0.13-0.26) but significant (pConclusions
IPOS-COV is the first patient-centred measure adapted for severe COVID to support key to timely management. Future studies could further evaluate its responsiveness and clinical utility with clinimetric approaches.
Original languageEnglish
Article number bf96511f-f5d0-4324-a9de-9da9f4bc3b98
JournalHealth and Quality of Life Outcomes
Publication statusAccepted/In press - 20 Feb 2023


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