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RehabMeasures Instrument

Nottingham Health Profile

Last Updated

Purpose

Assesses perceived health (encompassing the social and personal effects of illness).

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Instrument Details

Acronym NHP

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

  • Pulmonary Disorders
  • Stroke Recovery

Key Descriptions

  • Patient-completed questionnaire used to determine and quantify perceived health problems.
  • Composed of 38 items divided into six domains:
    1) Sleep
    2) Mobility
    3) Energy
    4) Pain
    5) Emotional reactions
    6) Social isolation
  • Items use a Yes/No answer format.
  • Each item is weighted.
  • NHP scores are calculated by averaging domain scores.
  • Total scores range from 0 (no perceived distress) to 100 (maximum perceived distress).

Number of Items

45

Time to Administer

10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated with references for the COPD population by Jessica Chapuis, SPT and Liz Weamer, SPT in 2011

ICF Domain

Participation

Measurement Domain

General Health

Considerations

  • The NHP does not assess incontinence, stigma, eating problems, financial difficulty, intellectual ability or memory.
  • Positive perceptions of well-being not assessed. 
  • In a large general population survey (n = 1,063), the RAND 36-Item Health Survey 1.0 was able to detect chronic diseases even though the same sample scored 0 on the NHP (VanderZee et al, 1996).
  • Baro et al. (2006) reported that the NHP could be successfully administered to 70.1% of a sample of 134 severely disabled patients. Among patients with normal cognitive functioning the administration rate was 98%.  86.3% of patients in this sample diagnosed with moderate cognitive impairment were able to successfully complete the measure; while only 5.9% of patients with severe cognitive impairment were able to complete the measure.

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Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Disabled Population (McHorney & Tarlov, 1995)

  • Longitudinal SEM = 16
  • Cross-sectional SEM = 23

Test/Retest Reliability

Soft Tissue Injury-UE/Lower Back: 
(Beaton et al, 1997; Subjects recruited from a work site (injured < 1 week; n = 53); physiotherapy clinics (injury = 4 weeks; n = 34); and a tertiary level rehabilitation center (injured > 4 weeks; n = 40))

  • Excellent test-retest reliability (ICC = 0.95) 

Internal Consistency

Disabled Population: (Baro et al, 2006)

  • Excellent, normal cognitive functioning patients  (Cronbach's alpha = 0.82)
  • Excellent, moderate cognitive functioning patients (Cronbach's alpha = 0.87)

In patients: (McHorney & Tarlov, 1995)

  • Poor to Excellent Internal Consistency across 8 domains (Cronbach's alpha = 0.34-0.81)

Headache / Migraine: (Essink-Bot et al, 1997)

  • Adequate internal consistency (Cronbach's alpha = 0.72)

Criterion Validity (Predictive/Concurrent)

Disabled Population: (Baro et al, 2006)

  • Poor correlation with the Barthel Index for individuals with normal cognitive status (r = 0.39, p < 0.01*)

  • Adequate correlation with the Barthel Index for individuals with moderate cognitive impairment (r = 0.40, p < 0.01)

Floor/Ceiling Effects

Disabled Population: (Baro et al, 2006)

  • oor effects: >20% for Energy and Physical Mobility among patients with moderate cognitive impairment and for energy among patients with normal cognitive function
  • eiling effects: >20 % for Energy and Social among patients with normal cognitive function

 

Disabled Population: (McHorney & Tarlov, 1995: n = 353)

  • Poor ceiling effects for Physical Mobility (74%), Pain (78%), Energy (62%), Social Isolation (78%), Emotional Reactions (48%) and Sleep (62%)

Responsiveness

Workers: (Beaton et al, 1997; n = 45; Soft Tissue Injury-UE / lower back)

Test re-test ICC (C.I.) 

Observed Change

Effect Size

SRM (95% C.I.)~

 

NHP Overall

0.95 (0.91,0.97)

10.2

0.52(Moderate)

0.66 (0.34, 0.98)

NHP Pain

0.87 (0.77, 0.98)

21.14

0.57(Moderate)

0.70 (0.39, 1.01)

NHP Physical Function

0.76 (0.61, 0.86)

8.6

0.48

(Small)

0.64 (0.34, 0.95)

~ Standardized response mean SRM; mean (T1 - T2) / Std Dev of Observed change

 

 

 

 

Pulmonary Diseases

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Standard Error of Measurement (SEM)

COPD (Prieto, et al, 1997: n = 321 males; mean age = 64.9 (9.6) years)

NHP Domain

SEM

Phyiscal Mobility

12.1

Pain

11.2

Energy

19.2

Social Isolation

12.8

Emotional Reactions

12.4

Internal Consistency

COPD (Jans, et al, 1999: n = 170; mean age = 57 (8) years)

  • Adequate internal consistency (Cronbach’s alpha = 0.59-0.73)

Construct Validity

COPD (Jans, et all, 1999: n = 170; mean age = 57 (8) years)

  • Adequate construct validity

Floor/Ceiling Effects

COPD (Prieto et al, 1997: n = 321 males; mean age = 64.9 (9.6) years)

  • Adequate floor effects: < 2.5% for all domains except for Energy (15.6%)
  • eiling effects: Physical Mobility (17.2), Pain (45.6%), Energy (50.0%), Social Isolation (61.6%) and Emotional Reactions (24.1%)

Alzheimer's Disease and Progressive Dementia

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Interrater/Intrarater Reliability

Dementia: (Boyer et al, 2004; n = 99; mean age = 81.8 (8.2) years; mild to moderate dementia)

Agreement between patient reports proxy reports (family and care givers):

Patient-Family proxy reliability

 

 

NHP Dimension

n

ICC

95% C.I.

Physical mobility

68

0.66*

0.50 to 0.77

Social Isolation

73

0.41*

0.20 to 0.58

Pain

64

0.41*

0.19 to 0.60

Emotional reaction

62

0.33

0.09 to 0.53

Energy

78

0.50*

0.31 to 0.65

Sleep

65

0.44*

0.22 to 0.62

** Excellent, * Adequate

ICC <0.40 were considered to indicate poor agreement, ICC ranging from 0.4 to 0.75 indicate adequate agreement, ICC greater than 0.75 indicate excellent agreement 

Stroke

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Test/Retest Reliability

Acute Stroke: (Gompertz et al, 1993; n = 21; mean age = 69 years; 2 weeks between assessments)

NHP Domain

Spearman's rho

Strength of Relationship

Energy

0.72*

Adequate

Pain

0.73*

Adequate

Emotion

0.85*

Excellent

Sleep

0.44*

Poor

Social Isolation

0.67*

Adequate

Physical mobility

0.80*

Excellent

*p < 0.05 (Spearman's rho)

 

 

Criterion Validity (Predictive/Concurrent)

Chronic Stroke: (Wilkinson et al, 1997; n = 96; age at stroke = 66 years (range 28 - 74); age at follow-up = 71 years (range 34 - 79); average interval between assessments = 4.9 years)

 

Rank Correlation Coefficient with Barthel Index

 

 

NHP Dimension

r

P value

Energy

- 0.605**

< 0.001

Pain

- 0.499*

< 0.001

Emotion

- 0.423*

< 0.001

Sleep

- 0.189

> 0.05

Social interaction

- 0.460*

< 0.001

Physical mobility

- 0.840**

< 0.001

 

 

 

** Excellent correlation, * Adequate correlation

 

 

Back Pain

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Floor/Ceiling Effects

Low Back Pain: (Lurie, 2000)

  • Poor ceiling effects: 70% of respondents reported highest possible scores on Physical Mobility Dimensions and 80% achieved the possible score on Social Isolation Dimensions 

Bibliography

Baro, E., Ferrer, M., et al. (2006). "Using the Nottingham Health Profile (NHP) among older adult inpatients with varying cognitive function." Quality of Life Research 15(4): 575-585. Find it on PubMed

Beaton, D. E., Hogg-Johnson, S., et al. (1997). "Evaluating changes in health status: reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders." Journal of Clinical Epidemiology 50(1): 79-93. Find it on PubMed

Boyer, F., Novella, J. L., et al. (2004). "Agreement between dementia patient report and proxy reports using the Nottingham Health Profile." International Journal of Geriatric Psychiatry 19(11): 1026-1034. Find it on PubMed

Essink-Bot, M. L., Krabbe, P. F., et al. (1997). "An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQol instrument." Medical Care 35(5): 522-537. Find it on PubMed

Gompertz, P., Pound, P., et al. (1993). "The reliability of stroke outcome measures." Clinical rehabilitation 7(4): 290. 

Jans, M. P., Schellevis, F. G., et al. (1999). "The Nottingham Health Profile: score distribution, internal consistency and validity in asthma and COPD patients." Quality of Life Research 8(6): 501-507. Find it on PubMed

Lurie, J. (2000). "A review of generic health status measures in patients with low back pain." Spine (Phila Pa 1976) 25(24): 3125-3129. Find it on PubMed

McHorney, C. A. and Tarlov, A. R. (1995). "Individual-patient monitoring in clinical practice: are available health status surveys adequate?" Quality of Life Research 4(4): 293-307. Find it on PubMed

Prieto, L., Alonso, J., et al. (1997). "Are results of the SF-36 health survey and the Nottingham Health Profile similar? A comparison in COPD patients. Quality of Life in COPD Study Group." Journal of Clinical Epidemiology 50(4): 463-473. Find it on PubMed

VanderZee, K. I., Sanderman, R., et al. (1996). "A comparison of two multidimensional measures of health status: the Nottingham Health Profile and the RAND 36-Item Health Survey 1.0." Quality of Life Research 5(1): 165-174. Find it on PubMed

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