الفهرس 
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Abstract
Quality of life has become an urgent and valuable concern in healthcare and social policy. The WHO defines QOL as an individuals’ conception of their life position in the context of the value and culture systems in which they live and related to their standards, goals, expectations and concerns. Quality of life measures are vital that often required continuous appraisal as a necessary part of health outcomes. HRQOL is also an important element of effective patient centered health care plans. For chronic disease populations, measurement of QOL provides a meaningful way to determine the impact of health care when cure is not possible. COPD is one of these chronic diseases. It is considered the third leading cause of deaths worldwide.
There are different types of scales used to measure QOL. LS is the most common used all over the world. It‟s an ordinal scale which indicates participant‟s level of agreement with particular statement. LS is not only used for measuring agreement, but also it is used to estimate importance, quality, frequency, and likelihood.
Visual analogue scale is a plain psychometric response scale used to measure objective and subjective characteristics. It is 100 millimeter vertical or horizontal line anchored at each end by words descriptive of opposing statements or the minimal and maximal extremes of the dimension being measured. Respondents are instructed to mark across on the straight line at the point that most accurately expresses their agreement degree.
Most questionnaires were originally developed and validated for English-speaking populations then translated to different languages. This is usually done through: forward translation then, expert panel back-translation after that, pre-testing and cognitive interviewing afterwards final version is consequently prepared. Arabic is the major language in the Arab region that faces various health, equity, socio-political, gender, economic and environmental challenges. For this reason, many studies with translation and cultural adaptation should be done in that region using these translated questionnaires.
In a previous study of Arabic version questionnaire about cancer patient‟s QOL using LS, individual patient‟s response pattern showed U shape with patients who supported the extreme responses rather than central responses. Authors suggested that difference in cultural concepts made it difficult for Egyptian population, on whom the study was done, to understand the points of Likert scale.
The aim of this study was to study the performance and ease of use of visual analogue scales as compared to Likert scale for assessing QOL of chronic obstructive pulmonary disease patients. The specific objectives of the study were:
To measure health related quality of life of chronic obstructive pulmonary disease patients using the WHOQOL-BREF short form questionnaire with its original Likert scale.
To measure the health-related quality of life of chronic obstructive pulmonary disease patients using the visual analogue scale.
To assess the concordance of results of the scales and the rate of endorsement of the various points on both scales.The study was conducted in Alexandria Main University Hospital and El-Maamoora Chest hospital using a cross-sectional approach among COPD patients aged 18 years or above who presented as inpatient or visited outpatient clinics.
For the cross-sectional study, a predesigned interviewing questionnaire was used to collect the needed information from patients. It included: socio-demographic data and medical history. The Arabic form of the World Health Organization’s QOL questionnaire (WHOQOL-BREF) was administrated to participants. It is a short version of the WHOQOL-100 scale. It is a generic self-administered questionnaire that consists of 26-item. It is a questionnaire of 5-point Likert-type scale. Then, after one hour from completing the first Likert questionnaire, a new designed VAS form which was built on the same questionnaire items of the Likert scale and was administered on its new VAS form to the same individuals.
The collected data were revised for accuracy and completeness, coded and analyzed using SPSS version 26 software for tabulation and analysis. The given graphs were constructed using Microsoft Excel software.
The study revealed the following main results:
Section I: Sociodemographic characteristics of studied patients:
- The patients‟ age ranged from 21 to 78 years with a mean of 46 ± 12.175 years
- Mostly COPD patients are males, so in this study they were 95.3% of the patients, while female patients were about 4.7 %.
- More than three fifths (62.7%) of the patients were married, 21.3% were single, while divorced and widowed only represented 7.3% and 8.7%, respectively.
- Less than two fifths (39.3%) of patients had university education, more than one third (37.3%) had secondary education, 18 % of them had preparatory education, while 2% had primary education, also 2% were illiterates and only 1.3% had religious education.
- Those who were employed constituted 40.4% of the patients, one fifth of patients (20%) were professionals as physician, engineer or teacher, those who were retired represented 17.3%, less than one tenth (9.3%) of patients were unemployed, those who engaged in manual work were 6.7%, while 4.7 % and 1.3% were students and housewives respectively.
Section II: Results of performance of LS and VAS:
a. Test of normality
Kolmogorov Smirnov test was done. It revealed that the majority of data wasn’t follow normal distribution.
b. Wilcoxon signed - rank test
There was statistically significant difference in median between all paired domains on two scales response with p>0.0001.
c. Paired t- test
The VAS version yielded a slightly higher standard deviation than the LS (SD = 14.57 vs. 11.64 respectively), indicating more variation in the VAS scores. Also means of total VAS score (99.3) is higher than mean of Likert score (88.8).
. Internal Consistency Reliability
Cronbach‟s alpha was used as an index of internal consistency. The VAS Cronbach‟s alpha reliability coefficient was higher (a = .907) than LS Cronbach‟s alpha reliability coefficient (a=.840)
e. Agreement level
There is statistically significant agreement between Likert scale and VAS in all domains with minimal kappa agreement which indicated that participants‟ responses were consistent across the LS and VAS versions of the survey f. Intraclass correlations via different response scales
Spearman correlation coefficient was used to determine the correlation between the Likert scale and VAS. Overall, there is moderate correlation (0.554-0.703) between the Likert scale and VAS. Also, the total score Likert is strongly correlated with total score VAS (r = 0.726)
g. Multiple linear regression analysis
Multiple Linear regression was used to predict total VAS scores as dependent variable from gender, age, marital state, education and occupation. The adjusted R² of our model is 0.068 with the R² =0.099 that means that the linear regression explains only 1% of the variance in the data.
ANOVA tests refers to that overall regression model is a good fit for the data. The independent variables are statistically significantly predict the dependent variable, F(5, 144) = 3.170, p < .0010 . So, the regression model is a good fit of the data.