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Objective: The aim was to test the performance of a cross-culturally developed disease-generic quality of life (QoL) measure for children with chronic diseases in a multinational clinical study., Study Design and Setting: The study was conducted in pediatric hospitals across seven European countries in a sample of 1,153 children with seven chronic conditions, aged 8-16. The design included test and retest on child, parent, and clinical measures concerning health status, functioning, and quality of life., Results: The condition-generic QoL measure showed satisfactory item and scale performance, as well as structural validity across the seven countries. There was a high agreement between the child and proxy assessment across the different countries in all subscales of the condition-generic instrument, except for socioemotional dimensions in some countries. Gender, age, and severity-adjusted covariance analyses showed significant country differences in QoL. The discriminative potential of the condition-generic measure to distinguish between clinical characteristics was higher than that of a generic measures., Conclusion: The psychometric performance of both items and scales of the DISABKIDS condition oriented measure was good across cultures, despite a range of cross-cultural differences. The condition-generic measure performs better in discriminating with respect to clinical characteristics than the generic measures; however, results need replication in representative studies.

Rasch models for polytomous items were used to assess the scaling assumptions and compare item response patterns in the 10-item SF-36 physical functioning scale (PF-10) for general population respondents in Denmark, Germany, Italy, the Netherlands, Sweden, the United Kingdom, and the United States. The Rasch model of physical functioning developed in the United States was compared to models for other countries, and each country was compared to a multinational composite. Strong scale congruence across the seven countries was demonstrated; items that varied between countries and from the composite may reflect unique cultural response patterns or differences in translation. Scoring algorithms based on the Rasch model for each country were superior to the current Likert scoring in tests of relative validity (RV) in discriminating among age groups in all countries. In relation to the Likert PF-10 scoring (RV = 1.00), scores estimated using the Rasch rating scale model achieve a median RV of 1.31 (range: 1.01-1.59), while the Rasch partial credit model attained a median RV of 1.44 (range: 1.01-2.23). Rasch models hold good potential for improving health status measures, estimating individual scores when responses to scale items are missing, and equating scores across countries.