Adapting the Asthma Life Impact Scale (ALIS) for use in Southern European (Italian) and Eastern European (Russian) cultures

Figures & data

Table 1.  Demographic information for the cognitive debriefing and validation samples.

	Cognitive debriefing sample		Validation sample
	Russia (n = 9)	Italy (n = 15)	Italy (n = 61)	Russia (n = 71)
Gender (%)
Male	1 (11.1)	10 (66.7)	26 (42.6)	31 (43.7)
Female	8 (88.9)	5 (33.3)	34 (55.7)	40 (56.3)
Missing	0	0	1 (1.6)	0
Age (years)
Mean (SD)	55.4 (13.2)	63.5 (11.2)	40.7 (15.4)	49.5 (14.6)
Median (IQR)	56.0 (45.5–69.0)	67.0 (53.0–70.0)	38.0 (26.5–50.0)	53.0 (41.5–58.5)
Range	31.0–70.0	45.0–83.0	17.0–76.0	15.0–71.0
Marital status (%)
Married/living as married	6 (66.7)	7 (46.7)	29 (47.5)	43 (60.6)
Widowed	3 (33.3)	5 (33.3)	3 (4.9)	10 (14.1)
Divorced/separated	0	0	7 (11.5)	6 (8.5)
Never married	0	3 (20.0)	22 (36.1)	12 (16.9)
Employment status (%)
Full-time	4 (44.4)	4 (26.8)	36 (59.0)	32 (45.1)
Part-time	0	0	7 (11.5)	3 (4.2)
Homemaker	0	4 (26.6)	5 (8.2)	1 (1.4)
Retired	3 (33.3)	7 (46.7)	6 (9.8)	19 (26.8)
Long term sick leave	2 (22.2)	0	0	11 (15.5)
Student	0	0	7 (11.5)	2 (2.8)
Other	0	0	0	3 (4.2)

IQR, Inter-quartile range.

Table 2.  Patient-reported disease information.

	Italy (n = 61)	Russia (n = 71)
Asthma duration (years)
Median (IQR)	15.0 (10.0–20.0)	15.0 (10.0–20.5)
Mean (SD)	16.3 (10.0)	16.7 (8.6)
Range	44 (1–45)	39 (1–40)
Self-reported general health (%) Time 1
Very good	6 (9.8)	4 (5.6)
Good	27 (44.3)	20 (28.2)
Fair	23 (37.7)	34 (47.9)
Poor	5 (8.2)	13 (18.3)
Very poor	0	0
Self-reported asthma severity (%) Time 1
Mild	31 (50.8)	9 (12.7)
Moderate	24 (39.3)	32 (45.1)
Quite severe	6 (9.8)	27 (38.0)
Very severe	0	2 (2.8)
Missing	0	1 (1.4)
Hospitalized during last week (%)
Yes	11 (18.0)	51 (71.8)
No	50 (82.0)	19 (26.8)
Missing	0	1 (1.4)
Receiving treatment for asthma (%)
Yes	24 (39.3)	68 (95.8)
No	34 (55.7)	1 (1.4)
Missing	3 (4.9)	2 (2.8)

IQR, Inter-quartile range.

Table 3.  Russian validation: Clinical validation data at Time 1.

	Russia (n = 71)
%FEV1
Median (IQR)	71.2 (60.4–82.9)
Mean (SD)	73.0 (18.8)
Range	41–138
%PEF
Median (IQR)	61.5 (49.8–74.1)
Mean (SD)	63.2 (18.4)
Range	21–116
Clinician-rated general health (%)
Very good	11 (15.5)
Good	16 (22.5)
Fair	28 (39.4)
Poor	14 (19.7)
Very poor	2 (2.8)
Clinician-rated asthma severity (%)
No symptoms	4 (5.6)
Mild	22 (31.0)
Moderate	27 (38.0)
Quite severe	16 (22.5)
Very severe	2 (2.8)

IQR, Inter-quartile range.

Table 4.  Descriptive statistics for the ALIS.

	Median (IQR)	Mean (SD)	Range	% scoring minimum	% scoring maximum
Time 1
Italy	5 (2–9)	5.8 (5.4)	0–22	21.3	1.6
Russia	8 (3.8–13)	8.3 (5.7)	0–22	4.2	1.4
Time 2
Italy	4 (1–8)	5.3 (5.1)	0–21	21.3	0.0
Russia	7 (2.5–12)	7.7 (5.9)	0–22	7.0	1.4

IQR, Inter-quartile range.

Table 5.  Corrected item total correlations.

Item	Italian		Russian
	Corrected item total correlation	Cronbach’s alpha if item deleted	Corrected item total correlation	Cronbach’s alpha if item deleted
Inability to be adventurous	0.62	0.91	0.59	0.91
Dependent on treatment	0.40	0.91	0.37	0.92
Social limitations	0.50	0.91	0.49	0.92
Feel old	0.52	0.91	0.45	0.92
Need to pace activities	0.67	0.91	0.50	0.92
Self-confidence	0.46	0.91	0.45	0.92
Preoccupation with medication	0.55	0.91	0.55	0.91
Limit activities	0.75	0.91	0.71	0.91
Let others down	0.39	0.91	0.57	0.91
Cautious where to go	0.55	0.91	0.64	0.91
Affects relationships	0.49	0.91	0.42	0.92
Lowered mood	0.65	0.91	0.71	0.91
Interest in sex	0.63	0.91	0.41	0.92
Prevents visiting	0.47	0.91	0.69	0.91
Limits potential	0.59	0.91	0.59	0.91
Feel isolated	0.64	0.91	0.55	0.91
Need for energy	0.65	0.91	0.67	0.91
Appear lazy	0.35	0.92	0.13	0.92
Planning activities	0.58	0.91	0.59	0.91
Preoccupation with asthma	0.57	0.91	0.75	0.91
Controlled by illness	0.58	0.91	0.76	0.91
Limit social activities	0.70	0.91	0.58	0.91

Table 6.  Convergent validity between ALIS and other outcome assessments.

	Italy		Russia
	Correlation	n	Correlation	n
NHP Energy level	0.63	60
Pain	0.40	60
Emotional reactions	0.46	60
Sleep	0.46	60
Social Isolation	0.34	59
Physical mobility	0.52	59
NHPD	0.56	59
CASIS			0.85	70
CAFS			0.87	68
%FEV1			−0.35	70
%PEF			−0.40	70

All correlations significant, p < 0.01.

Table 7.  Mean ALIS scores by patient reported known groups (Time 1).

Variable	Patient sub-group	Italy		Russia
		n	Mean (SD)	n	Mean (SD)
Asthma duration	<15 years	28	4.6 (4.3)	30	6.5 (5.6)
	≥15 years	33	6.9 (6.0)	39	9.5 (5.6)
	p	61	0.13	69	<0.05
Self-perceived general health	Very good/good	33	2.6 (2.8)	23	3.3 (3.0)
	Fair	23	8.1 (3.9)	34	8.9 (4.3)
	Poor/very poor	5	16.6 (4.7)	13	15.5 (3.9)
	p	61	<0.001	70	<0.001
Self-perceived COPD severity	Mild	31	3.3 (3.2)	9	3.6 (4.2)
	Moderate	24	6.6 (4.2)	32	6.2 (4.4)
	Quite severe	6	15.8 (6.3)	29	12.1 (5.2)
	p	61	<0.001	70	<0.001
Hospitalized during previous week?	Yes	11	11.6 (6.7)	51	9.4 (5.5)
	No	50	4.6 (4.1)	19	5.3 (5.3)
	p	61	<0.001	70	<0.01
Receiving asthma treatment?	Yes	24	8.0 (6.2)
	No	34	4.6 (4.5)
	p	58	<0.05

Table 8.  Mean ALIS scores by clinician-rated known groups (Russia time 1).

Variable	Patient sub-group	Russia
		n	Mean (SD)
Clinician-rated general health	Excellent/very good	11	2.6 (2.8)
	Good	16	5.5 (4.3)
	Fair	27	8.5 (4.5)
	Poor/very poor	16	14.6 (4.1)
	p	70	<0.001
Clinician-rated asthma severit	No symptoms/mild	26	3.7 (3.2)
	Moderate	26	9.2 (4.4)
	Quite severe/very severe	18	13.7 (4.8)
	p	70	<0.001
%FEV1	<Median	34	10.1 (5.9)
	>Median	36	6.6 (5.1)
	p	70	<0.01
%PEF	<Median	34	11.2 (5.2)
	>Median	36	5.5 (4.7)
	p	70	<0.001