Further development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)

Polly R Duncan*, Lauren J Scott, Shoba Dawson, Muzrif Mohamed Munas, Yvette V Pyne, Katherine Chaplin, Daisy M Gaunt, Line Guenette, Chris Salisbury

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


To undertake further psychometric testing of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and examine whether reversing the scale reduced floor effects.


UK primary care.

Adults (≥18 years) with ≥3 long-term conditions randomly selected from 4 General Practices and invited by post.

Baseline survey: socio-demographics, MTBQ (original or version with scale reversed), treatment burden questionnaire (TBQ), four questions (from QQ-10) on ease of completing the questionnaires. Follow-up survey (1-4 weeks after baseline): MTBQ, TBQ and QQ-10. Anonymous data collected from electronic GP records: consultations (preceding 12 months), and long-term conditions. The proportion of missing data and distribution of responses were examined for the original and reversed version of the MTBQ, and the TBQ. Intra-class correlation coefficient (ICC) and Spearman’s rank correlation (Rs) assessed test-retest reliability and construct validity respectively. Ease of completing the MTBQ and TBQ was compared. Interpretability was assessed by grouping global MTBQ scores into zero and tertiles (>0).

244 adults completed the baseline survey (consent rate 31%, mean age 70 years) and 225 completed the follow-up survey. Reversing the scale did not reduce floor effects or data skewness. The global MTBQ scores had good test-retest reliability (ICC for agreement at baseline and follow-up 0.765, 95% confidence interval 0.702-0.816). Global MTBQ score was correlated with global TBQ score (Rs 0.77, p-value<0.001), weakly correlated with number of consultations (Rs 0.17, p-value=0.010), and number of different General Practitioners consulted (Rs 0.23, p-value<0.001), but not correlated with number of long-term conditions (Rs-0.063, p-value=0.330). Most participants agreed that both the MTBQ and TBQ were easy to complete and included aspects they were concerned about.

This study demonstrates test-retest reliability and ease of completion of the MTBQ, and builds on a previous study demonstrating good content validity, construct validity, and internal consistency reliability of the questionnaire.
Original languageEnglish
Article numbere080096
Number of pages11
JournalBMJ Open
Issue number4
Early online date10 Apr 2024
Publication statusPublished - 10 Apr 2024

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2024.


  • Questionnaire
  • Patient reported outcome measure
  • Treatment burden
  • multimorbidity
  • primary care


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