Validation of the Burden Index of Caregivers (BIC), a multidimensional short care burden scale from Japan

Background: We constructed a concise multidimensional care burden scale that reflects circumstances unique to Japan, with a focus on intractable neurological diseases. We surveyed 646 family caregivers of patients with intractable neurological diseases or stroke using 28 preliminary care burden scale items obtained from qualitative research. The results were used to finalize the feeling of care burden scale (BIC: burden index of caregivers), and verify its reliability and validity. Methods: The survey was conducted among caregivers providing home health care to patients with intractable neurological diseases (PD [ Parkinson's disease], SCD [ spinocerebellar degeneration], MSA [ multiple system atrophy], and ALS [ amyotrophic lateral sclerosis]) or CVA ( cerebrovascular accident) using a mailed, self-administered questionnaire between November, 2003 and May, 2004. Results: Response rates for neurological and CVA caregivers were 50% and 67%, respectively, or 646 in total ( PD, 279; SCD, 78; MSA, 39; ALS, 30; and CVA, 220). Item and exploratory factor analyses led to a reduction to 11 items, comprising 10 items from the 5 domains of time-dependent burden, emotional burden, existential burden, physical burden, and service-related burden; and 1 item on total burden. Examination of validity showed a moderate correlation between each domain of the BIC and the SF-8 ( Health related quality of life scale, Short Form-8), while the correlation coefficient of the overall BIC and CES-D was 0.62. Correlation between the BIC and ZBI, a preexisting care burden scale, was high ( r = 0.84), while that with the time spent on providing care was 0.47. The ICC ( Intraclass correlation coefficient) by test-retest reliability was 0.83, and 0.68 to 0.80 by individual domain. Conclusion: These results show that the BIC, a new care burden scale comprising 11 items, is highly reliable and valid.