The Multimorbidity Treatment Burden Questionnaire (MTBQ) is a concise, simply-worded set of questions to measure treatment burden in people with multimorbidity. It has been designed for use in primary care research to assess the effects of interventions that might increase or decrease treatment burden. It is based on an existing evidence-based framework and was tested as part of the 3D Study. 

Treatment burden is defined as a patient’s perception of the effort required to manage their health conditions and the impact that this has on their general well-being and day-to-day life. This includes coordinating healthcare appointments, taking multiple medicines, self-monitoring their health and making lifestyle changes.

There are two versions of the questionnaire: a 10-item version and a 13-item version. The three additional questions in the 13-item questionnaire (questions 3, 9 and 10) are optional. They are included because, although not relevant to the study population in which the questionnaire was tested (see the 3D study for more information), they may be useful for other patient groups. For example, one of the questions is about cost of treatment but the majority of participants in the 3D Study did not have to pay for prescriptions or other health treatment.

The MTBQ is for primary care and other healthcare and health service researchers who need to measure what impact interventions that they are testing have on patients' treatment burden. Further work is being conducted to develop a 'Short Treatment Burden Questionnaire' (STBQ) for use in a clinical setting. 

The MTBQ is available free for non-commercial use only and is licensed under a MTBQ licence (Office document, 63kB). The terms of this licence state that the MTBQ must not be adapted, translated or otherwise adjusted without first seeking prior approval from the authors. The University of Bristol will retain rights to any adapted or translated versions.

If you would like to use the MTBQ, please complete the MTBQ registration form (Office document, 12kB) and return this to: polly.duncan@bristol.ac.uk. You will then be sent a licensed copy of the MTBQ. In the meantime, you can access the:

MTBQ 10-item review copy (PDF, 126kB)

and the 

MTBQ 13-item review copy (PDF, 144kB)

For information on how to score, report and interpret the MTBQ, please see the MTBQ user guide (PDF, 159kB).

Scoring of the MTBQ

MTBQ global score

Each question is scored as follows: zero (not difficult/ does not apply), one (a little difficult), two (quite difficult), three (very difficult), four (extremely difficult). Participants should be excluded if more than 50% of their responses are missing. To calculate a global score, each participant’s average score is calculated from the questions answered and multiplied by 25 to give a score from 0-100.

Interpreting the global MTBQ score

We generated four categories of treatment burden by grouping global MTBQ scores greater than 0 into tertiles: no burden (score 0), low burden (score <10), medium burden (10-22), high burden (>=22).

Reporting of global MTBQ scores

We recommend that, due to the skewness of global MTBQ scores, researchers should report the median or interquartile range rather than the mean and SD, and report the proportion of patients with high, medium, low or no treatment burden (global MTBQ scores ≥ 22, 10-21, <10 and 0 respectively).

The MTBQ was developed by Dr Polly Duncan, under the supervision of Professor Chris Salisbury, at the University of Bristol.

The measure was comprehensively tested using international standards for developing and validating questionnaires. A key strength of the MTBQ is that it was validated in a large sample of the population for whom it is intended: elderly multimorbid patients with a mean age of 71 years and three or more long-term conditions. These patients were participants in the 3D Study, which aimed to improve the care of patients with multiple long-term conditions in general practice.

Original English validation papers

Duncan P, Murphy M, Man M-S, et al. Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ).

Duncan P, Scott L, Dawson S, et al. Further development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ).

Validation papers for translated versions

Samorinha C, Saidawi W, Duncan P, et al. Translation, cross-cultural adaptation and validation of the Arabic multimorbidity treatment burden questionnaire (MTBQ-A): A study of adults with multimorbidity. (Accepted/In press)

Vasiliauskienė O, Vasiliauskas D, Duncan P, et al. Validation of the Lithuanian multimorbidity treatment burden questionnaire (MTBQ) and its association with primary care patient characteristics. 

Brandão, A. C., Santiago, L. M., & Simões, J. A. Cross-cultural adaptation and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) for European-spoken Portuguese. 

Guénette L, Turcotte V, Bélanger L, et al. Multimorbidity Treatment Burden Questionnaire (MTBQ): Translation, Cultural Adaptation, and Validation in French-Canadian. 

Pedersen MH, Duncan P, Lasgaard M, et al. Danish validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and findings from a population health survey: a mixed-methods study 

Schulze, J., Breckner, A., Duncan, P. et al. Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire. 

Dou, L., Huang, J., Duncan, P. et al. Translation, cultural adaptation and validation of the Chinese Multimorbidity Treatment Burden Questionnaire(C-MTBQ): a study of older hospital patients. 

Translations

The MTBQ has been translated, culturally adapted and validated in Danish, Chinese, Dutch, French-Canadian and German, Lithuanian, Portuguese and Arabic. Studies are underway to develop and validate the MTBQ in the following languages: Bengali, Hebrew, Japanese, Korean, Persian, Russian, Spanish, Thai and Turkish.

Further psychometric testing has been carried out on the Multimorbidity Treatment Burden Questionnaire (MTBQ), including test-retest reliability, construct validity and assessing ease of completing the questionnaire. The findings have been submitted for publication and are awaiting peer review.

A 'Short Treatment Burden Questionnaire' (STBQ) is being developed and validated for use in a clinical setting. 

A 'Carer Treatment Burden Questionnaire' is also being developed.