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Biomedical subjects

Caroline B Terwee

Publications and source records attributed to Caroline B Terwee.

At least 19 recordsLinked to original sources
PubMed2006

Reproducibility and responsiveness of the Symptom Severity Scale and the hand and finger function subscale of the Dutch arthritis impact measurement scales (Dutch-AIMS2-HFF) in primary care patients with wrist or hand problems.

BACKGROUND: To determine the clinimetric properties of two questionnaires assessing symptoms (Symptom Severity Scale) and physical functioning (hand and finger function subscale of the AIMS2) in a Dutch primary care population. METHODS: The first 84 participants in a 1-year follow-up study on the diagnosis and prognosis of hand and wrist problems completed the Symptom Severity Scale and the hand and finger function subscale of the Dutch-AIMS2 twice within 1 to 2 weeks. The data were used to assess test-retest reliability (ICC) and smallest detectable change (SDC, based on the standard error of measurement (SEM)). To assess responsiveness, changes in scores between baseline and the 3 month follow-up were related to an external criterion to estimate the minimal important change (MIC). We calculated the group size needed to detect the MIC beyond measurement error. RESULTS: The ICC for the Symptom Severity Scale was 0.68 (95% CI: 0.54-0.78). The SDC was 1.00 at individual level and 0.11 at group level, both on a 5-point scale. The MIC was 0.23, exceeding the SDC at group level. The group size required to detect a MIC beyond measurement error was 19 for the Symptom Severity Scale. The ICC for the hand and finger function subscale of the Dutch-AIMS2 was 0.62 (95% CI: 0.47-0.74). The SDC was 3.80 at individual level and 0.42 at group level, both on an 11-point scale. The MIC was 0.31, which was less than the SDC at group level. The group size required to detect a MIC beyond measurement error was 150. CONCLUSION: In our heterogeneous primary care population the Symptom Severity Scale was found to be a suitable instrument to assess the severity of symptoms, whereas the hand and finger function subscale of the Dutch-AIMS2 was less suitable for the measurement of physical functioning in patients with hand and wrist problems.

Activities of Daily Living↗
PubMed2006

Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach.

BACKGROUND: Minimally important changes (MIC) in scores help interpret results from health status instruments. Various distribution-based and anchor-based approaches have been proposed to assess MIC. OBJECTIVES: To describe and apply a visual method, called the anchor-based MIC distribution method, which integrates both approaches. METHOD: Using an anchor, patients are categorized as persons with an important improvement, an important deterioration, or without important change. For these three groups the distribution of the change scores on the health status instrument are depicted in a graph. We present two cut-off points for an MIC: the ROC cut-off point and the 95% limit cut-off point. RESULTS: We illustrate our anchor-based MIC distribution method determining the MIC for the Pain Intensity Numerical Rating Scale in patients with low back pain, using two conceivable definitions of minimal important change on the anchor. The graph shows the distribution of the scores of the health status instrument for the relevant categories on the anchor, and also the consequences of choosing the ROC cut-off point or the 95% limit cut-off point. DISCUSSION: The anchor-based MIC distribution method provides a general framework, applicable to all kind of anchors. This method forces researchers to choose and justify their choice of an appropriate anchor and to define minimal importance on that anchor. The MIC is not an invariable characteristic of a measurement instrument, but may depend, among other things, on the perspective from which minimal importance is considered and the baseline values on the measurement instrument under study. A balance needs to be struck between the practicality of a single MIC value and the validity of a range of MIC values.

Health Status Indicators↗
PubMed2006

Translation and validation of the SF-36 Health Survey for use among Turkish and Moroccan ethnic minority cancer patients in The Netherlands.

In this study, the SF-36 Health Survey was translated into two oral Moroccan languages and the existing Turkish version was culturally adapted for use in The Netherlands, and was tested among 79 Moroccan and 90 Turkish cancer patients. There were normal levels of missing item responses but a higher administration time. With minor exceptions, the scale structure of the SF-36 was confirmed and the reliability of the scales met the 0.70 criterion for group comparisons. The questionnaire distinguished clearly between subgroups formed on the basis of performance status and was responsive to change in performance status over time. Some evidence of differential item function (DIF) was found in both ethnic groups. These results support the use of the SF-36 among Turkish and Moroccan cancer patients in The Netherlands. Additional studies are needed to confirm the psychometrics of the questionnaire when used among these ethnic minority groups in other Western European countries.

Adult↗
PubMed2006

Quality criteria were proposed for measurement properties of health status questionnaires.

OBJECTIVES: Recently, an increasing number of systematic reviews have been published in which the measurement properties of health status questionnaires are compared. For a meaningful comparison, quality criteria for measurement properties are needed. Our aim was to develop quality criteria for design, methods, and outcomes of studies on the development and evaluation of health status questionnaires. STUDY DESIGN AND SETTING: Quality criteria for content validity, internal consistency, criterion validity, construct validity, reproducibility, longitudinal validity, responsiveness, floor and ceiling effects, and interpretability were derived from existing guidelines and consensus within our research group. RESULTS: For each measurement property a criterion was defined for a positive, negative, or indeterminate rating, depending on the design, methods, and outcomes of the validation study. CONCLUSION: Our criteria make a substantial contribution toward defining explicit quality criteria for measurement properties of health status questionnaires. Our criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies. The future challenge will be to refine and complete the criteria and to reach broad consensus, especially on quality criteria for good measurement properties.

Evaluation Studies as Topic↗
PubMed2006

Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change.

Changes in scores on health status questionnaires are difficult to interpret. Several methods to determine minimally important changes (MICs) have been proposed which can broadly be divided in distribution-based and anchor-based methods. Comparisons of these methods have led to insight into essential differences between these approaches. Some authors have tried to come to a uniform measure for the MIC, such as 0.5 standard deviation and the value of one standard error of measurement (SEM). Others have emphasized the diversity of MIC values, depending on the type of anchor, the definition of minimal importance on the anchor, and characteristics of the disease under study. A closer look makes clear that some distribution-based methods have been merely focused on minimally detectable changes. For assessing minimally important changes, anchor-based methods are preferred, as they include a definition of what is minimally important. Acknowledging the distinction between minimally detectable and minimally important changes is useful, not only to avoid confusion among MIC methods, but also to gain information on two important benchmarks on the scale of a health status measurement instrument. Appreciating the distinction, it becomes possible to judge whether the minimally detectable change of a measurement instrument is sufficiently small to detect minimally important changes.

Attitude to Health↗
PubMed2006

When to use agreement versus reliability measures.

BACKGROUND: Reproducibility concerns the degree to which repeated measurements provide similar results. Agreement parameters assess how close the results of the repeated measurements are, by estimating the measurement error in repeated measurements. Reliability parameters assess whether study objects, often persons, can be distinguished from each other, despite measurement errors. In that case, the measurement error is related to the variability between persons. Consequently, reliability parameters are highly dependent on the heterogeneity of the study sample, while the agreement parameters, based on measurement error, are more a pure characteristic of the measurement instrument. METHODS AND RESULTS: Using an example of an interrater study, in which different physical therapists measure the range of motion of the arm in patients with shoulder complaints, the differences and relationships between reliability and agreement parameters for continuous variables are illustrated. CONCLUSION: If the research question concerns the distinction of persons, reliability parameters are the most appropriate. But if the aim is to measure change in health status, which is often the case in clinical practice, parameters of agreement are preferred.

Humans↗
PubMed2006

Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients.

BACKGROUND AND OBJECTIVES: To test the hypothesis that self-reported physical functioning is more influenced by pain than performance-based physical functioning. METHODS: 163 knee-osteoarthritis patients completed the performance-based DynaPort KneeTest (DPKT), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and SF-36 (self-report measures of pain and physical functioning) before, 3, 6, and 12 months after knee replacement. RESULTS: Correlations between (two) self-reported measures of functioning and (two) pain measures were higher (0.57-0.74) than correlations between the performance-based measure of functioning and the two pain measures (0.20 and 0.26). In factor analysis, WOMAC and SF-36 pain and physical functioning subscores loaded on the first factor (eigenvalue 3.2), while DPKT KneeScore2 loaded on the second factor (eigenvalue 0.92). Before surgery, correlations between performance-based and self-reported physical functioning were higher in patients with less pain (0.43) compared to patients with more pain (0.17), for the WOMAC (as expected), but not for the SF-36. After surgery, when the pain had diminished, the correlations between performance-based and self-reported physical functioning were higher, especially for the WOMAC. CONCLUSIONS: Our hypothesis was convincingly supported by the results of the WOMAC, and somewhat less by the results of the SF-36. We consider this as evidence for a lack of content validity of the WOMAC.

Activities of Daily Living↗
PubMed2006

The course and prognosis of hip complaints in general practice.

BACKGROUND: The general practitioner needs to discriminate complaints with need of specialist care from those that can be managed in primary care. However, no previous research has studied prognostic indicators for the course of hip complaints in a primary care population. PURPOSE: The purpose of this study was to investigate the course of hip complaints presented in general practice and to identify relevant prognostic indicators of outcome. METHODS: Data were collected by means of self-administered questionnaires containing questions about sociodemographic variables, characteristics of the complaints, and several intraindividual and extraindividual factors, including several psychosocial variables (e.g., pain coping, distress, and kinesiophobia). After 3 and 12 months of follow-up perceived recovery, change in pain intensity and change in functioning were assessed. Multiple regression analyses were performed to investigate the association between the potential prognostic indicators and the 3 outcome measures. RESULTS: We included 139 patients with hip complaints, presented in general practice. Only 24% reported recovery after 3 months, increasing to 37% after 12 months. A history of hip complaints, a longer duration of the current episode of hip complaints, or more severe complaints, were associated with a less favorable prognosis. Furthermore, more vital patients and patients who met the Norm for Healthy Activity had a higher probability of a favorable outcome. Pain transformation and worrying were significant associated with recovery and changes in functioning after 3 months. CONCLUSIONS: Different prognostic indicators were found to be associated with perceived recovery, changes in pain intensity, and changes in functioning. Future research should aim at investigating the mechanisms that can underlie these associations.

Adaptation, Psychological↗
PubMed2005

Course and prognosis of knee complaints in general practice.

OBJECTIVE: Patients frequently present with knee complaints in general practice. Information about the course and prognosis of knee complaints is needed to inform patients and facilitate decisions on referral and treatment. The objective of the study was to assess the course of knee complaints and to identify predictors of outcome in patients visiting their general practitioner with a new episode of knee complaints. METHODS: Data were collected by means of self-administered questionnaires. After 3 and 12 months of followup, the following outcomes were assessed: perceived recovery, change in pain, and change in physical functioning. As potential predictors of outcome, several sociodemographic variables, characteristics of the symptom, baseline scores of the outcome measures, and intra- and extra-individual variables were analyzed using multiple regression analyses. RESULTS: We included 251 patients with a new episode of knee complaints presented in general practice. Only 25% reported recovery after 3 months, increasing to 44% after 12 months. A history of knee complaints, a longer duration of the current episode of knee complaints, other coexisting musculoskeletal complaints, and a higher level of distress were associated with a worse prognosis. In the linear regression models, 41-53% of the variance in pain reduction and improvement in functioning could be explained by the predictors. The area under the receiver operating characteristic curves, estimating the predictive accuracy of the Cox regression models concerning perceived recovery, was 0.77 after 3 months and 0.72 after 12 months. CONCLUSION: Many patients did not recover after 12 months. Distress was found to be strongly associated with less pain reduction and less improvement in functioning.

Cohort Studies↗
PubMed2005

Changes to the subscales of two vision-related quality of life questionnaires are proposed.

BACKGROUND AND OBJECTIVE: Psychometrically sound questionnaires for the assessment of vision-related quality of life (QOL) are scarce. Therefore, the objective was to further validate two vision-related QOL questionnaires in a Dutch population of visually impaired elderly. METHODS: A total of 329 visually impaired older persons referred to low vision services completed the low vision QOL (LVQOL) and Vision-Related Quality of Life Core Measure (VCM1) questionnaires at baseline, after 1-4 weeks (retest), and after 5 months. Confirmatory factor analyses were performed on baseline data. The smallest detectable change (SDC) was assessed, based on the standard error of measurement (SEM). Change scores between the baseline and 5 months follow-up data were related to a general transition question to assess the minimal important change (MIC). Furthermore, the MIC was related to the SDC, to examine whether the MICs were detectable beyond measurement error. RESULTS: The original factor structures could not be confirmed. After omitting items and remodeling, adequate fits were obtained. SDCs comprised at least one quarter of the scale for all scales and subscales on the individual level and exceeded the MICs on every occasion. CONCLUSION: We propose MICs of 5-10 points for the scales and subscales of the LVQOL and VCM1. The questionnaires are not useful in the follow-up of individual patients.

Aged↗
PubMed2005

Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice.

STUDY DESIGN: An observational prospective cohort study in general practice. OBJECTIVES: To describe the clinical course and to identify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up. SUMMARY OF BACKGROUND DATA: Knowledge on the clinical course and predictors of outcome in neck and shoulder symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis. METHODS: Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses. RESULTS: The recovery rate was low; 24% of the patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%. CONCLUSIONS: The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms.

Adult↗
PubMed2005

Reproducibility and validity of the DynaPort KneeTest.

OBJECTIVE: To determine the reproducibility and validity of the DynaPort KneeTest, a performance-based test that measures quality of movement of patients undergoing total knee replacement (TKR). METHODS: A total of 92 patients with osteoarthritis (OA) of the knee performed the KneeTest twice on the same day; 94 healthy controls performed the KneeTest once. During the test, 29 activities were performed with accelerometers attached to the body. Relevant functional parameters were extracted from the accelerometers. A selection of parameters was used to calculate activity scores, based on the ability of parameters to discriminate between patients and controls (regression analyses). Based on internal consistency analyses (Cronbach's alpha), redundant activities were removed. Four cluster scores and a total KneeScore were calculated from the remaining activity scores. Reproducibility and validity of the cluster scores and the total KneeScore 2 were assessed. RESULTS: Based on internal consistency analyses, the test was reduced to 23 activities. Inter- and intraobserver reliability using intraclass correlation coefficients were 0.90 (0.83-0.94) and 0.95 (0.83-0.98), respectively. Limits of inter- and intraobserver agreement were -8.3 to 11.3 and -4.2 to 9.0. Construct validity was confirmed by expected correlations with the Western Ontario and McMaster University Osteoarthritis Index physical functioning (0.55), Medical Outcomes Study Short Form-36 Health Survey physical functioning (0.62), and Knee Society Score function (0.64). CONCLUSION: The KneeTest is a useful performance-based measure for research in patients with knee OA undergoing TKR, with good reliability and validity. Further research is required to improve its usefulness for clinical practice.

Aged↗
PubMed2005

Health-related and overall quality of life of patients with chronic hip and knee complaints in general practice.

BACKGROUND: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. METHODS: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. RESULTS: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. CONCLUSION: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints only.

Chronic Disease↗
PubMed2005

The impact of non-traumatic hip and knee disorders on health-related quality of life as measured with the SF-36 or SF-12. A systematic review.

OBJECTIVES: The purpose of this review is to summarize the available evidence on the impact of non-traumatic hip or knee disorders on health-related quality of life (HRQL), as measured with the Short Form 36 Health Survey (SF-36) or Short Form 12 Health Survey (SF-12), by comparing this with data from reference populations. METHODS: Studies were identified by an electronic search of the MEDLINE, PsychInfo and Cinahl databases. Studies with the following features were included: study population included patients with non-traumatic hip or knee disorders, the SF-36 or SF-12 was used as an outcome measure and mean scores on these HRQL measures were presented. Using mean HRQL scores from the selected studies and scores from reference populations, z-scores were computed. Pooled estimates were computed for subgroups of studies with similar patients in similar settings. RESULTS: A total of 40 studies met the inclusion criteria. Patients with non-traumatic hip and knee disorders scored up to 2.5 standard deviations (SDs) below reference population values, especially on the physical aspects of HRQL. Social and mental aspects were up to 1 SD below reference population values, especially in patients in clinical settings. CONCLUSIONS: The impact of non-traumatic hip or knee disorders on HRQL is substantial, especially on the physical aspects of HRQL.

Health Status↗
PubMed2005

Are factor analytical techniques used appropriately in the validation of health status questionnaires? A systematic review on the quality of factor analysis of the SF-36.

Factor analysis is widely used to evaluate whether questionnaire items can be grouped into clusters representing different dimensions of the construct under study. This review focuses on the appropriate use of factor analysis. The Medical Outcomes Study Short Form-36 (SF-36) is used as an example. Articles were systematically searched and assessed according to a number of criteria for appropriate use and reporting. Twenty-eight studies were identified: exploratory factor analysis was performed in 22 studies, confirmatory factor analysis was performed in five studies and in one study both were performed. Substantial shortcomings were found in the reporting and justification of the methods applied. In 15 of the 23 studies in which exploratory factor analysis was performed, confirmatory factor analysis would have been more appropriate. Cross-validation was rarely performed. Presentation of the results and conclusions was often incomplete. Some of our results are specific for the SF-36, but the finding that both the application and the reporting of factor analysis leaves much room for improvement probably applies to other health status questionnaires as well. Optimal reporting and justification of methods is crucial for correct interpretation of the results and verification of the conclusions. Our list of criteria may be useful for journal editors, reviewers and researchers who have to assess publications in which factor analysis is applied.

Factor Analysis, Statistical↗
PubMed2005

Interobserver reproducibility of the visual estimation of range of motion of the shoulder.

OBJECTIVES: To assess interobserver reproducibility (agreement and reliability) of visually estimated shoulder range of motion (ROM) and to study the influence of clinical characteristics on the reproducibility. DESIGN: Test-retest analyses. SETTING: Various health care settings in the Netherlands. PARTICIPANTS: Consecutive patients with shoulder complaints (N = 201) referred by 20 general practitioners, 2 orthopedic physicians, and 20 rheumatologists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Independent visual estimation by 2 physiotherapists of the ROM. Agreement was calculated as the mean difference in visual estimation between examiners +/-1.96 x standard deviations of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on a 2-way random effects analysis of variance. RESULTS: The lowest level of agreement was for visual estimation of active and passive elevation (limits of agreement, -43.4 to 39.8 and -46.7 to 41.5, respectively, for the difference between the affected and contralateral sides), for which the level of agreement was most clearly associated with pain severity and disability. The ability to differentiate between subjects was acceptable for all movements for the difference between the affected and contralateral sides (ICCs, > .70) except for horizontal adduction (ICC = .49). CONCLUSIONS: Interobserver agreement was low for the assessment of active and passive elevation, especially for patients with a high pain severity and disability. Except for horizontal adduction, visual estimation seems suitable for distinguishing differences between affected and contralateral ROM between subjects.

Activities of Daily Living↗
PubMed2005

Construct validity of the DynaPort KneeTest: a comparison with observations of physical therapists.

OBJECTIVE: To assess the construct validity of the DynaPort KneeTest (KneeTest), which is a performance-based test to assess functioning of patients with knee osteoarthritis (OA). Scores on the KneeTest (KneeScore) were compared with observations of physical therapists of the patients' functional disability. The reliability of these observations was also assessed. METHOD: Twelve physical therapists received identical video tapes showing the performance of 33 patients on the KneeTest. Each physical therapist rated the functional disability of each patient, performing the 23 activities of the KneeTest, on 23 Visual Analogue Scales (VAS(activity)). The 23 VAS(activity) scores were averaged into a VAS(average) score. At the end of the test, an overall rating for the general performance of the patient was given on a VAS(overall). Inter-observer Reliability was assessed for the VAS(activity) scores, VAS(average), and the VAS(overall). RESULTS: Inter-observer reliability of the VAS(average) was higher (ICC 0.85, 95% CI 0.74-0.92) than the VAS(overall) (ICC 0.65, 95% CI 0.51-0.77). The correlation between the KneeScore and the VAS(average), averaged over the 12 physiotherapists, was 0.86. CONCLUSION: The construct validity of the KneeTest was supported by the strong correlation with the ratings of the patients' disability by physical therapists. Given these findings and the high test-retest reliability of the KneeTest that was found in our previous study, we conclude that the KneeTest is a valid measure for assessing functioning in orthopedic and physical therapy research in patients with knee-OA before and after total knee replacement. Longitudinal validity has to be evaluated yet.

Activities of Daily Living↗