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Construction and validation of the Alberta Infant Motor Scale (AIMS).

The Alberta Infant Motor Scale (AIMS), an observational assessment scale, was constructed to measure gross motor maturation in infants from birth through independent walking. Based upon the literature, 58 items were generated and organized into four positions: prone, supine, sitting and standing. Each item describes three aspects of motor performance--weight-bearing, posture and antigravity movements. Content validation of the instrument was accomplished through a mail survey of Canadian pediatric physical therapists and consultation with an international panel of experts. Five hundred and six infants, age-stratified from birth through 18 months, participated in the reliability and validity testing of the AIMS. In addition, 20 infants who were experiencing abnormal motor development and 50 infants at risk for motor disorders were assessed and compared with the results of the full-term sample. Results to be presented include: 1) test-retest and inter-rater reliability estimates; 2) correlations between the AIMS and the Bayley and Peabody motor scores; and 3) scaling of the items along the age continuum for normal motor development.

Child Development↗

Validation of the multiple organ dysfunction (MOD) score in critically ill medical and surgical patients.

OBJECTIVE: To validate the Multiple Organ Dysfunction (MOD) score externally. DESIGN: Prospective observational cohort study. SETTING: Mixed medical/surgical ICU in a tertiary referral university hospital. PATIENTS AND PARTICIPANTS: Thousand eight hundred and nine patients admitted to ICU for more than 24 h over a 3-year period. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The MOD score was calculated daily for all patients. The criterion validity of the individual organ scores, the maximal MOD score and the change in MOD score were assessed by examining the relationship between increasing scores and ICU mortality. Increased maximal MOD scores and each of the six individual organ scores, and change in MOD scores were associated with increased mortality. CONCLUSIONS: Maximal and individual organ scores have criterion validity when tested in a different ICU from that in which the scores were derived, indicating that the scoring systems are reproducible. The association of change in MOD score with mortality indicates that the score is responsive. These data, combined with previous data establishing concept and content validity, indicate that the MOD score is a valid measure of multi-organ dysfunction.

Critical Care↗

The alcoholic family: a nursing diagnosis validation study.

This study was designed to develop and validate a new nursing diagnosis, altered family processes: alcoholism. The Delphi technique was used to obtain nurse experts' (N = 201) ratings of terms for the definition, related factors, and defining characteristics. Degree of consensus was determined by analyzing the mean, frequencies, and Fehring's (1987) Diagnostic Content Validity Index for items. Findings supported a proposed definition and related factors including family history of alcoholism and lack of problem-solving skills. Defining characteristics were grouped into three categories: feelings (e.g. mistrust, insecurity, powerlessness, unhappiness), roles, and relationships (e.g. disturbed family dynamics, inconsistent parenting, marital problems), and behaviors (e.g. impaired communication, dependency, denial). Future research includes the proposal and testing of nursing interventions for alcoholic families.

Adult↗

The Overt Agitation Severity Scale for the objective rating of agitation.

Two studies tested the reliability and validity of the Overt Agitation Severity Scale (OASS), a new instrument developed to define and objectively rate the severity of agitated behavior. The authors postulate that agitation should be conceptualized as vocal and motor behaviors on a continuum of expressions that extends from anxiety to aggression. Content validity through expert agreement was achieved in the development of test construction over a 2-year period. Results of two pilot studies (n = 25 and n = 14 subjects) established the reliability and validity of the OASS to measure agitation severity. The OASS differs from other agitation scales in that it confines its rating exclusively to observable behavioral manifestations of agitation.

Aged↗

The community-acquired pneumonia symptom questionnaire: a new, patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia.

STUDY OBJECTIVE: s: To develop and validate a patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia (CAP). DESIGN: A psychometric study within an international, prospective, randomized, double-blind study. The CAP-symptom questionnaire (CAP-Sym) is a new, 18-item, patient-reported outcome measure that evaluates the bothersomeness of CAP-related symptoms during the past 24 h using a 6-point Likert scale. We used "gold standard" psychometric methods to comprehensively evaluate the acceptability, reliability, validity, and responsiveness of the CAP-Sym. SETTING: Sixty-four centers in 13 countries (France, Germany, Hungary, Israel, Italy, Norway, Poland, Portugal, South Africa, Spain, Sweden, Switzerland, United Kingdom). PATIENTS: Five hundred fifty-six patients with CAP, recruited from outpatient clinics, general practice, and hospital centers. INTERVENTIONS: Randomization 1:1 to moxifloxacin (400 mg once daily), oral or standard oral treatment (amoxicillin, 1 g tid, or clarithromycin, 500 mg bid), alone or in combination, for up to 14 days. RESULTS: Standard psychometric tests confirmed the acceptability (item nonresponse, item-endorsement frequencies, item/scale floor and ceiling effects), reliability (internal consistency, item-total and inter-item correlations, test-retest reliability), validity (content, construct, convergent, discriminant, known groups), and responsiveness of the CAP-Sym. CONCLUSIONS: The CAP-Sym is a practical and scientifically sound patient-based outcome measure of CAP-related symptoms that has been developed using "gold standard" methods. As the only fully validated measure of symptoms in patients with CAP, which is quick and easy to administer and is more responsive than the generic Medical Outcomes Study 36-Item Short-Form Health Survey, the CAP-Sym provides a practical and rigorous method for improving the evaluation of outcomes in clinical trials and audit.

Adult↗

Health status: types of validity and the index of well-being.

The concept of validity as it applies to measures of health and health status is examined in the context of a set of standard, widely accepted definitions of validity. Criterion validity is shown to be irrelevant to health status measures because of the lack of a single specific, directly observable measure of health for use as a criterion. To overcome this problem, the Index of Well-being has been constructed to fulfill the definition of content validity by including all levels of function and symptom/problem complexes, a clearly defined relation to the death state, and consumer ratings of the relative desirability of the function levels. Data from a two-wave household interview survey provide convergent evidence of construct validity by demonstrating an expected positive correlation of the Index of Well-being with self-rated well-being and expected negative correlations with age, number of chronic medical conditions, number of reported symptoms or problems, number of physician contacts, and dysfunctional status. Discriminant evidence of construct validity is demonstrated by predicted differences in correlation between concurrent Index of Well-being scores and self-assessed overall health status, and between the Index of Well-being scores and self-rated well-being on different days. A simple method of estimating a currently usable comprehensive population index of health status, the Weighted Life Expectancy, is described.

Activities of Daily Living↗

A questionnaire for measuring patient satisfaction to general anesthesia.

BACKGROUND AND OBJECTIVES: Measurement of patient satisfaction to general anesthesia needs a valid and reliable tool to cover all dimensions of satisfaction. However, there is no standard tool in a Thai version for measurement of this satisfaction. The objective of this study was to develop a valid and reliable tool for measurement of patient satisfaction to general anesthesia. METHOD: Review of the medical literature and patients' interviews were performed to generate the ideas and dimensions of satisfaction. Items were generated according to customer satisfaction. The pilot questionnaire was set and verified for content validity by item correlation. One item of low item correlation was deleted. The pilot study was performed by application of the pilot questionnaire to patients to detect problems on processes to derive responses and problems of the questionnaire. Another two items were excluded due to high missing responses. The results of reliability analysis were satisfactory. Revision of the pilot questionnaire was taken eventually into the final questionnaire. Then, the final questionnaire was processed to obtain Cronbach's alpha coefficient at King Chulalongkorn Memorial Hospital. Finally, retest for reliability was taken at Police General Hospital in order to prove its generalization. RESULTS: The constructed final questionnaire composed of ten items. All item correlations were higher than 0.5. Cronbach's alpha coefficients obtained in King Chulalongkorn Memorial Hospital and Police General Hospital were 0.8775 and 0.7571, respectively. CONCLUSION: The developed questionnaire was qualified for both validity and reliability. Also verified for the wide application in another hospital.

Adolescent↗

Psychometric qualities of the Fatigue Assessment Scale in Croatian sarcoidosis patients.

BACKGROUND AND AIM: Fatigue is an unspecific symptom, but a major problem in sarcoidosis patients. There is a need for a reliable and valid way to measure fatigue. The Fatigue Assessment Scale (FAS) has good psychometric properties in healthy and sarcoidosis samples in the Netherlands, but nothing is known about the psychometric qualities of the FAS in sarcoidosis samples from other countries. Therefore, we examined the reliability, construct, and content validity in Croatian sarcoidosis patients. METHODS: Croatian sarcoidosis patients from a pulmonary outpatient clinic completed the FAS and a symptom inventory questionnaire. RESULTS: The internal consistency of the FAS was 0.91. Using exploratory factor analysis and Mokken scale analysis, the scale was unidimensional. A dichotomous fatigue item distinguished between individuals who scored high or low on the FAS. Concerning discriminant validity, individuals reporting health complaints were more tired. The FAS correlated moderately with a number of neurological and psychological problems. Females and lower educated individuals reported more fatigue. CONCLUSIONS: The Croatian translation of the FAS has good reliability and validity in a sarcoidosis sample. Future research is needed to explore the psychometric qualities (i) of the Croatian FAS in healthy individuals and (ii) of the FAS in other languages.

Adult↗

Development and initial validation of a scale to measure emotional abuse among school children aged 13-15 years in Sri Lanka.

OBJECTIVE: To develop a scale to measure emotional abuse among school children aged 13-15 years in Sri Lanka that can be used in field settings. METHOD: Emotional abuse was defined based on available literature. Review of literature and discussions with a panel identified 85 items indicating abusive behaviors. Content validity and social acceptability were achieved by getting the views of this same panel and parents, respectively. Item analysis and assessment of validity were carried out based on the responses to the draft instrument by 105 children aged 13-15 years attending a school in an urban slum area. The test-retest reliability of the scale was assessed using the responses from 144 students from a different school. Criterion validity was established by comparing the independent assessments of a psychiatrist for the presence or absence of emotional abuse with the respective scores of the children on the scale. RESULTS: The scale developed to assess emotional abuse included 46 items having a Cronbach alpha of .89. The test-retest reliability was .73. A cutoff score of 95 was identified at a sensitivity of 76.9% and a specificity of 51.4%. CONCLUSIONS: A scale that had a satisfactory level of reliability and validity was socially acceptable, which could be used in school settings in Sri Lanka was developed to enable identification of emotional abuse among school children aged 13-15.

Adolescent↗

Validation of social isolation related to maturational age: elderly.

The purpose of this study was to obtain expert validation of the defining characteristics used when diagnosing social isolation in the elderly and to compare these characteristics with those identified in the NANDA Taxonomy I Revised (1990) and the characteristics identified by the investigator through a literature review. A descriptive survey design using Fehring's Diagnostic Content Validity Model and a Q-Sort methodology was used. The sample consisted of 300 registered nurses (68% response rate) selected randomly from the ANA's Council of Gerontology and Community Health. Findings suggest the need for clinical validation of this diagnosis and the possible need for the addition of developmental age categories to the defining characteristics of social isolation.

Adult↗

Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee.

BACKGROUND: The Lysholm knee scale is a condition-specific outcome measure that was originally designed to assess ligament injuries of the knee. The purpose of this study was to determine the psychometric properties of the Lysholm knee scale for various chondral disorders of the knee. METHODS: Test-retest reliability, internal consistency, content validity, criterion validity, construct validity, and responsiveness to change were determined for the Lysholm knee scale within subsets of an overall study population of 1657 patients with chondral disorders of the knee. The study population was a heterogeneous group of patients with various types of traumatic and degenerative chondral lesions, including isolated lesions and those associated with meniscal and ligament injuries. RESULTS: The overall Lysholm knee scale and six of the eight domains had acceptable test-retest reliability (intraclass correlation coefficient = 0.91) and internal consistency (Cronbach alpha = 0.65). The overall Lysholm knee scale demonstrated acceptable floor (0%) and ceiling (0.7%) effects; however, the floor effects for the domain of squatting and the ceiling effects for the domains of limp, instability, support, and locking were unacceptable (>30%). There was acceptable criterion validity with significant (p < 0.05) correlations between the overall Lysholm knee scale and the physical functioning, role-physical, and bodily pain domains of the Short Form-12 scale; the pain, stiffness, and function domains of the Western Ontario and McMaster Universities Osteoarthritis Index; and the Tegner activity scale. The overall Lysholm knee scale had acceptable construct validity, with all nine hypotheses demonstrating significance (p < 0.05), and it had acceptable responsiveness to change (effect size, 1.16; standardized response mean, 1.10), with large effects (> or = 0.80) for the domains of pain, limping, swelling, and squatting and a small effect (> or = 0.20) for the domain of instability. CONCLUSIONS: The Lysholm knee scale demonstrated overall acceptable psychometric performance for outcomes assessment of various chondral disorders of the knee, although some domains demonstrated suboptimal performance. Psychometric testing of other condition-specific knee instruments in patients with chondral disorders of the knee would be helpful to allow for comparison of psychometric properties.

Adult↗

Assessment of neonatal resuscitation skills: a reliable and valid scoring system.

OBJECTIVE: To study the reliability and validity of a scoring instrument for the assessment of neonatal resuscitation skills in a training setting. METHODS: Fourteen paediatric residents performed a neonatal resuscitation on a manikin, while being recorded with a video camera. The videotapes were analysed using an existing scoring instrument with an established face and content validity, adjusted for use in a training setting. Intra- and inter-rater reliability were assessed by comparing the ratings of the videotapes of three raters, one of who rated the videotapes twice. Intra-class coefficients (ICC) were calculated for the sum score, percentages of agreement and kappa coefficients for the individual items. To study construct validity, the performance of a second resuscitation of by residents was assessed after they had received feedback on their first performance. RESULTS: The ICC were 0.95 and 0.77 for intra- and inter-rater reliability, respectively. The median percentage of intra-rater agreement was 100%; inter-rater agreement 78.6-84.0%. The median kappa was 0.85 for intra-rater reliability, and 0.42-0.59 for inter-rater reliability. Residents showed a 10% improvement (95% confidence interval -4; 23%) on performance of a second resuscitation, which supports the instrument's construct validity. CONCLUSION: A useful and valid instrument with good intra-rater and reasonable inter-rater reliability is now available for the assessment of neonatal resuscitation skills in a training setting. Its reliability can be improved by using a more advanced manikin and by training of the raters.

Cardiopulmonary Resuscitation↗

The norwegian version of the psoriasis disability index--a validation and reliability study.

OBJECTIVE: The aim of this study was to translate the Psoriasis Disability Index (PDI) into Norwegian and validate it in a Norwegian setting. The PDI is a measure that was developed to assess the impact of psoriasis on the patient's life. METHODS: Two hundred and eighty-two patients with psoriasis were included in the study (80% outpatients, and 20% hospitalized). RESULTS: Face and content validity were assessed as satisfactory. The PDI seems to capture issues of importance to patients. The results indicate that the PDI does not capture a unidimensional concept. A factor analysis (principal component with orthogonal rotation) resulted in three factors (physical, social, and hygienic) that were substantially different. All three factors had satisfactory internal consistency. Altogether they explained 58% of the variance. In addition, there were differing patterns of correlations with external criteria, such as dimensions of SF-36, as well as with sex, age, and education. CONCLUSIONS: The PDI has been found to have acceptable reliability in this study. However, further validation is necessary to estimate the sensitivity to change.

Journal Article↗

[Development of a questionnaire to measure the effect of urinary incontinence on female sexuality: a reliability and validity study].

OBJECTIVES: This study developed a measure of the degree of the effect of urinary incontinence on female sexuality and tested the reliability and validity of the developed measure. Effect of Urinary Incontinence on Sexuality Questionnaire (EISQ). METHODS: The EISQ was developed from a thorough literature review and interviews of 20 individuals with urinary incontinence who said their incontinence had affected their dyadic relationship. These items were submitted to an analysis of content validity. This work resulted in a 28 items questionnaire that used a 4-point Likert-type response scale. The reliability and validity of the EISQ was tested with 144 women with incontinence who visited out-patient clinic in six hospitals. RESULTS: Cronbach's alpha as the index of internal consistency was high. The EISQ total was 0.90 and alpha ranged from 0.70 to 0.93 for the six subscales. Six factors each with an eigenvalue greater-than-or-equal-to-one were extracted from a principal components factors analysis with varimax rotation. The cumulative percentage of variance explained by this solution was 69.0%. Concurrent validity analyses confirmed our predictions that the EISQ scores were related to Patient Incontinence Stress (ISQ-P) scores. CONCLUSION: The EISQ proved to be reliable and valid as a self-administered measure for assessing the effect of urinary incontinence on female sexuality. The EISQ has demonstrated sufficient psychometric properties to warrant continued study of other samples and to explore the relationship between EISQ and other outcome variables.

Adult↗

The ophthalmic clinical evaluation exercise: reliability determination.

PURPOSE: Reliable and valid tools must be developed to assess the core residency competencies identified by the Accreditation Council for Graduate Medical Education. The Ophthalmic Clinical Evaluation Exercise (OCEX) is a tool designed to assess the ophthalmology resident's competence in patient care. The OCEX has been shown to have face and content validity. This study will determine the degree to which the OCEX is reliable and has construct validity. PARTICIPANTS: Ninety-four academic ophthalmology teaching faculty from ophthalmology residency programs across the country. METHODS: Participants reviewed a video compact disc of the same resident and new patient encounter and then completed the OCEX. A scoring rubric was provided. RESULTS: Results indicate that the OCEX is a reliable tool for faculty to use to assess residency competency. The coefficient alpha statistic (a measure of reliability/internal consistency) for the OCEX as a whole was 0.81. The alpha statistics for 3 of 4 subscales that comprise the OCEX (i.e., interviewing skills = 0.65, interpersonal skills/professionalism = 0.73, case presentation = 0.70) were lower than the OCEX as a whole, but were acceptable for new scales. However, the alpha for the examination subscale (i.e., 0.27) was extremely low. Interrater reliability assessment shows that of 33 individual OCEX items, 31 (94%) had at least 85% of the raters rating the student in 1 of 2 consecutive rating categories. CONCLUSIONS: The OCEX shows both reliability and validity and, therefore, meets the Accreditation Council for Graduate Medical Education criteria for an acceptable assessment tool.

Accreditation↗

The significant other version of the Pain Catastrophizing Scale (PCS-S): preliminary validation.

Researchers have hypothesized that pain catastrophizing has a social function. Although work has focused on the catastrophizing of individuals with chronic pain (ICPs), little is known about the pain catastrophizing of their significant others. The purpose of this study was to test the validity of a revised version of the original PCS [Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524.] in which individuals were instructed to report on their own catastrophizing about their significant other's pain. In Study 1, a confirmatory factor analysis was conducted to determine the factor structure of the PCS-Significant Other (PCS-S) in a diverse sample of university undergraduates (n=264). An oblique second-order 3-factor model with two cross-loadings provided the best fit and this model was invariant across gender and racial groups. This factor structure was cross-validated in Study 2 with a second sample of university undergraduates (n=213). Results indicated that the 3-factor structure with two cross-loadings was a viable model of significant others' pain catastrophizing across gender and racial groups. In Study 3, this factor structure was replicated and the content validity of the PCS-S was examined in a sample of adult ICPs and their spouses (n=111). Spouse catastrophizing was related to ICP pain severity and interference as well as both spouses' depressive symptoms. In addition, ICPs were at a greater risk for psychological distress when both spouses had higher levels of catastrophizing. The PCS-S has the potential to be a useful and valid measure of pain catastrophizing in the significant others of ICPs.

Adult↗

Psychometric evaluation of the Hemodialysis Stressor Scale.

This report updates the psychometric information available on the Hemodialysis Stressor Scale. The tool is a 29-item scale that rates the incidence and severity of stressors associated with hemodialysis treatment of end-stage renal disease. Six items are classified as physiologic stressors and 23 as psychosocial stressors. Alpha homogeneity coefficients achieved acceptable standards for reliability. Content validity is demonstrated by the varied sources used to ascertain pertinent items for the scale. Construct validity of the scale was investigated by factor analysis (N = 174). A two-factor solution to evaluate the validity of the physiological-psychosocial dichotomy showed insufficient support for this simplistic dichotomous classification of hemodialysis stressors. A subsequent unrestricted factor solution to explore the multidimensionality of the scale yielded eight factors, but only three were significant, so a three-factor solution was subjected to rotation. The content of the 6 physiological and 9 psychosocial items loading significantly on Factor I characterized this factor as psychobiological; Factor II consisted of 12 psychological and social stressors; Factor III pertained to 8 dependency and restriction stressors. The three-factor solution was seen as the best-fitting solution with this particular data set because it was conceptually clear, informative, and parsimonious.

Adult↗

Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee.

BACKGROUND: A torn meniscus is one of the most common indications for knee surgery. The purpose of this study was to determine the psychometric properties of the Lysholm knee score and the Tegner activity scale when used for patients with a meniscal injury of the knee. METHODS: Test-retest reliability, content validity, criterion validity, construct validity, and responsiveness to change were determined for the Lysholm score and the Tegner activity scale. Test-retest reliability was measured in a group of 122 patients at least two years after they had undergone surgery for a meniscal lesion. This group completed a follow-up form and then completed it again within four weeks. The other tests were performed in a group of 191 patients who had only a meniscal lesion at the time of the surgery and a group of 477 patients who had a meniscal lesion and other intra-articular lesions. RESULTS: The overall Lysholm score showed acceptable test-retest reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change. There were unacceptable ceiling effects (>30%) for the Lysholm domains of limp, instability, support, and locking. The Tegner activity scale showed acceptable test-retest reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change. CONCLUSIONS: Overall, the Lysholm knee score and the Tegner activity scale demonstrated acceptable psychometric performances as outcome measures for patients with a meniscal injury of the knee. Some domains of the Lysholm score showed suboptimal performance, and the Tegner scale had only a moderate effect size. Psychometric testing of other condition-specific knee instruments for patients with a meniscal lesion of the knee would be helpful to allow comparison of the properties of the various knee instruments.

Humans↗