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Certification examinations for massage therapists: a psychometric analysis.

OBJECTIVE: To describe the components of the Alberta Registered Massage Therapists Society (ARMTS) examination and their psychometric properties. METHODS: All 3 components of the ARMTS examination (knowledge, clinical judgement, and clinical skills) were administered to 112 candidates. The examination consisted of 2 written components (140 multiple-choice questions on basic science knowledge and 60 multiple-choice questions on clinical judgment) and a clinical competency assessment of the following practical skills with standardized patients: (1) taking a case history, (2) assessing physical condition, and (3) treating the condition. All components of the examination were criterion-referenced with the methods of minimum performance level (MPL). RESULTS: The internal consistency reliability coefficients (Cronbach alpha) ranged from 0.60 to 0.88 for all test components. The descriptive statistics, performance levels, and reliability estimates indicate that the examination is functioning well. Concurrent, criterion-related validity evidence was provided by correlations between the examination components that ranged from r = 0.24 (P <.05) to r = 0.78 (P <.01). Factor analysis produced 3 factors: information processing, clinical treatment, and follow-up management. CONCLUSIONS: The results provide evidence of adequate-to-good internal consistency reliability and content validity. Empirical validity evidence based on concurrent, criterion-related measures is provided by the correlational analysis. The significant correlations indicate that although performance is related across the examination, the various components do assess unique and independent domains. This is further supported by the results of the factor analysis that provide evidence for discriminant validity of the measures (ie, they discriminate between domains of measurement such as information processing, treatment, and basic knowledge). Taken together, these results indicate that the ARMTS examination has evidence for both reliability and validity.

Canada↗

Development of a youth survey to measure risk behaviors, attitudes and assets: examining multiple influences.

Currently, most surveys assessing adolescent health concerns focus primarily on risk behaviors and negative influences rather than positive influences such as assets. The purpose of this paper is to describe the development and validation of the Adolescent Health Attitude and Behavior Survey (AHABS). This instrument was developed to measure the prevalence of youth health risk behaviors, attitudes towards adolescent sexual behavior and youth assets in a statewide evaluation effort. The questionnaire was completed by 4368 public high school students in Grades 9-12. Content validity was established through an extensive review of literature, a group process and factor analyses. Reliability was established through Cronbach's alpha coefficients. Factor loadings ranged from 0.48 to 0.84 for scales measuring attitudes towards adolescent sexual behavior and alpha coefficients ranged from 0.61 to 0.81. Factor loadings ranged from 0.34 to 0.90 for scales measuring youth assets and alpha coefficients ranged from 0.69 to 0.85. Because of several limitations (e.g. construct validity was not measured), additional development work is needed. Therefore, the AHABS is still in a developing, but promising, state. Additional psychometric work will provide program practitioners and evaluators with a psychometrically sound tool to measure behaviors, attitudes and assets.

Adolescent↗

Testing the reliability and validity of computer-mediated social support measures among older adults: a pilot study.

With the increasing number of older adult online users, the Internet and e-mail are becoming a new source of social support for older adults. To assess this computer-mediated social support, two traditional social support measures were modified: (1) the Lubben Social Network Scale and (2) the Medical Outcomes Study Social Support Survey. The purpose of this pilot study was to test the reliability and validity of these modified measures. This study was a single group descriptive study with two data collection points. Data were collected using Web surveys. A total of 38 older adult participants completed the first survey; 35, the second survey. The findings of this preliminary study provided evidence for the reliability, content validity, and, to a limited extent, construct validity, of the modified measures. Additional studies with a larger representative sample are needed to further examine the psychometric aspects of these measures.

Aged↗

Assessing clinical competence: a pilot project to evaluate the feasibility of a standardized patient -- based practical examination as a component of the Swiss certification process.

PURPOSE: advances in the assessment of clinical competence have prompted medical schools and licensing authorities to complement written and oral tests with practical ones. The purposes of this project were to (1) determine how clinical competencies not effectively addressed on the present Swiss federal examinations can be assessed adequately on a standardised patient-based practical examination (SCE) and (2) evaluate the SCE validity, reliability and feasibility. METHOD: a bilingual, three-hour standardised patient-based clinical examination was pilot tested in 2003 with 48 volunteered fifth and sixth-year students from the five Swiss medical schools. All students took the same eight 15-minute patient cases. To ensure the test content validity, test cases were selected by a multi-disciplinary and -institutional committee of clinical faculty on the basis of predefined exam blueprint criteria and in reference to the Swiss catalogue of learning objectives. RESULTS: moderate correlations between the SCE and the existing Federal final written examinations (0.46) and the newly pilot-tested structured oral examination or SOE (0.56) [3] suggested that they were complementary to one another and that each might emphasise aspects of the clinical competence which others might not. The reliability (a coefficient) of the SCE scores ranged from 0.73 to 0.77. CONCLUSIONS: limited experiences gathered throughout the SCE pilot project demonstrated its feasibility. Preliminary results suggested that SCE scores had a good level of construct validity and reliability and seemed to complement scores obtained on the final certification written examinations and the newly tested SOE. These results, however, need to be further confirmed with larger samples studies.

Certification↗

Validity of the patient-focused wrist outcome instrument: do impairments represent functional ability?

The development of outcome instruments has been reported to be a long process, often taking years to complete. In a previous article, we reported on the rationale behind the construction of a new wrist outcome instrument that assesses, from the wrist-injured individual's perspective, their ability to perform activities of daily living following a wrist disorder. Content validity and test-retest reliability of the wrist outcome instrument also was demonstrated. Here we report on the results of the assessment of other aspects of validity, specifically construct validity of the wrist outcome instrument and the ability of the instrument to detect change over time. We evaluated these psychometric properties against frequently used clinical tests that assess impairments and thus report on the relationship between the ability to perform activities of daily living and impairment measures.

Activities of Daily Living↗

Development and validation of an instrument for characterizing food-related behavior.

An instrument for differentiating between individuals exhibiting conformist and nonconformist or nontraditional food consumption patterns was developed and used for recruitment and identification of respondents for a study of food-related behavior and attitudes. The instrument was designed so that use or nonuse of only one or two foods or food groups was not sufficient to establish the food consumption pattern. Content validity was established by an expert panel. Additional data collected during the study served to demonstrate that the instrument had predictive validity for identification of individuals who followed alternative food consumption patterns. Respondents were asked to indicate their preferred food practices; their designation was related to classification by the Food-Related Behavior Characterization Instrument. Patterns of food exclusion and of frequency of consumption of 35 foods and food groups were consistent with classifications as conformists or nonconformists. In addition to research applications, this instrument may be a valuable tool in clinical settings and for community assessment. Although it is not a substitute for a more detailed dietary history, rapid identification of nonconforming food-related behavior is possible with the Food-Related Behavior Characterization Instrument.

Adolescent↗

Utilization of research methodology in designing and developing an interdisciplinary course in ethics.

Development research methodology was utilized to design an interdisciplinary ethics course for students from seven disciplines: dental hygiene, nursing, nurse anesthesia, occupational therapy, physician assistant, physical therapy, and social work. Two research questions, 'What content areas should be considered for inclusion in an interdisciplinary course in Ethics?' and 'What design framework, format, or structure would best fit the content chosen?' guided the study. An interdisciplinary faculty design team conducted a comparative analysis of each of the seven discipline's codes of ethics to find common topics of interest. Further analysis then grouped these topics into eight categories of professional responsibility. The result was a fifteen-week course with validated content relevant to all disciplines.

Bioethics↗

Development of validated instrument to measure medical student learning in clinical urology: a step toward evidence based education.

PURPOSE: To date published efforts to assess and improve medical student learning in urology have been limited due to the lack of an assessment tool with which to measure student learning. We report the development of a validated measure of medical student learning in urology. MATERIALS AND METHODS: Four core topics in clinical urology were selected as the focus of the test development, namely prostate cancer, screening with prostate specific antigen, benign prostatic hyperplasia and erectile dysfunction. Detailed curricula and multiple choice questions were created for each topic. Content validity of the curriculum and 28 item examination was established by a panel of 2 urologists and 2 medical physicians. Instrument reliability was determined by administering the test on line to third-year surgery students. Test construct validity was established through its administration to 19 urology residents and attending physicians. RESULTS: Reliability of the 28-item test instrument was measured by Cronbach's alpha at 0.76 and its 1-week test-retest reliability was 0.72. All urology experts performed well on the test. Mean urological expert scores were significantly higher than mean student post-test scores (24.9 +/- 2.1 vs 17.8 +/- 3.8, 2-tailed t test p <0.001). Urological experts with greater urological training had higher scores than those with less residency training. CONCLUSIONS: This study documents the development of a validated measure of medical student learning in urology. This validated instrument has the potential to improve educational quality control at medical schools and facilitate the development of effective, evidence based teaching methods.

Adult↗

Test of an instrument to measure function-related quality of life in patients with ulcerative colitis.

An instrument for measuring function-related quality of life (QOL) in patients with ulcerative colitis was tested for validity, reliability, and responsiveness, using concepts and statistical methods easily understandable for pharmaceutical researchers. For this 8-week study, 374 patients were randomised and received placebo or oral mesalazine (mesalamine) at 1g, 2g, or 4g daily. A 10cm visual analogue scale and patient diaries were used to measure the 12 QOL parameters at baseline and study termination. Physician's Global Assessment was measured at end-point and used to assess change in the disease state of each patient. Analysis of covariance was used to test the construct validity, reliability and responsiveness of the instrument. Construct validity (p less than or equal to 0.0001), reliability (p greater than 0.05), and responsiveness (p less than or equal to 0.0001) were established for all 12 parameters of the instrument. We conclude that the instrument demonstrated precision in measuring function-related QOL in patients with active ulcerative colitis. Furthermore, content validity was maximised by combining disease-specific and general questions in the instrument.

Adult↗

VEINES-QOL/Sym questionnaire was a reliable and valid disease-specific quality of life measure for deep venous thrombosis.

OBJECTIVE: To assess the validity of VEINES-QOL/Sym, a patient-reported questionnaire to evaluate quality of life and symptoms in patients with deep venous thrombosis (DVT). STUDY DESIGN AND SETTING: Psychometric study within the Venous Thrombosis Outcomes (VETO) Study, a prospective cohort study of long-term outcomes after DVT. A total of 359 English- and French-speaking patients with acute, objectively diagnosed DVT were recruited at seven hospitals in Quebec, Canada. The VEINES-QOL/Sym questionnaire, a 26-item patient-reported measure that generates separate summary scores for symptoms (VEINES-Sym) and quality of life (VEINES-QOL) was evaluated for acceptability, reliability, validity, and responsiveness in VETO Study subjects. RESULTS: Standard psychometric tests confirmed the acceptability (missing data, item endorsement frequencies, floor and ceiling effects), reliability (internal consistency, item-total and inter-item correlations, test-retest), validity (content, construct, convergent, discriminant, known groups), and responsiveness to clinical change of the VEINES-QOL/Sym in patients with DVT. CONCLUSION: The VEINES-QOL/Sym is a practical and scientifically sound patient-reported measure of outcomes that was developed using gold-standard methods. VEINES-QOL/Sym is valid and reliable for use as a measure of quality of life and symptoms in patients with acute DVT and provides a rigorous tool to allow more comprehensive evaluation of outcomes in clinical trials and epidemiological studies of patients with DVT.

Acute Disease↗

Development and psychometric testing of a symptom index for pelvic organ prolapse.

A wide range of symptoms are commonly ascribed to pelvic organ prolapse including pain, awareness of lump, bowel, bladder and sexual dysfunction. The aim of this work was to develop and validate an instrument to quantify symptoms related to pelvic organ prolapse. Consultation with symptomatic women and specialists in coloproctology, urology, gynaecology and sexual health resulted in a questionnaire with 25 questions. In total, 203 women participated in a psychometric testing of this instrument, 152 cases with prolapse and 51 controls without. The content validity, criterion validity, reliability and responsiveness of the questionnaire were evaluated. The questionnaire proved a reliable and valid instrument for the assessment of symptoms related to uterovaginal prolapse. It is also sensitive to change.

Case-Control Studies↗

Development and testing of the caregiver reciprocity scale.

The purpose of this study was to develop and validate the dimensions of caregiver reciprocity. Social exchange and equity theory served as a conceptual framework for examining recprocal intergenerational exchanges of assistance and support. In the first phase of the study, 12 caregivers of elderly parents, including in-laws, were interviewed to provide narrative data from which items were developed. Content validity was judged by two separate panels of experts. The revised CRS was tested with 303 adult children for reliability and validity, including internal consistency, test-retest reliability, exploratory factor analysis, and convergent and discriminant validity testing using structural equation modeling. Support for construct validity was demonstrated for four factors: Warmth and Regard, Intrinsic Rewards of Giving, Love and Affection, and Balance within Family Caregiving.

Aged↗

The Japanese version of Skindex-16: a brief quality-of-life measure for patients with skin diseases.

A practical quality-of-life measure applicable to patients with skin diseases is necessary. Recently developed dermatological quality-of-life measures must be translated and adapted for use in cultures other than the ones in which they were created. In this study, we translated and adapted culturally into Japanese a skin-disease-specific, brief quality-of-life measure, Skindex-16, and studied its reliability and validity. Forward-and back-translations of Skindex-16 were carried out. Six doubtful items as well as the term "skin condition" required a second forward- and back-translation to reach satisfactory agreement with the original instrument. Cross-cultural adaptation and cross-sectional questionnaire studies were then performed to evaluate the reliability and validity of the instrument. One hundred patients and 30 healthy adults responded to the Japanese version. The internal-consistency reliability of the final Japanese version of Skindex-16 was high (range of Cronbach's alpha for each scale, symptoms, emotions, and functioning, was 0.83-0.92). The Japanese version showed construct and content validity. As hypothesized, scores for dermatological patients were higher than those for healthy persons (mean global scores 36 +/- 23 vs 1 +/- 2, p < 0.001) and scores for patients with inflammatory diseases were higher than those for patients with isolated skin lesions (mean global scores 48 +/- 21 vs 22 +/- 17, p < 0.001), indicating a poorer quality of life. Most patients' responses to an open-ended question about their skin disease were similar to those of the American responders and were addressed according to the items. In conclusion, we have developed a semantically equivalent translation of Skindex-16 into Japanese. It is a reliable and valid measure of the effects of skin disease on the quality of life in Japanese patients.

Adaptation, Psychological↗

[Reliability and validity of the modified Perceived Health Competence Scale (PHCS) Japanese version].

PURPOSE: In community and workplace health plans, the Perceived Health Competence Scale (PHCS) is employed as an index of health competency. The purpose of this research was to examine the reliability and validity of a modified Japanese PHCS. METHODS: Interviews were sought with 3,000 randomly selected Japanese individuals using a two-step stratified method. Valid PHCS responses were obtained from 1,910 individuals, yielding a 63.7% response rate. Reliability was assessed using Cronbach's alpha coefficient (henceforth, alpha) to evaluate internal consistency, and by employing item-total correlation and alpha coefficient analyses to assess the effect of removal of variables from the model. To examine content validity, we assessed the correlation between the PHCS score and four respondent attribute characteristics, that is, sex, age, the presence of chronic disease, and the existence of chronic disease at age 18. The correlation between PHCS score and commonly employed healthy lifestyle indices was examined to assess construct validity. General linear model statistical analysis was employed. RESULTS: The modified Japanese PHCS demonstrated a satisfactory alpha coefficient of 0.869. Moreover, reliability was confirmed by item-total correlation and alpha coefficient analyses after removal of variables from the model. Differences in PHCS scores were seen between individuals 60 years and older, and younger individuals. These with current chronic disease, or who had had a chronic disease at age 18, tended to have lower PHCS scores. After controlling for the presence of current or age 18 chronic disease, age, and sex, significant correlations were seen between PHCS scores and tobacco use, dietary habits, and exercise, but not alcohol use or frequency of medical consultation. CONCLUSION: This study supports the reliability and validity, and hence supports the use, of the modified Japanese PHCS. Future longitudinal research is needed to evaluate the predictive power of modified Japanese PHCS scores, to examine factors influencing the development of perceived health competence, and to assess the effects of interventions on perceived health competence.

Adult↗

[Cultural adaptation and validation of the "Fibromyalgia Impact Questionnaire"--Portuguese version].

The aim of this study was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Portuguese (Portugal) and to evaluate its reliability and validity by use with Portuguese--speaking patients with Fibromyalgia. After translating the FIQ into Portuguese we administered it to 68 patients with Fibromyalgia together with an informed consent, a Portuguese version of the Health Assessment Questionnaire (HAQ) and a formulary with the socio-demographic characteristics and duration of the complaints. The content validity was assessed with a panel of experts, with high consensus. In the concurrent validity, we obtained significant correlations between the FIQ first item and the HAQ [r = 0,531 (p = 0,001)]. Cronbach's alpha was 0,814, indicating an acceptable level of internal consistency. In conclusion, the Portuguese version of the FIQ is a reliable and valid instrument for measuring health status and physical functioning in Portuguese patients with Fibromyalgia. This instrument is available for use in the clinical practice.

Adult↗

Can care of elderly be measured? A method for estimating the individual care of recipients in community health care.

BACKGROUND: Almost every country in the Western world has great difficulties allocating enough financial resources to meet the needs in the care of the increasing elderly population. The main problem is common to all countries and concerns the efforts to meet elderly persons' needs on an individual level while still maintaining society's responsibility for distributing justice. The aim of this study is to elaborate an instrument for measuring the quality of individual care and staff's working time in order to allocate public resources fairly. The present study gives an account of a new classification system named TiC (Time in Care), indicating how it can be used most effectively and also investigating the validity and reliability of the system. METHODS: All recipients in 13 sheltered homes for elderly care (n = 505) in a Swedish municipality were surveyed regarding the care they needed, in dimensions of General Care, Medical Care, Cognitive Dysfunction and Rehabilitation, and the time required. Construct validity was assessed by means of factor analysis. The inter-rater agreement of two raters concerning 79 recipients was measured using weighted Kappa. The stability of the instrument and its sensitivity to change were investigated through test-retest reliability measurements, conducted once a month during a six-month period. The content validity of the instrument was also assessed. RESULTS: Factor analysis resulted in a reduction of the number of items from 25 to 16 in three dimensions: General Care, Medical Care and Cognitive Dysfunction. The Kappa analysis showed satisfactory to excellent inter-rater agreement. The care need scores were basically stable but showed sensitivity to change in health status. CONCLUSION: The instrument was found to be useful and reliable for assessing individual needs in community health care.

Aged↗

Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community.

BACKGROUND: The Health of the Nation Outcome Scales (HoNOS) have been developed for assessing the effectiveness of mental health services. AIMS: To investigate the validity and reliability of the HoNOS in patients in contact with mental health services. METHOD: Subjects (age range 19-64) came from day hospitals, acute in-patient units and out-patient clinics in general practice. We obtained the opinions of experienced professionals, advocacy groups and patient groups to evaluate consensual and content validity. RESULTS: One hundred patients were assessed using the package of rating scales. Interrater and test-retest reliability were good for some items and poor for others. The HoNOS had good criterion validity: acute in-patients had higher scores than day patients and out-patients. HoNOS also had good concurrent validity, correlating well with other scales. Comments suggested that the HoNOS was a useful and suitable scale for this population but psychotic symptoms and certain social factors were not sufficiently covered. CONCLUSION: The HoNOS had good validity but variable reliability. It may be better than existing scales because of the wide range of areas which it covers.

Activities of Daily Living↗

[Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Results from German samples].

BACKGROUND: The Beck Depression Inventory (BDI) underwent revision in 1996 (BDI-II) with the goal of addressing DSM-IV depression criteria. The present study assessed psychometric properties of the German version of the BDI-II. PATIENTS AND METHODS: The BDI-II was translated into German and evaluated in a series of studies with clinical and nonclinical samples. RESULTS: The content validity of the BDI-II has improved by following DSM-IV symptom criteria. Internal consistency was satisfactorily high (alpha>or=0.84), and retest reliability exceeded r>or=0.75 in nonclinical samples. Associations with construct-related scales (depression, dysfunctional cognitive constructs) were high, while those with nonsymptomatic personality assessment (NEO-FFI) were lower. The BDI-II differentiated well between different grades of depression and was sensitive to change. CONCLUSION: The German BDI-II demonstrates good reliability and validity in clinical and nonclinical samples. It may now replace the older version of the BDI for assessing self-rated severity of depression and course of depressed symptoms under treatment.

Adolescent↗