Summative assessment in general practice. Content validity of video recorded consultations needs to be proved.
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BACKGROUND: Because there are no child-friendly, validated, self-report measures of dyspnea or breathlessness, we developed, and provided initial validation, of three, 7-item, pictorial scales depicting three sub-constructs of dyspnea: throat closing, chest tightness, and effort. METHODS: We developed the three scales (Throat closing, Chest tightness, and Effort) using focus groups with 25 children. Subsequently, seventy-nine children (29 children with asthma, 30 children with cystic fibrosis. and 20 children who were healthy) aged 6 to 18 years rated each picture in each series, using a 0-10 scale. In addition, each child placed each picture in each series on a 100-cm long Visual Analogue Scale, with the anchors "not at all" and "a lot". RESULTS: Children aged eight years or older rated the scales in the correct order 75% to 98% correctly, but children less than 8 years of age performed unreliably. The mean distance between each consecutive item in each pictorial scale was equal. CONCLUSION: Preliminary results revealed that children aged 8 to 18 years understood and used these three scales measuring throat closing, chest tightness, and effort appropriately. The scales appear to accurately measure the construct of breathlessness, at least at an interval level. Additional research applying these scales to clinical situations is warranted.
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Health-related Quality of Life measures are being increasingly considered as tools to aid decisions of health resource allocation, given their potential to comprehensively assess the impact of a given illness or health intervention on the individual. The development of suitable measures requires an understanding of the way external and psychological variables interact to determine subjective well-being and necessitates careful determination of those variables most important to the patient.
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The purpose of the study was to develop and preliminarily test the feasibility, validity, reliability, and factor structures of the Pain Opioid Analgesics Beliefs Scale-Cancer (POABS-CA) in hospitalized adults diagnosed with cancer in Taiwan. This scale was developed in three phases. In Phase I, item development was based on qualitative analysis as well as a review of the literature. Face validity, content validity, and feasibility were also evaluated. In Phase II, internal consistency reliability was further tested in 42 subjects with pain. In Phase III, test-retest reliability, internal consistency, and essential construct validity were further assessed in a sample of 361 hospitalized cancer patients with pain. The POABS-CA evolved from testing as a 10-item 5-point Likert-type instrument. Higher scores indicated more negative beliefs regarding opioids and their use in managing pain. Satisfactory face validity and content validity were found. The POABS-CA was also shown to be a reliable and stable pain belief scale, with Cronbach's alpha and test-retest reliability of 0.70 and 0.94, respectively. Two factors, namely pain endurance beliefs and negative effect beliefs, were extracted from the principal component factor analysis to support the construct validity. In conclusion, preliminary evidence indicates the POABS-CA is a reliable, stable, valid and easily applied scale for assessing beliefs regarding opioid use for cancer pain. Further studies should test this scale in different populations to increase its applications in cancer pain management.
OBJECTIVE: International ASAS consensus statement proposed the use of the BASDAI to evaluate active disease in ankylosing spondylitis patients before the use of anti-TNF agents. To analyze the psychometric properties of the different versions of the BASDAI. METHODS: All versions available in English were analyzed according to the methods developed by the American Psychological Association. Except for the initial version, the procedure of translation was accepted if a translation followed by a back translation was carried out. The psychometric properties analyzed were: face validity, content validity, construct validity (factorial analysis, convergent and divergent validity), reliability (test retest, Cronbach's coefficient alpha), and responsiveness. RESULTS: Except for the German version which was not available in English, the following versions were analyzed: English (En), French (Fr), Swedish (Sw), Spanish (Sp), and Turkish (Tu). The procedure translation was correct in all the versions without taking into account the initial En version. Face validity was validated in all versions. No version initially defined the dimensions for the content validity. Construct validity was partially studied and validated in En, Fr and Sp. Reliability was validated in En, Fr, Tu, and partially in other versions. In all versions, except for the Fr, responsiveness was demonstrated. CONCLUSION: The English version of the BASDAI is the most validated tool. Some efforts had to be made to continue the validation procedure of all versions of the BASDAI. This is an important step for further international comparison.
OBJECTIVE: To validate the Dutch translation of the Canadian Measure of Processes of Care for Service Providers questionnaire (MPOC-SP) for use in paediatric rehabilitation settings in the Netherlands. DESIGN: The construct validity, content validity, face validity, and reliability of the Dutch MPOC-SP were determined. SUBJECTS: The 163 service providers that participated in the validation study represented seven children's rehabilitation centres and affiliated schools in the Netherlands (overall response rate 55.6%). In this sample 19 disciplines were represented. MAIN MEASURES: The MPOC-SP consists of 27 items (assessing four domains) and was designed to examine how service providers think about the quality of care they provide and to assess the extent to which these services are family centred. Fifty-three service providers filled out an additional face validity questionnaire. RESULTS: All items correlated best and significantly with their own scale score (r(s) 0.48-0.82, P<0.001). The Pearson's correlation coefficients were all significant and confirmed that the four scales measure different aspects of a same construct, namely family-centred service. The content validity and the face validity of the Dutch MPOC-SP were good, indicating the questionnaire measures relevant aspects of family-centred service delivery in paediatric rehabilitation settings in the Netherlands. The test-retest analyses (intraclass correlation coefficient (ICC) 0.83-0.89) and the internal consistency analyses (alpha 0.65-0.84) showed that the Dutch MPOC-SP is a reliable tool. CONCLUSIONS: The Dutch MPOC-SP is a reliable and valid instrument to measure the family-centredness of service delivery.
BACKGROUND: A variety of interventions are available to support the caregivers of dementia patients. For the purposes of service planning, we developed an instrument to assess the needs of these caregivers and to determine whether needs are met. The reliability and validity of this new instrument was also investigated. METHODS: The development of the Carers' Needs Assessment for Dementia (CNA-D), was based on in-depth interviews and a focus group. The combined inter-rater and test-retest reliability was investigated among 45 dementia caregivers. Correlations of the CNA-D with the Zarit Burden Inventory were used to analyze concurrent validity. Content validity was investigated by performing a separate survey among 40 caregivers and 40 professionals. RESULTS: The CNA-D is a semi-structured research interview including 18 problem areas. For each problem area, the CNA-D offers several possible interventions. The relevance of the problem areas and the interventions (content validity) was confirmed by most of the study participants. Significant positive associations were found between the total score of the Zarit Burden Inventory and the number of problems and the number of unmet needs according to the CNA-D. The agreement between the interviewers was "excellent" (kappa above 0.75) in 73.7% of the problem areas and in 69.9% of the interventions. CONCLUSIONS: The CNA-D is a valid and reliable instrument for comprehensively assessing the needs of dementia caregivers.
The Employment Standards Act of Ontario and Labour Relations policy in health care organizations require that employment decisions be based on the comparative level of knowledge, skills, abilities, and experience of job applicants. Reliable and valid employment interviews guide employers in that process. A semistructured staff nurse employment interview tool was developed and tested for reliability and validity (content and predictive) on a medical unit in an acute-care hospital setting. Of 25 interview questions evaluated as having content validity based on comparison with the job analysis and Standards of Practice, five (holistic care, assessments of patient's ability to cope, teaching, collaboration, and problem-solving) were identified as having statistically significant relationships with performance outcomes evaluated one year after the initial interview. Total interview test scores were predictive of overall competency in job performance. Those questions evaluated as content valid and as attaining predictive validity were used as the basis for the development of a structured staff nurse employment interview questionnaire.
OBJECTIVES: The McMaster Toronto Arthritis patient preference questionnaire (MACTAR) is a functional index that measures change in impaired activities selected by each patient in a baseline interview, and change in rheumatoid arthritis (RA) disease activity. In addition, it contains questions on the state of physical, social and emotional function and overall health, and their relation to RA. We evaluated MACTAR's feasibility and validity (content validity, construct validity, and responsiveness). METHODS: A randomized trial of combined treatment in 155 patients with early RA; patients' mean age at baseline was 50 years and median disease duration since diagnosis was 4 months. RESULTS: Feasibility: MACTAR requires trained interviewers. In the trial, interviews took about 15 min. In longer term followup, activities selected at baseline may become less relevant as the pattern of disability changes. Followup from 153 patients (99%) was available. At least 5 impaired activities were identified and ranked by 147 patients (95%); interviewers could follow 99% of these. The scoring system proved complex and required amendments. Content validity: Although its main focus is physical function, the MACTAR also contains generic questions; 75% of the patients named at least one impaired activity from the category "mobility." Only 48% were covered by Health Assessment Questionnaire (HAQ) items. Construct validity: MACTAR scores correlate highly with other functional indices and with measures of disease activity. Responsiveness: At 16 weeks the standardized response mean for the total MACTAR score in the combined-treatment group was excellent, at 2.2. Items that directly address change were even more responsive. CONCLUSION: The MACTAR interview is a valid and highly responsive instrument to assess change in functional ability of patients with early RA with active disease. It provides insight into problems--mainly of physical function--that really matter to patients. For standard clinical trials and clinical care, feasibility of the MACTAR is limited and the simpler HAQ remains the instrument of choice.
BACKGROUND AND PURPOSE: The Chronic Fatigue Syndrome-Activities and Participation Questionnaire (CFS-APQ) is a recently developed disease-specific assessment tool for monitoring activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS). In this study, the convergent validity, content validity, and test-retest reliability of data obtained with the Dutch-language version of the questionnaire were examined. SUBJECTS AND METHODS: One hundred eleven consecutive patients with CFS were enrolled, of whom 47 fulfilled all inclusion criteria. The subjects were first asked to rate their pain, fatigue, and ability to concentrate using 3 visual analog scales, to list at least 5 activities that had become difficult to perform due to their complaints, and to complete the CFS-APQ. Furthermore, subjects were asked to complete a modified version of the CFS-APQ at home and return it to the investigators. The content of the questionnaire was reviewed using the World Health Organization's International Classification of Impairments, Disability and Health (ICIDH) beta II draft. Spearman rank correlation coefficients (R) were used for the convergent validity analysis, and intraclass correlation coefficients were computed for the assessment of the test-retest data. RESULTS: Overall scores on the CFS-APQ correlated with the scores from the visual analog scales for pain (R=.51, P<.001) and fatigue (R=.50, P<.001). The majority of the responses (157 out of 183 answers [85.8%]) to the request to "list difficult activities" matched the content of the CFS-APQ. Using the ICIDH beta II draft, 21 out of 26 questions were found to address activities, and the remaining 5 questions measured the participation level. The Cronbach alpha coefficient was.94, and intraclass correlation coefficients for test-retest reliability of the overall scores were >or= .95 (P<.001). DISCUSSION AND CONCLUSION: The results substantiate the convergent validity, content validity, and reliability of the CFS-APQ scores for patients with CFS.
Hostility, a phenomenon that has been linked to cardiovascular disease and all-cause mortality, is often measured by the Cook-Medley hostility (Ho) scale. Although there is an adolescent version of the Ho scale, it has had little testing with only Anglo-American samples. This pilot study tested the reliability and validity of the adolescent version of the Ho scale with a multiethnic sample of adolescents. Sixty adolescents participated. Reliability was measured using Chronbach's alpha. The Ho scale was correlated with the Speilberger State-Trait Anger Expression Inventory (1988) scales to determine concurrent validity. A factor analysis assessed construct validity; content validity was assessed by analyzing tape-recorded descriptions of a circumstance that provoked anger, as remembered by each adolescent. Internal consistency reliability was .75. The hostility measure was most highly correlated with anger expression (r = .62, p = .000) and trait anger (r = .50, p = .000). The factor analysis generated three factors (suspicious alienation, cynical aggression and justified mistrust), that accounted for 34.5% of the variance. The content analysis resulted in five anger-provoking themes: aggression, unfulfilled personal expectations, mistrust/lying, criticism of effort, and rejection. The majority of items in the scale (74%) were related to one of the themes.
The purpose of this paper is to describe the development of the "Compliance of Hypertensive Patients" scale (=CHPS), and assessment of its reliability and validity. Previous scales incorporate only activity in health regimens as indicators of hypertensive patients' compliance. The "Compliance of Hypertensive Patients" scale was developed to incorporate other indicators of compliance also, such as intention, responsibility and collaboration. Data were collected from a convenience sample of 103 patients, in five health care centres in Finland. Dimensionality was explored using principal component analysis and internal consistency was estimated according to a standard item analysis approach and Theta coefficient. Validity was assessed using face validity, content validity and criterion-related validity (through the use of concurrent validity). The data supported five subscales, labelled: lifestyle, intention, attitude, responsibility and smoking. Inter-item correlations ranged from 0.24 to 0.61 and corrected item-total correlations from 0.32 to 0.67, across subscales. The Theta coefficient demonstrated good internal consistency. This scale forms a useful starting point in the development of a reliable and valid tool to assess compliance of hypertensive patients, based on several indicators.