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An on-site test battery to evaluate giant slalom skiing performance.

The purpose of this study was to determine if an on-site test battery would distinguish among three levels of giant slalom skiing ability. The test battery consisted of a 20-m shuttle run test, Wingate 60s cycling test, hexagonal obstacle test, high box test, double leg jumping test and vertical jump test. These tests were selected since previous studies have identified aerobic endurance, anaerobic endurance, power and agility as important components for Alpine skiers. Both construct validity and criterion related validity of the test battery were examined using data from 11 club skiers, 14 divisional level skiers, and 9 provincial level skiers. To establish construct validity, univariate F tests examined differences among the three levels of skiers. Significant (P less than 0.05) differences were found between the club skiers and the better skiers (divisional and provincial level) for the following test variables: peak power, mean power, and post-exercise lactate for a 60s Wingate cycle ergometer test, high box test, hexagonal obstacle test, double leg jumping test, and shuttle run test. Criterion related validity was established since there were significant correlations between giant slalom performance time and the hexagonal obstacle test (r = 0.82), high box test (r = -0.80), and double leg jumping (r = -0.86). These data illustrate that an on-site test battery can be used to distinguish among giant slalom Alpine skiers.

Adolescent↗

Validity of the MISTELS simulator for laparoscopy training in urology.

BACKGROUND AND PURPOSE: The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) consists of a series of five laparoscopic exercises performed in an endotrainer box. MISTELS has been validated for use in both training and evaluation of general surgery residents in fundamental laparoscopic skills. The purpose of this study was to demonstrate the construct validity of MISTELS for urology residents. SUBJECTS AND METHODS: Seventeen participants were evaluated during performance of the five MISTELS tasks (peg transfer, pattern cutting, ligating loop, and suturing with extracorporeal and intracorporeal knots) using the standardized scoring system, which rewards both speed and precision. Participants included 13 urology residents (PGY 1-5), 1 fellow, and 3 urologists experienced in laparoscopy. Results are expressed as median (range). The Mann-Whitney U-test was used to compare MISTELS scores for 9 novice (PGY 1-4) and 8 experienced urologists (PGY 5-attending). P < 0.05 was considered statistically significant. RESULTS: The median MISTELS total normalized score for novices was 52.3 (range 15-68.9) compared with 71.7 (range 56.3-82.9) for experienced urologists (P = 0.007). Although the experienced group achieved higher scores in all five individual tasks, statistically significant differences were demonstrated for the peg transfer and intracorporeal suture tasks only. CONCLUSION: These data provide evidence for construct validity of the MISTELS system for urology residents.

Education, Medical, Graduate↗

Validity and reliability of a pediatric reach test.

PURPOSE: The purpose of this study was to develop and evaluate the validity and reliability of a Pediatric Reach Test (PRT). METHODS: The Functional Reach Test was modified to incorporate side reaching in addition to forward reaching in both sitting and standing. Nineteen children developing typically (age 3.0 to 12.5 years) completed the standing section of the PRT as well as laboratory force platform tests of standing balance. On two separate occasions, two different raters evaluated 10 children with cerebral palsy (age 2.6 to 14.1 years) in both the sitting and standing sections of the PRT. RESULTS: Concurrent validity was supported with the observation of moderate-to-high correlations between the standing section of the PRT and laboratory tests of limits of stability (r = 0.42 to 0.77). Construct validity was supported with the observation of high correlations between the standing section of the PRT and a laboratory test of steadiness in quiet stance (r = -0.79) and age (r = 0.83). Construct validity was also supported with a high correlation between the total PRT score and Gross Motor Function Classification System level (rs = -0.88) among the sample of children with cerebral palsy. Test-retest reliability and inter-tester reliability with children with cerebral palsy ranged from intraclass correlation coefficients of 0.54 to 0.88 and 0.50 to 0.93, respectively. CONCLUSIONS: This study provides evidence that the PRT is a simple, valid, and reliable measure with potential for use with children.

Journal Article↗

Evaluating instruments for quality: testing convergent validity of the consumer emergency care satisfaction scale.

Having reliable and valid instruments is a necessity for nurses and others measuring concepts such as patient satisfaction. The purpose of this article is to describe the use of convergence to test the construct validity of the Davis Consumer Emergency Care Satisfaction Scale (CECSS). Results indicate convergence of the CECSS with the Risser Patient Satisfaction Scale and 2 single-item visual analogue scales, therefore supporting construct validity. Persons measuring patient satisfaction with nurse behaviors in the emergency department can confidently use the CECSS.

Adolescent↗

A validation of the functional independence measurement and its performance among rehabilitation inpatients.

The Functional Independence Measurement (FIM) is a new functional status instrument for use among rehabilitation inpatients, but its validity and reliability have been only partially established. Because of its rapid dissemination, we sought further evidence concerning the FIM's internal consistency, responsiveness over time, and construct validity. We examined Uniform Data System (UDS) data on 11,102 general rehabilitation inpatients from the Pacific Northwest. Mean age was 65 and 51% were male. The most common diagnoses were stroke (52%), orthopedic conditions (10%), and brain injury (10%). Internal consistency of the FIM was calculated using Cronbach's alpha. To assess FIM responsiveness, we examined differences between admission and discharge FIM scores. For construct validation purposes, we hypothesized that the FIM would vary with age, comorbidity, discharge destination, and impairment severity. Comorbidity was quantified with the Charlson Comorbidity Index. The FIM had a high overall internal consistency (discharge FIM alpha = .93). The FIM registered significant functional gains during rehabilitation (33% FIM score improvement, p < .001), as do many other functional status indicators. The greatest and least functional improvements were observed for traumatic brain injury and low back pain (53% and 8% FIM score improvement, respectively). The FIM discriminates patients on the basis of age, comorbidity, and discharge destination. Severity differences could be distinguished among spinal cord injury and stroke patients. We conclude that the FIM has high internal consistency and adequate discriminative capabilities for rehabilitation patients. It is a good indicator of burden of care, and demonstrates some responsiveness, but its capacity to measure change over time needs further examination and comparison with competing scales.

Aged↗

Development and validation of an instrument to determine patient knowledge: the oral anticoagulation knowledge test.

BACKGROUND: Studies examining the relationship between patient knowledge regarding warfarin therapy and its safe and effective use are limited by the lack of validated knowledge assessment tools. OBJECTIVE: To develop and validate an instrument to assess patient knowledge regarding oral anticoagulation therapy. METHODS: Four nationally recognized anticoagulation experts participated in the instrument development process to ensure content validity. The Oral Anticoagulation Knowledge (OAK) test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin to assess construct validity. A subgroup of warfarin subjects were retested approximately 2-3 months after initial testing to assess test-retest reliability. Internal consistency reliability was assessed by calculating a Kuder-Richardson 20 value. Item analysis was used to assess performance of individual questions. RESULTS: An initial 23 item instrument was pilot tested for readability and comprehension. The OAK test was administered to 74 subjects taking warfarin and 27 age-matched subjects not on warfarin. Thirty-two subjects on warfarin repeated the OAK test an average of 75 days following initial administration. Subjects taking warfarin scored significantly higher than those not on warfarin (72% vs 52%, respectively; p < 0.001), supporting the construct validity of the instrument. Test-retest reliability was acceptable, with a Pearson's correlation coefficient of 0.81. Internal consistency reliability was confirmed by a calculated Kuder-Richardson 20 value of 0.76. CONCLUSIONS: The OAK test is a brief, valid, and reliable knowledge assessment instrument that may be a useful tool for research and clinical practice to augment patient education programs.

Adult↗

Development of the purposeful action medication-taking questionnaire.

This three-phase study describes the development and psychometric properties of the Medication-Taking Questionnaire (MTQ) to measure the purposeful action domain (reasons individuals decide to accept medication treatment) in the medication adherence model for hypertension. During Phase I, items were evaluated for content validity and clarity. Item analysis, internal consistency, and exploratory factor analysis were preformed during Phase II to finalize the MTQ: Purposeful Action as 12 items and 2 subscales (treatment benefits and medication safety). Phase III evaluated the MTQ: Purposeful Action for temporal stability and construct validity. The final version MTQ: Purposeful Action demonstrated good internal consistency, temporal stability, and construct validity. The MTQ: Purposeful Action appears to have good psychometric characteristics that represent the decision-making process for adherence in medication treatment for hypertension.

Adult↗

Cross-cultural validation of an international questionnaire, the General Measure of the Functional Assessment of Cancer Therapy scale (FACT-G), for Japanese.

The General Measure of the Functional Assessment of Cancer Therapy scale (FACT-G) was developed in an English-speaking culture (USA). To determine if FACT-G could be used in Japan, a cross-cultural validation was performed. The Japanese version was created through an iterative forward-backward translation sequence used throughout the FACT multi-lingual translation project. In evaluating psychometric testing, its construct validity was investigated by factor analysis and multi-trait scaling analysis. Clinical validity was estimated by known-groups comparison using stage, performance score (PS) and patient location, and validated longitudinally by PS. The FACT-G (version 3) was given to 180 patients with lung cancer. Analyses showed that the scales of Physical, Functional, Emotional Well-Being, and Relationship with Doctors were constructively valid in Japan. Japanese patients felt that familial relationships were different than those with friends and neighbors, indicating that the Social/Family Well-Being scale needed cultural adaptation. Two items concerning coping with illness and acceptance of illness did not load predictably onto their respective scales and were considered to be cross-culturally problematic. However, clinical validity demonstrated its sensitivity. Japanese version 4 has been improved to address the weakness in an attempt to become an instrument that is applicable across cultures.

Adult↗

Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty.

BACKGROUND: Cross cultural validity is of vital importance for international comparisons. OBJECTIVE: To investigate the validity of international Dutch-English comparisons when using the Dutch translation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). PATIENTS AND METHODS: The dimensionality, reliability, construct validity, and cross cultural equivalence of the Dutch WOMAC in Dutch and Canadian patients waiting for primary total hip arthroplasty was investigated. Unidimensionality and cross cultural equivalence was quantified by principal component and Rasch analysis. Intratest reliability was quantified with Cronbach's alpha, and test-retest reliability with the intraclass correlation coefficient. Construct validity was quantified by correlating sum scores of the Dutch WOMAC, Arthritis Impact Measurement Scales (Dutch AIMS2), Health Assessment Questionnaire (Dutch HAQ), and Harris Hip Score (Dutch HHS). RESULTS: The WOMAC was completed by 180 Dutch and 244 English speaking Canadian patients. Unidimensionality of the Dutch WOMAC was confirmed by principal component and Rasch analysis (good fit for 20/22 items). The intratest reliability of the Dutch WOMAC for pain and physical functioning was 0.88 and 0.96, whereas the test-retest reliability was 0.77 and 0.92, respectively. Dutch WOMAC pain sum score correlated 0.69 with Dutch HAQ pain, and 0.39 with Dutch HHS pain. Dutch WOMAC physical functioning sum score correlated 0.46 with Dutch AIMS2 mobility, 0.62 with Dutch AIMS2 walking and bending, 0.67 with Dutch HAQ disability, and 0.49 with Dutch HHS function. Differential item functioning (DIF) was shown for 6/22 Dutch items. CONCLUSIONS: The Dutch WOMAC permits valid international Dutch-English comparisons after correction for DIF.

Aged↗

Validity of measures of pain and symptoms in HIV/AIDS infected households in resources poor settings: results from the Dominican Republic and Cambodia.

BACKGROUND: HIV/AIDS treatment programs are currently being mounted in many developing nations that include palliative care services. While measures of palliative care have been developed and validated for resource rich settings, very little work exists to support an understanding of measurement for Africa, Latin America or Asia. METHODS: This study investigates the construct validity of measures of reported pain, pain control, symptoms and symptom control in areas with high HIV-infected prevalence in Dominican Republic and Cambodia Measures were adapted from the POS (Palliative Outcome Scale). Households were selected through purposive sampling from networks of people living with HIV/AIDS. Consistencies in patterns in the data were tested used Chi Square and Mantel Haenszel tests. RESULTS: The sample persons who reported chronic illness were much more likely to report pain and symptoms compared to those not chronically ill. When controlling for the degrees of pain, pain control did not differ between the chronically ill and non-chronically ill using a Mantel Haenszel test in both countries. Similar results were found for reported symptoms and symptom control for the Dominican Republic. These findings broadly support the construct validity of an adapted version of the POS in these two less developed countries. CONCLUSION: The results of the study suggest that the selected measures can usefully be incorporated into population-based surveys and evaluation tools needed to monitor palliative care and used in settings with high HIV/AIDS prevalence.

Journal Article↗

Validity of self-reports of alcohol and other drug use: a multitrait-multimethod assessment.

Four methods (self-reported rating, self-reported intake, peer-reported rating, peer-reported intake) and multiple analytical criteria were employed to assess the construct validity of reports of three types of substance use (alcohol, marijuana, and cigarettes) in a study of 194 college students who were members of friendship pairs. The resulting multitrait-multimethod matrix was analyzed in the traditional fashion as well as with confirmatory factor analysis. Convergent and discriminant validity for the three substance use traits were quite adequate, although the validity of one measure (the peer-reported intake measure of alcohol use) may be considered inadequate according to some criteria. This study demonstrates the usefulness of multimethod assessment and confirmatory factor analysis for research on construct validity and for derivation of more accurate measures of drug use.

Adolescent↗

The Cumberland ankle instability tool: a report of validity and reliability testing.

OBJECTIVE: To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability. DESIGN: Cross-sectional study. SETTING: General community. PARTICIPANTS: Volunteer sample of 236 subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman rho. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach alpha equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC(2,1)). RESULTS: There were significant correlations between the CAIT and LEFS (rho=.50, P<.01) and VAS (rho=.76, P<.01). Construct validity and internal reliability were acceptable (alpha=.83; point measure correlation for all items, >0.5; item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1); sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC(2,1)=.96). CONCLUSIONS: CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.

Adult↗

[How to evaluate the quality of information transfer from physician to patient? Choice of psychometric tests for a decision tree in a Regional Cancer Centre].

BACKGROUND: Decision boards are used to transfer information from physicians to patients to help them participate in the clinical decision-making process. We present the tests and results of the psychometric properties of a decision board in a sample of healthy volunteers. METHODS: In the Regional Cancer Centre located in Lyon, we developed a decision board for post-menopausal women with breast cancer after lumpectomy without any poor prognostic factors. Two treatment options were proposed, one involving chemotherapy and the other not. We tested for the following psychometric properties: comprehension, construct validity and reliability. Comprehension was evaluated using a questionnaire, in order to test whether the rates of correct answers were due to chance alone. The construct validity was assessed by changing the information provided (relapse and survival rates, characteristics of chemotherapy) and testing whether the proportion of healthy volunteers choosing an option changed in a predictable and significant way. The reliability was evaluated using the test-retest method. Two reliability statistics were computed: the Pearson correlation and the Intraclass Correlation Coefficient. RESULTS: In the sample of 40 healthy volunteers, 23 chose the option with chemotherapy and 17 the option without chemotherapy. Results show that the decision board was comprehensive, valid (the women changed their choices in a predictable way) and reliable (Pearson correlation and Intraclass Correlation Coefficient close to 1). CONCLUSION: The choice of the psychometrics properties tested and the statistical tests used are discussed. The psychometric properties of our tool are found to be satisfactory.

Aged↗

[Validation of the Italian version of the Kjellberg and Iwanowski's Mood Scale].

Two questionnaires were administered to evaluate stress risk factors in 1652 employees of the Milan Town Council (772 Social Service personnel and 880 administrative staff). The study was focused on cardiovascular diseases. The Mopsy questionnaire is a selection of scales selected by the World Health Organization for international multicenter studies on cardiovascular morbidity, while the Mood Scale of Kjellberg & Iwanowski (1989) is a brief scale translated from Swedish used to measure "actual" stress and arousal state in neurotoxicology. The aim of the present study was to validate the Italian version of the Mood Scale for its possible use in health surveillance and research on stress and arousal changes at work. Appropriate statistical data analyses were applied to study the construct validity (factor analysis), concurrent validity (correlations with the Mopsy scale) and internal consistency (Cronbach alpha). The data confirm the Swedish results on the Mood Scale factor analysis. A good face and construct validity and a good internal consistency were observed. Nevertheless, the Mood Scale does not allow collection of demographic, anamnestic and personal data as does the Mopsy questionnaire.

Adult↗

Patient management problems. Issues of validity.

Patient management problems (PMP) are being used in medical examinations with increasing frequency despite evidence which throws doubt on their validity as measures of clinical competence. This study investigated the construct validity of a PMP constructed in both written and interview formats. Each test was administered to groups of students of different seniorities and to two groups of doctors, interns and post-interns. The pattern of scores for the different groups was not that expected of a valid test of competence. The most competent groups (the post-interns) generally scored less well on the calculated indices than the senior students and interns. These findings were similar for both formats of the test so cueing was not thought to be the major factor. It appears that the scoring system is at fault. A comparison of performance on the written and interview (uncued) formats showed that many more options were chosen by all groups tested on the written PMP. It was concluded that written PMPs cannot yet be regarded as a valid simulation of clinical performance. Although content validity is high this does not appear to be so for construct validity or concurrent validity.

Australia↗

Adolescent health promotion scale: development and psychometric testing.

The purpose of this study was to assess the psychometric properties of a newly devised instrument, the Adolescent Health Promotion scale (AHP), a 40-item Likert-type self-report instrument used to detect unhealthy lifestyles in adolescents. Content validity was considered to be supported based on the findings of previous studies and the observations of a panel of 14 content experts. This study examined the construct validity and reliability of the instrument. The psychometric properties of the AHP, including item analysis, factor analysis, and reliability measures, were assessed based on the responses of 1,128 Taiwanese adolescents. Kaiser-Meyer-Olkin (KMO) measures and Bartlett's sphericity test showed that the samples met the criteria for factor analysis. Factor analysis yielded a six-factor instrument that explained 51.14% of the variance in the 40 items. The six factors were social support, life appreciation, health responsibility, nutritional behaviors, exercise behaviors, and stress management. The Cronbach alpha reliability coefficient for the total scale was 0.932, and alpha coefficients for the subscales ranged from 0.75 to 0.88. The results of this study indicate that the AHP has good construct validity and reliability in Taiwanese and that its use by school health nurses to assess adolescent health promotion programs is warranted.

Adolescent↗

Construction and validation of a bone marrow tissue microarray.

BACKGROUND: The use of tissue microarrays (TMAs) is now a generally accepted method for the investigation of solid tumours. However, little is known about the applicability of the TMA technique for analysis of patients with acute leukaemia. A bone marrow (BM)-TMA analysis with 15 different immunohistochemical markers was performed. The TMA was validated by comparison with the corresponding full tissue sections. MATERIALS AND METHODS: A BM-TMA comprising 148 cases of acute leukaemia, including 115 acute myeloid leukaemia (AML) and 33 acute lymphoblastic leukaemia (ALL) cases, was constructed. Expression of CD3, CD10, CD15, CD20, CD34, CD61, CD68, CD79a, CD99, CD117, CD138, myeloperoxidase, haemoglobin A1, glycophorin and terminal deoxynucleotidyl transferase was immunohistochemically analysed. 50 cases of the TMA were directly compared with the corresponding full tissue section to validate the results. RESULTS: Morphologically and immunohistochemically, 6 (4%) of 148 cases and 765 (11%) cores of 6912 individual analyses were not evaluable. A direct comparison of TMA cases with conventional full sections showed a concordance of the results of 100%. CONCLUSIONS: The small size of bone-marrow biopsies and the presence of bony trabeculae do not preclude construction and analysis of acute leukaemia TMAs. Acute leukaemia cases on TMA displayed the characteristic phenotypic profiles expected in different AML and ALL subtypes. Therefore, the TMA technique is also a promising method for high-throughput analysis of combined marker expression and clinicopathological correlations in patients with leukaemia.

Acute Disease↗

Evaluating the clinical skills of foreign medical school graduates participating in an internship preparation program.

In the fall of 1986, the Ministry of Health of the province of Ontario, Canada, implemented a special 36-week internship preparation program for graduates of foreign medical schools. The program accepts 24 candidates per year and is offered at the five Ontario medical schools. At the time of this study, two cohorts of participants had completed the program. As part of the evaluation process, each participant was administered a battery of the same Objective Structured Clinical Examination-type test stations, prior to and on completion of the pre-internship experience. Repeating the same examination permitted investigation of the predictive and construct validities of the clinical skills tests, as well as the stability of the validity and high reliability estimates that emerged from the testing of the first cohort. The results provide convincing evidence of the testing approach's predictive and construct validity and reliability.

Clinical Competence↗