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The Friedrich-Lively Instrument to Assess the Impact of Schizophrenia on Siblings (FLIISS): Part II--reliability and validity assessment.

Siblings of persons with schizophrenia who provide primary or secondary care for their sibling and support to parents may experience stress, decreased quality of life, grief, chronic illness, depression, and anxiety. The effects on siblings have not been widely studied and there have not been appropriate instruments to measure the types and degree of stress and associated mental, emotional, and physical distress. The Friedrich-Lively Instrument to Assess the Impact of Schizophrenia on Siblings (FLIISS) is a comprehensive instrument based on extensive research and work with siblings of persons with schizophrenia. Construction of the FLIISS and its relationship to a conceptual model of stress is presented in an article (Part I) elsewhere in this issue. In this article (Part II), reliability results and construct validity are reported for the FLIISS. The FLIISS demonstrates appropriate usefulness and content, acceptable internal consistency, and strong construct validity. Health professionals can use the instrument for collecting information that will increase their ability to identify sources of stress faced by siblings of persons with schizophrenia and develop interventions to help these siblings.

Adult↗

Development and results of a questionnaire to measure carer satisfaction after stroke.

STUDY OBJECTIVE: To develop a carer satisfaction questionnaire for use as an outcome measure in stroke, to test the measure for reliability and validity, and to survey levels of carer satisfaction with services for stroke patients. DESIGN: Postal survey of carer satisfaction with stroke services was carried out using the questionnaire we developed and tested. Internal consistency was tested and construct validation was explored by examining correlations with other outcome measures (the Faces Scale, the Nottingham Health Profile, the short form of the Geriatric Depression Scale, and the patient's Barthel Index score). SETTING: Two adjacent districts in North East Thames Regional Health Authority. PARTICIPANTS: A total of 103 carers were identified from 219 people who had survived a stroke to six months. During the pilot stage, six of seven carers who were invited to participate in in depth interviews and 15 of 23 carers (65%) who were invited to completed the first draft of the questionnaire. MAIN RESULTS: The questionnaire was divided into two sections, one on inpatient services (Carer Hospsat) and one on services after discharge (Carer Homesat). The questionnaire had construct validity, providing significant correlations with the Faces Scale (Carer Hospsat r = 0.59, p < 0.00001 and Carer Homesat r = 0.68, p < 0.00001), the patients' Barthel score (Carer Hospsat r = 0.25, p = 0.01), and the patients' Nottingham extended Activities of Daily Living (ADL) scale (Carer Hospsat r = 0.31, p = 0.002). Internal consistency was high for both sections (Cronbach's alpha: Carer Hospsat 0.87, Carer Homesat 0.79). Most carers (77%) were satisfied with the care their relative or friend received while in hospital, but only 39% were satisfied with services after discharge. CONCLUSIONS: Carer satisfaction is an important outcome measure in stroke research. This study has shown that carers are dissatisfied with services after hospital discharge. Our questionnaire is valid, reliable, and sensitive and could be used to test interventions aimed at improving services.

Aftercare↗

The cognitive validity of the Script Concordance Test: a processing time study.

BACKGROUND: According to the theory on which the Script Concordance Test (SCT) is based, scripts contain expectations on features that are associated with each illness and about the range of values that are typical, atypical, or incompatible. PURPOSE: To document the construct validity of the SCT, we investigated the theory prediction that once a script is activated, new incoming information (e.g., additional clinical features) is processed faster if it is typical for that script than if it is atypical. If it is incompatible, processing time falls in between. METHODS: We presented 2 groups of participants (30 fourth-year medical students and 30 full-time geriatricians) with 64 clinical vignettes (divided over 5 types of prevalent clinical presentations in geriatrics), each accompanied by a diagnostic hypothesis aimed to instantiate an appropriate script. Next, we presented a new finding, which could be typical, atypical, or incompatible given the hypothesis. Participants had to decide as quickly and accurately as possible whether the new finding increased, decreased, of did not affect the likelihood of the diagnostic hypothesis. We administered the test on a computer. The dependent variable was processing time. We analyzed data with a repeated measure 2 x 3 analysis of variance. RESULTS: Typical information was processed faster than atypical and incompatible information (M = 10.6 sec vs. 19.2 sec and 16.4 sec, respectively; p lt; .001 for both). Incompatible information was processed faster than atypical information (16.4 sec vs. 19.2; p < .001). There was no significant difference between the groups of geriatricians and students. CONCLUSION: It is possible to predict what kind of information will be processed faster depending of the typicality and compatibility of clinical data for given hypotheses. Results support SCT construct validity.

Clinical Clerkship↗

Psychometric evaluation of the cultural competence assessment instrument among healthcare providers.

BACKGROUND: The relevance of healthcare provider cultural competency to the achievement of goals for reduction in extant health disparities has been demonstrated; however, there are deficits with regard to cultural competency measurement. OBJECTIVES: To examine the test-retest reliability of the cultural competence assessment instrument (CCA) among hospice providers, and to examine the reliability and validity of the CCA among healthcare providers in nonhospice settings. METHOD: Test-retest reliability of the CCA was assessed using a sample of 51 hospice respondents who completed the CCA at two time points. The internal consistency reliability and construct validity of the CCA for healthcare providers in nonhospice settings were evaluated using a convenience sample of 405 healthcare providers. RESULTS: The CCA demonstrated adequate test-retest reliability (r = .85, p = .002) in hospice providers over 4 months. Among healthcare providers in nonhospice settings, the CCA had an internal consistency reliability of .89 overall (.91 and .75 for the two subscales). Construct validity was supported by principal axis factor analysis, which showed two factors with item loadings above .40, explaining 56% of the variance. Mean scores of the CCA were significantly higher for providers who reported previous diversity training compared to those who had not. DISCUSSION: Findings for the psychometric properties of the CCA supported its potential as an instrument for measuring provider cultural competence. Knowledge gained will be useful for developing future research studies and specific cultural competence intervention approaches for healthcare providers that may decrease health disparities.

Adult↗

The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning.

OBJECTIVES: Most evidence-based practice (EBP) educational assessment tools evaluated to date have focused on specific knowledge components or technical skills. Other important potential barriers to the adoption of EBP, such as attitudinal, perceptual and behavioural factors, have yet to be studied, especially in the undergraduate setting. Therefore, we developed and validated a knowledge, attitude and behaviour questionnaire designed to evaluate EBP teaching and learning in an undergraduate medical curriculum. METHODS: We derived the questionnaire from a comprehensive literature review, informed by international and local experts and a Year 5 student focus group. We determined its factor structure and refined and validated the questionnaire according to the responses of a cohort of Year 5 and a combined group of Years 2 and 3 students using principal components factor analysis with varimax rotation. Factor reliability was computed using Cronbach's alpha coefficient. We assessed construct validity by correlating the factors with other measures of EBP activity and examined responsiveness through paired t-test of the pre/post factor mean scores. RESULTS: A 43-item questionnaire was developed. Four factors were identified from both student groups. The overall questionnaire as well as each factor had high construct validity (Cronbach's alpha > 0.7 for each scale). No significant correlations were found between the 4 factors, confirming their orthogonality. Positive correlations, however, resulted between factor mean scores and other EBP activities. The responsiveness of the questionnaire was satisfactory. CONCLUSION: A reliable knowledge, attitude and behaviour measure of EBP teaching and learning appropriate for undergraduate medical education has been developed and validated.

Adult↗

Measuring patient attributes and engagement in treatment.

Brief but comprehensive instruments measuring patient motivation, psychosocial functioning, treatment process, social network support, and services received are needed for monitoring drug abuse treatment delivery and patient progress. Combining this information across patients within a program also provides useful indicators about institutional composition and functioning. Consequently, the same assessment tools can be used to identify areas where treatment protocols need to be changed, and to monitor improvements following such changes. The Texas Christian University (TCU) Client Evaluation of Self and Treatment (CEST)(1) is a 144-item self-rating instrument that includes 16 scales measuring patient functioning and treatment perceptions. Psychometric properties (including reliability and construct validity) of the scales are examined in this article, based on patient samples drawn from 87 programs that participated in a series of staff training workshops. Acceptable reliabilities (.70 or above) were generally reported, and construct validity was also demonstrated (although the confirmatory factor analyses suggested some item pools could represent more than one factor). Prediction analyses were conducted using selected scales from each measurement domain to illustrate their sensitivity to treatment program contexts.

Anxiety↗

Current concepts in validity and reliability for psychometric instruments: theory and application.

Validity and reliability relate to the interpretation of scores from psychometric instruments (eg, symptom scales, questionnaires, education tests, and observer ratings) used in clinical practice, research, education, and administration. Emerging paradigms replace prior distinctions of face, content, and criterion validity with the unitary concept "construct validity," the degree to which a score can be interpreted as representing the intended underlying construct. Evidence to support the validity argument is collected from 5 sources: CONTENT: Do instrument items completely represent the construct? RESPONSE PROCESS: The relationship between the intended construct and the thought processes of subjects or observers. INTERNAL STRUCTURE: Acceptable reliability and factor structure. RELATIONS TO OTHER VARIABLES: Correlation with scores from another instrument assessing the same construct. CONSEQUENCES: Do scores really make a difference? Evidence should be sought from a variety of sources to support a given interpretation. Reliable scores are necessary, but not sufficient, for valid interpretation. Increased attention to the systematic collection of validity evidence for scores from psychometric instruments will improve assessments in research, patient care, and education.

Humans↗

Ankle osteoarthritis scale.

Although there is a wide array of outcome tools for assessing patients with symptomatic ankle arthritis, no disease-specific instrument for ankle arthritis has been shown to be reliable and valid. The purpose of this study was to develop a simple, reliable, and validated outcome measure for the clinical assessment of ankle osteoarthritis. We modified the Foot Function Index, a visual analog-based scale used to assess rheumatoid foot problems, to measure patient symptoms and functional limitations stemming from osteoarthritis of the ankle joint. Test-retest reliability and criterion and construct validity were determined for the overall Ankle Osteoarthritis Scale and its two subscales (pain and disability). Overall reliability (r=0.97; 95% confidence interval [CI], 0.94-0.99), pain subscale reliability (r=0.95; 95% CI, 0.90-0.98), and disability subscale reliability (r=0.94; 95% CI, 0.88-0.97) were excellent. Criterion validity testing of the instrument with the WOMAC (a disease-specific scale for osteoarthritis) and the SF-36 (a general health survey) showed a high degree of concordance for related subscales. Construct validity using a physical measure of ankle function demonstrated sensitivity of the instrument to the degree of joint dysfunction. Normative data were obtained from 562 individuals who were not patients (264 men and 298 women). The responses were analyzed for trends in gender, body mass index, presence of arthritis, history of fracture in relation to the response levels, and age. A small but statistically significant main effect for gender was found, with women consistently reporting higher pain, disability, and total index scores. Body mass index and arthritis were also found to correlate with response answers across the subscale and total index scores; however, these factors only accounted for 12% of the variation. The Ankle Osteoarthritis Scale is a reliable and valid self-assessment instrument that specifically measures patient symptoms and disabilities related to ankle arthritis.

Adult↗

Validity, reliability, and sensitivity to change of a French version of the arthritis impact measurement scales 2 (AIMS2) in patients with rheumatoid arthritis treated with methotrexate.

OBJECTIVE: To develop and validate a cross cultural version of the Arthritis Impact Measurement Scales 2 (AIMS2) to be used by French speaking populations. METHODS: A French version of the AIMS2 was obtained using back translation, committee review, and pretesting. The French AIMS2 was studied in 127 patients with rheumatoid arthritis (RA) about to receive therapy with methotrexate (MTX). Construct validity of the questionnaire was assessed by factor analysis. Convergent validity was evaluated by correlation coefficients with joint counts, pain assessment, and sedimentation rate. Reliability was assessed by test-retest procedure at a 10-day interval, Cronbach's coefficients of internal consistency, and within scale factor analyses. Sensitivity to change after 12 and 24 weeks of therapy with MTX was assessed with computation of standardized response means (SRM) and paired t test comparisons. RESULTS: Factor analyses of the French version clearly identified the same scales of the AIMS2, except for the walking and bending scale which loaded on several factors. Convergent validity of the physical and symptom components of the instrument was demonstrated by significant correlations with clinical and laboratory features. All the scales were reliable (intraclass correlation coefficients: 0.65 to 0.90; percentage of explained variance larger than 50% in all but one scale; Cronbach's alpha: 0.70 to 0.90). Sensitivity to change was demonstrated in 11 of the 12 scales (SRM: 0.30 to 0.77). Most of the improvement was noted by Week 12. CONCLUSIONS: This cross cultural adaptation of AIMS2 in French is valid, reliable, and responsive in patients with RA in whom MTX therapy is instituted. It would permit international comparison studies. This study provides evidence for construct validity and responsiveness of the original version of the AIMS2, not demonstrated previously.

Activities of Daily Living↗

Measurement of perceived competence in Dutch children with mild intellectual disabilities.

BACKGROUND: Little research has been conducted on the perceived competence of children with mild intellectual disabilities (MID). One of the reasons for the marked absence of research appears to be the lack of reliable and clearly valid measurement instruments for this particular group of children. In the present study, it was examined whether a pictorial scale originally designed to measure perceived competence in typically developing children could successfully be used with children with MID. METHODS: The pictorial scale was administered to a group of 106 children with MID. The construct validity, reliability and stability of the scale were investigated. RESULTS: The results of the exploratory factor analyses and the confirmatory factor analyses supported the conceptual framework proposed. The construct validity was also supported by the pattern of intercorrelations between the subscales. The scale had adequate internal consistency and the stability analyses showed sufficient stability across a 4-month period. CONCLUSIONS: The findings show the psychometric properties of the pictorial scale to justify its use with children with MID.

Child↗

Examining the validity of the Academic Motivation Scale by comparing scale construction to self-determination theory.

This study examined the construct validity of the Academic Motivation Scale. Specifically, subscale correlations were examined to assess whether support for a continuum of self-determination would be provided. The three types of Intrinsic Motivation were significantly and positively correlated with each other .67, .62, and .58, while the three types of Extrinsic Motivation were significantly and positively intercorrelated .50, .49, and .45. The former subscales, however, correlated higher with Introjected Regulation than Identified Regulation, suggesting that Introjected Regulation may be indicative of more self-determined behavior than has previously been believed. Also, the Intrinsic Motivation To Accomplish subscale had a stronger relationship with two of the Extrinsic Motivation subscales, Identified Regulation and Introjected Regulation, than did the Extrinsic Motivation subscales with each other. This suggests that the differences between Extrinsic and Intrinsic Motivation are not as obvious as has been believed. Also, contrary to self-determination theory, Amotivation had a stronger negative correlation with Identified Regulation (r = -.31) than with any of the Intrinsic Motivation subscales (rs = -.27, -.19, and -.11).

Achievement↗

Evaluation of a Romanian version of the Bath Ankylosing Spondylitis Functional Index (BASFI) in patients with spondylarthropathies.

OBJECTIVE: To develop a Romanian version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and to determine its metric properties in patients with spondylarthropathies (SpA). METHODS: A Romanian version of BASFI was obtained after translation, back-translation and pretesting. Altogether 41 SpA patients fulfilling the ESSG criteria were included, 34 of them satisfying the modified New York criteria for ankylosing spondylitis. BASFI was completed by the patients along with assessment of clinical and disease activity variables by both the patient and physician. Scalability, internal consistency, reliability and construct validity of the Romanian BASFI were assessed. RESULTS: Mean time to complete the questionnaire was 2 minutes. Scalability (0.2-9.7, 95% of the scale), internal consistency (Cronbach's alpha = 0.93), reliability (intraclass correlation coefficient = 0.82) and construct validity (correlations (absolute value(r) = 0.37-0.59) with spinal pain, nocturnal pain, patient's and physician's global assessment, fingers-to-floor distance, occiput-to-wall distance, modified Schober test, intermalleolar distance, and Dougados articular index) were all very satisfactory. CONCLUSIONS: Translation and cultural differences did not alter the well-known value of BASFI. Therefore, the Romanian version of BASFI is reproducible and valid for the assessment of patients with spondylarthropathies.

Activities of Daily Living↗

Assessing role activities of individuals receiving long-term hemodialysis: psychometric testing of the revised Inventory of Functional Status-Dialysis (IFS-Dialysis).

The purpose of the study was to examine the reliability and validity of the revised IFS-Dialysis, a theory-based self-report measure of the extent to which individuals receiving long-term hemodialysis are actually performing role activities. The IFS-Dialysis was administered to 186 individuals receiving hemodialysis. Chronbach's alpha was used to assess internal consistency reliability, and structural equation modeling was used to assess the construct validity of the revised measure. Alpha reliability for the total instrument was 0.88, and subscale alpha coefficients ranged from 0.75 to 0.85. Construct validity of the IFS-Dialysis was supported by the significant relationship of each item to its respective subscale latent variable, and model testing indicated a good fit of the measurement model to the data. The IFS-Dialysis can be used to obtain clinical assessments of the extent to which individuals receiving long-term hemodialysis treatments are engaging in role activities. Interventions can then be implemented to facilitate an optimal level of activity performance for each individual.

Activities of Daily Living↗

A validity analysis of the Work Productivity Short Inventory (WPSI) instrument measuring employee health and productivity.

The Work Productivity Short Inventory (WPSI) was developed to quickly estimate decrements in productivity associated with 15 common disease conditions. Three versions of the WPSI were developed that differed according to the length of the recall period (12 months, 3 months, or 2 weeks). The content, predictive, and construct validity of metrics generated from the WPSI were assessed based on response patterns found in the 3 versions and via comparison to information in national data sources or in the subject company's medical care claims and short-term disability program files. The WPSI provided evidence of content and construct validity to support its intended purpose. Evidence for predictive validity was weaker but still present. The WPSI can be used to provide information on the relative importance of health conditions that affect productivity at work for a large group of employees.

Absenteeism↗

Validation of the NOSGER (Nurses' Observation Scale for Geriatric Patients): reliability and validity of a caregiver rating instrument.

The Nurses' Observation Scale for Geriatric Patients (NOSGER) is a rating scale for use in geriatric patients that can be applied by nurses or other caregivers. It deals with the daily behavior of elderly patients and measures impairment in six areas (dimensions): memory; instrumental activities of daily living (IADL); (basic) activities of daily living (ADL); mood; social behavior; and disturbing behavior. Objectivity, stability, construct validity, and acceptance of the scale have been established in previous studies using an earlier version of the NOSGER. The present validation study considered 50 healthy old subjects, 25 patients with mild dementia, 25 patients with advanced (mostly moderate according to DSM-III-R criteria) dementia, and 25 elderly patients with depression. The NOSGER was completed by relatives in the case of subjects living in their own homes and by nurses or other caregivers for institutionalized subjects. In addition to the NOSGER, selected tests of concentration, memory, and performance were applied as outside criteria. Interrater reliability (objectivity) was estimated by variance component analysis. Values between rtt = .68 and rtt = .89 (all p < .001) were found for the six NOSGER dimensions, the values being higher for the cognitive dimensions (memory, IADL, ADL) than for the noncognitive ones (mood, social behavior, disturbing behavior). Retest reliability (stability), which was calculated via rank order correlations, was somewhat higher for the cognitive NOSGER dimensions (memory rs = .91, IADL rs = .92, ADL rs = .88; p < .001) than for the noncognitive ones (mood rs = .85, social behavior rs = .87, disturbing behavior rs = .84; p < .001). All these values satisfy the level of rtt > or = .80 required in accordance with psychometric standards. The concurrent validity of the NOSGER dimensions was assessed using correlations with external criteria with which similarity of content was expected. The NOSGER dimensions memory, IADL, ADL, and social behavior were found to correlate closely with external criteria of similar content, whereas no satisfactory concurrent validities were found for the dimensions mood or disturbing behavior. The NOSGER dimensions were also correlated with a number of unrelated external criteria so as to reveal any discordances. For the dimensions memory, IADL, ADL, and social behavior, no clear-cut discriminant validities were found. This suggests that these four dimensions may function as parameters not just of different areas of behavior, but also of a general factor that might be described as "cognitive intactness." As a further aspect of construct validity, significant differences (all p < .001) between the four groups of subjects were found in five of the six NOSGER dimensions (memory, IADL, ADL, mood, social behavior): The healthy subjects differed significantly from all three patient groups in five of the six dimensions; the moderately demented group differed from the depressed group in four of the six dimensions and from the mildly demented group in two of the six dimensions; and the mildly demented group differed significantly from the depressed group in terms of mood (significance levels are after application of the Bonferroni correction). Significant group differences (p generally < .001) were also found for most of the objective performance tests used (data not presented).

Activities of Daily Living↗

Reliability and validity of the Modified Erikson Psychosocial Stage Inventory in diverse samples.

The Modified Erikson Psychosocial Stage Inventory (MEPSI) is a relatively simple survey measure designed to assess the strength of psychosocial attributes that arise from progression through Erikson's eight stages of development. The purpose of this study was to employ secondary analysis to evaluate the internal-consistency reliability and construct validity of the MEPSI across four diverse samples: healthy young adults, hemophilic men, healthy older adults, and older adults with chronic obstructive pulmonary disease. Special attention was given to the performance of the measure across gender, with exploratory analyses examining possible age cohort and health status effects. Internal-consistency estimates for the aggregate measure were high, whereas subscale reliability levels varied across age groups. Construct validity was supported across samples. Gender, cohort, and health effects offered interesting psychometric and theoretical insights and direction for further research. Findings indicated that the MEPSI might be a useful instrument for operationalizing and testing Eriksonian developmental theory in adults.

Adaptation, Psychological↗

Independent validation of the Sleep Apnoea Quality of Life Index.

BACKGROUND: Obstructive sleep apnoea (OSA) affects important domains of quality of life which remain unexplored by conventional sleep recordings. The objective of this study was to examine the measurement properties (both discriminative and evaluative) of the Sleep Apnoea Quality of Life Index (SAQLI), a new OSA specific quality of life questionnaire. METHODS: Consecutive patients recently diagnosed with OSA completed a French version of the SAQLI twice over a 3 month period. Its construct validity and responsiveness were tested by comparing baseline and change scores obtained in each domain (symptoms, activities, emotions, social interactions) with those of questionnaires measuring related constructs (SF-36, Epworth Scale, Beck Depression Inventory, and Symptom Checklist 90). The symptoms scores were also correlated with physiological measures obtained at baseline polysomnographic recording. RESULTS: Forty seven patients (40 men) of mean (SD) age 53 (10) years and mean (SD) apnoea/hypopnoea index 38 (21) participated in the study. During the study period 33 of the 47 patients were treated for OSA (31 with nasal CPAP, one with uvulopalatopharyngoplasty, and one with an oral appliance). Moderate to high correlations were found between the scores in each domain of the SAQLI and the corresponding instruments. There were significant differences in change scores between patients who were treated and those who were not, moderate correlations between SAQLI change scores and changes in the corresponding instruments, and no correlation between the symptoms scores and the baseline nocturnal features. Most of these correlations met the a priori predictions made regarding their magnitude. CONCLUSION: The SAQLI has strong construct validity and is responsive to change in quality of life but has the disadvantage of having to be administered by an interviewer.

Cross-Sectional Studies↗

Validation of an independent living scale for post-acute rehabilitation applications.

The Independent Living Scale (ILS) was developed in a post-acute traumatic brain injury (TBI) rehabilitation facility over a 15-year period to assess three main areas: (1) activities of daily living, (2) behaviour, and (3) initiation. The purpose of this study was to examine the psychometric properties of the ILS, including test--retest stability, construct validity, and statistical fit. Statistical analysis was completed on all weekly scores between the years 1986-1995 (n = 5250). A previous study showed ILS inter-rater reliability to be 0.85 and convergent validity 0.82--0.87. This study demonstrated a test--retest stability of 0.72, the Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0.94 (marvelous), and a Bartlett Test of Sphericity result of 'scale items independent'. The ILS was shown to have good construct validity, inter-rater reliability, internal consistency, instrument stability, and convergent validity.

Activities of Daily Living↗