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Psychometric properties of the sensory scale of the Fugl-Meyer Assessment in stroke patients.

OBJECTIVE: To examine the psychometric properties of the sensory scale of the Fugl-Meyer Assessment (FMA-S) in stroke patients with a broad range of neurological and functional impairment at times from 14 to 180 days after stroke. SUBJECTS: A total of 176 first stroke patients consecutively admitted to a university-based medical centre. DESIGN: This prospective, longitudinal investigation was based on data collected at 14, 30, 90 and 180 days after stroke. MAIN OUTCOME MEASURES: Reliability (inter-rater reliability and internal consistency), validity (convergent and predictive validity) and responsiveness of the FMA-S were examined. RESULTS: The inter-rater agreement of the total score of the FMA-S was excellent, with an intraclass correlation coefficient of 0.93. The Cronbach's alphas of the FMA-S at four time points after stroke ranged from 0.94 to 0.98, indicating excellent internal consistency. However, the FMA-S showed a significant ceiling effect (more than 44.4% of the subjects achieving the highest score), poor to moderate inter-rater reliability for light touch items (weighted kappa ranging from 0.30 to 0.55), low to moderate validity (Spearman's rho ranging from 0.29 to 0.53), and low to moderate responsiveness (standardized response mean ranging from 0.27 to 0.67) at different post-stroke stages of recovery. CONCLUSIONS: The psychometric properties of the FMA-S in measuring sensory function do not support its clinical use in stroke patients. Further studies on methods to improve the psychometric properties of the FMA-S are needed.

Activities of Daily Living↗

[The Knee Injury and Osteoarthritis Outcome Score--a multifunctional questionnaire to measure outcome in knee arthroplasty].

AIM: It was the purpose of this investigation to create a German version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and to test its appropriateness in patients with advanced gonarthritis. METHOD: Reliability (test-retest reliability, internal consistency), validity (convergent construct validity and divergent construct validity), sensitivity to change as well as practicability and acceptance of this questionnaire were tested in 90 patients. RESULTS: The test-retest reliability was acceptably high for all subscales, it ranged between r = 0.65 and 0.78 and the questionnaire showed a high internal consistency in almost all of the subscales. The comparison to the results of the questionnaire "Short Form-12" (SF-12) as well as to the patients self-assessment of health status showed high concordance in nearly all subscales, however it was only moderate for the symptom scale. Furthermore the KOOS was able to show significant differences between patients and healthy controls. When testing the sensitivity to change, the KOOS could demonstrate significant improvements within 3 months and the instrument has shown to be practicable with a high acceptance by the patients. CONCLUSION: With the German version of the Knee Injury and Osteoarthritis Outcome Score a multidimensional instrument is available now to measure health status as well as therapeutic effects in patients with knee problems. Modifying the subscale "symptoms" could further optimize this questionnaire in patients with advanced gonarthritis.

Adolescent↗

[The Minimal Record of Disability and multiple sclerosis. Results of the evaluation of 200 patients].

The Minimal Record of Disability (MRD) for Multiple Sclerosis (MS) evaluates impairment in MS through 4 sets of data: Demographic Data, Kurtzke Disability Status Scale (DSS), Incapacity Status Scale (ISS) and Environmental Status Scale (ESS). We assessed with the 1985 version of MRD 200 consecutive patients attending our MS clinic during a 6 months period. 170 were out-patients and 30 inpatients. Diagnosis was definite in 197 and probable in 3. ESS and ISS were rated by a medical student according to a planned interview. The validity and internal consistency of DSS, ISS and ESS were evaluated by dependence analysis of each item to the sum of all items, and multivariate analysis was carried out on the first 15 items of ISS. Main clinical data were: age 43.0 +/- 11.8 years; age at onset of MS: 27.3 +/- 10.3; sex ratio (F/M): 1.75/1; mean DSS score: 4.6 +/- 0.1. Administration of MRD was easy and general acceptance was good. Some refinement in wording is needed for 5 items of ISS--mainly for "mood and thought disturbances" and "mentation" which do not score adequate mood and intellectual impairment in MS--and for 2 items of ESS. These 2 scales are otherwise of practical use and cover all the area of disability and handicap in MS. The levels of internal consistency of DSS, ISS and ESS are high, as well as correlations between the 3 scales (p less than 0.001). Correlations with age and duration of MS were established for total scores of DSS but not ISS and ESS. Our data confirms the validity of MRD as an evaluation tool of MS patients; they show that MRD can be applied with minor modifications to MS patients and support its use in therapeutic trials, rehabilitation and socio-economic inquiries.

Adult↗

A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.

We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.

Adult↗

Vascular depression: A distinct diagnostic subtype?

Vascular depression has been proposed as a unique and valid diagnostic subtype on the basis of studies of external (concurrent and predictive) validity. Validating a diagnostic entity on the basis of external validity is problematic, because it presupposes that the construct is well defined (i.e., the proposed features cluster together to define a distinct patient group). Because such evidence has not been obtained, we propose that the next critical step in evaluating this potential subtype is to establish internal (construct) validity and highlight taxometric analysis and latent class cluster analysis as illustrative multivariate statistical techniques that can be used in this effort. The psychometric approach advocated here (despite its inherent assumptions and limitations) might substantially improve on previous diagnostic efforts (e.g., expert consensus), and vascular depression might serve as a prototype for future psychiatric classification.

Cerebrovascular Disorders↗

Validity of a new quality of life scale for functional dyspepsia: a United States multicenter trial of the Nepean Dyspepsia Index.

OBJECTIVE: The lack of a suitable disease-specific, health-related quality of life instrument for dyspepsia prompted the development of the Nepean Dyspepsia Index (NDI). The utility of the NDI in functional dyspepsia is unknown. We aimed to assess the validity of this new quality of life instrument for the first time in United States patients with documented functional dyspepsia. METHODS: The long form of the NDI contains a symptom index and 42 items designed to measure impairment of subjects' ability to engage in and to enjoy relevant aspects of their life because of dyspepsia, as well as a ranking of the individual importance of each aspect. Patients (n = 101, mean age 51 yr, 62% female) who had a history of functional dyspepsia for > or = 1 month and a negative endoscopy within the prior 1 yr were followed for 14 days. Patients completed the NDI and the validated Speilberger State-Trait Anxiety Inventory, Beck Depression Inventory, Short Form-36, and a global assessment of symptoms and quality of life at baseline and 14 days later; the NDI was also retested at 48 h and 2 wk. RESULTS: Five clinically relevant factors (subscales), namely, tension/sleep, interference, eating/drinking, knowledge/control, and work/study were identified by factor analysis, after incorporating individual importance ratings (25 items total). All subscales had excellent face validity and internal consistency (Chronbach's alpha, all >0.85). Reliability was also excellent (intraclass correlations all >0.84). There were modest typically negative correlations between a number of the NDI subscales and the Short Form-36, anxiety, and depression, indicating that the NDI is disease-specific and supporting its validity. Changes in NDI scales correlated moderately with global assessment of change (total score r = -0.49), indicating initial responsiveness. CONCLUSIONS: The Nepean Dyspepsia Index is a valid, disease-specific index for functional dyspepsia, measuring symptoms and health-related quality of life.

Dyspepsia↗

[Validation of a French adaptation of the international prostatic symptom score].

OBJECTIVE: To evaluate the reliability and the validity of a French Canadian version of the International Prostatic Symptom Score. DESIGN: Between November 23, 1993 and April 8, 1994, a self-administered questionnaire was submitted to a group of men on two occasions at an interval of at least one week. This questionnaire was composed of seven questions designed to score the severity of prostatic symptoms and two questions designed to score quality of life. CONTEXT: Family medicine unit and prostatic cancer screening programme of the hormonal treatment clinic of the Laval University hospital centre. PARTICIPANTS: Men between the ages of 50 and 80 years presenting for prostatic cancer screening or for a family medicine visit were invited to participate. A total of 207 men answered the questionnaire on the first occasion and all but two answered the questionnaire on the second occasion. MAIN ASSESSMENT CRITERIA: The internal consistency of the scale, its test-retest stability, the correlation between the prostatic symptom index of the scale and the quality of life index and the urine output were estimated. RESULTS: The internal consistency of the scale has found to be good, with Cronbach's coefficient alpha equal to 0.82. Each question of the scale displayed a good test-retest stability, with coefficient Kappa varying between 0.41 and 0.66 according to the question. The correlation coefficient between the prostatic symptom index of the scale and the quality of life index was 0.75 (P < 0.001). An inverse linear relationship was observed between urine output and the prostatic symptom index, with a correlation coefficient of -0.289 (p < 0.001). CONCLUSION: The psychometric qualities of the adapted scale, evaluated during the present study, are similar to the qualities of the original English language I-PSS scale. The present French version of the scale constitutes a reliable and valid tool to assess the severity of prostatic symptoms in the Quebec male population.

Aged↗

Internal consistency reliability and construct validity of an Arabic translation of the shortened form of the Fennema-Sherman Mathematics Attitudes Scales.

A sample of 480 (246 boys and 234 girls) students in Grade 11 in the United Arab Emirates completed an Arabic version of the shortened form of the Fennema-Sherman Mathematics Attitudes Scales. A factor analysis of the intercorrelations of responses to 51 items indicated the same general factors as in the original study. Internal consistency estimates of the reliability of scores on the total scale and on each scale for the short form were acceptable, with coefficients alpha ranging from .72 to .89.

Adolescent↗

The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries.

OBJECTIVE: The purpose of this study was to develop and test a core set of questions to measure patients' experiences of in-patient care. Questions were selected from the bank of items developed for use in in-patient surveys undertaken by the Picker Institute for the purposes of assessing the quality of care. DESIGN: The data reported here come from surveys of patients who had attended acute care hospitals in five countries: the United Kingdom, Germany, Sweden, Switzerland, and the USA. Questionnaires were mailed to patients' homes within 1 month of discharge, either to all patients, or to a random sample, discharged during a specified period. SAMPLE: A total of 62 925 questionnaires were returned, with response rates of 65% (UK), 74% (Germany), 63% (Sweden), 52% (Switzerland), and 46% (USA). RESULTS: Fifteen items were selected from the bank of questions included in the Picker in-patient questionnaires. These items have a high degree of face validity and when summed to an index they show a high degree of construct validity and internal reliability consistency. DISCUSSION: Fifteen items derived from the longer form Picker in-patient survey have been found to provide a meaningful picture of patient experiences of health care, and constitute the 15-item Picker Patient Experience Questionnaire. These questions comprise a core set that should be measured in all in-patient facility surveys. The Picker Patient Experience Questionnaire represents a step forward in the measurement of patient experience as it provides a core set of questions around which further optional modules may be added. Scores are easy to interpret and actionable. CONCLUSION: This small set of questions could be incorporated into in-patient surveys in different settings, enabling the comparison of hospital performance and the establishment of national or international benchmarks.

Europe↗

Casting light on the concept of patient satisfaction by studying the construct validity and the sensitivity of a questionnaire.

PURPOSE: This study aims to explore the construct validity and the sensitivity of a patient satisfaction questionnaire for the purpose of gaining a better understanding of the concept, and of issues surrounding its measurements. DESIGN/METHODOLOGY/APPROACH: Several statistical analyses were used to study the reliability, construct validity, and the sensitivity of a patient satisfaction questionnaire. FINDINGS: The study supported the construct validity, high internal consistency, and homogeneity of the instrument. Two factors were found; one consisted of negatively worded items and the other of positively worded items. The negatively worded items contributed more than the positively worded items to the sensitivity of the instrument. Items were identified that contribute little or nothing to the construct validity and/or the sensitivity of the questionnaire. RESEARCH LIMITATIONS/IMPLICATIONS: The effect of wording on the variability and sensitivity of the instrument can be explained both as a consequence of response set bias and with regard to the theories against which two phenomena were being measured - patient satisfaction and patient dissatisfaction. The development of two kinds of instruments is proposed: those that measure patient dissatisfaction and are sensitive to minute changes in nursing care and those that measure both concepts and capture what patients find important in their care. ORIGINALITY/VALUE: The paper demonstrates how an analysis of the construct validity and the sensitivity of patient satisfaction instrument, can enhance understanding of the concept. It contributes to the debate about whether patient satisfaction and dissatisfaction are opposite ends of the same continuum or two different phenomena that require two different definitions.

Data Interpretation, Statistical↗

Development of a validated quality of life tool specific to children with bladder dysfunction.

AIMS: To date there have not been any generic or continence-specific measurement tools that allow clinicians to investigate quality of life in children with bladder dysfunction. The aim of this research was to create a cross-cultural tool to assess and measure the wider psychosocial impact of current and new interventions for bladder dysfunction in children. MATERIALS AND METHODS: The study was conducted in three parts: expert consultation with continence clinicians; design and administration of a child-completed international questionnaire; item analysis, validity and reliability testing, and design of a new tool. RESULTS: The need for a pediatric incontinence QoL measure evaluation was strongly endorsed by clinicians. Data from 156 child-completed questionnaires collected in 10 countries was analyzed for item characteristics and found to be free of item correlation and ceiling and floor effects. Factor analysis revealed 2 factors, which were labeled intrinsic and extrinsic. Rasch analyses showed the internal validity of both subscales was reasonable good. Cronbach's alpha for each factor was 0.91 and 0.72. After analysis, items were selected for the new tool, PinQ, and evaluated for ambiguity, clarity, comprehension level required, choice of words and phrases, and age-appropriate concepts. Twenty-one items were finally selected and randomly positioned within the tool. CONCLUSIONS: A cross-cultural tool that quantifies the holistic effect of bladder dysfunction in children has been designed and tested for validity.

Adolescent↗

Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients.

In this study, the psychometric properties of a quality of life scale, the WHOQOL-Bref, were examined in a population of 533 Dutch adult psychiatric outpatients. Participants underwent two semistructured interviews in order to obtain Axis-I and II diagnoses, according to DSM-IV. Besides the WHOQOL-Bref they also completed questionnaires for measuring psychopathological symptoms (SCL-90) and perceived social support (PSSS). Scores on 25 of the 26 questions of the WHOQOL-Bref had a good distribution. Similar to previous findings, exploratory factor analysis revealed a four-factor structure. A priori expected associations were found between the domains of the WHOQOL-Bref, on the one hand, and dimensions of the SCL-90 and the PSSS-score, on the other hand, indicating good construct validity. The internal consistency of the four domains of the WHOQOL-Bref ranged from 0.66 to 0.80. Domain scores of the WHOQOL-Bref correlated around 0.92 with the WHOQOL-100 domain scores. Relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-Bref domain scores. It is concluded that the content validity, construct validity, and the reliability of the WHOQOL-Bref in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-Bref, therefore, is an adequate measure for assessing quality of life at the domain level in a population of adult psychiatric outpatients.

Adult↗

Psychometric evaluation and establishing norms of Croatian SF-36 health survey: framework for subjective health research.

AIM: To provide population norms and evaluate metric characteristics of the Croatian version of SF-36 Health Survey, an internationally used instrument for assessing subjective health. METHOD: The questionnaire was administered to a representative sample of Croatian adult population (n=9070). Three standard techniques were used in data analysis: reliability tests, descriptive statistics, and factor analysis. The population norms were presented in two standard forms--the SF-36 Health Profile and percentile values for different age groups of men and women. RESULTS: The Croatian version of the SF-36 had generally acceptable metric characteristics including its construct validity. The internal consistency of the SF-36 scales ranged from 0.78 to 0.94. Pearson bivariate correlations showed moderate associations between SF-36 scales, and factor analysis provided one latent dimension underlying all SF-36 scales which explained 63.3% of the score variance. Less favorable results were obtained concerning its discriminative validity. All SF-36 scales showed negative asymmetry of score distributions, and some had high floor and ceiling effects--skewness estimations ranged from -0.12 to -0.91, with the highest floor effect of 30% and ceiling effect of 63%. CONCLUSION: Presented population norms for the Croatian version of SF-36 Health Survey showed that SF-36 may be used as a valid and reliable instrument in research in subjective health of Croatian population.

Adolescent↗

[Glossary of conformal radiotherapy].

Most of the concepts and terms related to conformal radiotherapy were produced by English-speaking authors and eventually validated by international groups of experts, whose working language was also English. Therefore, a significant part of this literature is poorly accessible to the French-speaking radiation oncology community. The present paper gathers the 'official' definitions already published in French, along with propositions for the remaining terms which should be submitted to a more formal and representative validation process.

Computer Simulation↗

Haemoglobin, haematocrit and red blood cell indices in elite cyclists. Are the control values for blood testing valid?

BACKGROUND: In international cycling and cross-country skiing competitions, blood tests are used to unmask the performance enhancing misuse of erythropoietin. Haematocrit (cycling) and haemoglobin (cross-country skiing) limits have been set by international sporting federations (haematocrit 50%, haemoglobin 18.5 g/dl). Athletes tested above these cut-off values are declared unfit for competition. To investigate the validity of these regulations, we studied haemoglobin, haematocrit and red blood cell indices of elite cyclists before erythropoietin became commercially available. MATERIAL AND METHODS: We investigated 523 blood samples of 92 male elite cyclists (age 16-31 years) from 1978 to 1987. Haematocrit, haemoglobin and red blood cell count were analysed automatically, erythrocyte indices were calculated. RESULTS: Haemoglobin (-0.3 +/- 1 g/dl), haematocrit (-1.2 +/- 2.8%) and red blood cell count (-0.2 +/- 0.4 x 10(6)/mm3) decreased significantly (p < 0.05) with increasing training workload. The erythrocyte indices showed no significant change. Fifty-four blood samples (10.3%) showed a haematocrit above 50%, one sample presented a haemoglobin mass higher than 18.5 g/dl. During periods of increased workload, less athletes tested above the haematocrit limit. CONCLUSION: The current haematocrit limit used in blood tests might lead to a high number of false positive tests.

Adolescent↗

Quality of life in patients with inflammatory bowel disease: translation, data quality, scaling assumptions, validity, reliability and sensitivity to change of the Norwegian version of IBDQ.

BACKGROUND: The use of quality of life (QoL) questionnaires in clinical medicine must be based on instruments that are reliable and valid. The aim of this study was to describe the translation of the Inflammatory Bowel Disease Questionnaire (IBDQ) into Norwegian, its scaling assumptions and the psychometric properties of the translated questionnaire. METHOD: All patients included were recruited from an ongoing epidemiological study started in 1990 (the IBSEN trial), based on the registration of undiagnosed cases of Crohn disease (CD) or ulcerative colitis (UC) in subjects permanently residing in the study area the year before registration. At the 5-year follow-up visit in the hospital, all patients between 18 and 75 years of age were invited to participate in this QoL study, and those willing were interviewed and asked to complete the two QoL questionnaires, IBDQ and SF-36, on two different occasions separated by 6 months. The IBDQ was tested for validity, reliability and responsiveness. RESULTS: In total, 497 patients (93%) completed the IBDQ questionnaire at visit 1, and 493 (92%) completed SF-36. The mean age was 43.3 years, 48% were female. We found that the Norwegian version of the IBDQ (N-IBDQ) consists of five underlying dimensions in contrast to the four dimensions previously reported. Psychometric testing of the N-IBDQ indicates that the questionnaire is valid, reliable, has a high degree of responsiveness and that the results are comparable to those reported from other groups, even though our findings are based on a different factorial structure than the original McMaster version. CONCLUSION: The N-IBDQ consists of five different dimensions in contrast to the four dimensions previously reported. Good item internal consistency, validity, reliability and responsiveness were demonstrated.

Adolescent↗

Psychometric properties of virtual reality vignette performance measures: a novel approach for assessing adolescents' social competency skills.

This study examined the psychometric properties of performance measures for three novel, interactive virtual reality vignette exercises developed to assess social competency skills of at-risk adolescents. Performance data were collected from 117 African-American male 15-17 year olds. Data for 18 performance measures were obtained, based on adolescents' interaction with a provocative virtual teenage character. Twelve of the 18 performance measures loaded on two factors corresponding to emotional control and interpersonal communication skills, providing support for their factorial validity. The internal reliability coefficients for the two multi-item measures were 0.88 and 0.91, respectively. Additional analyses with established measures of three psychosocial factors (beliefs supporting aggression, aggressive conflict-resolution style and hostility) and behavioral criteria (e.g., self-reported behavioral misconduct and drug use) provided limited support for the construct and criterion-related validity of the performance measures. Study findings suggest that the virtual reality vignette exercises may represent a promising approach for assessing adolescents' social competency skills.

Adolescent↗

Olanzapine plasma level in relation to antimanic effect in the acute therapy of manic states.

The aim of this study was to evaluate internal as well as external validity of the two most frequently used mania scales, the Young Mania Rating Scale (YMRS) and the Bech-Rafaelsen Mania Scale (MAS), in patients with DSM-IV mania. Mokken analysis was used to evaluate internal validity in which a coefficient of homogeneity of 0.40 or higher indicates that the total score is a sufficient statistic. The external validity was evaluated by plasma-level relationship of olanzapine. In total, 20 patients with DSM-IV mania were analysed, and the coefficient of homogeneity was acceptable for the MAS, but not for the YMRS. In a subgroup of females who over 2 weeks had received a fixed dose of 20 mg olanzapine daily, a significant association was found between MAS scores and plasma levels, but this association was not obtained with the YMRS. In conclusion, the MAS was found superior to the YMRS in regard to both internal and external validity.

Antimanic Agents↗