Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review

Cross-cultural adaptation, reliability, and validity of the Turkish version of the Neck OutcOme Score

Background/aim

This study aims to determine the validity and reliability of the Turkish version of the Neck OutcOme Score (NOOS).

Materials and methods

Two hundred eight patients suffering from nonspecific neck pain participated in the study. Test–retest reliability and internal consistency were assessed using intraclass correlation coefficients (2, 1) and Cronbach’s alpha, respectively. The dimensionality was investigated with the factor analysis. The construct validity was determined by testing whether the hypothesis of correlations between NOOS subscales, Short Form-36 subscales, and the Neck Disability Index were met using Spearman’s rank correlation coefficient. Ceiling/floor effects and measurement error were tested as well.

Results

The intraclass correlation coefficient results varied between 0.721 and 0.844. Cronbach’s alpha values of the subscale were found to be between 0.847 and 0.916 in the internal consistency analysis. The factor analysis showed that the questionnaire has five factors. Floor/ceiling effects were considered not to be present.

Conclusion

It was found that the Turkish version of the NOOS is valid and reliable.

Psychometric Properties of Patient-Reported Outcome Measures for Use in Patients with Anterior Cruciate Ligament Injuries: A Systematic Review

BACKGROUND

Despite the high costs of anterior cruciate ligament (ACL) injuries to patients and society, we are not aware of any systematic reviews that have been performed on patient-reported outcome instruments designed for this patient population. The purpose of the present review is to identify currently available patient-reported outcome questionnaires for patients with ACL injuries, to appraise and assess the methodological quality and psychometric evidence of the evaluations of identified instruments, and to summarize the overall evidence for each included questionnaire.

METHODS

A computerized literature search was performed to identify articles appropriate for inclusion in this systematic review. Search terms were related to outcome instruments, ACL injuries, and psychometric properties. Two independent reviewers assessed the suitability of articles for inclusion. The methodological quality of instrument evaluation was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Psychometric properties were assessed with use of the quality criteria established by Terwee et al. The 2 assessments were synthesized to obtain an overall rating of the psychometric evidence for each questionnaire.

RESULTS

Forty-one studies investigating 24 instruments were included. The International Knee Documentation Committee (IKDC) Form and the Knee injury and Osteoarthritis Outcome Score (KOOS) were the most frequently assessed instruments. The ACL-Return to Sport after Injury (ACL-RSI) scale had 6 properties with positive evidence and was the highest-quality instrument overall.

CONCLUSIONS

Many of the included studies had low COSMIN ratings. The ACL-RSI is a reliable and valid scale to measure outcomes for patients with ACL injuries. Further assessments with improved methodological quality are needed to determine the psychometric properties of other instruments.

Poor quality patient reported outcome measures bias effect estimates in orthopaedic randomized studies

OBJECTIVES

The objective was to assess the potential for biased treatment effects associated with patient-reported outcome measures (PROMs) of varying psychometric quality in randomized clinical trials (RCTs) for rotator cuff disease (RCD).

STUDY DESIGN AND SETTING

We searched for RCTs published in the past 5 years (January 2011 to December 2016) in the top five 2015 impact factor orthopedic journals. We accepted RCTs including human participants with RCD, published in English, and using PROMs specific to RCD. We extracted data on study design, sample size, risk of bias for RCTs, quality of PROM used, estimates of effect, and associated measures of variance. PROMs were given numerical ratings of psychometric quality from a prior publication. Continuous measures of effect were transformed by dividing the effect estimate by the standard deviation. Multilevel linear regression analyses were performed to determine whether PROM quality was associated with the magnitude of effect.

RESULTS

Overall, we included 72 RCTs reporting 174 separate outcomes. Mean sample size was 66.8 (95% CI 62.30 to 71.27), mean risk of bias score across all studies was 7.00/10 (95% CI 6.72 to 7.29), psychometric quality summary scores ranged from -2 to 10, and the standardized mean effect estimate was 0.47 (95% CI -0.17 to 1.11). Regression revealed that higher-quality PROMs had smaller estimates of effect (β = -0.32; 95% CI -0.51 to -0.13; P = 0.001). We also found that a longer follow-up period predicted slightly increased effect estimates (β = 0.08; 95% CI 0.02 to 0.13; P = 0.007).

CONCLUSIONS

PROMs with poor or unknown psychometric properties overestimate treatment effects in clinical research of RCD by 68.4% (β -0.32/standardized mean effect 0.47). To our knowledge, this is the first empirical evidence that variations in the quality of PROMs bias treatment effect estimates. Researchers and clinicians using data from PROMs must be cautious to explore the quality of that measure so as to not mislead decision-making resulting from biased outcomes.

Measurement properties of oral health related patient reported outcome measures in patients with oral cancer: A systematic review using COSMIN checklist

Background

Oral cancer (OC) is one of the common malignant neoplasm resulting in a range of debilitating symptoms. Patient reported outcome measures (PROMs) could provide a valuable insight into the impact of OC on patients’ quality of life (QoL). Selecting an adequate instrument among available PROMs for OC has been challenging for clinicians due to lack of information on their psychometric quality. This systematic review provides an extensive overview of methodological quality of all currently available PROMs for OC.

Method

A systematic search was performed in PubMed, Scopus, Web of Science and CINAHL for relevant literature until 10^th January 2019 and data was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the identified studies was assessed per measurement property according to the COnsensus-based Standards for the selection of health Measurements Instruments (COSMIN) checklist.

Results

Seven studies were found evaluating 6 health-related QoL PROMs. Among six, there were 1 disease-specific and 5 generic PROMs. Information regarding important measurement properties was often incomplete. The evidence for the quality of measurement properties was found to be variable, none of the instruments performed sufficient on all measurement properties. Considering results of this review, QOL-OC appeared to have adequate COSMIN measurement properties.

Conclusion

QOL-OC can be implemented in future studies to better understand symptoms and expectations of OC patients and help inform clinicians to formulate treatment strategies as per patients’ needs.

Clinical validation of the "7 × 7" questionnaire for patients with functional gastrointestinal disorders

BACKGROUND AND AIM

Physicians use different scales and questionnaires to assess the severity of clinical symptoms in patients with functional gastrointestinal disorders. The current study aimed to validate the "7 × 7" questionnaire for assessment of severity of the symptoms as a tool for the efficacy of treatment of functional gastrointestinal disorders, using the Clinical Global Impressions scale as the reference standard.

METHODS

Fifty inpatients aged from 18 to 64 with a confirmed diagnosis of irritable bowel syndrome (26 patients, 52%), functional dyspepsia (15 patients, 30%), or both (9 patients, 18%) were prospectively enrolled in the study. We used both the 7 × 7 questionnaire and the Clinical Global Impressions scale before and after 28 days of stable treatment.

RESULTS

Our study revealed a significant correlation between the 7 × 7 questionnaire and the Clinical Global Impressions scale results in assessment of severity of the clinical symptoms and their dynamics during treatment. The 7 × 7 questionnaire showed sensitivity of 74.5% and specificity of 54.1% for evaluating patients with mild to severe disease and 66.6% and 76%, respectively, for evaluating patients with moderate to severe disease. The Cronbach's alpha coefficient was 0.719. The intraclass correlation coefficient among participants in whom the condition remained the same was 0.973 (12 participants [24.5%]).

CONCLUSIONS

The 7 × 7 questionnaire is a convenient, sensitive, and reliable tool for assessing the severity of symptoms and treatment efficacy in people with functional gastrointestinal disorders.

Assessment of oral health-related quality of life instruments for oral submucous fibrosis: A systematic review using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist

Quality of life (QoL) instruments are becoming increasingly important in research and often used in clinical practice. Various QoL instruments have been developed/ validated for assessment of oral health-related QoL (OHRQoL) in patients with oral submucous fibrosis (OSF). Selection of an adequate instrument is challenging in routine practice due to lack of information on psychometric quality of measurement instruments. This systematic review gives an extensive overview of quality of all the currently available measurement instruments for use in OSF patients. PubMed, Scopus, Web of Science and CINAHL were searched for relevant literature until December 2018 and the information was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the identified studies was assessed per measurement property according to the COnsensus-based Standards for the selection of health Measurements Instruments (COSMIN) checklist. Four studies that met the inclusion criteria were included. Three generic and one disease-specific QoL instruments were identified. Information regarding important measurement properties was often incomplete. The evidence for the quality of measurement instruments was found to be variable, none of the instruments performed sufficient on all measurement properties. Based on the available information, OHRQoL-OSF appeared to have adequate COSMIN measurement properties. As recently published, newer QoL instruments have not yet been evaluated in an adequate manner for use in OSF. We suggest future studies should implement OSF-specific OHRQoL-OSF to better understand OSF patients' perspectives and help inform clinicians to propose treatment strategies as per patients' needs.

The content and construct validity of the modified patient specific functional scale (PSFS 2.0) in individuals with neck pain

Study design: Clinical measurement study.Background: The Patient Specific Functional Scale (PSFS) is a commonly used outcome measure, however answering options differ and content validity has yet to be assessed.Objective: To assess the content validity of the PSFS in patients with neck pain presenting to a physical therapist. And secondly, to assess the construct validity of the PSFS using the preferred version identified in the content validity study.Methods: The target population consisted of patients with neck pain presenting to physical therapy. First, content validity was assessed through semi structured interviews and content thematic analysis. Second, construct validity was assessed on the PSFS 2.0 by examining its correlation with the Neck Disability Index (NDI).Results: Eleven patients were interviewed. Patients indicated the concept of 'activity limitations' is very important to them. The PSFS is considered to be relevant and easy to understand. Patients had an explicit preference for the PSFS 2.0 version (using a different answering option and example list) and indicated they preferred to answer the PSFS 2.0 together with a clinician. One hundred patients participated in the construct validity study on the PSFS 2.0. The median PSFS 2.0 score was 4.5 and the correlation with the NDI was substantial (0.54).Conclusion: The results of this study indicate that in individuals with neck pain, the PSFS is appropriate however; PSFS 2.0 is the preferred version. The PSFS 2.0 is considered to be valid in terms of content validity and construct validity for patients with neck pain.

Neck pain in episodic migraine: a cross-sectional study

Purpose: It has been reported that neck pain is more prevalent in episodic migraineurs (EM) than in the general population. Subjects with episodic migraine exhibited widespread hypersensitivity in cranio-cervical region. Our objectives were to explore the potential factors associated with the presence of neck pain for EM, and whether there were differences in pericranial muscle tenderness between EM with and without neck pain.

Patients and methods: Fifty EM with neck pain (34.76±8.04) and 50 age- and sex-matched EM without neck pain (34.26±9.39) were enrolled. The characteristics of headaches and some lifestyle factors were assessed in two groups. The migraine disability score and neck disability index were also recorded. During migraine-free period, cranio-cervical muscle tenderness scores and mechanical pain threshold were assessed for all patients.

Results: There were no significant differences in pain intensity (p=0.44), migraine disability (p=0.71), duration (p=0.44) or frequency (p=0.85) of headache between EM with and without neck pain. The lifestyle factors including smoking, alcohol, coffee, body mass index≧23kg/m², poor sleeping (<8 h/day) and time spent on TV and computers (>2 h/day) were not associated with the presence of neck pain in this study. Compared with EM without neck pain, those with neck pain had higher neck tenderness (p<0.01) and higher cephalic tenderness scores (p<0.01). Neck Disability Index scores were positively correlated with neck and total muscle tenderness scores.

Conclusion: There was a significant difference in cranio-cervical muscle tenderness scores between EM with and without neck pain. For EM, the factors studied in the current research seemed not associated with the onset of neck pain, and further studies including other factors are needed.

Psychometric testing of a short-form questionnaire for the measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation

AIM

The aim of the present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample.

METHODS

Questionnaire data were collected in three different contexts, in primary care via eight different multimodal rehabilitation teams and in specialised care via two different specialist care centres. The sample consisted of 116 men (n=29) and women (n=87) with non-specific musculoskeletal disorders.Data were analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the principal component analysis in the present study and the results attained in a previous study with a similar aim and design.

RESULTS

The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model, and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had only partly comparable result compared with previous study.

CONCLUSION

The results of the present study did not prove the suggested short-form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended.

TRIAL REGISTRATION NUMBER

92199001.

Widespread Pressure Pain Hypersensitivity, Health History, and Trigger Points in Patients with Chronic Neck Pain: A Preliminary Study

Background

Pain sensitivity in chronic neck pain patients may be influenced by health conditions related to higher levels of widespread pressure pain hypersensitivity (sensitization). Trigger points have also been reported to play a role in the sensitization process.

Objectives

To investigate the association between pressure pain thresholds, trigger points, and health conditions in patients with chronic neck pain.

Design

Original research, preliminary study.

Setting

A private clinic.

Subjects

Thirty-four chronic mechanical neck pain patients and 34 chronic whiplash-associated neck pain patients, giving a final sample of 68 chronic neck pain patients.

Methods

Patients underwent an assessment of pressure pain thresholds over the upper trapezius, extensor carpi radialis longus, and tibialis anterior muscles and were screened for the presence of trigger points in the upper trapezius muscle. Further, information about health history conditions was obtained and collected in a form.

Results

Significantly negative correlations between all pressure pain thresholds and duration of health history conditions were found (all P &lt; 0.02). Significantly lower pressure pain thresholds (all P &lt; 0.01) were found in patients with active trigger points as compared with those with latent trigger points.

Conclusion

Widespread pressure pain hypersensitivity was associated with duration of health history conditions, suggesting that long-lasting health complaints may act as a triggering/perpetuating factor, driving sensitization in individuals with chronic neck pain. Active trigger points may be associated with higher widespread pressure hypersensitivity.

Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration

PURPOSE

To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD).

METHODS

We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification.

RESULTS

We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire.

CONCLUSION

The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.

Examining item content validity using property fitting analysis via multidimensional scaling

OBJECTIVES

Multiple-item measuring instruments are frequently used in a wide range of disciplines for the purpose of research in substantive areas. The quality of items in these instruments determine to a large extent whether the results are trustworthy. In this paper, we suggested to use property fitting analysis to evaluate the appropriateness of items content validity based on explicit item property criteria.

METHODS

Using Center for Epidemiologic Studies Depression scale as an example, item property fitting analyses via multidimensional scaling model was used to quantitatively evaluate the properties of items based on rating data from 12 counselors.

RESULTS

The results of the analyses indicated that using explicit item property criteria to select items for subsequent psychometric analyses improved the item quality in terms of reliability and factor structure.

CONCLUSIONS

Item property fitting analysis seemed to provide the researcher a viable quantitative method when evaluating item content validity.

Comparison of psychometric properties between recall methods of interview-based physical activity questionnaires: a systematic review

BACKGROUND

This systematic review examined the methodological quality of studies and assessed the psychometric qualities of interview-administered Past-week and Usual-week Physical Activity Questionnaires (PAQs). Pubmed and Embase were used to retrieve data sources.

METHODS

The studies were selected using the following eligibility criteria: 1) psychometric properties of PAQs were assessed in adults; 2) the PAQs either consisted of recall periods of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were interview-administered. The COSMIN taxonomy was utilised to critically appraise study quality and a previously established psychometric criteria employed to evaluate the overall psychometric qualities.

RESULTS

Following screening, 42 studies were examined to determine the psychometric properties of 20 PAQs, with the majority of studies demonstrating good to excellent ratings for methodological quality. For convergent validity (i.e., the relationship between PAQs and other measures), similar overall associations were found between Past-week PAQs and Usual-week PAQs. However, PAQs were more strongly associated with direct measures of physical activity (e.g., accelerometer) than indirect measures of physical activity (i.e., physical fitness), irrespective of recall methods. Very few psychometric properties were examined for each PAQ, with the majority exhibiting poor ratings in psychometric quality. Only a few interview-administered PAQs exhibited positive ratings for a single psychometric property, although the other properties were either rated as poor or questionable, demonstrating the limitations of current PAQs.

CONCLUSION

Accordingly, further research is necessary to explore a greater number of psychometric properties, or to develop new PAQs by addressing the psychometric limitations identified in the current review.

Measuring outcomes following tibial fracture

AIM

The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes.

METHODS

A systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.

RESULTS

A total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological "outcomes" were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture.

CONCLUSION

We recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.

Comparison of Patient Reported Outcome Measurement Information System With Neck Disability Index and Visual Analog Scale in Patients With Neck Pain

STUDY DESIGN

A retrospective analysis of a patient-reported outcomes database from a single institution from December 2016 to April 2017.

OBJECTIVE

To validate the association of Patient Reported Outcome Measurement Information System (PROMIS) with Neck Disability Index (NDI) in patients with neck pain and examine each instruments ability to capture concomitant arm pain and concomitant back pain.

SUMMARY OF BACKGROUND DATA

PROMIS has been increasingly utilized and its computer adapted testing methodology improves assessment of pain and disability. However, literature is lacking regarding how these instruments perform in neck pain patients with concomitant arm pain or back pain.

METHODS

Inclusion criteria were age >18 years and a primary complaint of neck pain. The NDI; Visual Analog Scale (VAS) back, neck, arm, and leg; and PROMIS physical function, pain intensity, and pain interference questionnaires were administered. Propensity score matching was performed to compare patients with high and low back and arm pain by controlling for neck pain. Bivariate correlations and independent samples t tests were performed to assess linear relationships and compare back and arm pain groups with PROMIS.

RESULTS

Approximately, 130 patients were included. NDI correlated strongly to PROMIS physical function (r = -0.771, P < 0.001), pain intensity (r = 0.605, P < 0.001), and pain interference (r = 0.786, P < 0.001). VAS neck and arm pain also correlated to the PROMIS pain intensity instrument (VAS neck: r = 0.642, P < 0.001; VAS arm: r = 0.376, P < 0.001).After matching for neck pain, the high and low back pain groups each included 32 patients. There were significant differences in PROMIS physical function when high and low back pain groups were compared (39.07 vs. 43.68, P = 0.031). No significant difference was found for any outcome metric for high and low arm pain groups.

CONCLUSION

PROMIS instruments are capable of characterizing pain and disability in patients with neck pain and are sensitive to disability in regions adjacent to the neck.

LEVEL OF EVIDENCE

3.

Evaluating the Cross-Cultural Adaptation, Reliability, and Validity of the Persian Versions of the Copenhagen Neck Function Disability Scale and Neck Bournemouth Questionnaire

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

To evaluate cross-cultural adaptation and psychometric properties of the Copenhagen Neck Function Disability Scale (CNFDS) and Neck Bournemouth Questionnaire (NBQ) in patients with chronic nonspecific neck pain.

SUMMARY OF BACKGROUND DATA

CNFDS and NBQ are among the most popular scales to investigate aspects of life in patients with chronic neck pain. To date, the Persian versions of these scales have not been validated.

METHODS

Following the translation process, the questionnaires were given to 106 patients with chronic nonspecific neck pain. To evaluate reliability, Cronbach alpha and test-retest reliability were evaluated. To investigate construct validity, the Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) were used. Internal consistency of the scales was evaluated with exploratory factor analysis.

RESULTS

No missing data were observed for the NBQ, and missing data affected 0% to 3% of the CNFDS items. There were no floor or ceiling effects. Cronbach alpha was 0.92 for the CNFDS and 0.95 for the NBQ. Test-retest reliability was estimated as 0.86 for the CNFDS and 0.91 for the NBQ. The CNFDS correlated very well with the NDI pain subscale, and the NPDS. The NBQ correlated very well with the NPDS and NDI, and correlated well with the CNFDS and its subscales. Exploratory factor analysis detected three dimensions for the CNFDS and confirmed unidimensionality of the NBQ.

CONCLUSION

The Persian versions of the CNFDS and NBQ have acceptable validity and reliability for use with Persian-speaking patients with chronic nonspecific neck pain.

LEVEL OF EVIDENCE

2.

Self-criticism self-report measures: Systematic review

PURPOSE

Self-criticism is a transdiagnostic process that has been attracting research and clinical interest. The accurate measurement of this construct is therefore crucial; however, there are currently numerous measures of self-criticism and no guidelines about which to use in different contexts. This systematic review evaluated the measurement properties of self-report questionnaires of self-criticism.

METHODS

OvidSP and Web of Science were used to search through multiple databases, and an initial grey literature search was completed. Studies were included when the main focus was to evaluate the measurement properties of English version of scales or subscales that aimed to measure self-criticism in an adult population. Both the methodological quality of included studies and the specific measurement properties were evaluated; these ratings were then combined into a best evidence synthesis.

RESULTS

Five scales and five subscales were identified, described in 16 papers. The scales were designed to measure different types of self-criticism including trait or repetitive self-criticism and self-criticism in response to difficult situations or as a mood regulation strategy. The majority of included studies were either rated as having poor methodological quality, or were given indeterminate or negative ratings for the measurement properties they reported. Questionnaire content varied depending on how the authors conceptualized self-criticism. Issues were also highlighted in relation to the checklist used to rate methodological quality.

CONCLUSIONS

Tentative recommendations were made about two measures of self-criticism based on existing evidence; future research is required. Furthermore, questionnaire choice should be based on the type of self-criticism being assessed.

PRACTITIONER POINTS

Self-criticism has been associated with a range of clinical difficulties including depression and eating disorders and is increasingly the focus of research, including treatment studies directly targeting self-criticism. Since different researchers have conceptualized self-criticism differently, a number of self-criticism self-report questionnaires have been developed that vary in terms of design, structure, and content. This systematic review identified and evaluated the measurement properties of self-report questionnaires of self-criticism and makes tentative recommendations about their use in clinical and research settings and areas for future research.

Development, validity and reliability of the Italian version of the Copenhagen neck functional disability scale

BACKGROUND

Valid and reliable patient-reported outcome measures support health professionals in evaluating the results of clinical research and practice. The Copenhagen Neck Functional Disability Scale (CNFDS) has shown promising measurement properties to measure disability in patients with neck pain, but an Italian version of this questionnaire is not available. The objective of this study was to cross-culturally adapt the CNFDS into Italian (CNFDS-I), and to assess its validity and reliability in patients with neck pain.

METHODS

The CNFDS-I was developed according to well-established guidelines for cross-cultural adaptation of patient-reported outcome measures. A cross-sectional clinimetric study was conducted to evaluate its validity and reliability. Patients with chronic neck pain (pain > 3 months) participated in this study. The following measurement properties (defined by the COSMIN initiative) were assessed: structural validity (exploratory factor analysis), internal consistency (Cronbach's α), construct validity [by testing hypotheses on expected correlations with the Neck Disability Index (NDI), the Neck Bournemouth Questionnaire (NBQ), and pain Visual Analogue Scale (VAS)]. Test-retest reliability [Intraclass Correlation Coefficient for agreement (ICCagreement)], and measurement error [Smallest Detectable Change (SDC)] were also assessed in 50 clinically stable patients. Floor/ceiling effects and acceptability were calculated.

RESULTS

One-hundred and sixty-two patients (mean age = 47.9 ± 14.5 years, 70% female) were included. The CNFDS-I exhibited sufficient unidimensionality (one factor explained 83% of the variability) and internal consistency (α = 0.83). Construct validity was sufficient as all correlations with the other questionnaires were as expected (r = 0.846 with NDI, r = 0.708 with NBQ, r = 0.570 with VAS). Test-retest reliability was excellent (ICCagreement = 0.99, 95% CI from 0.995 to 0.999), while measurement error was equal to 8.31 scale points (27% scale range). No floor/ceiling effects were detected. The average time for filling the questionnaire was two minutes.

CONCLUSIONS

The CNFDS-I proved to be a valid and reliable outcome measure to assess disability in patients with chronic neck pain. Head-to-head comparison studies on the CNFDS-I measurement properties against other disability measures for neck pain (e.g. NDI and NBQ) are required to determine the relative merits of these different measures.

Measurement Properties of the Functional Rating Index: A Systematic Review and Meta-analysis

STUDY DESIGN

A systematic review and meta-analysis.

OBJECTIVE

To assess the measurement properties of the Functional Rating Index (FRI) and determine whether its measurement properties are comparable with other region-specific questionnaires.

SUMMARY OF BACKGROUND DATA

In addition to low back pain (LBP) and neck pain (NP), multiregion spinal pain (SP) is a common problem with a considerable prevalence in the general population. The FRI was built to assess physical functioning in patients with SP. However, a systematic review assessing evidence of its measurement properties in separated populations and a comparison with other questionnaires regarding each measurement property is lacking.

METHODS

Articles concerning the FRI's measurement properties or head-to-head comparison with other questionnaires on measurement properties were obtained from MEDLINE, Embase, CINAHL, and PsycINFO. Two reviewers independently reviewed the articles, extracted data, and conducted the methodological quality assessment. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of the included studies.

RESULTS

A total of 18 studies evaluating the FRI's measurement properties, including seven that carried out head-to-head comparisons in at least one measurement property with other questionnaires, were included in the current review. Our findings show strong positive evidence for structural validity and internal consistency in patients with SP and LBP. Evidence for most of the FRI's measurement properties is limited, conflicting, or even unknown. The current evidence shows that the FRI is comparable with both the Oswestry Disability Index and the Neck Disability Index in responsiveness. However, relevant information about the majority of the other measurement properties is lacking.

CONCLUSION

Our finding suggests that clinicians and researchers should use the FRI with caution until there are more studies with high methodological quality that support the view that it is positive in all measurement properties, especially in regard to patients with multiregion SP.

LEVEL OF EVIDENCE

1.

Content and psychometric evaluations of questionnaires for assessing physical function in people with low back disorders. A systematic review of the literature

Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders in the low back. Specifically:Which questionnaires are used to assess physical function in people with musculoskeletal disorders in the low back?What aspects of physical function do those questionnaires measure?What are the measurement properties of the questionnaires?Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations of them. The content of the questionnaires was categorised according to the International Classification of Function, Disability and Health, and the psychometric evaluations were categorised using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist.Results: The questionnaires measured disability or ability to cope in everyday life, rather than physical function as such. Different aspects of a person's mobility and ability to attend to one's personal care were most often included regarding activity and participation. For body functions, items about sleep and pain were most often included. The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.Conclusions: The extent of psychometric evaluations differed substantially, as did the items included. Focus of measurement was predominantly on activities in daily life.Implications for rehabilitationValid and reliable instruments that measure relevant aspects of low back disorders are needed to provide early diagnostics and effective treatment.Most questionnaires need more psychometric evaluations to establish the quality.The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.The results may be useful when making decisions about which measurement instruments to use when evaluating low back disorders.

Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review

OBJECTIVE

The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS).

METHODS

We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A-D).

RESULTS

Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D).

CONCLUSION

The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials.

Patient-Reported Outcome Measures Used for Neck Disorders: An Overview of Systematic Reviews

BACKGROUND

The evaluation of patient-reported outcome measures for the neck from multiple systematic reviews will provide a broader view of, and may identify potential conflicting or consistent results for, their psychometric properties.

OBJECTIVES

The purpose of this study was to conduct an overview of systematic reviews and synthesize evidence to establish the current state of knowledge on psychometric properties of patient-reported outcome measures for patients with neck disorders.

METHODS

In this overview of systematic reviews, an electronic search of 6 databases (MEDLINE, Embase, CINAHL, ILC, the Cochrane Central Register of Controlled Trials, and LILACS) was conducted to identify reviews that addressed at least one measurement property of outcome measures for people with neck pain. Only systematic reviews with patient-reported outcome measures were included in the analysis. Risk of bias was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Data on measurement properties were extracted from each systematic review.

RESULTS

From 13 systematic reviews, 8 patient-reported outcome measures were evaluated in 2 or more reviews. Risk-of-bias scores ranged from moderate (5-7) to high (4 and lower). Findings on internal consistency, test-retest reliability, construct validity, responsiveness to change, and content and structural validity were synthesized for the Neck Disability Index (NDI) in 11 systematic reviews; the Northwick Park Neck Pain Questionnaire and Neck Pain and Disability scale (NPDS) in 6 systematic reviews; the Copenhagen Neck Functional Disability Scale in 5 systematic reviews; the Neck Bournemouth Questionnaire in 4 systematic reviews; the Core Neck Pain Questionnaire and Patient-Specific Functional Scale in 3 systematic reviews, and the Whiplash Disability Questionnaire in 2 systematic reviews.

CONCLUSION

High-quality evidence was found of good to excellent internal consistency and moderate to excellent test-retest reliability for the NDI. Moderate-quality evidence was found of good to excellent internal consistency and good test-retest reliability for the Northwick Park Neck Pain Questionnaire. High-quality evidence was found of excellent test-retest reliability and good to strong construct validity with pain scales for the Copenhagen Neck Functional Disability Scale. Moderate-quality evidence was found of unclear to excellent internal consistency and moderate to strong concurrent associations with the NDI and global assessment of change for the Neck Pain and Disability scale. Moderate-quality evidence was found of excellent internal consistency for the Whiplash Disability Questionnaire and of high test-retest reliability for the Patient-Specific Functional Scale. J Orthop Sports Phys Ther 2018;48(10):775-788. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8131.

Evaluating the psychometric quality of school connectedness measures: A systematic review

INTRODUCTION

There is a need to comprehensively examine and evaluate the quality of the psychometric properties of school connectedness measures to inform school based assessment and intervention planning.

OBJECTIVE

To systematically review the literature on the psychometric properties of self-report measures of school connectedness for students aged six to 14 years.

METHODS

A systematic search of five electronic databases and gray literature was conducted. The COnsensus-based Standards for the selection of heath Measurement INstruments (COSMIN) taxonomy of measurement properties was used to evaluate the quality of studies and a pre-set psychometric criterion was used to evaluate the overall quality of psychometric properties.

RESULTS

The measures with the strongest psychometric properties was the School Climate Measure and the 35-item version Student Engagement Instrument exploring eight and 12 (of 15) school connectedness components respectively.

CONCLUSIONS

The overall quality of psychometric properties was limited suggesting school connectedness measures available require further development and evaluation.

Muscle tone assessments for children aged 0 to 12 years: a systematic review

AIM

The aim of this study was to identify and examine the psychometric properties of muscle tone assessments for children aged 0 to 12 years.

METHOD

Four electronic databases were searched to identify studies that included assessments of resting and/or active muscle tone. Methodological quality and overall psychometric evidence of studies were rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

RESULTS

Twenty-one assessments were identified from 97 included studies. All assessments were broad developmental assessments that included muscle tone items or subscales. Most assessments (16/21) were designed for young children (<2y). Four assessments measured resting and active tone and demonstrated at least moderate validity or reliability: the Amiel-Tison Neurological Assessment (ATNA) at term, Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), Premie-Neuro for newborn infants, and the Hammersmith Infant Neurological Examination (HINE) for infants aged 2 months to 2 years. For children over 2 years, the Neurological Sensory Motor Developmental Assessment (NSMDA) assesses resting and active tone but has limited validity.

INTERPRETATION

The ATNA at term, NNNS, Premie-Neuro, HINE, and NSMDA can assess resting and active tone in infants and/or children. Further psychometric research is required to extend reliability, validity, and responsiveness data, particularly for older children.

WHAT THIS PAPER ADDS

This is the first review of muscle tone assessments for children aged 0 to 12 years. Twenty-one assessments contain muscle tone items and 16 are for children under 2 years. Four assessments are reliable or valid to measure both resting and active tone.

Quality of health literacy instruments used in children and adolescents: a systematic review

OBJECTIVE

Improving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.

DESIGN

Systematic review.

SETTING

A wide range of settings including schools, clinics and communities.

PARTICIPANTS

Children and/or adolescents aged 6-24 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.

RESULTS

There were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.

CONCLUSIONS

More rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.

The measurement of collaboration within healthcare settings: a systematic review of measurement properties of instruments

BACKGROUND

There is a growing call by consumers and governments for healthcare to adopt systems and approaches to care to improve patient safety. Collaboration within healthcare settings is an important factor for improving systems of care. By using validated measurement instruments a standardized approach to assessing collaboration is possible, otherwise it is only an assumption that collaboration is occurring in any healthcare setting.

OBJECTIVES

The objective of this review was to evaluate and compare measurement properties of instruments that measure collaboration within healthcare settings, specifically those which have been psychometrically tested and validated.

INCLUSION CRITERIA, TYPES OF PARTICIPANTS

Participants could be healthcare professionals, the patient or any non-professional who contributes to a patient's care, for example, family members, chaplains or orderlies. The term participant type means the designation of any one participant; for example 'nurse', 'social worker' or 'administrator'. More than two participant types was mandatory.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

The focus of this review was the validity of tools used to measure collaboration within healthcare settings.

TYPES OF STUDIES

The types of studies considered for inclusion were validation studies, but quantitative study designs such as randomized controlled trials, controlled trials and case studies were also eligible for inclusion. Studies that focused on Interprofessional Education, were published as an abstract only, contained patient self-reporting only or were not about care delivery were excluded.

OUTCOMES

The outcome of interest was validation and interpretability of the instrument being assessed and included content validity, construct validity and reliability. Interpretability is characterized by statistics such as mean and standard deviation which can be translated to a qualitative meaning.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The databases searched included PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Emerald Fulltext, MD Consult Australia, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Informit Health Databases, Scopus, UpToDate and Web of Science. The search for unpublished studies included EThOS (Electronic Thesis Online Service), Index to Theses and ProQuest- Dissertations and Theses.

METHODOLOGICAL QUALITY

The assessment of methodological quality of the included studies was undertaken using the COSMIN checklist which is a validated tool that assesses the process of design and validation of healthcare measurement instruments.

DATA COLLECTION

An Excel spreadsheet version of COSMIN was developed for data collection which included a worksheet for extracting participant characteristics and interpretability data.

DATA SYNTHESIS

Statistical pooling of data was not possible for this review. Therefore, the findings are presented in a narrative form including tables and figures to aid in data presentation. To make a synthesis of the assessments of methodological quality of the different studies, each instrument was rated by accounting for the number of studies performed with an instrument, the appraisal of methodological quality and the consistency of results between studies.

RESULTS

Twenty-one studies of 12 instruments were included in the review. The studies were diverse in their theoretical underpinnings, target population/setting and measurement objectives. Measurement objectives included: investigating beliefs, behaviors, attitudes, perceptions and relationships associated with collaboration; measuring collaboration between different levels of care or within a multi-rater/target group; assessing collaboration across teams; or assessing internal participation of both teams and patients.Studies produced validity or interpretability data but none of the studies assessed all validity and reliability properties. However, most of the included studies produced a factor structure or referred to prior factor analysis. A narrative synthesis of the individual study factor structures was generated consisting of nine headings: organizational settings, support structures, purpose and goals; communication; reflection on process; cooperation; coordination; role interdependence and partnership; relationships; newly created professional activities; and professional flexibility.

CONCLUSIONS

Among the many instruments that measure collaboration within healthcare settings, the quality of each instrument varies; instruments are designed for specific populations and purposes, and are validated in various settings. Selecting an instrument requires careful consideration of the qualities of each. Therefore, referring to systematic reviews of measurement properties of instruments may be helpful to clinicians or researchers in instrument selection.

IMPLICATIONS FOR PRACTICE

Systematic reviews of measurement properties of instruments are valuable in aiding in instrument selection. This systematic review may be useful in instrument selection for the measurement of collaboration within healthcare settings with a complex mix of participant types. Evaluating collaboration provides important information on the strengths and limitations of different healthcare settings and the opportunities for continuous improvement via any remedial actions initiated.

IMPLICATIONS FOR RESEARCH

Development of a tool that can be used to measure collaboration within teams of healthcare professionals and non-professionals is important for practice. The use of different statistical modelling techniques, such as Item Response Theory modelling and the translation of models into Computer Adaptive Tests, may prove useful. Measurement equivalence is an important consideration for future instrument development and validation. Further development of the COSMIN tool should include appraisal for measurement equivalence. Researchers developing and validating measurement tools should consider multi-method research designs.

Concurrent validity and interrater reliability of a new smartphone application to assess 3D active cervical range of motion in patients with neck pain

BACKGROUND

There is a lack of valid, reliable, and feasible instruments for measuring planar active cervical range of motion (aCROM) and associated 3D coupling motions in patients with neck pain. Smartphones have advanced sensors and appear to be suitable for these measurements.

OBJECTIVES

To estimate the concurrent validity and interrater reliability of a new iPhone application for assessing planar aCROM and associated 3D coupling motions in patients with neck pain, using an electromagnetic tracking device as a reference test.

DESIGN

Cross-sectional study.

METHODS

Two samples of neck pain patients were recruited; 30 patients for the validity study and 26 patients for the reliability study. Validity was estimated using intraclass correlation coefficients (ICCs), and by calculating 95% limits of agreement (LoA). To estimate interrater reliability, ICCs were calculated. Cervical 3D coupling motions were analyzed by calculating the cross-correlation coefficients and ratio between the main motions and coupled motions for both instruments.

RESULTS

ICCs for concurrent validity and interrater reliability ranged from 0.90 to 0.99. The width of the 95% LoA ranged from about 5° for right lateral bending to 11° for total rotation. No significant differences were found between both devices for associated coupling motion analysis.

CONCLUSIONS

The iPhone application appears to be a useful discriminative tool for the measurement of planar aCROM and associated coupling motions in patients with neck pain. It fulfills the need for a valid, reliable, and feasible instrument in clinical practice and research. Therapists and researchers should consider measurement error when interpreting scores.

Validity and Responsiveness of the Pain Self-Efficacy Questionnaire in Patients With Neck Pain Disorders

Study Design Longitudinal clinimetric study. Background Pain self-efficacy predicts poor recovery and mediates the relationship between pain and disability in patients with neck pain disorders (NPDs). The Pain Self-Efficacy Questionnaire (PSEQ) is a frequently used instrument to measure pain self-efficacy; however, its measurement properties have never been evaluated in a group of patients with NPDs. Objectives This study aimed to assess validity and responsiveness of the PSEQ in patients with NPDs. Methods Patients with NPDs (n = 161) were included. Confirmatory and exploratory factor analysis was used to assess structural validity. Twelve hypotheses on expected correlations with other instruments were formulated a priori to assess construct validity. Responsiveness was evaluated in 146 patients with NPDs who underwent multimodal rehabilitation by testing 12 hypotheses on expected effect sizes, area under the curve, and correlations with change in other instruments. Results Factor analyses showed that the PSEQ is a unidimensional instrument with moderate construct validity and responsiveness (50% to 75% of hypotheses met). Validity was consistent when analyzed separately for patients with whiplash-associated disorders and idiopathic neck pain, and responsiveness was better in patients with idiopathic neck pain. Conclusion The PSEQ is a unidimensional measure of pain self-efficacy in patients with NPDs, as found by previous studies in other populations. Nevertheless, in contrast with previous studies, its construct validity and responsiveness were found to be suboptimal in NPDs, suggesting that the content validity of the PSEQ and of the comparator instruments used in this study should be better assessed. J Orthop Sports Phys Ther 2018;48(3):204-216. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7605.

The quality of instruments to assess the process of shared decision making: A systematic review

OBJECTIVE

To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies.

METHODS

In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397.

RESULTS

We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated.

CONCLUSIONS

Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.

Measurement properties of depression questionnaires in patients with diabetes: a systematic review

Purpose

To conduct a systematic review on measurement properties of questionnaires measuring depressive symptoms in adult patients with type 1 or type 2 diabetes.

Methods

A systematic review of the literature in MEDLINE, EMbase and PsycINFO was performed. Full text, original articles, published in any language up to October 2016 were included. Eligibility for inclusion was independently assessed by three reviewers who worked in pairs. Methodological quality of the studies was evaluated by two independent reviewers using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Quality of the questionnaires was rated per measurement property, based on the number and quality of the included studies and the reported results.

Results

Of 6286 unique hits, 21 studies met our criteria evaluating nine different questionnaires in multiple settings and languages. The methodological quality of the included studies was variable for the different measurement properties: 9/15 studies scored ‘good’ or ‘excellent’ on internal consistency, 2/5 on reliability, 0/1 on content validity, 10/10 on structural validity, 8/11 on hypothesis testing, 1/5 on cross-cultural validity, and 4/9 on criterion validity. For the CES-D, there was strong evidence for good internal consistency, structural validity, and construct validity; moderate evidence for good criterion validity; and limited evidence for good cross-cultural validity. The PHQ-9 and WHO-5 also performed well on several measurement properties. However, the evidence for structural validity of the PHQ-9 was inconclusive. The WHO-5 was less extensively researched and originally not developed to measure depression.

Conclusion

Currently, the CES-D is best supported for measuring depressive symptoms in diabetes patients.

Electronic supplementary material

The online version of this article (10.1007/s11136-018-1782-y) contains supplementary material, which is available to authorized users.

Assessing Features of Psychometric Assessment Instruments: A Comparison of the COSMIN Checklist with Other Critical Appraisal Tools

The past 20 years have seen the development of instruments designed to specify standards and evaluate the adequacy of published studies with respect to the quality of study design, the quality of findings, as well as the quality of their reporting. In the field of psychometrics, the first minimum set of standards for the review of psychometric instruments was published in 1996 by the Scientific Advisory Committee of the Medical Outcomes Trust. Since then, a number of tools have been developed with similar aims. The present paper reviews basic psychometric properties (reliability, validity and responsiveness), compares six tools developed for the critical appraisal of psychometric studies and provides a worked example of using the COSMIN checklist, Terwee-m statistical quality criteria, and the levels of evidence synthesis using the method of Schellingerhout and colleagues (2012). This paper will aid users and reviewers of questionnaires in the quality appraisal and selection of appropriate instruments by presenting available assessment tools, their characteristics and utility.

Patient-reported outcome measures for patients with meniscal tears: a systematic review of measurement properties and evaluation with the COSMIN checklist

OBJECTIVE

Meniscal tears occur frequently in the population and the most common surgical treatment, arthroscopic partial meniscectomy, is performed in approximately two million cases worldwide each year. The purpose of this systematic review is to summarise and critically appraise the evidence for the use of patient-reported outcome measures (PROMs) in patients with meniscal tears.

DESIGN

A systematic review was undertaken. Data on reported measurement properties were extracted and the quality of the studies appraised according to Consensus-based Standards for the Selection of Health Measurement Instruments.

DATA SOURCES

A search of MEDLINE, Embase, AMED and PsycINFO, unlimited by language or publication date (last search 20 February 2017).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Development and validation studies reporting the measurement properties of PROMs in patients with meniscal tears were included.

RESULTS

11 studies and 10 PROMs were included. The overall quality of studies was poor. For measurement of symptoms and functional status, there is only very limited evidence supporting the selection of either the Lysholm Knee Scale, International Knee Documentation Committee Subjective Knee Form or the Dutch version of the Knee injury and Osteoarthritis Outcome Score. For measuring health-related quality of life, only limited evidence supports the selection of the Western Ontario Meniscal Evaluation Tool (WOMET). Of all the PROMs evaluated, WOMET has the strongest evidence for content validity.

CONCLUSION

For patients with meniscal tears, there is poor quality and incomplete evidence regarding the validity of the currently available PROMs. Further research is required to ensure these PROMs truly reflect the symptoms, function and quality of life of patients with meniscal tears.

PROPERO REGISTRATION NUMBER

CRD42017056847.

Patient reported outcomes in orthopaedics

Patient reported outcome measures (PROMs) are key tools when performing clinical research and PROM data are increasingly used to inform clinical decision-making, patient-centered care, health policy and more recently, reimbursement decisions. PROMs must possess particular properties before they are used. Thus purpose of this paper is to give an overview of PROMs, their definition, how their evidence can be assessed, how they should be reported in clinical research, how to choose PROMs, the types of PROMs available in orthopaedics, where these measures can be found, PROMs in orthopaedic clinical practice and what are some key next steps in this field. If PROMs are used in accordance with the guidance in this article, I believe we will gain considerable insight into PROMs in orthopaedics and will advance this field in a way that can contribute to science, improve patient care and save considerable resources. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2098-2108, 2017.

A Quality Assessment of Patient-Reported Outcome Measures for Sexual Function in Neurologic Patients Using the Consensus-based Standards for the Selection of Health Measurement Instruments Checklist: A Systematic Review

CONTEXT

Impaired sexual function has a significant effect on quality of life. Various patient-reported outcome measures (PROMs) are available to evaluate sexual function. The quality of the PROMs to be used for neurologic patients remains unknown.

OBJECTIVE

To systematically review which validated PROMs are available to evaluate sexual function in neurologic patients and to critically assess the quality of the validation studies and measurement properties for each identified PROM.

EVIDENCE ACQUISITION

A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. The included publications were assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist.

EVIDENCE SYNTHESIS

Twenty-one studies for PROMs regarding sexual function were identified for the following patient groups: spinal cord injury (11 studies), multiple sclerosis (MS; 6 studies), Parkinson's disease (2 studies), traumatic brain injury (1 study), and epilepsy (1 study). The evidence for the quality of PROMs was found to be variable, and overall evaluation of measurement properties was lacking in 71% of the studies. The measurement error and responsiveness were not studied in any of the publications.

CONCLUSIONS

Several PROMs have been identified to evaluate sexual function in neurologic patients. Strong evidence was found only for the Multiple Sclerosis Intimacy and Sexuality Questionnaire-15 and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 for patients with MS, although evidence was lacking for certain measurement properties as well. Future research should focus on identifying relevant PROMs and establishing adequate quality for all measurement properties in studies with high methodological quality.

PATIENT SUMMARY

A quality assessment of patient-reported outcome measures (PROMs) for sexual function in neurologic patients was made. The evidence found for good PROMs was limited. Studies with high methodological quality are needed to improve the quality of PROMs to evaluate sexual function in neurologic patients.

Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates

BACKGROUND CONTEXT

Severe adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1%, and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement, whereas image guidance has been suggested to improve placement accuracy.

PURPOSE

This study aimed to systematically review the screw-related complication and breach rates from posterior spinal instrumentation and fusion with pedicle screws for patients with AIS when using free-hand methods for screw insertion compared with image guidance methods.

STUDY DESIGN

This is a systematic review of prognosis, comparing image guidance with no image guidance in surgery.

PATIENT SAMPLE

One randomized controlled trial and multiple prospective cohort studies that reported complication or breach rates in posterior spinal instrumentation and fusion with pedicle screws for AIS.

OUTCOME MEASURES

Number of complications and breaches reported in databases or recorded from postoperative imaging.

METHODS

Databases searched included MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science. Studies of Level 3 evidence or greater as defined by the Centre for Evidence-Based Medicine were included. Articles were screened to focus on patients with AIS undergoing posterior fusion with pedicle screws or hybrid systems. Two independent reviewers screened abstracts, full texts, and extracted data. The Quality in Prognostic Studies (QUIPS) appraisal tool was used to determine studyrisk of bias (ROB). Level of evidence summary statements were formulated based on consistency and quality of reporting.

RESULTS

Seventy-nine cohort studies were identified, including four comparing computed tomography (CT) guidance with free-hand methods head-to-head, eight on image guidance, and 671. on free-hand methods alone. Moderate evidence from individual head-to-head studies show CT guidance has lower breach rates than free-hand methods. No complications were found in these studies. From individual cohort studies, moderate evidence shows CT guidance has lower point estimates of breach rates than free-hand methods at 7.9% compared with 9.7%-17.1%. Screw-related complication rates are conflicting at 0% in CT navigation compared with 0%-1.7% in 13 low- and moderate-quality studies.

CONCLUSIONS

Although point estimates on breach rates are decreased with CT navigation compared with free-hand methods, complication rates remain conflicting between the two methods. Current evidence is limited by small sample sizes, lack of comparison groups, and poorly predefined complications. Randomized controlled trials with larger samples with standardized definitions and recording of predefined breach and complication occurrences are recommended.

Health-Related Resource-Use Measurement Instruments for Intersectoral Costs and Benefits in the Education and Criminal Justice Sectors

BACKGROUND

Intersectoral costs and benefits (ICBs), i.e. costs and benefits of healthcare interventions outside the healthcare sector, can be a crucial component in economic evaluations from the societal perspective. Pivotal to their estimation is the existence of sound resource-use measurement (RUM) instruments; however, RUM instruments for ICBs in the education or criminal justice sectors have not yet been systematically collated or their psychometric quality assessed. This review aims to fill this gap.

METHODS

To identify relevant instruments, the Database of Instruments for Resource Use Measurement (DIRUM) was searched. Additionally, a systematic literature review was conducted in seven electronic databases to detect instruments containing ICB items used in economic evaluations. Finally, studies evaluating the psychometric quality of these instruments were searched.

RESULTS

Twenty-six unique instruments were included. Most frequently, ICB items measured school absenteeism, tutoring, classroom assistance or contacts with legal representatives, police custody/prison detainment and court appearances, with the highest number of items listed in the Client Service Receipt Inventory/Client Sociodemographic and Service Receipt Inventory/Client Service Receipt Inventory-Children's Version (CSRI/CSSRI/CSRI-C), Studying the Scope of Parental Expenditures (SCOPE) and Self-Harm Intervention, Family Therapy (SHIFT) instruments. ICBs in the education sector were especially relevant for age-related developmental disorders and chronic diseases, while criminal justice resource use seems more important in mental health, including alcohol-related disorders or substance abuse. Evidence on the validity or reliability of ICB items was published for two instruments only.

CONCLUSION

With a heterogeneous variety of ICBs found to be relevant for several disease areas but many ICB instruments applied in one study only (21/26 instruments), setting-up an international task force to, for example, develop an internationally adaptable instrument is recommended.

Psychometric Characteristics of Non-instrumental Swallowing and Feeding Assessments in Pediatrics: A Systematic Review Using COSMIN

As early diagnosis of swallowing and feeding difficulties in infants and children is of utmost importance, there is a need to evaluate the quality of the psychometric properties of pediatric assessments of swallowing and feeding. A systematic review was performed summarizing the psychometric properties of non-instrumental assessments for swallowing and feeding difficulties in pediatrics; no data were identified for the remaining twelve assessments. The COSMIN taxonomy and checklist were used to evaluate the methodological quality of 23 publications on psychometric properties. For each assessment, an overall quality score for each measurement property was determined. As psychometric data proved incomplete, conflicting or indeterminate for all assessments, only preliminary conclusions could be drawn; the most robust assessment based on current data is the dysphagia disorder survey (DDS). However, further research is needed to provide additional information on all psychometric properties for all assessments.

Effectiveness of a multimodal pain management concept for patients with cervical radiculopathy with focus on cervical epidural injections

Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy. 54 patients who had undergone inpatient MPM for 10 days were evaluated before and after 10-days treatment. The NRS (0-10) value for arm pain could be reduced from 6.0 (IQR 5.7-6.8) to 2.25 (IQR 2.0-3.1) and from 5.9 (IQR 4.8-6.0) to 2.0 (IQR 1.7-2.6) for neck pain. Neck pain was reduced by 57.4% and arm pain by 62.5%. 2 days after epidural steroid injection, pain was reduced by 40.1% in the neck and by 43.4% in the arms. MPM seems to be an efficient short-term approach to treating cervical radiculopathy. Cervical translaminar epidural steroid injection is an important part of this concept. In the absence of a clear indication for surgery, MPM represents a treatment option.

Creation of a core outcome set for clinical trials of people with shoulder pain: a study protocol

Background

The selection of appropriate outcomes or domains is crucial when designing clinical trials, to appreciate the effects of different interventions, pool results, and make valid comparisons between trials. If the findings are to influence policy and practice, then the chosen outcomes need to be relevant and important to key stakeholders, including patients and the public, healthcare professionals and others making decisions about health care. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials. Recent reviews of the measurement properties of patient-reported outcome measures for shoulder disorders revealed a large selection of diverse measures, many with questionable validity, reliability, and responsiveness. These issues could be addressed through the development and use of an agreed standardized collection of outcomes, known as a core outcome set (COS), which should be measured and reported in all trials of shoulder disorders. The purpose of the present project is to develop and disseminate a COS for clinical trials in shoulder disorders.

Methods/Design

The methods for the COS development will include 3 phases: (1) a comprehensive review of the core domains used in shoulder disorder trials; (2) an international Delphi study involving relevant stakeholders (patients, clinicians, scientists) to define which domains should be core; and (3) an international focus group informed by the evidence identified in phases 1 and 2, to determine which measurement instruments best measure the core domains and identification of any evidence gaps that require further empiric evidence.

Discussion

The aim of the current proposal is to convene several meetings of international experts and patients to develop a COS for clinical trials of shoulder disorders and to develop an implementation strategy to ensure rapid uptake of the core set of outcomes in clinical trials. There would be an expectation that the core set of outcomes would always be collected and reported, but it would not preclude use of additional outcomes in a particular trial.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2054-9) contains supplementary material, which is available to authorized users.

Neck Pain: Revision 2017

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.

A systematic review evaluating the psychometric properties of measures of social inclusion

INTRODUCTION

Improving social inclusion opportunities for population health has been identified as a priority area for international policy. There is a need to comprehensively examine and evaluate the quality of psychometric properties of measures of social inclusion that are used to guide social policy and outcomes.

OBJECTIVE

To conduct a systematic review of the literature on all current measures of social inclusion for any population group, to evaluate the quality of the psychometric properties of identified measures, and to evaluate if they capture the construct of social inclusion.

METHODS

A systematic search was performed using five electronic databases: CINAHL, PsycINFO, Embase, ERIC and Pubmed and grey literature were sourced to identify measures of social inclusion. The psychometric properties of the social inclusion measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria.

RESULTS

Of the 109 measures identified, twenty-five measures, involving twenty-five studies and one manual met the inclusion criteria. The overall quality of the reviewed measures was variable, with the Social and Community Opportunities Profile-Short, Social Connectedness Scale and the Social Inclusion Scale demonstrating the strongest evidence for sound psychometric quality. The most common domain included in the measures was connectedness (21), followed by participation (19); the domain of citizenship was covered by the least number of measures (10). No single instrument measured all aspects within the three domains of social inclusion. Of the measures with sound psychometric evidence, the Social and Community Opportunities Profile-Short captured the construct of social inclusion best.

CONCLUSIONS

The overall quality of the psychometric properties demonstrate that the current suite of available instruments for the measurement of social inclusion are promising but need further refinement. There is a need for a universal working definition of social inclusion as an overarching construct for ongoing research in the area of the psychometric properties of social inclusion instruments.