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

Feasibility of using the patient-reported outcomes measurement information system in academic health centers: case series design on pain reduction after chiropractic care

OBJECTIVE

The purpose of this study was to test the utility of Patient-Reported Outcomes Measurement Information System (PROMIS) as a resource for collecting data on patient-reported outcomes (PRO) within academic health centers at a chiropractic college; and, to describe changes in PRO following pragmatic chiropractic care incorporating instrument-assisted soft tissue mobilization (IASTM) on pain symptoms.

METHODS

This was a pre-post intervention design without a control group (case series) involving 25 patients (14 females and 11 males; 40.5 ± 16.39 years, range 20-70 years) who completed their chiropractic care and their baseline and post-treatment pain assessments. The pragmatic chiropractic care intervention included both spinal manipulation and IASTM to treat pain symptoms. PRO's were collected using PROMIS to measure pain behavior, pain interference and pain intensity.

RESULTS

The average pre-post assessment interval was 33 ± 22.5 days (95% CI, 23-42 days). The durations of treatments ranged from one week to 10 weeks. The median number of IASTM treatments was six. Pre-post decreases in T-scores for pain behavior and pain interference were 55.5 to 48.4 and 57.7 to 48.4, respectively (P < .05). Only 12 patients had a baseline T-score for pain intensity greater than 50. The pre-post decrease in pain intensity T-scores for these 12 patients was from 53.4 to 40.9.

CONCLUSION

Within the limitations of a case series design, these data provide initial evidence on the utility of PROMIS instruments for clinical and research outcomes in chiropractic patients.

Reliability and validity of the pain on movement questionnaire (POM) in chronic neck pain

OBJECTIVE

This analysis aimed to determine reliability, validity, and responsiveness of the pain on movement (POM) questionnaire, an instrument developed to determine pain intensity induced by head movement.

DESIGN

Data from nine randomized controlled trials for the treatment of chronic nonspecific neck pain were reanalyzed to determine reliability and validity of the POM questionnaire.

METHODS

POM was assessed as ratings of pain intensity induced by head movement in six different directions. The instrument's structure was assessed using a factor analysis. Reliability (internal consistency) was determined using Cronbach's alpha, and validity (convergent validity) was determined by correlating the POM with pain at rest on a visual analog scale (VAS), the neck disability index (NDI), quality of life (short-form 36 health survey questionnaire [SF-36]) and range of motion. Responsiveness was indicated by sensitivity to changes over time in a subsample of 49 patients.

RESULTS

Overall, 482 patients (mean age 50.3 ± 12.4 years, 72.3% female) were included in the analysis, and 458 of them provided complete data set for the POM. Average POM was 43.9 ± 20.8 mm on the VAS. The POM showed very good reliability as indicated by high internal consistency and moderate validity as indicated by significant correlations with the pain at rest, the NDI, and the SF-36. No correlations were found for POM with range of motion. The POM further proved to be responsive as it was sensitive to changes over time, and those changes were correlated to changes in pain intensity and NDI.

CONCLUSIONS

The POM seems to be a reliable and valid instrument to assess POM in patients with chronic nonspecific neck pain.

Measurement properties of patient-reported outcome measures (PROMS) in Patellofemoral Pain Syndrome: a systematic review

This systematic review investigated the measurement properties of disease-specific patient-reported outcome measures used in Patellofemoral Pain Syndrome. Two independent reviewers conducted a systematic search of key databases (MEDLINE, EMBASE, AMED, CINHAL+ and the Cochrane Library from inception to August 2013) to identify relevant studies. A third reviewer mediated in the event of disagreement. Methodological quality was evaluated using the validated COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) tool. Data synthesis across studies determined the level of evidence for each patient-reported outcome measure. The search strategy returned 2177 citations. Following the eligibility review phase, seven studies, evaluating twelve different patient-reported outcome measures, met inclusion criteria. A 'moderate' level of evidence supported the structural validity of several measures: the Flandry Questionnaire, Anterior Knee Pain Scale, Functional Index Questionnaire, Eng and Pierrynowski Questionnaire and Visual Analogue Scales for 'usual' and 'worst' pain. In addition, there was a 'Limited' level of evidence supporting the test-retest reliability and validity (cross-cultural, hypothesis testing) of the Persian version of the Anterior Knee Pain Scale. Other measurement properties were evaluated with poor methodological quality, and many properties were not evaluated in any of the included papers. Current disease-specific outcome measures for Patellofemoral Pain Syndrome require further investigation. Future studies should evaluate all important measurement properties, utilising an appropriate framework such as COSMIN to guide study design, to facilitate optimal methodological quality.

Systematic review of the psychometric properties of balance measures for cerebellar ataxia

OBJECTIVE

To review systematically the psychometric properties of balance measures for use in people with cerebellar ataxia.

DATA SOURCES

Medline, AMED, CINAHL, Web of Science and EMBASE were searched between 1946 and April 2014.

REVIEW METHODS

Two reviewers independently searched data sources. Cerebellar-specific and generic measures of balance were considered. Included studies tested psychometric properties of balance measures in people with cerebellar ataxia of any cause. Quality of reported studies was rated using the Consensus Based Standards for the selection of health status Measurement INstruments (COSMIN) checklist.

RESULTS

Twenty-one articles across which 16 measures had been tested were included for review. Using the COSMIN, quality of methodology in studies investigating psychometric properties of generic balance measures (n=10) was rated predominantly as 'poor'. Furthermore, responsiveness has not been tested for any generic measures in this population. The quality of studies investigating psychometric properties of balance sub-components of the cerebellar-specific measures (n=6) ranged from 'poor' to 'excellent'; however, Minimally Clinically Important Difference has not been determined for these cerebellar-specific measures.

CONCLUSION

The Posture and Gait (PG) sub-component of the International Cooperative Ataxia Rating Scale (ICARS) demonstrates the most robust psychometric properties with acceptable clinical utility.

Neck pain disability is related to the frequency of migraine attacks: a cross-sectional study

BACKGROUND

Migraine and neck pain can be critical causes of disability. The contribution of neck pain for the overall disability of individuals with migraine remains unknown.

OBJECTIVE

To contrast the disability experienced by individuals with episodic and chronic migraine with and without neck pain as captured by the Neck Disability Index.

METHODS

Disability due to neck pain was assessed using the Neck Disability Index in individuals with episodic or chronic migraine seen at a university-based headache center. Neck disability was defined as mild (score ranging from 5 to 14 points), moderate (15-24 points), severe (25-34 points) or complete (35 points or higher). To compare differences between groups, a chi-square test was applied. Log-binomial logistic regression was used to estimate disability as a function of headache status after adjustments for age, time since migraine onset, and headache intensity.

RESULTS

Sample consisted of 169 individuals, 104 with episodic migraine and 65 with chronic migraine. Any disability due to neck pain happened in 69% of those with episodic migraine, relative to 92% in chronic migraine (P < .001). Individuals with chronic migraine were at a significantly increased risk to have mild (RR = 2.5; CI 95% 1.1-6.1), moderate (RR = 3.7; CI 95% 1.5-8.8) and severe (RR = 5.1; CI 95%2.1-11.9) cervical disability relative to those with episodic migraine. Relative risks remained significant after adjustments. Time since episodic or chronic migraine onset significantly influenced the model (P = .035), but age and headache intensity did not (P = .27; P = .46).

CONCLUSION

Neck pain significantly adds to the overall disability of individuals with episodic and chronic migraine.

Measurement properties of rheumatoid arthritis-specific quality-of-life questionnaires: systematic review of the literature

PURPOSE

This study conducted a systematic review of the methodological quality of the psychometric evaluation process and the quality of measurement properties of rheumatoid arthritis (RA)-specific health-related quality-of-life (HRQOL) questionnaires with the purpose of obtaining the best evidence to help in the selection of the most appropriate instrument for measuring HRQOL in RA patients.

METHODS

A systematic literature search was performed to identify RA-specific HRQOL questionnaires in databases. The methodological quality of the studies was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The quality of the measurement properties was assessed using quality criteria. The evidence regarding the measurement properties was pooled using best-evidence synthesis, with considerations of the number and methodological quality of the studies, and the consistency of their findings in terms of the quality of the measurement properties.

RESULTS

The search identified 37 studies describing 9 instruments. Best-evidence synthesis suggested that the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire had the strongest positive evidence, especially with respect to reliability, measurement error, and content validity, and moderate positive evidence with respect to hypothesis testing and responsiveness.

CONCLUSIONS

The current evidence suggests that the best-validated instrument among the RA-specific HRQOL measures is the RAQoL questionnaire in terms of both methodological quality in the process of psychometric evaluation and the quality of the measurement properties. However, there is limited evidence regarding internal consistency and structural validity of the RAQoL. Further efforts are warranted to establish the psychometric quality of this questionnaire.

Psychometric properties of 2-minute walk test: a systematic review

OBJECTIVE

To systematically review the psychometric evidence on the 2-minute walk test (2MWT).

DATA SOURCES

Electronic searches of databases including MEDLINE, CINAHL, Academic Search Premier, SPORTDiscus, PsycINFO, EMBASE, the Cochrane Library, and DARE were done until February 2014 using a combination of subject headings and free texts.

STUDY SELECTION

Studies were included if psychometric properties of the 2MWT were (1) evaluated; (2) written as full reports; and (3) published in English language peer-reviewed journals.

DATA EXTRACTION

A modified consensus-based standard for the selection of health measurement instruments checklist was used to rate the methodological quality of the included studies. A quality assessment for statistical outcomes was used to assess the measurement properties of the 2MWT.

DATA SYNTHESIS

Best-evidence synthesis was collated from 25 studies of 14 patient groups. Only 1 study was found that examined the 2MWT in the pediatric population. The testing procedures of the 2MWT varied across the included studies. Reliability, validity (construct and criterion), and responsiveness of the 2MWT also varied across different patient groups. Moderate to strong evidence was found for reliability, convergent validity, discriminative validity, and responsiveness of the 2MWT in frail elderly patients. Moderate to strong evidence for reliability, convergent validity, and responsiveness was found in adults with lower limb amputations. Moderate to strong evidence for validity (convergent and discriminative) was found in adults who received rehabilitation after hip fractures or cardiac surgery. Limited evidence for the psychometric properties of the 2MWT was found in other population groups because of methodological flaws.

CONCLUSIONS

There is inadequate breadth and depth of psychometric evidence of the 2MWT for clinical and research purposes-specifically, minimal clinically important changes and responsiveness. More good-quality studies are needed, especially in the pediatric population. Consensus on standardized testing procedures of the 2MWT is also required.

Informing the NHS Outcomes Framework: evaluating meaningful health outcomes for children with neurodisability using multiple methods including systematic review, qualitative research, Delphi survey and consensus meeting

Background

The identification of suitable outcome measures will improve the evaluation of integrated NHS care for the large number of children affected by neurodisability, and has the potential to encourage the provision of more appropriate and effective health care. This research sought to appraise the potential of patient-reported outcome measures (PROMs) for children and young people with neurodisability.

Aim

This research aimed (i) to identify key outcomes of health care for children with neurodisability, beyond morbidity and mortality, from the perspectives of children, parents and professionals; (ii) to critically appraise existing generic multidimensional PROMs; and (iii) to examine whether or not the key outcomes might be measured by existing PROMs. We also sought agreement on a definition of neurodisability.

Methods

Data were gathered in three main ways, (i) a systematic review identified eligible generic multidimensional PROMs and peer-reviewed studies evaluating psychometric performance using English-language questionnaires. Studies were appraised for methodological quality and psychometric performance was appraised using standard criteria. (ii) Focus groups and interviews with children and young people with neurodisability, and separately with parents, sought to identify important outcomes of NHS care, and their feedback on example PROM questionnaires. (iii) An online Delphi survey was conducted with a multidisciplinary sample of health professionals to seek agreement on appropriate NHS outcomes. In addition, we convened a consensus meeting with a small nominal group of young people, parents and professionals; the group sought agreement on a core set of important health outcomes.

Results

From the systematic review, we identified 126 papers that reported eligible evidence regarding the psychometric performance of 25 PROMs. Evidence of psychometric robustness was more favourable for a small number of PROMs: KIDSCREEN (generic), DISABKIDS (chronic-generic) and Child Health Utility 9D (preference-based measure). The Pediatric Quality of Life Inventory and KINDL offer both self-report and a proxy report version for a range of age bands, but evidence of their psychometric performance was weaker. Evidence was lacking in one or more respects for all candidate PROMs, in both general populations and those with neurodisability. Proxy reporting was found generally to be poorly correlated with self-report. Focus groups and interviews included 54 children and young people, and 53 parents. The more important health outcomes were felt to be communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. In addition, parents of children with intellectual impairment identified behaviour, toileting and safety as important outcomes. Participants suggested problems with the face validity of example PROM questionnaires for measuring NHS care. In the Delphi survey, 276 clinicians from a wide range of professions contributed to at least one of four rounds. Professionals rated pain, hearing, seeing, sleep, toileting, mobility and communication as key goals for the NHS but also identified treating neurological symptoms as important. Professionals in the Delphi survey and parents working with the research team agreed a proposed definition for neurodisability. The consensus meeting confirmed overlap between the outcomes identified as important by young people, parents and professionals, but not complete agreement.

Conclusions

There was agreement between young people, parents and professionals regarding a core suite of more important health outcomes: communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. In addition, behaviour, toileting and safety were identified as important by parents. This research suggests that it would be appropriate to measure these constructs using PROMs to assess health care. None of the candidate PROMs in the review adequately captures all of the identified constructs, and there is inadequate evidence that candidate PROMs are psychometrically robust for use across children with neurodisability. Further consultation with young people, families and professionals is warranted to support the use of PROMs to measure NHS outcomes. Research to test potential PROMs with different age groups and conditions would be valuable.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Assessment of the quality of measures of child oral health-related quality of life

Background

Several measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.

Methods

A systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.

Results

The search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.

Conclusion

The three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

The influence of study population and definition of improvement on the smallest detectable change and the minimal important change of the neck disability index

Background

Reported values of the minimal important change (MIC) and the smallest detectable change (SDC) for the neck disability index (NDI) differ strongly, raising questions about the generalizability of these parameters. The SDC and the MIC are possibly influenced by the study design or by the study population. We studied the influence of the type of anchor, the definition of improvement and population characteristics on the SDC and the MIC of the NDI.

Methods

A cohort study including 101 patients with non-specific, chronic neck pain. SDC and MIC were calculated using two types of external anchors. For each anchor we applied two different definitions to dichotomize the population into improved and unimproved patients. The influence of patient characteristics was assessed in relevant subgroups: patients with or without radiating pain and patients with different baseline scores.

Results

The influence of different anchors and different definitions of improvement on estimates of the SDC and the MIC was only minimal. The SDC and the MIC were similar for subgroups of patients with or without radiation, but differed strongly for subgroups of patients with higher or lower baseline scores.

Conclusions

Our study shows that estimates of the SDC and the MIC of the NDI can be influenced by population characteristics. It is concluded that we cannot adopt a single change score to define relevant change by combining the result of previous studies.

CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial

Background

Cervical radicular syndrome (CRS) due to a herniated disc can be safely treated by surgical decompression of the spinal root. In the vast majority of cases this relieves pain in the arm and restores function. However, conservative treatment also has a high chance on relieving symptoms. The objective of the present study is to evaluate the (cost-) effectiveness of surgery versus prolonged conservative care during one year of follow-up, and to evaluate the timing of surgery. Predisposing factors in favour of one of the two treatments will be evaluated.

Methods/design

Patients with disabling radicular arm pain, suffering for at least 2 months, and an MRI-proven herniated cervical disc will be randomised to receive either surgery or prolonged conservative care with surgery if needed. The surgical intervention will be an anterior discectomy or a posterior foraminotomy that is carried out according to usual care. Surgery will take place within 2–4 weeks after randomisation. Conservative care starts immediately after randomisation. The primary outcome measure is the VAS for pain or tingling sensations in the arm one year after randomisation. In addition, timing of surgery will be studied by correlating the primary outcome to the duration of symptoms. Secondary outcome measures encompass quality of life, costs and perceived recovery. Predefined prognostic factors will be evaluated. The total follow-up period will cover two years. A sample size of 400 patients is needed. Statistical analysis will be performed using a linear mixed model which will be based on the ‘intention to treat’ principle. In addition, a new CRS questionnaire for patients will be developed, the Leiden Cervical Radicular Syndrome Functioning (LCRSF) scale.

Discussion

The outcome will contribute to better decision making for the treatment of cervical radicular syndrome.

Trial registration

NTR3504

Dutch-Flemish translation of 17 item banks from the patient-reported outcomes measurement information system (PROMIS)

BACKGROUND

The Patient-Reported Outcomes Measurement Information System (PROMIS(®)) is a new, state-of-the-art assessment system for measuring patient-reported health and well-being of adults and children that has the potential to be more valid, reliable and responsive than existing PROMs. The PROMIS items can be administered in short forms or, more efficiently, through computerized adaptive testing. This paper describes the translation of 563 items from 17 PROMIS item banks (domains) for adults from the English source into Dutch-Flemish.

METHODS

The translation was performed by FACITtrans using standardized methodology and approved by the PROMIS Statistical Center. The translation included four forward translations, two back-translations, three to five independent reviews (at least two Dutch, one Flemish) and pre-testing in 70 adults (age range 20-77) from the Netherlands and Flanders.

RESULTS

A small number of items required separate translations for Dutch and Flemish: physical function (five items), pain behaviour (two items), pain interference (one item), social isolation (one item) and global health (one item). Challenges faced in the translation process included: scarcity or overabundance of possible translations, unclear item descriptions, constructs broader/smaller in the target language, difficulties in rank ordering items, differences in unit of measurement, irrelevant items or differences in performance of activities. By addressing these challenges, acceptable translations were obtained for all items.

CONCLUSION

The methodology used and experience gained in this study can be used as an example for researchers in other countries interested in translating PROMIS. The Dutch-Flemish PROMIS items are linguistically equivalent. Short forms will soon be available for use and entire item banks are ready for cross-cultural validation in the Netherlands and Flanders.

Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review

We aimed to review tools used to assess balance in clinical practice in children and adults with cerebral palsy (CP), to describe their content and measurement properties and to evaluate the quality of the studies that have examined these properties. CINAHL, Embase, and PubMed/MEDLINE were searched. The COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) was used to assess the 'quality of studies' and the Terwee criteria were used to assess the 'result of studies'. Twenty-two clinical balance tools were identified from 35 papers. The content and focus of the tools varied significantly. There was moderate or limited levels of evidence for most of the measurement properties of the tools; the strongest level of evidence was found for the Trunk Control Measurement Scale and the Level of Sitting Scale, in the category 'maintain balance', the Timed Up and Go and the Segmental Assessment of Trunk Control in the categories 'achieve balance' and 'restore balance' respectively. Information on responsiveness was scarce. Further studies providing better evidence for reliability and responsiveness for clinical balance tools are needed. In the meantime, results of studies evaluating effects of treatment of balance in individuals with CP should be interpreted with caution.

Measurement properties of the norwegian version of the neck disability index in chronic neck pain

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

Neck pain is common in adults and often follows a chronic course accompanied by considerable functional reduction. Longstanding neck pain is often associated with problems engaging in work, emotional distress, and fear of movement. These issues add to the pain-associated disability. The neck disability index (NDI) is the most commonly used instrument to evaluate neck-associated pain. Our aim was to test the unidimensionality and scaling of the Norwegian version of NDI across sex, age, work status, education, pain intensity, pain distribution, and different levels of emotional distress in patients referred to specialized care.

SUMMARY OF BACKGROUND DATA

A total of 249 patients with neck pain, aged 16 years or older were included. All patients were referred to the Neck and Back Outpatient Clinic at Oslo University Hospital. Demographic factors, pain intensity and distribution, emotional distress, and fear of movement were recorded.

METHODS

A Rasch analysis was used to evaluate the unidimensionality, scaling, and invariance of NDI across sex, age, education, and work status. RESULTS.: The data did not fit the Rasch model (X = 63.18, P < 0.0003). Three items (lifting, reading, driving) had disordered response thresholds. The pain, headache, and sleep items also did not fit the Rasch model. Differential item function was detected for work status. Unidimensionality and interval scaling was obtained for a 7-item version (NDI-7) by converting the ordinal score to Rasch-weighted interval scores. The NDI matched the distribution of the patients' disability, with a slightly higher disability level reflected by the NDI compared with the patients.

CONCLUSION

The Rasch analysis lends support to the unidimensionality of the 7 items of the NDI, to its usefulness in capturing the disability in patients with neck disorder and it being generally robust to external factors.

The six-minute walk test in chronic pediatric conditions: a systematic review of measurement properties

BACKGROUND

The Six-Minute Walk Test (6MWT) is increasingly being used as a functional outcome measure for chronic pediatric conditions. Knowledge about its measurement properties is needed to determine whether it is an appropriate test to use.

PURPOSE

The purpose of this study was to systematically review all published clinimetric studies on the 6MWT in chronic pediatric conditions.

DATA SOURCES

The databases MEDLINE, EMBASE, CINAHL, PEDro, and SPORTDiscus were searched up to February 2012.

STUDY SELECTION

Studies designed to evaluate measurement properties of the 6MWT in a chronic pediatric condition were included in the systematic review.

DATA EXTRACTION

The methodological quality of the included studies and the measurement properties of the 6MWT were examined.

DATA SYNTHESIS

A best evidence synthesis was performed on 15 studies, including 9 different chronic pediatric conditions. Limited evidence to strong evidence was found for reliability in various chronic conditions. Strong evidence was found for positive criterion validity of the 6MWT with peak oxygen uptake in some populations, but negative criterion validity was found in other populations. Construct validity remained unclear in most patient groups because of methodological flaws. Little evidence was available for responsiveness and measurement error. Studies showed large variability in test procedures despite existing guidelines for the performance of the 6MWT.

LIMITATIONS

Unavailability of a specific checklist to evaluate the methodological quality of clinimetric studies on performance measures was a limitation of the study.

CONCLUSIONS

Evidence for measurement properties of the 6MWT varies largely among chronic pediatric conditions. Further research is needed in all patient groups to explore the ability of the 6MWT to measure significant and clinically important changes. Until then, changes measured with the 6MWT should be interpreted with caution. Future studies or consensus regarding modified test procedures in the pediatric population is recommended.

German translation, cross-cultural adaptation and validation of the whiplash disability questionnaire

BACKGROUND

The Australian Whiplash Disability Questionnaire (WDQ) was cross-culturally translated, adapted, and tested for validity to be used in German-speaking patients. The self-administered questionnaire evaluates actual pain intensity, problems in personal care, role performance, sleep disturbances, tiredness, social and leisure activities, emotional and concentration impairments with 13 questions rated on an 11-point rating scale from zero to ten.

METHODS

In a first part, the Australian-based WDQ was forward and backward translated. In a consensus conference with all translators and health care professionals, who were experts in the treatment of patients with a whiplash associated disorder (WAD), formulations were refined. Original authors were contacted for clarification and approval of the forward-backward translated version. The German version (WDQ-G) was evaluated for comprehensiveness and clarity in a pre-study patient survey by a random sample of German-speaking patients after WAD and four healthy twelve to thirteen year old teenagers. In a second part, the WDQ-G was evaluated in a patient validation study including patients affected by a WAD. Inpatients had to complete the WDQ-G, the North American Spine Society questionnaire (NASS cervical pain), and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at entry in the rehabilitation centre.

RESULTS

In the pre-study patient survey (response rate 31%) patients rated clarity for title 9.6 ± 0.9, instruction 9.3 ± 1.4 and questions 9.6 ± 0.7, and comprehensiveness for title 9.6 ± 0.7, instruction 9.3 ± 1.4 and questions 9.8 ± 0.4. Time needed to fill in was 13.7 ± 9.0 minutes. In total, 70 patients (47 females, age = 43.4 ± 12.5 years, time since injury: 1.5 ± 2.6 years) were included in the validation study. WDQ-G total score was 74.0 ± 21.3 points (range between 15 and 117 points). Time needed to fill in was 6.7 ± 3.4 minutes with data from 22 patients. Internal consistency was confirmed with Cronbachs's α = 0.89. Concurrent validity showed a highly significant correlation with subscale pain and disability (NASS) at r = 0.74 and subscale pain (SF-36) at r = 0.71.

CONCLUSIONS

The officially translated and adapted WDQ-G can be used in German-speaking patients affected by a WAD to evaluate patients' impairments in different domains. The WDQ-G is a self-administered outcome measure showing a high internal consistency and good concurrent validity.

Walking tests for stroke survivors: a systematic review of their measurement properties

PURPOSE

To provide an overview of walking tests including their measurement properties that have been used in stroke survivors.

METHOD

Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF).

RESULTS

Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only.

CONCLUSIONS

Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.

Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist

Background

The COSMIN checklist is a standardized tool for assessing the methodological quality of studies on measurement properties. It contains 9 boxes, each dealing with one measurement property, with 5–18 items per box about design aspects and statistical methods. Our aim was to develop a scoring system for the COSMIN checklist to calculate quality scores per measurement property when using the checklist in systematic reviews of measurement properties.

Methods

The scoring system was developed based on discussions among experts and testing of the scoring system on 46 articles from a systematic review. Four response options were defined for each COSMIN item (excellent, good, fair, and poor). A quality score per measurement property is obtained by taking the lowest rating of any item in a box (“worst score counts”).

Results

Specific criteria for excellent, good, fair, and poor quality for each COSMIN item are described. In defining the criteria, the “worst score counts” algorithm was taken into consideration. This means that only fatal flaws were defined as poor quality. The scores of the 46 articles show how the scoring system can be used to provide an overview of the methodological quality of studies included in a systematic review of measurement properties.

Conclusions

Based on experience in testing this scoring system on 46 articles, the COSMIN checklist with the proposed scoring system seems to be a useful tool for assessing the methodological quality of studies included in systematic reviews of measurement properties.