Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment

Cross-cultural psychometric properties of the Persian version of the Measure of Processes of Care for Service Providers questionnaire

Background

The Measure of Processes of Care is the most widely used tool for measuring family-centredness and perceptions of the care process. This study assessed the psychometric properties of the Persian language version of the Measure of Processes of Care for Service Providers questionnaire.

Methods

In a cross-sectional study, the Measure of Processes of Care for Service Providers questionnaire was translated three times based on a backward–forward method. The Persian version of the Measure of Processes of Care for Service Providers was used with 150 health providers in Iran. The Pearson correlation coefficient, Cronbach alpha and interclass correlation coefficient were used for reliability analysis. Content validity index and content validity ratio and confirmatory factor analysis was used for validity assessments.

Results

The test-retest correlation was higher than 0.95 and the interclass correlation coefficient was higher than 0.8 in all domains. The consistency coefficient was calculated as r=0.989 and the Cronbach alpha calculated as 0.994, which varied from 0.978 to 0.994. The content validity index average was 0.97, which varied from 0.90 to 0.99. Moreover, the content validity ratio average calculated 0.726 and ranged from 0.60 to 0.95. The goodness of fit index was acceptable as CMIN =χ2: 411.52, df; 280, P<0.001, CMIN/df; 1.47, root mean square error of approximation: 0.056; P value: 0.19, goodness of fit index and Tucker–Lewis index was 0.951 and 0.938 respectively.

Conclusion

The Persian translation of the Measure of Processes of Care for Service Providers questionnaire is a standard tool for assessing family-centred care with acceptable reliable and valid. It could be used in all health, clinical and rehabilitation centres to assess family-centred care in health care providers and can be an incentive to improve the quality of family-related services.

Effectiveness of self-management programme in people with chronic kidney disease: A pragmatic randomized controlled trial

AIMS

To examine the effectiveness of a self-management intervention compared with usual care in adults with chronic kidney disease (CKD) on self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure.

DESIGN

A parallel group randomized controlled trial.

METHODS

Patients aged ≥ 18 years with CKD stages 3-5 were recruited between November 2015 and June 2016. Participants were randomly allocated into either the intervention (N = 68) or control group (N = 67). The control group received usual care, while the intervention group received usual care plus a self-management programme from a nurse. The intervention was guided by social cognitive theory (SCT) and included a face-to-face educational session followed by telephone support. Both groups were followed for 16 weeks.

RESULTS

There were no significant differences in self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure between the two groups at baseline. At week 16, compared with the control group, large effect sizes for improved self-management, knowledge, and self-efficacy were detected. For health-related quality of life, the physical and mental health components significantly improved. However, no significant differences in either systolic or diastolic blood pressures were found.

CONCLUSION

In earlier stages of CKD, a simple self-management education benefits patients.

IMPACT

Effective self-management in the earlier stages of CKD contributes to slowing its progression, improving health outcomes and lowering the burden on healthcare systems. This study demonstrated that SCT increases CKD self-management by strengthening knowledge and self-efficacy. Nurses can give this education.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616000038493.

Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis

Study Objectives

A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort.

Methods

Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes.

Results

The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average.

Conclusions

Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.

The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy

BACKGROUND

Measuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities.

METHODS

This multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities.

DISCUSSION

The development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care.

TRIAL REGISTRATION

NCT02491866.

Development and psychometric evaluation of a Dutch-translated shorter Breast Cancer Treatment Outcome Scale (Dutch BCTOS-13)

PURPOSE

To create a Dutch translated short version of the Breast Cancer Treatment Outcome Scale (BCTOS) and validate it in patients who have completed both breast conserving surgery and adjuvant radiotherapy.

METHODS

The BCTOS consists of items comparing the treated with the untreated breast. After forward and backward translation, we tested the BCTOS-12 plus 5 additional items. Two-hundred breast cancer patients treated with breast conserving therapy (BCT) between January 2016 and December 2017, were asked to complete the BCTOS items twice with a 2 week interval. The EORTC QLQ-BR23 breast and arm symptoms subscales were completed once in parallel. Feasibility was assessed by missing or non-unique answer rates and content validity with floor and ceiling effect analysis. Construct validity was evaluated with 1) principal component analysis (PCA) 2) convergent validity and 3) known groups comparison (clinical validity differentiating between patients with and without locoregional side effects). From all potential items with good feasibility, content and construct validity, items were selected for the Dutch BCTOS based on clinical validity. The relation to the EORTC QLQ-BR23 subscales and reliability was tested for the new Dutch BCTOS.

RESULTS

Hundred and one of 200 (50.5%) approached patients participated in this study, with follow-up after surgery ranging from 5 to 29 months. Feasibility was high (1.5% missing answers). Content validity testing showed a floor effect > 20% in all 17 items. PCA showed that all items loaded well (> 0.4) into the assigned subscale and revealed two distinct subscales: cosmesis and function. Based on clinical validity, item "breast shape" was replaced by "breast elevation/position" and "overall skin appearance". Very good clinical validity (Cohen's d = 1.38) was found for the new Dutch BCTOS-13. Correlation to the EORTC QLQ-BR23 subscales was high (ICC = 0.65-0.85) for both subscales. Test-retest reliability (Cohen's d = 0.105) and internal consistency (Cronbach's α =0.90) were excellent.

CONCLUSIONS

Psychometric evaluation of a newly developed Dutch BCTOS-13 questionnaire in BCT patients showed excellent results, that were slightly better than the original BCTOS-22 and the shortened BCTOS-12. The good clinical validity makes the BCTOS-13 a useful tool to identify patients with unfavourable cosmetic and functional outcomes, requiring specific attention.

Translation and psychometric evaluation of the Hebrew version of the Health Care Providers' Pain and Impairment Relationship Scale

BACKGROUND AND PURPOSE

Physiotherapists' different attitudes towards low back pain (LBP) are associated with patients' attitudes towards pain and with patients' disability. The Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) is a self-administered instrument that assesses the attitudes and beliefs of health care professionals regarding LBP and the patient's daily function. The aims of this study are to translate, culturally adapt, and asses the psychometric properties of the Hebrew version of the HC-Pairs.

METHODS

The English version of the HC-Pairs was forward-backward translated, pretested, and reviewed by a panel of experts. Reliability was determined by computing Cronbach's α, and validity by exploring the correlations between the HC-Pairs' scores and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) scores. Confirmatory factor analysis was performed. A convenience sample of 277 physiotherapists was invited to fill the HC-Pairs and PABS-PT questionnaires and a sociodemographic questionnaire.

RESULTS

The forward-backward translation process revealed minor discrepancies between the texts. After the pretest, the expert panel agreed on a final version. A sample of 241 physiotherapists completed the questionnaires (response rate of 87%; 241/277); 213 met the inclusion criteria. Factor analysis suggests that the Hebrew version of the scale fits the one-factor model. Cronbach's α was 0.81 after deletion of two items and indicated good internal consistency. The scores produced by the instrument showed a substantial correlation with those of the biomedical dimension of the PABS-PT, and poor correlation with the behavioural dimension, in the expected directions.

CONCLUSION

The findings of the present study on the psychometric properties of the HC-Pairs are positive. Nevertheless, the Hebrew version of the HC-Pairs is still in a developmental stage. Further psychometric research is needed to assess the attitudes and beliefs of Hebrew-speaking physiotherapists, which have been shown to be associated with treatment orientations and work recommendations.

Translation and validation of Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 Diabetes Module) in Brazil-Portuguese language

OBJECTIVE

The aim of the present study was to create a translated version of the Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 Diabetes Module) in Brazilian Portuguese that was conceptually equivalent to the original American English version and to linguistically validate it in a Brazilian pediatric population with type 1 diabetes mellitus and their parents or caregivers.

METHODS

The instrument was translated, back-translated, and then administered to 83 children/adolescents (5-18 years) with type 1 diabetes mellitus and their family members and to 25 parents/caregivers of patients aged between 2 and 4 years. The final translated version was tested for reliability by analyzing internal consistency, intraobserver (test-retest) reliability, and concurrent validity.

RESULTS

Cronbach's alpha coefficient for the total score of the questionnaires of children/adolescents (α=0.85) and their parents (α=0.82) was above the recommended minimum of 0.70 for group comparisons. Intraobserver reliability and concurrent validity exhibited a significant positive correlation (p<0.001), indicating the reliability of the translated instrument. A moderate but significant positive correlation (r=0.40; p<0.001) was demonstrated between the total scores of patient self-report and parent proxy-report scales. There was no significant correlation between glycated hemoglobin (HbA1c) levels and the respective scores in the questionnaires answered by patients and their parents/caregivers.

CONCLUSION

The analysis of the translated version of the PedsQL™ 3.0 Diabetes Module revealed adequate psychometric characteristics with respect to reliability and validity following administration to a sample of Brazilian children/adolescents with type 1 diabetes mellitus and their caregivers.

Effect of reinforced, targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire in patients with atrial fibrillation: A randomized controlled trial

BACKGROUND

The knowledge level of atrial fibrillation patients about their arrhythmia, its consequences and treatment is poor. The best strategy to provide education is unknown.

AIM

To investigate the effect of reinforced targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ).

METHODS

Sixty-seven atrial fibrillation patients were randomized to standard care (including brochures) or targeted education. Follow-up visits were scheduled after one, three, six and 12 months. Targeted education during each visit focused on the knowledge gaps revealed by the JAKQ. Patients completed two questionnaires to assess their quality of life and symptom profile. Adherence to non-vitamin K antagonist oral anticoagulants was measured using electronic monitoring.

RESULTS

Sixty-two patients (31 education; 31 standard care) completed follow-up. Median baseline score on the JAKQ was similar in education (62.5%) and standard care group (56.3%; p=0.815). The intervention group scored significantly better over time (one month: 75.0%, 12 months: 87.5%; p<0.001) whereas there was no significant improvement in the control group (one month: 62.5%, 12 months: 62.5%; p=0.085). Providing targeted education after completion of the JAKQ required on average 6.9±4.6 min. Some improvements in quality of life, symptom burden and adherence were shown, without significant differences between the two groups ( p-values between 0.282 and 0.677).

CONCLUSION

The JAKQ is an effective tool for providing individualized education. A first targeted educational session significantly improved patients' knowledge level. Additional educational sessions maintained and strengthened this effect. A larger scale study is warranted to evaluate the impact on adherence and outcome measures.

Testing the influence of cultural determinants on help-seeking theory

Despite increased risks for mental health problems, East Asian immigrant women have the lowest overall service-utilization rates of any cultural group in the United States. Although the influence of cultural processes as the cause of low service use is widely speculated, no empirical study has tested cultural determinants (including culturally specific idioms of distress, culture-based illness interpretations, or concerns about social consequences), social contextual factors, perceived need (PN), and help-seeking (HS) behaviors. In the present study, we examined how cultural determinants, such as symptom experience, beliefs and interpretations, and perceptions about the social environment, affect PN and HS type for Japanese women living in the United States. Increasing physical symptom severity increased the predicted probability of endorsing PN. For those participants with PN, 48.6% of them used medical HS (χ2 = 11.27, p = .00), and 12.5% of them used the psychological HS (χ2 = 7.43, p = .01). Multivariate logistic regression revealed that, when PN is considered with the other cultural variables while controlling for structural variables, PN increases the odds of medical HS (OR = 2.78, 95% CI [1.0-5.8], p < .01). The odds of medical HS are also increased with higher social support (OR = 1.07, 95% CI [1.0-1.1], p < .01). Finally, the presence of interpersonal stigma beliefs decreased the odds of medical HS (OR = 2.4, 95% CI [1.1-5.3], p < .03). Clinical and research implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cross-Cultural Adaptation and Validation of the Vocal Fatigue Index into Persian

INTRODUCTION

The aim of the present study was the cross-cultural adaptation and validation of the Vocal Fatigue Index (VFI) in Persian.

METHODS

The English version of the VFI was translated to Persian using the guidelines of International Quality of Life Assessment. Eighty participants with voice disorders and 50 healthy controls without any voice disorders completed the Persian version of the VFI. The 80 participants with voice disorders completed the VFI a second time a week from the initial completion to evaluate test-retest reliability.

RESULTS

The VFI measure demonstrated a strong internal consistency. Cronbach alpha coefficient was 0.95 for tiredness and avoidance of voice use, 0.86 for physical discomfort and 0.83 for improvement or lack thereof of symptoms with voice rest. VFI also showed a high test-retest reliability (r = 0.75-0.89).

CONCLUSIONS

The Persian version of the VFI is considered to be a valid and reliable questionnaire for identifying individuals with probable vocal fatigue. The VFI can be utilized in clinics across Iran in the assessment and treatment of individuals with vocal fatigue.

Quality of Life of Celiac Patients in Brazil: Questionnaire Translation, Cultural Adaptation and Validation

(1) Background: Celiac disease (CD) is a common autoimmune disorder. The manifestations of the disease and the obligatory life-long gluten-free diet (GFD) are associated with the impairment of patients’ quality of life. Therefore, the present study aimed to translate, culturally adapt and validate a celiac disease quality of life (CD-QoL) questionnaire and apply it to a representative number of Brazilian CD patients. (2) Methods: A cross-cultural Brazilian-Portuguese version of the CD-QoL was developed according to revised international guidelines. The questionnaire was administered to 450 celiac patients. The reliability, reproducibility and validity were studied. (3) Results: The Brazilian CD-QoL questionnaire presents valid measures of reproducibility and internal consistency. Early diagnosis is related to higher scores of Brazilian CD-QoL social, sub- and total scale. There was a positive correlation between higher education level and higher QoL. Individuals with partners tend to have a better emotional subscale of QoL. CD-patients who follow a strict GFD have highest QoL scale values. Men scored higher than women on the CD-QoL. All results were statistically significant except for the gastrointestinal subscale. (4) Conclusions: Brazilian CD-QoL allows comparative research between different celiac populations in the world. QoL research will help in the development of effective strategies to improve Brazilian celiac patients’ quality of life.

Validation of Serbian Version of Dysfunctional Voiding Symptom Score (DVSS) Questionnaire

Objective: The aims of our study were to translate the dysfunctional voiding symptom score (DVSS) from English to Serbian; culturally adopt the items; assess the internal consistency and the test–retest reliability of DVSS_SR in patients with dysfunctional voiding (DV); evaluate and test the construct and divergent validity of DVSS_SR against demographic parameters (gender and education); and examine the level of explained variability for each item of DVSS_SR against demographic parameters (gender and education). Methods: The cross-sectional observational study included 50 patients with dysfunctional voiding aged 5 years and above. The DVSS questionnaire was translated from English into Serbian by the forward–backward method. Internal consistency was assessed with Cronbach α and test–retest reliability with intraclass correlation coefficient (ICC). For validity testing we performed construct and divergent validity analyses. Results: There was excellent internal consistency for every item except for Item 6 (0.787) and Item 3 (0.864), where internal consistency was good. The observed test/retest ICC for average measures was more than 0.75 (excellent) for all DVSS_SR items. Gender and educational level does not correlate significantly with each item of DVSS_SR (p > 0.05). For divergent validity, there were no significant differences in mean values of each item of DVSS_SR between genders and different levels of education (p > 0.05). Variability that can be explained for gender and educational level was below 10%. Conclusion: Translated DVSS_SR is of adequate validity and reliability for assessing DV in children.

Validation of the Japanese Version of the Low Anterior Resection Syndrome Score

BACKGROUND

The low anterior resection syndrome (LARS) score is a patient-reported outcome measure to evaluate the severity of bowel dysfunction after rectal cancer surgery by scoring the major symptoms of LARS. The aim of this study was to translate the English version of the LARS score into Japanese and to investigate the validity and reliability of the LARS score.

METHODS

The LARS score was translated in Japanese following current international recommendations. A total of 149 rectal cancer patients completed the LARS score questionnaire and were also asked a single question assessing the impact of bowel function on quality of life (QoL). A total of 136 patients answered the LARS score questionnaire twice.

RESULTS

The Japanese LARS score showed high convergent validity, based on its good correlation between the LARS score and QoL (p < 0.001). The LARS score was able to discriminate between patients according to the tumor distance to anal verge (p < 0.001), type of surgery (p < 0.001), and time since surgery (p = 0.001). Patients after ultra-low anterior resection and intersphincteric resection showed especially high scores. The score also had high test-retest reliability (intraclass correlation coefficient: 0.87).

CONCLUSION

The Japanese LARS score is a valid and reliable tool for measuring LARS. The LARS score is appropriate for assessments in postoperative bowel function and international comparison. Using this score, patient-reported outcome measures of LARS in Japanese patients can be shared internationally. Additional validation reports from non-English speaking countries can support the LARS score as a worldwide assessment tool for postoperative bowel dysfunction.

Gender Differences in Psychosocial and Physical Outcomes in Haitian Amputees

OBJECTIVE

The purpose of this study was to investigate the gender differences in psychosocial and physical outcomes in users of lower-extremity prostheses who became amputees after the 2010 earthquake in Haiti.

METHOD

We enrolled 140 unilateral amputees in this cross-sectional study in Port-au-Prince, Haiti. Trained staff administered the assessments by reading the questions aloud to participants. Participants completed the Trinity Amputation and Prosthesis Experience Scales and Locomotor Capabilities Index about 2 yr after the earthquake.

RESULTS

We found no gender differences in psychosocial adjustment and physical outcomes, except for strenuous physical activities and phantom pain, and both genders reported difficulty in social adjustment. After controlling for strenuous physical activities and phantom pain, we found that men showed worse psychosocial adjustment than women.

CONCLUSION

Services for psychosocial adjustment are critical for traumatic amputees and should be incorporated into rehabilitation programs after a disaster. Interventions should consider gender roles in the indigenous culture.

Psychometric Evaluation of the Brunei-Malay SF-36 version 2 Health Survey

Objectives: To culturally adapt the Short Form Health-36 version 2 (SF-36v2) into the Brunei-Malay context and determine its reliability and validity for measuring health-related quality of life (HRQOL) in healthy individuals and patients with chronic kidney disease in Brunei Darussalam. Methods: An iterative multistep strategy involving setting up a bilingual expert panel, pretesting, text revision and back translation was used to prepare the Brunei-Malay SF-36v2 as an adaptation from the Malaysian-Malay SF-36v2. The Brunei-Malay SF-36v2 was then self-administered to a sample of healthy individuals (n=95) and predialysis chronic kidney disease outpatients (n=95) resident in Brunei. The mean (SD) age of the participants was 46.6 (17.8) years. Results: Data completion rate was 100% with minimal floor effects (≤0.21) in all the 8 domains and >15% ceiling effects in 3 of the 8 domain scales. Cronbach’s alpha was >0.70 for all the 8 domain scales. Scaling success was 100% for convergent validity, with 100% item discriminant validity for all domain scales except Social Functioning (94%), Mental Health (85%) and General Health (85%). Principal component analysis of the two-factor dimension explained 68% overall variance and accounted for 81% reliable variance, but the exact SF-36 two-factor summary constructs in the standard algorithm were not replicated in the Bruneian population. Conclusions: The Brunei-Malay SF-36v2 is a valid and reliable instrument for measuring HRQOL in healthy individuals and patients with chronic kidney disease in Brunei. The summary scales should, however, be interpreted with caution. Further studies should be carried out to assess additional psychometric properties of the Brunei-Malay SF-36v2.

Cross-cultural adaptation methods of instruments in the nursing area

OBJECTIVE

To analyze scientific publications in order to identify the cross-cultural adaptation methods of instruments that are mainly applied in nursing.

METHOD

Integrative review, in the electronic sources Medline - Pubmed, Cinahl, Lilacs, Scopus and Web of Science. 96 peer-reviewed papers, published between 2010 and 2015 were selected.

RESULTS

The articles that composed the sample were published in 59 different journals, 15.2% were Brazilian. The largest number of publications was concentrated in 2015 (31.2%), 28 countries appeared on the list which is led by Brazil (33.3%), followed by China (10.4%). It was used 26 different guidelines, however the one proposed by Beaton and their collaborators was mentioned in 47 (49.0%) articles and the Brislin's in 12 (12.5%).

CONCLUSION

This review does not allow us to define the most appropriate method, however all methods applied agreed on the use of back translation. In addition, many studies in different languages and countries showed the international acceptability of the method developed by Beaton et al.

A Persian-version of the stuttering severity instrument-version four (SSI-4): How the new additions to SSI-4 complement its stuttering severity score?

PURPOSE

The fourth version of the Stuttering Severity Instrument (SSI-4) has been available since 2009. It has some modifications and new features which make it more appropriate at least for clinical practice, although further documentation is needed. The objective of the current research was to translate SSI-4 into Persian language and to discuss its relative and absolute reliability as well as its criterion validity for Persian adults who stutter (PWS). We also aimed to study how the new subjective self-reports of the SSI-4 complement the stuttering severity score obtained from the SSI-3 or the SSI-4.

METHOD

The cross-cultural guideline recommended by the International Quality of Life Assessment project was used to translate the SSI-4 into Persian language. Thirty five PWS from ages 17 to 42 were recruited and 10 speech and language pathologists assessed their stuttering severity using either the SSI-4 or stuttering severity ratings (SR) to test validity and reliability of the Persian translated version.

RESULTS

A very high inter-judge relative reliability along with a poor absolute inter-judge reliability was found for the SSI-4 scores. The results were more promising for the intra-judge absolute reliability. Test-retest reliability of the complementary questions to the SSI-4 was also found acceptable. However, no strong relationship was found between the SSI-4 scores and its complementary questions.

CONCLUSION

The Persian version of the SSI-4 can be used reliably by trained SLPs for research and clinical purposes, but not to document small changes in stuttering severity. We argue that the response of participants to the complementary self-report questions should also be considered in calculating their stuttering severity score.

Impact of a tailored activity counselling intervention during inpatient rehabilitation after knee and hip arthroplasty - an explorative RCT

Background

The aim of the study was to improve physical activity (PA), well-being and clinical outcome after total knee and hip arthroplasty through tailored activity counselling during inpatient rehabilitation.

Methods

65 patients (aged 70.4 ± 7.3 years, BMI 28.5 ± 4.3) starting inpatient rehabilitation after primary knee or hip arthroplasty due to osteoarthritis were recruited and pseudo-randomized into an intervention (IG) and a control group (CG). Twice a week, the IG was encouraged to increase their daily step count by 5%. PA, e. g. number of steps, step frequency, or active minutes, was measured by step activity monitoring. Well-being and clinical outcome were assessed using the SF-36, Oxford Knee/Hip Score and Global rating of Change. Procedures were conducted at the onset of inpatient rehabilitation, and repeated one and 6 months after inpatient rehabilitation.

Results

Data sets were obtained from 49 patients (IG: n = 23, CG: n = 26). Both groups significantly increased their number of daily steps from the 1 month to the 6 months follow up after rehabilitation: CG: 9019 (95%CI: 7812, 10,226), IG: 9280 (7972, 10,588) and CG: 10921 (9571, 12,271), IG: 11326 (9862, 12,791) respectively. Additionally, well-being and clinical outcome improved significantly in both groups. No significant differences in physical activity, clinical outcome and well-being were found between the groups.

Conclusions

PA counselling during inpatient rehabilitation does not improve PA, well-being and clinical outcome in patients with primary knee or hip arthroplasty in addition to the rehabilitation program. PA interventions may be more effective after the completion of the inpatient rehabilitation phase.

Trial registration

DRKS DRKS00012682. Registered retrospectively on 03–07- 2017.

Validity and Reliability of the Dutch Adaptation of the Actinic Keratosis Quality of Life Questionnaire (AKQoL)

BACKGROUND

The Actinic Keratosis Quality of Life Questionnaire (AKQoL) is a disease-specific instrument to measure the impact of actinic keratosis (AK) on patients' lives.

OBJECTIVE

To validate and test the psychometric properties of the AKQoL translated into the Dutch language (AKQoL-NL).

METHODS

All new patients ≥50 years of age with untreated AK in a university medical center and a general hospital between August 2014 and August 2015 were eligible. The AKQoL was obtained and repeated after 2 weeks. The feasibility was tested by missing responses and response distribution. The internal consistency reliability of each domain was investigated with the Cronbach alpha, and test-retest reliability and validity with the Spearman correlation coefficient. AKQoL scores were compared to the Skindex-17 for convergent validity and to the Groningen Frailty Indicator scores for divergent validity.

RESULTS

A total of 153 of 190 eligible patients consented to participate. Feasibility analysis showed that none of the items missed ≥10% of responses but 5 of the 9 items showed floor effect. The AKQoL subscales showed a moderate internal consistency (Cronbach α = 0.235-0.468) and an excellent test-retest reliability (interclass correlation coefficient = 0.997-1). The AKQoL correlated poorly with the symptom component and moderately with the psychosocial component of the Skindex-17 (ρ = -0.015 to 0.346 and 0.324 to 0.501, respectively), which is less than expected. The AKQoL scored poorly in both of the Groningen Frailty Indicator (GFI) components (ρ = -0.97 to 0.12 and 0.185 to 0.276, respectively), as expected.

CONCLUSION

The AKQoL-NL is a feasible, moderately valid, and moderately reliable health-related quality of life questionnaire.

Psychometric properties of the Tilburg Frailty Indicator in older Spanish people

BACKGROUND

The Tilburg Frailty Indicator (TFI) is a 15-item scale. It diagnoses frailty in the elderly based on three domains: physical, psychological and social. A Spanish cross-cultural adaptation and its psychometric properties are presented here.

MATERIALS AND METHODS

Independent, non-institutionalized ≥70 year-olds were recruited. The TFI structure was assessed with Kuder-Richardson (KR-20) and confirmatory factor analyses. Sperman´s correlations (r_s) with Timed Up-and-Go, Self-assessed-health, Fried criteria, Short Physical Performance Battery, Gerontopole Frailty tool, assessed convergent validity. Known groups' validity and test-retest reliability were tested.

RESULTS

Based on n = 856 participants, domain and total scale KR-20 were <0.70. The social domain and certain physical items did not fit adequately. Most physical and total scaler_s were 0.31-0.48. Social domain r_s were <0.30. The TFI differentiated frail and no-frail subjects, but test-retest variation was considerable.

DISCUSSION

TFI applicability at different social contexts and frailty stages are worth of additional study. Certain scale aspects should be reconsidered.

Taking control: Is job crafting related to the intention to leave surgical training?

OBJECTIVE

The intention to leave surgical training, hereinafter referred as proxy of "attrition," is associated with poor well-being in the workplace. Attrition is suggested to diminish when residents possess job-crafting skills, that is, the ability to redefine their job in meaningful ways and maximize well-being at work by increasing structural and social resources and challenges and decreasing hindering demands. However, the evidence supporting this relationship is scant. This study sought to: 1) investigate to what extent residents possess job-crafting skills and compare residents' levels of job-crafting skills across years of residency training; 2) investigate the relationship between job crafting, well-being as measured by burnout and work-engagement rates, and the intention to leave; and 3) compare the levels of job-crafting skills and well-being between residents with and without serious intentions to leave.

METHODS

This cross sectional study was conducted in fifteen residency programs in Colombia. Surgical residents completed different questionnaires including the Dutch Job Crafting Scale (DJCS), MBI-Human Services Survey (MBI-HSS), Utrecht Work Engagement Scale (UWES-17) and an adapted version of the Nurse Turnover Intention Scale (NTIS). The objectives were addressed by independent analyses of variance (ANOVA), structural equation modeling techniques (SEM) and independent t-tests, respectively.

RESULTS

A total of 202 residents participated. Residents generally scored high on their job-crafting skills to increase structural and social resources as well as challenging demands, but were less positive about their skills to reduce hindering demands. No differences across years of training were found. Job crafting correlated positively with work-engagement, which was inversely related to the intention to leave. Conversely, job crafting correlated negatively with burnout, which bore a positive relationship to the intention to leave. Residents with serious intentions to leave exhibited lower levels of most job-crafting skills and work-engagement, compared to those without such intentions.

CONCLUSIONS

This study adds evidence that attrition is a process mediated by residents' well being at work, which can be molded by their job-crafting endeavors. Future research is needed to evaluate the effectiveness of interventions aimed at cultivating resident's job-crafting abilities in order to reduce attrition.

Exploring the associations between spiritual well-being, burden, and quality of life in family caregivers of cancer patients

OBJECTIVE

The spiritual dimension is important in the process of coping with stress and may be of special relevance for those caring for cancer patients in the various phases of caregivership, although current attention is most prevalent at the end of life. This study explores the associations among spiritual well-being (SWB), caregiver burden, and quality of life (QoL) in family caregivers of patients with cancer during the course of the disease.

METHOD

This is a cross-sectional study. All participants (n = 199) underwent the following self-report questionnaires: the SWB-Index, the Medical Outcomes Study Short Form, and the Caregiver Burden Inventory (CBI). SWB scores were dichotomized at a cutoff corresponding to the 75th percentile. Statistical analyses were made using the Student t or by chi-square test to compare high and low SWB groups.ResultThe high SWB group reported significantly better Medical Outcomes Study Short Form scores in bodily pain (p = 0.035), vitality (p &lt; 0.001), social activities (p = 0.001), mental health (p &lt; 0.001), and in standardized mental component subscales (p &lt; 0.001) than the low SWB group. No significant differences were detected between the two SWB groups in physical activity, physical role, general health, emotional status, and standardized physical component scale. The high SWB group also had better CBI scores in the physical (p = 0.049) and developmental burden (p = 0.053) subscales. There were no significant differences in the other CBI scores (overall and sections).Significance of resultsThis study points out that high SWB caregivers have a more positive QoL and burden. Knowledge of these associations calls for more attention on the part of healthcare professionals toward spiritual resources among family cancer caregivers from the moment of diagnosis and across the entire cancer trajectory.

Psychometric properties of the medical outcomes study sleep scale in Spanish postmenopausal women

OBJECTIVE

This study aimed to analyze the reliability and validity of the Spanish version of the Medical Outcomes Study Sleep Scale (MOS-SS), and its ability to discriminate between poor and good sleepers among a Spanish population with vestibular disorders.

METHODS

In all, 121 women (50-76 years old) completed the Spanish version of the MOS-SS. Internal consistency, test-retest reliability, and construct validity (exploratory factor analysis) were analyzed. Concurrent validity was evaluated using the Pittsburgh Sleep Quality Index and the 36-item Short Form Health Survey. To analyze the ability of the MOS-SS scores to discriminate between poor and good sleepers, a receiver-operating characteristic curve analysis was performed.

RESULTS

The Spanish version of the MOS-SS showed excellent and substantial reliability in Sleep Problems Index I (two sleep disturbance items, one somnolence item, two sleep adequacy items, and awaken short of breath or with headache) and Sleep Problems Index II (four sleep disturbance items, two somnolence items, two sleep adequacy items, and awaken short of breath or with headache), respectively, and good internal consistency with optimal Cronbach's alpha values in all domains and indexes (0.70-0.90). Factor analysis suggested a coherent four-factor structure (explained variance 70%). In concurrent validity analysis, MOS-SS indexes showed significant and strong correlation with the Pittsburgh Sleep Quality Index total score, and moderate with the 36-item Short Form Health Survey component summaries. Several domains and the two indexes were significantly able to discriminate between poor and good sleepers (P < 0.05). Optimal cut-off points were above 20 for "sleep disturbance" domain, with above 22.22 and above 33.33 for Sleep Problems Index I and II.

CONCLUSIONS

The Spanish version of the MOS-SS is a valid and reliable instrument, suitable to assess sleep quality in Spanish postmenopausal women, with satisfactory general psychometric properties. It discriminates well between good and poor sleepers.

Evaluating the reliability and validity of SF-8 with a large representative sample of urban Chinese

BACKGROUND

The Short Form-8 (SF-8) is a widely used instrument for measuring health-related quality of life (HRQOL). The purpose of the current study is to evaluate the reliability and validity of the Chinese version SF-8 using a large, representative sample of city residents in mainland China.

METHODS

We surveyed residents of 35 major cities in China using random digit dialing of both landlines and cell phones. We adopted a multi-stage stratified sampling scheme and selected a probability sample of 10,885 adults. Internal consistency reliability of the SF-8 was evaluated with item-total correlations and Cronbach's alphas. Construct validity was assessed with factor analysis. Known-groups validity was examined based on known HRQOL differences in age, gender, income, and overall quality of life.

RESULTS

We showed that SF-8 has very good internal consistency reliability and known-groups validity. Our results also confirmed that the traditional 2-factor structure of SF-8 (physical and mental health) is reasonable among Chinese city residents. Further, we showed that a 3-factor model (physical, mental, and overall health) fit the data better than the traditional 2-factor model.

CONCLUSIONS

This study is the first to confirm the traditional 2-factor structure of SF-8 using a large, representative sample from China. We have shown that the SF-8 Chinese version is feasible, reliable, and valid. Our findings support the use of the SF-8 summary scores for assessing general HRQOL among Chinese. Future studies may further explore the possibility of a 3-factor structure for the SF-8 among the Chinese population.

Patient-Reported Outcome (PRO) Consortium translation process: consensus development of updated best practices

This paper describes the rationale and goals of the Patient-Reported Outcome (PRO) Consortium's instrument translation process. The PRO Consortium has developed a number of novel PRO measures which are in the process of qualification by the U.S. Food and Drug Administration (FDA) for use in clinical trials where endpoints based on these measures would support product labeling claims. Given the importance of FDA qualification of these measures, the PRO Consortium's Process Subcommittee determined that a detailed linguistic validation (LV) process was necessary to ensure that all translations of Consortium-developed PRO measures are performed using a standardized approach with the rigor required to meet regulatory and pharmaceutical industry expectations, as well as having a clearly defined instrument translation process that the translation industry can support. The consensus process involved gathering information about current best practices from 13 translation companies with expertise in LV, consolidating the findings to generate a proposed process, and obtaining iterative feedback from the translation companies and PRO Consortium member firms on the proposed process in two rounds of review in order to update existing principles of good practice in LV and to provide sufficient detail for the translation process to ensure consistency across PRO Consortium measures, sponsors, and translation companies. The consensus development resulted in a 12-step process that outlines universal and country-specific new translation approaches, as well as country-specific adaptations of existing translations. The PRO Consortium translation process will play an important role in maintaining the validity of the data generated through these measures by ensuring that they are translated by qualified linguists following a standardized and rigorous process that reflects best practice.

Emerging good practices for Translatability Assessment (TA) of Patient-Reported Outcome (PRO) measures

This paper presents emerging Good Practices for Translatability Assessment (TA) of Patient-Reported Outcome (PRO) Measures. The ISOQOL Translation and Cultural Adaptation Special Interest Group (TCA-SIG) undertook the review of several TA approaches, with the collaboration of organizations who are involved in conducting TA, and members of the TCA-SIG. The effort led to agreement by the writing group on Good Practices for 1) the terminology to be used in referring to translatability process, 2) the best definition of TA, 3) the methodology that is recommended at each step of the process, 4) the persons involved in TA, 5) the timing of assessment, 6) the review criteria for TA, and 7) the recommendations to be made at the end of the TA process. With input from the TCA-SIG membership and in consultation with experts in the field, these emerging good practices can guide the future use of TA in the development of PROs.

The Swedish RAND-36 Health Survey - reliability and responsiveness assessed in patient populations using Svensson's method for paired ordinal data

Background

The Short Form 36-Item Survey is one of the most commonly used instruments for assessing health-related quality of life. Two identical versions of the original instrument are currently available: the public domain, license free RAND-36 and the commercial SF-36.

RAND-36 is not available in Swedish. The purpose of this study was threefold: to translate and culturally adapt the RAND-36 into Swedish; to evaluate its reliability and responsiveness using Svensson’s method for paired ordered categorical data; and to assess the usability of an electronic version of the questionnaire.

The translation process included forward and backward translations and reconciliation. Test-retest reliability was examined during a period of two-weeks in 84 patients undergoing dialysis for chronic kidney disease. Responsiveness was examined in 97 patients before and 2 months after a cardiac rehabilitation program. Usability tests and cognitive debriefing of the electronic questionnaire were carried out with 18 patients.

Results

The Swedish translation of the RAND-36 was conceptually equivalent to the English version. Test-retest reliability was supported by non-significant relative position (RP) values among dialysis patients for all RAND-36 subscales (range − 0.02 to 0.10; all confidence intervals (CI) included zero). Responsiveness was demonstrated by significant improvements in RP values among cardiac rehabilitation patients for all subscales (range 0.22–0.36; lower limits of all CI > 0.1) except two subscales (General health, RP -0.02; CI -0.13 to 0.10; and Role functioning/emotional, RP 0.03; CI -0.09 to 0.16). In cardiac rehabilitation patients, sizable individual variation (RV > 0.2) was also shown for the Pain, Energy/fatigue and Social functioning subscales.

The electronic version of RAND-36 was found easy and intuitive to use.

Conclusions

Our results provide evidence supporting the reliability and responsiveness of the newly translated Swedish RAND-36 and the user-friendliness of the electronic version. Svensson’s method for paired ordinal data was able to characterize not only the direction and size of differences among the patients’ responses at different time points but also variations in response patterns within groups. The method is therefore, besides being suitable for ordinal data, also an important and novel tool for gaining insights into patients’ response patterns to treatment or interventions, thus informing individualized care.

Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany

PURPOSE

Comparability of patient-reported outcome measures over different languages is essential to allow cross-national research. We investigate the comparability of the PROMIS Profile 29, a generic health-related quality of life measure, in general population samples in the UK, France, and Germany and present general population reference values.

METHODS

A web-based survey was simultaneously conducted in the UK (n = 1509), France (1501), and Germany (1502). Along with the PROMIS Profile 29, we collected sociodemographic information as well as the EQ-5D. We tested measurement invariance by means of multigroup confirmatory factor analysis (CFA). Differences in the health-related quality of life between countries were modeled by linear regression analysis. We present general population reference data for the included PROMIS domains utilizing plausible value imputation and quantile regression.

RESULTS

Multigroup CFA of the PROMIS Profile 29 showed that factor means are insensitive to potential measurement bias except in one item. We observed significant differences in patient-reported health between countries, which could be partially explained by the differences in overall ratings of health. The physical function and pain interference scales showed considerable floor effects in the normal population in all countries.

CONCLUSIONS

Scores derived from the PROMIS Profile 29 are largely comparable across the UK, France, and Germany. Due to the use of plausible value imputation, the presented general population reference values can be compared to data collected with other PROMIS short forms or computer-adaptive tests.

The Persian Version of the "Life Satisfaction Scale": Construct Validity and Test-Re-Test Reliability among Iranian Older Adults

After forward-backward translation, the LSS was administered to 334 Persian speaking, cognitively healthy elderly aged 60 years and over recruited through convenience sampling. To analyze the validity of the model’s constructs and the relationships between the constructs, a confirmatory factor analysis followed by PLS analysis was performed. The Construct validity was further investigated by calculating the correlations between the LSS and the “Short Form Health Survey” (SF-36) subscales measuring similar and dissimilar constructs. The LSS was re-administered to 50 participants a month later to assess the reliability. For the eight-factor model of the life satisfaction construct, adequate goodness of fit between the hypothesized model and the model derived from the sample data was attained (positive and statistically significant beta coefficients, good R-squares and acceptable GoF). Construct validity was supported by convergent and discriminant validity, and correlations between the LSS and SF-36 subscales. Minimum Intraclass Correlation Coefficient level of 0.60 was exceeded by all subscales. Minimum level of reliability indices (Cronbach’s α, composite reliability and indicator reliability) was exceeded by all subscales. The Persian-version of the Life Satisfaction Scale is a reliable and valid instrument, with psychometric properties which are consistent with the original version.

Health-related quality of life (HRQoL) following transforaminal percutaneous endoscopic discectomy (TPED) for lumbar disc herniation: A prospective cohort study - early results

BACKGROUND

Lumbar discectomy is among the most frequently performed procedures in spinal surgery. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive technique that gains ground among surgeons in the recent years. TPED has been studied in terms of effectiveness, however little is known about its overall impact on health-related quality of life (HRQoL) of the patients.

OBJECTIVE

To investigate the progress of HRQoL following TPED.

PATIENTS AND METHODS

Seventy-six (76) patients were enrolled in the study. Mean age was 56.5 ±12.1 years with 38 (50%) males and 38 (50%) females. All patients underwent TPED at L3-L4 (27.6%), L4-L5 (52.6%) and L5-S1 (19.7%). SF-36 was used for the assessment of HRQoL preoperatively and at 6 weeks, at 3, 6 and 12 months after the procedure.

RESULTS

All aspects of SF-36 questionnaire showed statistically significant improvement one year after the procedure (p< 0.001). Role limitations due to physical problems, bodily pain and role limitations due emotional problems showed the highest improvement, followed by physical functioning, vitality, social functioning, mental health and general health.

CONCLUSIONS

TPED for lumbar disc herniation is associated with significant improvement in all aspects of health-related quality of life within 6 weeks postoperatively and the improvement remains significant one year after surgery, as measured by the SF-36 questionnaire.

An Italian Translation and Validation of the near Activity Visual Questionnaire (NAVQ)

Purpose

To validate the Near Activity Vision Questionnaire (NAVQ) in Italian to allow the assessment of presbyopia corrections in Italian-speaking patients.

Methods

An Italian version of the NAVQ was arranged through several steps: an initial forward translation (from English to Italian), a backward translation (from Italian to English), and finally a consensual version to check against the original NAVQ. This prospective study enrolled native Italian-speaking presbyopic patients with corrected distance visual acuity of 0.20 logMAR or better in each eye and free of ocular anomalies. Six different groups of patients were asked to complete the questionnaire: emerging presbyopic patients, reading spectacle users, multifocal spectacle users, multifocal contact lens (CL) wearers, monovision CL wearers, and monofocal intraocular lens patients. Subjects were asked to answer the questionnaire again 2 weeks after the first completion.

Results

A total of 207 subjects completed the questionnaire. Data analysis showed good internal consistency (Cronbach α = 0.93) and factorial validity with only one factor explaining 62.0% of the variance. Test-retest reliability was extremely good (ICC = 0.92) as well as discriminatory power of the questionnaire's ability to discriminate between subjects with different forms of presbyopic correction.

Conclusions

The Italian version of the NAVQ matches the properties of the original English version. It is a valid instrument to evaluate near activity visual quality of presbyopic Italian speakers.

Acceptability of a Touch Screen Tablet Psychosocial Survey Administered to Radiation Therapy Patients in Japan

BACKGROUND

Studies in western clinical settings suggest that touch screen computer surveys are an acceptable mode of collecting information about cancer patients' wellbeing

PURPOSE

We examined the acceptability of a touch screen tablet survey among cancer patients in Japan.

METHODS

Eligible patients (n = 262) attending a university hospital radiation therapy (RT) department were invited to complete a touch screen tablet survey about psychosocial communication and care. Survey consent and completion rates, the proportion and characteristics of patients who completed the touch screen survey unassisted, and patient-reported acceptability were assessed.

RESULTS

Of 158 consenting patients (consent rate 60 % [95 % CI 54, 66 %] of eligible patients), 152 completed the touch screen computer survey (completion rate 58 % [95 % CI 52, 64 %] of eligible patients). The survey was completed without assistance by 74 % (n = 113; 95 % CI 67, 81 %) of respondents. Older age was associated with higher odds of having assistance with survey completion (OR 1.09; 95 % CI 1.04, 1.14 %). Ninety-two percent of patients (95 % CI 86, 96 %) felt that the touch screen survey was easy to use and 95 % (95 % CI 90, 98 %) agreed or strongly agreed that they were comfortable answering the questions. Overall, 65 % (95 % CI 57, 73 %) of respondents would be willing to complete such a survey more than once while waiting for RT treatment.

CONCLUSIONS

Although patient self-reported acceptability of the touch screen survey was high, self-administered touch screen tablet surveys may not be entirely appropriate for older cancer patients or possibly for patients with lower educational attainment.

Impact of oral potentially malignant disorders on quality of life

BACKGROUND

Oral potentially malignant disorders (OPMDs) could have a significant psychological impact on patients, principally because of the unknown risk of malignant transformation, while the physical and functional impairments could differ. This study aimed to assess the impact of three different OPMDs and their disease stages on the quality of life (QoL) of affected patients.

METHODS

Oral leukoplakia (OL), oral lichen planus (OLP) and oral submucous fibrosis (OSF) patients who were undergoing treatment at an oral medicine clinic of a dental teaching hospital in India were the study population. All subjects completed the recently developed OPMDQoL questionnaire and a short form 12 item (version 2) health survey questionnaire (SF-12v2). OPMDQoL questionnaire consists of 20 items over four dimensions. A higher score denotes poor OHRQoL. SF-12v2 has two components, a Physical Component Summary (PCS) and Mental Component Summary (MCS).

RESULTS

A total of 150 subjects (50 each of OL, OLP and OSF) participated. OL patients (37.7 ± 7.9) reported significantly better OPMDQoL scores than OLP (47.3 ± 5.8) and OSF (45.4 ± 9.2) patients. OLP patients reported significant problems in obtaining a clear diagnosis for their condition, more so than the other OPMDs. OL patients reported fewer problems for the dimension, "physical impairment and functional limitations" than the OLP and OSF patients. A significant trend was observed with the overall OPMDQoL and MCS, deteriorating as the disease stage increased.

CONCLUSIONS

OLP and OSF have a significant impact on the QoL of affected individuals: OL less so. Increasing stage of the disease is associated with worsening QoL.

Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study

OBJECTIVE

To evaluate the results of surgical treatment of gynecomastia in the context of quality of life and satisfaction after the surgery.

METHODS

Fifty male patients (mean age, 25.1 years [SD = 8 years]) who underwent surgery for gynecomastia and completed both (preoperative and postoperative) stages of the study were included in the analysis. The quality-of-life evaluation instrument was The Short Form-36 Health Survey Questionnaire. Additionally, we used a short questionnaire including 2 questions about patient satisfaction with gynecomastia surgery.

RESULTS

The overall change in life satisfaction after gynecomastia surgery was 1 point on Likert scale (sign test, P < 0.0001). Participants after gynecomastia surgery scored significantly higher than before the procedure in all Short Form-36 Health Survey Questionnaire domains as well as in 2 main scales Psychical and Physical Health. The changes were especially visible for the domain social functioning and a scale Psychical Health (P < 0.0001).

CONCLUSIONS

Gynecomastia surgery significantly improved men's life quality in all aspects and especially in the social aspect and psychical health. This indicates that adult men with gynecomastia are a specific group of patients, in which surgery may result in life quality improvement even over the average scores.

Confirmatory Factor Analysis of the Malay Version of the Confusion, Hubbub and Order Scale (CHAOS-6) among Myocardial Infarction Survivors in a Malaysian Cardiac Healthcare Facility

BACKGROUND

The six item Confusion, Hubbub and Order Scale (CHAOS-6) has been validated as a reliable tool to measure levels of household disorder. We aimed to investigate the goodness of fit and reliability of a new Malay version of the CHAOS-6.

METHODS

The original English version of the CHAOS-6 underwent forward-backward translation into the Malay language. The finalised Malay version was administered to 105 myocardial infarction survivors in a Malaysian cardiac health facility. We performed confirmatory factor analyses (CFAs) using structural equation modelling. A path diagram and fit statistics were yielded to determine the Malay version's validity. Composite reliability was tested to determine the scale's reliability.

RESULTS

All 105 myocardial infarction survivors participated in the study. The CFA yielded a six-item, one-factor model with excellent fit statistics. Composite reliability for the single factor CHAOS-6 was 0.65, confirming that the scale is reliable for Malay speakers.

CONCLUSION

The Malay version of the CHAOS-6 was reliable and showed the best fit statistics for our study sample. We thus offer a simple, brief, validated, reliable and novel instrument to measure chaos, the Skala Kecelaruan, Keriuhan & Tertib Terubahsuai (CHAOS-6), for the Malaysian population.

TRANSLATION, CULTURAL ADAPTATION AND VALIDATION OF THE FOOT FUNCTION INDEX - REVISED (FFI-R)

Objective:

The aim of this study was to translate, culturally adapt, and validate the “Foot Function Index - Revised” (FFI-R) for use in Brazilian Portuguese.

Methods:

The scale was translated and administered (as recommended by Guillemin, 2000) to 52 patients in the postoperative period after foot and ankle surgery. Seven days after the initial assessment, the scale was readministered by a different interviewer. The data were entered into an Excel spreadsheet and analyzed using SPSS version 23.0 software for Mac. Reproducibility was assessed using intraclass correlation analysis.

Results

were considered statistically significant at a type I error rate of 5%. Results: The following random-effects intraclass correlation coefficients (ICC) were obtained for each score on the FFI-R: 0.625 for pain, 0.558 for stiffness, 0.757 for difficulty, 0.718 for activity restrictions, 0.854 for personal concerns, and 0.753 for the total score.

Conclusion:

The FFI-R was successfully translated to Portuguese and culturally adapted for use in Brazilian patients, demonstrating satisfactory validity and reliability. Level of Evidence I, Testing of Previously Developed Diagnostic Criteria on Consecutive Patients (with universally applied reference “golg” standard).

Cross-Cultural Adaptation, Validity, and Reliability of the Persian Version of the Orebro Musculoskeletal Pain Screening Questionnaire

STUDY DESIGN

Observational study.

PURPOSE

To cross-culturally translate the Orebro Musculoskeletal Pain Screening Questionnaire (OMPQ) into Persian and then evaluate its psychometric properties (reliability, validity, ceiling, and flooring effects).

OVERVIEW OF LITERATURE

To the authors' knowledge, prior to this study there has been no validated instrument to screen the risk of chronicity in Persian-speaking patients with low back pain (LBP) in Iran. The OMPQ was specifically developed as a self-administered screening tool for assessing the risk of LBP chronicity.

METHODS

The forward-backward translation method was used for the translation and cross-cultural adaptation of the original questionnaire. In total, 202 patients with subacute LBP completed the OMPQ and the pain disability questionnaire (PDQ), which was used to assess convergent validity. 62 patients completed the OMPQ a week later as a retest.

RESULTS

Slight changes were made to the OMPQ during the translation/cultural adaptation process; face validity of the Persian version was obtained. The Persian OMPQ showed excellent test-retest reliability (intraclass correlation coefficient=0.89). Its internal consistency was 0.71, and its convergent validity was confirmed by good correlation coefficient between the OMPQ and PDQ total scores (r=0.72, p<0.05). No ceiling or floor effects were observed.

CONCLUSIONS

The Persian version of the OMPQ is acceptable for the target society in terms of face validity, construct validity, reliability, and consistency. It is therefore considered a useful instrument for screening Iranian patients with LBP.

Cross-Cultural Validation of the Patient Perception of Integrated Care Survey

OBJECTIVE

To test the cross-cultural validity of the U.S. Patient Perception of Integrated Care (PPIC) Survey in a Dutch sample using a standardized procedure.

DATA SOURCES

Primary data collected from patients of five primary care centers in the south of the Netherlands, through survey research from 2014 to 2015.

STUDY DESIGN

Cross-sectional data collected from patients who saw multiple health care providers during 6 months preceding data collection.

DATA COLLECTION

The PPIC survey includes 59 questions that measure patient perceived care integration across providers, settings, and time. Data analysis followed a standardized procedure guiding data preparation, psychometric analysis, and included invariance testing with the U.S. dataset.

PRINCIPAL FINDINGS

Latent scale structures of the Dutch and U.S. survey were highly comparable. Factor "Integration with specialist" had lower reliability scores and noninvariance. For the remaining factors, internal consistency and invariance estimates were strong.

CONCLUSIONS

The standardized cross-cultural validation procedure produced strong support for comparable psychometric characteristics of the Dutch and U.S. surveys. Future research should examine the usability of the proposed procedure for contexts with greater cultural differences.

Transitional health care for patients with Hirschsprung disease and anorectal malformations

Background

Hirschsprung disease (HD) and anorectal malformations (ARM) are congenital disorders with potentially lifelong consequences. Although follow-up is performed in most pediatric patients, transfer to adult health care is often problematic. This study assesses transitional care with the help of questionnaires in consultation with adult patients.

Methods

This study was conducted in an outpatient clinic of a pediatric surgical center in the Netherlands. All patients born and treated for ARM or HD before 1992 were invited to visit our clinic. Patients completed questionnaires concerning disease-specific functioning and quality of life at an initial visit to in response to which individual treatment plans were modified. Patients were reviewed 1 year later.

Results

Twenty-seven patients (17 ARM and 10 HD), mean age 27.9 years (range 17–64 years) of the 168 invited visited the transitional clinic (17%). Passive fecal incontinence was reported by 7/27, other defecatory problems, including urge incontinence and incomplete evacuation in 17/27 and anal or abdominal pain reported by 9/27. Quality of life was lower than a matched population. Only 13/27 returned for repeat assessment at 1 year; however, a further 8 reported that that their problems had resolved. In those attending follow-up, negative thoughts and feelings about their condition had decreased and one more patient was fully continent. There was no change in quality of life, bowel function or pain recorded. Twelve out of thirteen patients reported that they had found the transitional clinic satisfactory.

Conclusions

The transitional outpatient clinic provides care adapted to the needs and wishes of adult HD and ARM patients. It is a novel addition to quality of care of patients with complex congenital disorders.