COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures

Properties of Measurements of Patient-Reported Outcome Measures Physical Activity Assessment in Chronic Kidney Disease: A Systematic Review

BACKGROUND AND PURPOSE

The assessment of physical activity (PA) using Patient-Reported Outcome Measures (PROMs) is routine due to its easy applicability and low cost. In the context of CKD, there are several studies that evaluate PA through PROM, but there is heterogeneity in the choice of tool. Therefore, the objective of this study was to identify, evaluate and synthesize the psychometric properties of PROMs used in the assessment of PA in CKD.

METHODS

A systematic review was carried out according to the PRISMA guidelines in PubMed, SciELO, Medline, Lilacs and EMBASE databases. The assessment of the quality of the studies was evaluated using the COSMIN Checklist and EMPRO tool.

RESULTS

15,137 studies were found, with 17 included. Eleven PROMs were found, of which 2 were elaborate to the CKD population: Chronic Kidney Disease Physical Activity Questionnaire (CKD-PAQ) and Low Physical Activity Questionnaire (LoPAQ). Criterion validity was the most evaluated psychometric property. Only CKD-PAQ shows satisfactory results in both evaluation tools for the psychometric properties evaluated.

DISCUSSION

This systematic review found no consensus in the literature for the best PROM for assessing PA in CKD. However, the CKD-PAQ appears to be promising as the only PROM with a favorable evaluation by both COSMIN RoB and EMPRO. There is a lack of studies evaluating PA in the early stages of CKD and its responsiveness, indicating a gap in the research. COSMIN RoB and EMPRO differed from each other, showing that the choice of the evaluation tool must be guided by the evaluator's expertise and objective.

TRIAL REGISTRATION

Systematic review registered in PROSPERO (CRD42022312143).

Instruments for Measuring Self-Efficacy in Patients With Rheumatoid Arthritis: A Systematic Review

Self-efficacy significantly impacts the quality of life for individuals with rheumatoid arthritis (RA). Identifying effective measurement tools is crucial for optimizing self-management programs. This systematic review evaluated the psychometric properties of self-efficacy instruments for patients with RA, searching eight databases from 1989 to March 2025. Using COSMIN guidelines and the GRADE system, 17 studies on eight instruments were analyzed. None reported measurement error, hypothesis testing, or responsiveness. The Arabic Self-Efficacy for Managing Chronic Disease scale was a level C recommendation due to internal consistency issues; seven others were level B. The joint protection self-efficacy scale showed better reliability and validity, tentatively recommended for RA self-efficacy assessment, but requires further validation. Future research should develop and assess additional self-efficacy tools for RA patients.

Communication Patient Reported Outcome Measures for Adults With Communication Disorders: A Systematic Review of Content Validity

BACKGROUND

Content validity is a key measurement property that should be considered when selecting or reviewing a patient-reported outcome measure (PROM). In the field of communication disorders, there are several PROMs available, most of which are disease specific. It is unknown what the quality of the content validity of these PROMs is.

AIMS

This study aimed to evaluate the content validity of existing communication PROMs used with adults with communication disorders.

METHODS

This study evaluated PROMs drawn from a previously published systematic literature review. Of 31 measures, 25 measures were included in this review, covering a range of communication-related constructs in different communication disorders. The process of rating followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for assessing the content validity of PROMs. There were three stages to the evaluation process comprising Step 1: evaluating the quality of the PROM development, Step 2: evaluating the quality of content validity studies on the PROM (if available) and Step 3: evaluating the content validity of the PROM overall, based on the quality and results of the available studies and the PROM itself.

MAIN CONTRIBUTION

Step 1: With regards to the quality of the PROM development, 21 of 25 PROMs were rated as inadequate. Step 2: Content validity studies were available for five of the PROMs. All of these studies were rated doubtful or inadequate. Step 3: The quality of the available evidence on content validity of the included PROMs was overall very low. Only the evidence on the content validity of the Communication Participation Item Bank (CPIB) and the Neuro-QoL (Quality of Life in Neurological Disorders) was rated as of moderate quality.

CONCLUSIONS

Results of this study highlight the scarcity of high-quality evidence on the development and content validity of PROMs that aim to capture the construct of communication. This review is a call to action for future PROMs to include both the target population and professionals in development and content validity testing, using rigorous methodology in the process.

WHAT THIS PAPER ADDS

What is already known on this subject There are several patient reported outcome measures (PROMs) available for adult communication disorders. Many of these PROMs have been assessed on one or more psychometric properties, typically reliability and validity aspects. Content validity is often overlooked in research. What this study adds Clinimetric and psychometric experts recommend content validity as the first and most important measurement property to consider when selecting a scale. This study is the first to provide a systematic assessment of the quality of content validity of communication PROMs used in adult communication disorders. What are the potential or clinical implications of this work? Using measures with good content validity during outcome measurement ensures that researchers and clinicians capture constructs that are relevant and important to clients. It also ensures that the measures used are accessible to the clients and comprehensively address their needs.

Brazilian Portuguese Version of the Diagnostic Criteria for Temporomandibular Disorders Axis II: Translation, Cross-Cultural Adaptation and Measurement Properties

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial tool for TMD assessment. To implement a translated version in the Brazilian context, standardised adaptation and validation are necessary.

OBJECTIVE (S)

To translate, adapt and verify the measurement properties of the DC/TMD Axis II instruments Pain Drawing (PD), Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS) and Oral Behaviours Checklist (OBC).

METHODS

The translation and cross-cultural adaptation processes of orofacial-related Axis II instruments followed the Guidelines for Establishing Cultural Equivalency. The validation research was carried out with 117 Brazilians with TMD, in two assessment days. Structural validity, internal consistency, test-retest reliability, measurement error, construct validity-hypothesis testing, and ceiling and floor effects were tested.

RESULTS

PD showed substantial reliability (Kappa 0.63), and GCPS, JFLS and OBC showed excellent reliability over time (intraclass correlation coefficient > 0.85). The internal consistency was adequate for all instruments (Cronbach's alpha > 0.77) except for the functional activities domain of OBC (Cronbach's alpha = 0.48). Construct validity was good for all instruments (75% hypotheses confirmed), except for the OBC total score. Regarding parameters of structural validity, GCPS showed Goodness of Fit Index = 0.98 for the solution with two domains. JFLS and OBC presented Goodness of Fit Index < 0.90 for the solutions with three and two domains, respectively.

CONCLUSION

The Brazilian Portuguese version of DC/TMD Axis II can be used in Brazil, but more studies are necessary to find an adequate structure for JFLS and OBC in a Brazilian sample.

Measurement Properties of the Caregiver Reaction Assessment Scale: A Systematic Review and Meta-Analysis

BACKGROUND

The Caregiver Reaction Assessment Scale is a widely used tool for evaluating the experiences of informal caregivers of older adults. Despite its global application, researchers from different countries have reported varying psychometric properties for the CRA, and a comprehensive evaluation of its overall psychometric quality remains lacking. Given the increasing reliance on informal caregivers in ageing populations worldwide, understanding the reliability and validity of the CRA is critical for improving caregiver support and enhancing care outcomes for older adults.

OBJECTIVES

This study aims to (1) systematically review the psychometric properties of the CRA scale using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology and (2) conduct a meta-analysis of Cronbach's alpha across different versions of the CRA scale to assess its internal consistency.

METHODS

We systematically searched 10 electronic databases from their inception to May 17, 2024, with an update on February 13, 2025. Two researchers independently screened and extracted data. Methodological quality was assessed using the COSMIN checklist, and a random-effects meta-analysis of Cronbach's alpha was performed. Measurement properties were rated according to updated COSMIN standards, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

RESULTS

A total of 21 studies were included in the review. The meta-analysis revealed acceptable internal consistency for the CRA scale, with Cronbach's alpha values ranging from 0.76 to 0.79. Based on COSMIN standards, one version of the CRA scale is recommended for use, 14 versions are weakly recommended and six versions do not meet validity or consistency standards.

CONCLUSION

The CRA scale is a reliable tool for assessing the experiences of informal caregivers of older adults and demonstrates potential for broader application in other informal caregiver groups. However, limited research on cross-cultural validity, stability, measurement error and criterion validity highlights the need for future studies to address these gaps by rigorously following COSMIN methodology.

IMPLICATIONS FOR PRACTICE

The findings suggest that the CRA scale enables researchers and practitioners to more accurately assess the experiences of informal caregivers of older adults, facilitating targeted interventions and support. Future research should focus on localising the scale and testing its cultural adaptability for diverse caregiver populations, ensuring its relevance and effectiveness in global caregiving contexts.

PROSPERO ID

The review was registered on PROSPERO (registration number: CRD42024508176).

Validation of PBC-10 in Japanese patients with primary biliary cholangitis

BACKGROUND AND AIM

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that significantly impairs health-related quality of life (HRQOL). The PBC-10, a short-form HRQOL assessment tool, was developed for rapid screening in clinical settings. This study aimed to verify the reliability and validity of the Japanese version of the PBC-10 in Japanese patients with PBC.

METHODS

We retrospectively analyzed HRQOL data from 496 Japanese outpatients with PBC, collected between 2015 and 2016. Reliability was assessed using Cronbach's alpha, item-total score correlations, and ceiling and floor effects. Validity was evaluated by examining correlations between PBC-10 scores and the total and subdomain scores of the Japanese version of the PBC-40, a validated PBC-specific HRQOL questionnaire.

RESULTS

Cronbach's alpha for the PBC-10 was 0.872, demonstrating high internal consistency. Strong item-total score correlations were observed for all items. No ceiling effects were noted, but floor effects were present across all items. The PBC-10 total score showed a very strong positive correlation with the PBC-40 total score (ρ = 0.964, p < 0.001). Strong correlations were also found between most PBC-10 items and the PBC-40 subdomains, supporting validity.

CONCLUSION

The Japanese version of the PBC-10 is a reliable and valid tool for rapidly assessing HRQOL in Japanese PBC outpatients. It has potential utility for identifying patients who may benefit from emerging treatments targeting symptom relief.

Self-Report Questionnaires to Measure Big Five Personality Traits in Children and Adolescents: A Systematic Review

Personality can be described by referring to the so-called Big Five traits, that is, Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. These dimensions contribute to explaining individual differences not only in adults but also in children and adolescents. Although many authors used adult or other-report instruments to assess the Big Five in young people, others developed or adapted specific self-report measures for them. A systematic overview of research articles developing or validating self-report questionnaires to measure the Big Five traits in children and/or adolescents is currently absent. Accordingly, a review of the literature seems necessary to better guide practitioners and researchers interested in this assessment. We consulted PsycINFO, PubMed, and Scopus. We extracted 20 articles from the initial 1449 records and another 4 articles by consulting their references. They described 10 questionnaires developed for 7-18-year-olds (with one exception). We provided detailed summaries of their language, trait labels, facets, length, item types, response scale, and item development or selection procedure. The structural validity and internal consistency of the selected questionnaires were evaluated by adapting the COSMIN guideline. All the questionnaires reflect an attempt to consider the cognitive skills and individual experiences that characterize children and/or adolescents. However, our findings highlighted some limitations in the validity or reliability of some of them. These results can provide guidance for selecting the most appropriate instrument depending on the contextual needs and for developing or adapting new questionnaires for this age group.

A Systematic Review of Instruments to Measure Nurses' Well-Being in the Work Environment

AIMS

To identify instruments for measuring nurses' well-being at work, evaluate their dimensions, validity, reliability, and determine the most comprehensive of all.

DESIGN

Systematic literature review of measurement properties.

DATA SOURCES

Science Direct, PubMed, ProQuest, EBSCO, Scopus, Sage, and Google Scholar for all periods.

REVIEW METHODS

Quantitative research articles that provide information on psychometric testing of instruments for measuring nurses' well-being were analyzed, excluding non-scientific, and non-English sources. The Consensus-based Standards for The Selection of Health Measurement Instrument (COSMIN) was used to identify the risk of bias. Terwee quality criteria were used to assess the quality of the measurement properties. The synthesis process was performed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). This study was registered in PROSPERO (CRD42024532860).

RESULTS

A total of 22 articles, covering 17 instruments developed based on different theories and concepts were identified. The number of items ranges from 5-69, with 1-8 dimensions, where the interpersonal relationship is the most widely used dimension. Only a few instruments assess nurses' well-being in particular units. Validity and reliability were tested through various methods, but none met all COSMIN criteria. GRADE analysis revealed that over half of the instruments had low-quality assessment results.

CONCLUSION

Instruments varied in structure, including the number of items, scales, and dimensions. The low-quality assessment results of most instruments highlight the need for better instrument development and validation, especially for nurses in specific units by considering their respective work culture and climate.

IMPACT

This study emphasizes the need to develop an instrument to measure nurses' well-being in certain units specifically according to the COSMIN guidelines to improve its validity and reliability. The results of such measurements can help management formulate effective intervention strategies and serve as a basis for further research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The measurement properties of patient experience scales in the intensive care unit: A systematic review

BACKGROUND

As health care recipients, patients play an essential role in evaluating health care quality. Critical care patients have specific experiences that differ from those of regular patients. Existing instruments of patient experience to improve intensive care quality and their measurement properties should be defined.

AIM

To review the existing tools for measuring patient experience in the intensive care unit (ICU) and evaluate their measurement properties.

STUDY DESIGN

This is a systematic review. The PubMed, CINAHL complete, Ovid: Embase, ProQuest Health and Medical complete and Cochrane Library databases were systematically screened from their inception to 9 November 2022. All the research that reported the development and measurement properties of instruments for ICU patient-perceived care was included. The COnsensus-based Standards for the selection of health Measurement Instruments risk of bias checklist (COSMIN-RoB-Checklist) was applied to assess the psychometric indicators of the included studies.

RESULTS

The search yielded 565 documents, of which 15 scales described in 17 studies met the inclusion requirements. Of the 15 scales, seven assessed ICU patient satisfaction and eight assessed patient experience. We categorized the items from existing scales into different elements based on the National Health Service (NHS) framework. The most frequently assessed elements are 'Respect for patient-centred values, preferences and expressed needs', 'Information, communication and education' and 'Physical comfort' (93.33%, 14/15), while 'Transition and continuity' (33.33%, 5/15) is the least frequently measured. There are no studies presenting all the criteria of measurement properties outlined by the COSMIN. In the scale development part, only eight of the items met the requirements of the pilot test. Among all the measurement properties, internal consistency (80%, 12/15) and structural validity (80%, 12/15) were the two most frequently measured attributes. The three most uncommon measurement properties were retest reliability (five, 33.33%), responsiveness (four, 26.67%) and measurement error (three, 20%).

CONCLUSIONS

To enhance the quality of intensive care, it is essential to use professional scales to gather feedback from ICU patients. This systematic review examines existing tools and evaluates their measurement properties using the COSMIN-RoB-Checklist. Further research is needed to develop a strong patient experience framework and reliable psychometric properties.

RELEVANCE TO CLINICAL PRACTICE

Given the insufficient attention to critical care patients' experience, this review summarizes current patient experience scales in the intensive care unit and presents their measurement properties. This helps clinicians select more appropriate tools, develop better intensive care patient experience scales, enhance the understanding of intensive care quality and ultimately improve the excellence of work in ICUs.

Measures of Psychological Mindedness: A Systematic Review of Psychometric Properties

OBJECTIVE

Psychological mindedness has been positively associated with psychological wellbeing and positive outcomes in psychological therapy. Valid and reliable measures of psychological mindedness are needed for accurate measurement of the construct. This paper is the first to provide a comprehensive review of existing measures of psychological mindedness.

METHODS

The review protocol was pre-registered and systematic with methods reported according to PRISMA criteria. The quality of studies reporting on psychometric properties of measurement tools was evaluated against the COSMIN criteria.

RESULTS

Twenty-three studies relating to six measures of psychological mindedness were included in the review. No measure demonstrated sufficient evidence when evaluated against all COSMIN measurement criteria. However, the Balanced Index of Psychological Mindedness (BIPM) demonstrated the most robust psychometric properties with sufficient evidence of structural validity and internal consistency demonstrated through studies of high quality.

CONCLUSIONS

Whilst the BIPM demonstrated the most robust measurement properties, further research is needed in relation to its content validity, cross-cultural validity, and responsiveness. The BIPM also does not incorporate 'other-oriented' psychological mindedness. Alternative measures such as the PMS and PMAP are available to measure psychological mindedness towards others but have less sufficient evidence of psychometric rigour.

Knee-Related Patient-Reported Outcome Measures for Young Adults: A Scoping Meta-Review

BACKGROUND

There is a lack of patient-reported outcome measures (PROMs) research on young adults and knee disorders. This scoping meta-review examined a young adult population and aimed to (1) provide an overview of knee-related PROMs research and (2) evaluate the measurement properties of the five most evaluated knee-related PROMs relevant for individual care and group-level analysis.

METHODS

A systematic search of the PubMed and COSMIN databases was conducted on 18 September 2023 and updated on 25 November 2024 to identify systematic reviews of knee-related PROMs in young adults. Data relevant to individual care and group-level analysis of the five most evaluated PROMs were extracted based on the PROM-cycle and analysed guided by COSMIN recommendations.

RESULTS

Fifteen systematic reviews were included, evaluating 80 knee-related PROMs. Ten of the 15 systematic reviews did not use a tool to synthesise multiple studies or a PROM evaluation tool. Knee Injury and Osteoarthritis Outcome Score (KOOS) had the strongest evidence to be an appropriate PROM for individual care and the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) for group-level analysis in a young adult population. However, none of the five PROMs demonstrated sufficient high-quality evidence across all identified measurement properties.

CONCLUSION

The scoping meta-review highlights that systemic reviews of measurement properties were reported inconsistently, making it challenging to detangle the extracted data. Therefore, advances in PROMs-specific methods and reporting recommendations should enhance the quality of PROM evidence, allowing readers to appraise relevant evidence and select the most appropriate PROMs for their intended purpose.

Long-term mental health outcomes after corneal transplantation and potential predictors: A multicentre prospective cohort study

INTRODUCTION

To evaluate the long-term effect of corneal transplantation on mental health outcomes and to assess potential predictors of these outcomes.

METHODS

For this multicentre prospective cohort study, patients awaiting corneal transplantation were recruited from 11 (academic) hospitals and eye clinics in the Netherlands. Participants (n = 238) completed the Centre for Epidemiological Studies Depression scale (CES-D), the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and the Dutch ICF Activity Inventory Emotional Health subscale (DAI-EH) and Fatigue subscale (DAI-F) 1 month prior and 3, 6, 12 and 24 months after corneal transplantation. Sociodemographic and clinical characteristics, as well as coping styles as measured with the Utrecht Coping List, were considered as potential predictors for mental health outcomes (depression, anxiety, emotional health problems and fatigue). Linear mixed models were used to analyse and predict symptoms of depression, anxiety, emotional health problems and fatigue over time.

RESULTS

Scores on the CES-D and HADS-A improved significantly from baseline to 24-months (mean scores CES-D: 8.6 vs. 7.7, p = 0.03; mean scores HADS-A: 3.7 vs. 3.2, p = 0.002). Scores on the DAI-EH and DAI-F also improved significantly from baseline to 24-months (mean scores DAI-EH: 10.7 vs. 7.5, p < 0.001; mean scores DAI-F: 17.4 vs. 11.3, p < 0.001). Male sex and Fuchs' dystrophy were important predictors of better mental health outcomes, whereas comorbidity, (dry) eye complaints and a passive reacting coping style were important predictors of worse mental health outcomes.

CONCLUSION

Corneal transplantation had a positive impact on mental health outcomes and important predictors were identified. This study may improve the understanding of patients and eyecare practitioners about the effects of corneal transplantation, leading to realistic communication about corneal transplantation expectations.

Utilization and psychometric properties of Quality of documentation of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO): A scoping review

AIMS

To summarize studies using the quality of diagnoses, interventions, and outcomes (Q-DIO) and to evaluate measurement properties of different Q-DIO translations/versions. This tool assesses the quality of nursing diagnoses, interventions, and outcomes documented in nursing practice.

DESIGN

A scoping review was carried out by using the updated methodology for scoping reviews of the Joanna Briggs Institute.

METHODS

The characteristics of different Q-DIO versions were summarized, and the methodological quality and measurement properties of the instrument(s) were assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

DATA SOURCES

In May 2024, searches across five databases and sources of gray literature were performed.

RESULTS

Out of 14,192 articles, 35 were deemed relevant, with 12 studies included in the COSMIN analysis. Based on the evaluation results, six versions of the Q-DIO were recommended for immediate use, and one was identified as pending further validation studies before having potential for recommendation.

CONCLUSIONS

This review underscores the extensive translation, adaptation, and validation of Q-DIO instruments across various languages and cultural contexts, emphasizing their global significance and effectiveness in nursing practice. These instruments demonstrate robust psychometric properties, especially in content validity and reliability.

IMPACT

This scoping review sheds light on the existing knowledge, application, and validity of the Q-DIO, offering suggestions for its improvement. The results could assist nurse educators, managers, and researchers in effectively using the tool.

REPORTING METHOD

This study was reported following the guidelines provided by the PRISMA-ScR.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A systematic review and meta-analysis of the parental stress scale's psychometric properties

Parental stress can affect the ability of parents to cope with the challenges of raising children. The result can be a negative cycle within the family dynamic, which in turn can interfere with children's development and emotional regulation. Among the many instruments available to assess parental stress, the Parental Stress Scale (PSS) deserves particular mention. To our knowledge, there are currently no systematic reviews evaluating the psychometric properties of the PSS. The aim of this systematic review was to assess the psychometric properties of the PSS using the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology and to conduct a meta-analysis. A thorough literature search was conducted from different databases. A meta-analysis to test the generalisability of PSS internal consistency across its component factors was performed. A total of 20 validation studies of the PSS were identified. Based on the COSMIN methodology, this instrument receives an 'A' rating, meaning that it is considered to be a cross-sectional instrument with the necessary scientific evidence for the assessment of the construct of parental stress. The meta-analysis testing the generalisability of its internal consistency yielded satisfactory results across the different factors. Future research should focus on those psychometric properties of the PSS that have not been studied as extensively, such as reproducibility, responsiveness, measurement error, and measurement invariance.

Cross-cultural adaptation of the Thai Xerostomia Inventory and Summated Xerostomia Inventory

OBJECTIVE

To cross-culturally adapt and validate the Thai version of the Xerostomia Inventory (XI) and Summated Xerostomia Inventory (SXI) for subjective evaluation of oral dryness in Thai middle-aged and older adults.

METHODS

The original English versions of the XI and SXI were cross-culturally translated into Thai. Content validity was examined by the expert panel and 30 pilot subjects. The XI/SXI-Thai were then administered to 200 Thai adults (aged 50 years or older) for further assessment of psychometric properties. The standard question, the Bother Index, and the Xerostomia Questionnaire were used as comparator instruments for the evaluation of criterion and construct validity, respectively. Internal consistency reliability was assessed using Cronbach's alpha.

RESULTS

The final XI/SXI-Thai were found to have good content validity. Both scales were able to distinguish between xerostomia and non-xerostomia groups. We observed moderate to strong correlation between the XI/SXI-Thai and other comparator instruments, reflecting good criterion and construct validity. Cronbach's alpha values were 0.875 and 0.847 for the XI-Thai and SXI-Thai, respectively.

CONCLUSIONS

The XI-Thai and SXI-Thai were found to be valid, reliable, and easily administrable instruments for xerostomia assessment in Thai middle-aged and older individuals in both clinical and research settings.

Assessing social connection for long-term care home residents: Systematic review using COnsensus-based Standards for the selection of health Measurement INstruments guidelines

Social connection is important for long-term care (LTC) residents' quality of life and care. However, there is a lack of consensus on how to measure it and this limits ability to find what improves and impairs social connection in LTC homes. We therefore aimed to systematically review and evaluate the measurement properties of existing measures of social connection for LTC residents, to identify which, if any, measures can be recommended. We searched eight electronic databases from inception to April 2022 for studies which reported on psychometric properties of a measure of any aspect(s) of social connection (including social networks, interaction, engagement, support, isolation, connectedness, and loneliness) for LTC residents. We used COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines to evaluate the measurement properties reported for each identified measure and make recommendations. We identified 62 studies reporting on 38 measures; 21 measured quality of life, well-being or life satisfaction and included a social connection subscale or standalone items and 17 measures specifically targeted social connection. We found there was little high-quality evidence on psychometric properties such as sufficient content validity (n = 0), structural validity (n = 3), internal consistency (n = 3), reliability (n = 1), measurement error (n = 0), construct validity (n = 4), criterion validity (n = 0) and responsiveness (n = 0). No measures demonstrated satisfactory psychometric properties on all these aspects, so none could be recommended for use. Thirty-four measures have the potential to be recommended but require further research to assess their quality and the remaining four are not recommended for use. Our review therefore found that no existing measures have sufficient evidence to be recommended for assessment of social connection in residents of LTC homes. Further validation and reliability studies of existing instruments or the development of new measures are needed to enable accurate measurement of social connection in LTC residents for future observational and interventional studies.

Highlights

Social connection is fundamental to person-centered care in long-term care homes.There is insufficient evidence for the reliability and validity of existing measures.No current measures can be recommended for use based on existing evidence.A reliable and valid measure of social connection is needed for future research.

A comprehensive examination of research instruments utilized for assessing the attitudes of healthcare professionals towards the use of restraints in mental healthcare: A systematic review

AIM

This systematic review aimed to identify, describe and evaluate questionnaires measuring health professionals' attitudes towards restraints in mental healthcare.

DESIGN

A systematic review was undertaken in accordance with the COSMIN protocol for systematic review and the relevant sections of the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

DATA SOURCES

OVID Medline, OVID nursing, Psychinfo, Embase and Cinahl were systematically searched from databases inception, with an initial search in December 2021 and updated in April 2022.

REVIEW METHODS

The inclusion criteria compromised articles reporting on self-reported instruments of attitudes or perceptions, development or validation of instruments and the evaluation of one or more measurement properties. Articles using multiple instruments in one study or not published in English were excluded. Two researchers independently extracted the data and appraised the methodological quality using the COSMIN guidelines and standards (consensus-based standards for the selection of health measurement instrument). A narrative synthesis without meta-analysis was performed. The systematic review was registered in PROSPERO Protocol ID CRD42022308818.

RESULTS

A total of 23 studies reporting ten instruments were included. The findings revealed a broad variation in the content of the questionnaires, the use of terms/constructs and the context in which the various instruments measure attitudes towards coercive measures. Many studies lacked sufficient details on report of psychometric properties. Finally, the results were not summarized and the evidence not GRADED.

CONCLUSIONS

There is a need for updated and adapted instruments with origins in theory and clear joint definitions such that attitudes towards coercive measures can be reliably assessed regarding the validity and reliability of instruments, which will be of importance to facilitate the use of instruments in research and clinical settings.

IMPACT

Reviews addressing surveys, self-reported attitudes towards restraints in mental healthcare and examination of psychometric properties seem limited. We highlight distinct complexity, psychometric limitations and broad variation in the context and content measuring attitudes towards coercive measures, and their various use of terms/constructs in the existing questionnaires. These findings contribute to further research regarding the development of questionnaires and the need of representing the concept well - carefully denoted by the indicators, likewise the importance of applying questionnaires with properly reported measurement properties in terms of validity and reliability to ensure the use in research and clinical settings.

A hybrid systematic narrative review of instruments measuring home-based care nurses' competency

AIM

The aim of the study was to identify and synthesize the contents and the psychometric properties of the existing instruments measuring home-based care (HBC) nurses' competencies.

DESIGN

A hybrid systematic narrative review was performed.

REVIEW METHODS

The eligible studies were reviewed to identify the competencies measured by the instruments for HBC nurses. The psychometric properties of instruments in development and psychometric testing design studies were also examined. The methodological quality of the studies was evaluated using the Medical Education Research Study Quality Instrument and COSMIN checklist accordingly.

DATA SOURCES

Relevant studies were searched on CINAHL, MEDLINE (via PubMed), EMBASE, PsychINFO and Scopus from 2000 to 2022. The search was limited to full-text items in the English language.

RESULTS

A total of 23 studies reporting 24 instruments were included. 12 instruments were adopted or modified by the studies while the other 12 were developed and psychometrically tested by the studies. None of the instruments encompassed all of the 10 home-based nursing care competencies identified in an earlier study. The two most frequently measured competencies were the management of health conditions, and critical thinking and problem-solving skills, while the two least measured competencies were quality and safety, and technological literacy. The content and structural validity of most instruments were inadequate since the adopted instruments were not initially designed or tested among HBC nurses.

CONCLUSION

This review provides a consolidation of existing instruments that were used to assess HBC nurses' competencies. The instruments were generally not comprehensive, and the content and structural validity were limited. Nonetheless, the domains, items and approaches to instrument development could be adopted to develop and test a comprehensive competency instrument for home-based nursing care practice in the future.

IMPACT

This review consolidated instruments used to measure home-based care nurses' competency. The instruments were often designed for ward-based care nurses hence a comprehensive and validated home-based nursing care competency instrument is needed. Nurses, researchers and nursing leaders could consider the competency instruments identified in this review to measure nurses' competencies, while a home-based nursing care competency scale is being developed.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required in this review.

Validity and internal consistency of four scales in patients with TMD: PHQ8, GAD7, PHQ15 and JFLS20

OBJECTIVES

The aim of this cross-sectional study was to explore the structural validity and internal consistency reliability of General Anxiety Disorder-7, Patient Health Questionnaire-8, 15 and Jaw Functional Limitation Scale-20 in patients with chronic pain of temporomandibular disorders.

MATERIALS AND METHODS

Validity and reliability were assessed in 129 patients diagnosed according to the diagnostic criteria for temporomandibular disorders. Structural validity was explored using factor analysis, and internal consistency by calculating Cronbach α.

RESULTS

Confirmatory factor analysis revealed a suitable 2-factor model for Patient Health Questionnaire-8, with Cronbach α of 0.89, and 0.86. One and 2-factor models were suitable for General Anxiety Disorder-7, with overall Cronbach α of 0.93 for the 1-factor model, and 0.91 and 0.84 for both factors in a 2-factor model. A 4-factor solution was appropriate for Patient Health Questionnaire-15, with Cronbach α of 0.72, 0.57, 0.71 and 0.73 for each factor separately. Exploratory factor analysis was conducted to explore the factor structure of Jaw Functional Limitation Scale 20, and a 3-factor solution was appropriate.

CONCLUSIONS

This study provides positive evidence of structural validity and internal consistency of these questionnaires in patients with pain of temporomandibular disorders. However, additional testing is required to explore further psychometric properties.

Consensus on the definition and assessment of external validity of randomized controlled trials: A Delphi study

External validity is an important parameter that needs to be considered for decision making in health research, but no widely accepted measurement tool for the assessment of external validity of randomized controlled trials (RCTs) exists. One of the most limiting factors for creating such a tool is probably the substantial heterogeneity and lack of consensus in this field. The objective of this study was to reach consensus on a definition of external validity and on criteria to assess the external validity of RCTs included in systematic reviews. A three-round online Delphi study was conducted. The development of the Delphi survey was based on findings from a previous systematic review. Potential panelists were identified through a comprehensive web search. Consensus was reached when at least 67% of the panelists agreed to a proposal. Eighty-four panelists from different countries and various disciplines participated in at least one round of this study. Consensus was reached on the definition of external validity ("External validity is the extent to which results of trials provide an acceptable basis for generalization to other circumstances such as variations in populations, settings, interventions, outcomes, or other relevant contextual factors"), and on 14 criteria to assess the external validity of RCTs in systematic reviews. The results of this Delphi study provide a consensus-based reference standard for future tool development. Future research should focus on adapting, pilot testing, and validating these criteria to develop measurement tools for the assessment of external validity.

Patient-reported, observer-reported and performance outcomes in qualification procedures at the European Medicines Agency 2013-2018

AIMS

To describe characteristics of applicant, tool, outcomes, regulatory responses and general learnings from European Medicines Agency (EMA) Qualification Procedures on patient-reported outcomes (PROs), observer-reported outcomes (ObsROs) and performance outcomes (PerfOs) finalized between January 2013 and December 2018.

METHODS

Descriptive analysis, and qualitative review of the regulatory outcomes of the study procedures.

RESULTS

Seventeen qualification programmes for PROs, 6 for ObsRO tools and 11 for PerfO tools were submitted by consortia, large and small/medium companies. Gastroenterology and neurology were the most frequent therapeutic areas. There was a high level of regulators' partial agreement (above 70%) with applicant's approaches with constructive input; EMA published Letters of Support for PRO (6), ObsRO (2) and PerfO (4) tools, and Qualification Opinions on PROs (2) and PerfOs (1). General issues related to Qualification Procedures on PROs raised by EU regulatorsincluded: population, appropriate studies to demonstrate ability to detect change, tool validation in interventional trials, anchoring, identification of the minimally important difference, item selection, weighting, and multiple domains. In addition, specific issues for ObsROs and PerfO tools validation are identified.

CONCLUSIONS

Regulators discussed principles and challenges of validation tailored to specific setting in tool development, providing constructive feedback. Regulatory outputs supportive of further development were published in over one-third of programs. We encourage applicants intending to use or develop novel PRO, ObsRO and PerfO tools that will generate evidence for regulatory submissions on medicines to consider Qualification procedures for novel methods to seek feedback on the development and validation of these tools.

The Medical Outcome Study Social Support Survey (MOS-SSS): A psychometric systematic review

AIMS

To evaluate and synthesize psychometric properties of the MOS-SSS and to identify quality versions of MOS-SSS for use in future research and practice.

DESIGN

A psychometric systematic review.

DATA SOURCES

Articles about the translation, adaptation, or validation of the MOS-SSS in Medline, PubMed, CINAHL, and Web of Science and their reference lists published before 11 November 2022.

REVIEW METHODS

The review followed the Consensus Standards for the Selection of Health Measurement Instruments guidelines.

RESULTS

The review included 35 articles. Eleven versions of MOS-SSS (3, 4, 5, 6, 8, 12, 13, 16, 18, 19, and 22 items) have been validated in various populations and 13 languages. Of 14 studies developing a translated version of MOS-SSS, four studies performed both an experts' evaluation of content validity and a face validity test; two studies reported translation evaluation in the form of a content validity index. Of 35 studies, six performed both exploratory factor analysis and confirmatory factor analysis for structural validity; hypotheses and measurements for construct validity testings were often not clearly stated; two examined criterion validity; and four assessed cross-cultural validity. Internal consistency reliabilities were commonly examined by calculating Cronbach's alpha and reported satisfactory. Five studies analysed test-retest reliabilities using intra correlation coefficient. Methodological concerns exist.

CONCLUSION

The English 19-item, Farsi Persian 19-item, and Vietnamese 19-item versions are recommended for future use in research and practice. Italian 19-item and Malaysian 13-item versions are not recommended to be used in future research and practice. All other versions considered in this review have potential use in future research and practice. Proper procedures for developing a translated version of MOS-SSS and validating the scale are recommended.

IMPACT

The review identified quality versions of MOS-SSS to measure social support in future research and practice. The study also indicated methodological issues in current validation studies. Application of the study findings and recommendations can be useful to improve outcome measurement quality and maximize the efficiency of resource use in future research and practice.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review synthesized the evidence from previous research and did not involve any human participation.

Instruments for assessing the spiritual needs of cancer patients: A systematic review of psychometric properties

AIMS AND OBJECTIVES

To identify available instruments for assessing cancer patients' spiritual needs and to examine their psychometric properties using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

BACKGROUND

Cancer patients frequently have significant spiritual needs. The nurse plays an integral role in assessing the patient's spiritual needs as part of providing holistic care. It is crucial to assess these needs using appropriate and reliable instruments.

DESIGN

A systematic review based on COSMIN methodology.

METHODS

Seven electronic databases (PubMed, EMBASE, CINAHL, Web of Science, ProQuest, CNKI and WANFANG) were systematically searched from inception until 14 February 2023. Two authors independently screened eligible literature, extracted data and evaluated methodological and psychometric quality. This systematic review was conducted following the PRISMA checklist.

RESULTS

Sixteen studies have reported 16 different versions of the instruments. None of the instruments were properly assessed for all psychometric properties, nor were measurement error, responsiveness and cross-cultural validity/measurement invariance reported. All of the instruments failed to meet the COSMIN quality criteria for content validity. The quality of evidence for structural validity and/or internal consistency in five instruments did not meet the COSMIN criteria. Eventually, five instruments were not recommended, and 11 were only weakly recommended.

CONCLUSION

Instruments to assess spiritual needs exhibited limited reliability and validity. The Spiritual Care Needs Scale is provisionally recommended for research and clinical settings, but its limitations regarding content validity and cross-cultural application must be considered in practice. Future research should further revise the content of available instruments and comprehensively and correctly test their psychometric properties.

RELEVANCE TO CLINICAL PRACTICE

The review findings will provide evidence for healthcare professionals to select instruments for recognising spiritual needs in cancer patients.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a systematic review with no patient or public participation.

Psychometric properties of patient-reported outcome measures assessing self-efficacy in patients with inflammatory bowel disease: A systematic review

AIMS

The aim of this study is to conduct a comprehensive evaluation of the patient-reported outcome measure assessing self-efficacy in patients with inflammatory bowel disease, and recommend the most robust measurement.

DESIGN

A systematic review of psychometric properties.

DATA SOURCES

We performed systematic electronic searches in the following databases from inception to 26 May 2022: PubMed, Embase, CINAHL, Web of Science, Cochrane Library, and PsycINFO via OVID.

REVIEW METHOD

This review evaluated the tools' quality in accordance with the Selection of Consensus-Based Health Measurement Instruments 2018 system Evaluation guidelines.

RESULTS

Three patient-reported outcome measures were identified in the five included studies. The "IBD-yourself" questionnaire revealed very low evidence for a sufficient hypothesis test for construct validity, moderate evidence for insufficient internal consistency, and very low evidence for uncertain measurement error. Evidence from Inflammatory Bowel Disease Self-Efficacy Scale validated internal consistency, structural validity, criterion validity, and hypothesis test for construct validity. However, evidence of moderate quality corroborated this reliability. The Adolescents and Young Adults Inflammatory Bowel Disease Self-Efficacy Scale demonstrated very low evidence for sufficient internal consistency, moderate evidence for a sufficient hypothesis test for construct and content validity, and very low evidence for uncertain reliability.

CONCLUSIONS

Compared with the other two measures, the Inflammatory Bowel Disease Self-Efficacy Scale has higher quality evidence of higher overall ratings for some of its psychometric properties, but there were some methodological problems that must be further studied to determine their quality.

IMPACT

It is uncertain whether a scale to assess self-efficacy in patients with inflammatory bowel disease has good measurement performance in clinical applications. This study first presents the methodological quality and psychometric properties of the self-efficacy scale used to assess patients with inflammatory bowel disease, which is based on the Consensus-Based Health Measurement Instruments standard. This study can help researchers and physicians decide which scale is the most suitable and reliable for patients with inflammatory bowel disease.

NO PATIENT OR PUBLIC CONTRIBUTION

Because this was a systematic review based on synthesizing information from previous studies, no human participants were included.

Instruments for measuring empowering patient education competence of nurses: Systematic review

AIM

This review aimed to identify validated self-reported instruments used to measure nurses' competence or attribute(s) of competence in empowering patient education, to describe their development and main content and critically appraise and summarize the quality of the instruments.

DESIGN

Systematic review.

DATA SOURCES

Electronic databases of PubMed, CINAHL and ERIC were searched from January 2000 to May 2022.

REVIEW METHODS

Data was extracted following predetermined inclusion criteria. With the support of the research group, two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist (COSMIN).

RESULTS

A total of 19 studies reporting 11 instruments were included. The instruments measured varied attributes of competence and the contents were heterogenous reflecting the complex nature of both empowerment and competence as concepts. Overall, the reported psychometric properties of the instruments and methodological quality of the studies were at least adequate. However, there was variation in the testing of the instruments' psychometric properties and lack of evidence limited the evaluation of both the methodological quality of the studies and quality of instruments.

CONCLUSION

The psychometric properties of the existing instruments assessing nurses' competence in empowering patient education need to be tested further, and future instrument development should be built on a clearer definition of empowerment as well as on more rigorous testing and reporting. In addition, continued efforts to clarify and define both empowerment and competence on the conceptual level are needed.

IMPACT

Evidence on nurses' competence in empowering patient education and its valid and reliable assessment instruments is scarce. Existing instruments are heterogenous and are often missing proper testing of validity and reliability. These findings contribute to further research on developing and testing the instruments of competence in empowering patient education and strengthening nurses' empowering patient education competence in the clinical practice.

Self-report instruments for measuring patient dignity: A psychometric systematic review

AIMS

To synthesize and evaluate the psychometric properties of self-report instruments that measure patient dignity.

DESIGN

A psychometric systematic review.

DATA SOURCES

A comprehensive search of studies published from inception until February 17, 2022, was performed using PubMed, Embase, CINAHL, Web of Science, and Scopus.

REVIEW METHODS

The methodological quality of the psychometric studies was evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

RESULTS

Eleven self-report instruments that evaluate dignity were identified. For most instruments, psychometric properties, including reliability, cross-cultural validity, responsiveness, and measurement error, had not been adequately examined. The Patient Dignity Inventory (PDI), the Jacelon's Attributed Dignity Scale (JADS), and the Inpatient Dignity Scale (IPDS) had acceptable content validity, structure validity, and internal consistency to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care.

CONCLUSION

The PDI, the JADS, and the IPDS are recommended for future clinical practice and research to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. Early identification of patients' dignity-related problems in nursing care can prevent negative health outcomes and help develop a timely intervention to promote patients' health and recovery.

IMPACT

Given that the psychometric properties of the existing self-report dignity instruments have not been systematically assessed, the present review utilized comprehensive methods according to COSMIN to evaluate and determine the most appropriate measure for research and practice. The PDI, the JADS, and the IPDS demonstrated satisfactory psychometric properties and are, thus, recommended for clinical and research applications. Nursing professionals can employ these instruments to assess and promptly identify dignity issues among both young and older adults in hospitals and communities.

Assessment of body perception disturbances in complex regional pain syndrome: A systematic review using the COSMIN guideline

OBJECTIVE

To conduct a systematic review to identify which tools are being used to assess body perception disturbances in Complex Regional Pain Syndrome (CRPS) and to provide an evidence-based recommendation in the selection of an assessment tool, based on measurement properties.

DATABASES AND DATA TREATMENT

Five electronic databases (EMBASE, Pubmed, PsycInfo, Science Direct and Web of Science) were searched for English or French written articles, with no time restrictions. All original articles using a body perception assessment tool with adult patients with CRPS were selected, regardless of their design (controlled trials, single case, qualitative study). Two investigators screened abstracts, selected full articles and extracted data independently.

RESULTS

Thirty-eight full-text papers were obtained and three main methods to evaluate body perception disturbances were identified: The Bath Body Perception Disturbance Scale, the Neglect-like Symptoms questionnaire adapted from Galer and the patient's body perception description. No full psychometric assessments were found. The Limb Laterality Recognition Task was also used in conjunction with another method.

CONCLUSIONS

Three main assessment methods for CRPS body perception disturbances are currently used. Full psychometric evaluation has not been completed for any of the assessment methods. As a consequence, we could not fully apply the COSMIN guideline. To date, there is no agreement concerning the use of a specific questionnaire or scale. The results indicate a need for further research such as psychometric properties of these questionnaires.

SIGNIFICANCE

This systematic review identified body perception disturbances assessment methods and their the psychometric properties in order to provide help and guidance to researchers and clinicians to investigate those clinical features.

Patient reported outcome measures assessing quality of life in patients with an intestinal stoma: A systematic review

AIM

Living with a stoma can greatly influence quality of life. The purpose of this systematic review was to identify all patient reported outcome measures (PROMs) assessing health related quality of life (HRQoL) or similar constructs related to an intestinal stoma and to evaluate their level of validation.

METHODS

The study was reported in line with PRISMA guidelines. The protocol was registered in PROSPERO prior to the study. Eligible studies were any study investigating psychometric properties of a stoma-specific PROM. The databases MedLine, Embase, CINAHL and Cochrane Libraries were searched for eligible studies. Studies were screened on title and abstract, then full-text for eligibility. Data extraction on the study populations, PROM characteristics, psychometric properties as well as quality assessment using the COSMIN Risk of Bias checklist was performed.

RESULTS

In total, 40 studies were included concerning the development and/or validation of 21 PROMs. For most PROMs, few psychometric properties were assessed. In general, quality of content validity was poor, quality of construct validity and reliability was good. Assessment of responsiveness was lacking.

CONCLUSION

This systematic review offers an overview of existing PROMs measuring stoma-related HRQoL and their psychometric properties. A large number of PROMs exist and their measures overlap considerably. The PROMs generally have a low level of validation, emphasizing the need for future studies to further validate existing PROMs, rather than developing new ones.

Which objective itch-assessment tools are applicable to patients with advanced cognitive impairments? A scoping review

BACKGROUND

Itching is an irritating and uncomfortable sensation that has a profound effect on patients' physical and mental health. It is a major under-recognised problem in older patients who cannot express their pain due to advanced cognitive impairment. Therefore, objective itch-assessment tools that do not rely on patients' reports of itching may be of value for this patient group.

OBJECTIVE

To summarise the characteristics of validated objective itch-assessment tools for patients with advanced cognitive impairment.

METHODS

This scoping review was conducted according to the PRISMA extension for scoping reviews checklist. The PubMed, CINAHL and Cochrane Library databases were searched, via database-specific search strategies, for articles published in English between January 1, 1990 and March 11, 2020. Based on the eligibility criteria, two authors independently screened the articles for inclusion. Thereafter, the lead author performed data extraction and analysis.

RESULTS

Three validated scratch-monitoring using accelerometers and a sound sensor and one validated scratch-mark assessment have been reported. The Actiwatch Plus, ActiTrac® , body-conducted sound sensor and Scoring Atopic Dermatitis index for scratching (SCORAD-scratch) had positive criterion validity outcomes. The Actiwatch Plus, ActiTrac® and body-conducted sound sensor were significantly correlated with scratch behaviour (r = 0.91, p < 0.001; r = 0.71, p = 0.042; r = 0.99, and p-value not shown, respectively). The SCORAD-scratch was significantly correlated with subjective itch-assessment scores (r = 0.78-0.80, p = <0.0001-0.010).

CONCLUSIONS

This scoping review summarises the characteristics of validated objective itch-assessment tools to investigate which of these are applicable to older patients with advanced cognitive impairments. Although there are limitations and further verification is required, the ActiTrac® , Actiwatch Plus and body-conducted sound sensor may be useful for measuring scratch movements and itching.

IMPLICATIONS FOR PRACTICE

Nurses and patients' families may better understand the characteristics and validity of each objective itch-assessment tool and select the optimal tool for patients with advanced cognitive impairment who cannot express their discomfort caused due to itching.

Neuropsychiatric Inventory domains cluster into neuropsychiatric syndromes in Alzheimer's disease: A systematic review and meta-analysis

BACKGROUND

Studies of patients with Alzheimer's disease (AD) have observed that neuropsychiatric symptoms (NPS) tend to co-occur as neuropsychiatric syndromes and have generally shown mixed results regarding the number and composition of syndromes. We systematically reviewed how neuropsychiatric syndromes in AD have been defined and compared the different published definitions in a pooled sample of AD patients using meta-analytic structural equation modeling (MASEM).

METHODS

Studies examining the factor structure of the Neuropsychiatric Inventory (NPI) and published from 1994 to 2021 were included. We contacted the corresponding authors of eligible studies for correlation coefficients between NPI items. We pooled correlations under a random effects MASEM model and fitted and compared measurement models from published studies to identify a best-fitting model.

RESULTS

Twenty-five studies were included in the systematic review, and correlations were obtained from seven studies for MASEM. For the NPI-10 (seven studies, n = 5185), a five-factor structure was found to have a good fit to the data. For the NPI-12 (four studies, n = 2397), we were unable to identify a factor structure that displayed a good model fit.

CONCLUSION

This systematic review and meta-analysis contribute to the development of a theoretical model of neuropsychiatric syndromes in AD and reveals the barriers that accompany MASEM methodology.

Instruments used to measure dating violence: A systematic review of psychometric properties

AIMS

To identify, synthesize and evaluate the psychometric properties of instruments that measure dating violence (DV).

DESIGN

Psychometric systematic literature review.

DATA SOURCES

The databases SCOPUS, PubMed, CINAHL, PsychINFO, and Web of Science were searched up to December 2021.

REVIEW METHOD

We evaluated the psychometric properties of the instruments included and their methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. The Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. The entire process was carried out by three independent reviewers. The review was registered at PROSPERO (registry number CRD42020161137).

RESULTS

A total of 35 studies evaluated 29 instruments measuring DV. Most studies reported data on content validity, structural validity and internal consistency. No studies tested measurement error and responsiveness. Only one instruments tested cross-cultural validity. It is of interest that the data reported for content validity were the worst evaluated, despite the fact that content validity is one of the key properties in developing and validating the measuring instrument.

CONCLUSIONS

There are a significant number of instruments published in this field, and it is important to evaluate and show their psychometric properties to help select evidence-based instruments. After carrying out the evaluation following the COSMIN guidelines, the authors of this study recommend that the three most suitable instruments are CADRI, WAS/Chinese version and PMWI-SF/Portuguese version (in that order).

IMPACT

Identifying and evaluating DV is the first step in designing effective interventions. To achieve this, it is necessary to have validated instruments with suitable psychometric properties. To date, this is the only published systematic review evaluating the psychometric properties of instruments that measure DV which reports on their methodological qualities. The results we found show a growing trend in developing new instruments, with the most suitable approach being to make a cross-cultural adaptation and validation of the instrument that best suits the value to be measured. In this way, data can be compared between different countries and standardized health care plans and policies designed to achieve better health outcomes. This study may help future researchers to choose the most suitable instrument for their research.

Image Analysis Systems to Calculate the Surface Area of Vitiligo Lesions: a Systematic Review of Measurement Properties

Several digital image analysis systems have been developed for surface calculation of vitiligo lesions. Critical assessment of their measurement properties is crucial to support evidence-based recommendations on the most suitable instruments and will reveal the need for future research. A systematic review was performed to systematically summarize, compare, and critically assess the measurement properties of digital and analogue analysis systems for surface calculation of vitiligo lesions following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations. Nineteen clinical trials were selected including 25 different instruments. Manual tracing on transparent sheets (contact planimetry) combined with digital measurement or point counting can be considered as the best validated method for the evaluation of target lesions taking into account the skin curvatures. Two-dimensional digital imaging analysis on photographs seems also robust although confirmatory data of different research groups using the same digital instrument in a wide range of skin types are missing. Analysis based on 3D photography is still in its early stage but is promising for whole-body analysis. However, the reported data on the quality of the instruments for surface area calculation of vitiligo lesions was in general rather limited. Therefore, future high-quality validation studies are required also including full body evaluations.

'I knew I'd be taken care of': Exploring patient experiences in the Emergency Department

Aims

To explore adult Emergency Department patient experiences to inform the development of a new Emergency Department patient‐reported experience measure.

Design

Descriptive, exploratory qualitative study using semi‐structured individual interviews with adult Emergency Department patients.

Methodology

Participants were recruited across two Emergency Departments in Southeast Queensland, Australia during September and October 2020. Purposive sampling based on maximum variation was used. Participants were recruited during their Emergency Department presentation and interviewed in 2‐weeks via telephone. Inductive thematic analysis followed the approach proposed by Braun and Clarke (2012).

Results

Thirty participants were interviewed, and four themes were inductively identified: Caring relationships between patients and Emergency Department care providers; Being in the Emergency Department environment; Variations in waiting for care; and Having a companion in the Emergency Department. Caring relationships between patients and Emergency Department care providers included being treated like a person and being cared for, being informed about and included in care, and feeling confident in care providers. Being in the Emergency Department environment included being around other patients, feeling comfortable and having privacy. Variations in waiting for care included expecting a longer wait, waiting throughout the Emergency Department journey and receiving timely care. Having a companion in the Emergency Department included not feeling alone, and observing care providers engage with companions.

Conclusion

Patient experiences in the Emergency Department are multifaceted, and themes are not mutually exclusive. These findings demonstrate consistency with the core experiential themes identified in the international literature.

Impact

Strategies to improve patient engagement in shared decision‐making, and communication between patients and care providers about wait times will be critical to optimizing Emergency Department patient experiences, and person‐centred practice. These findings holistically conceptualize patient experiences in the Emergency Department which is the first step to developing a new Emergency Department patient‐reported experience measure.

Evidence-based evaluation of owner-reported outcome measures for canine orthopedic care - a COSMIN evaluation of 6 instruments

OBJECTIVE

To systematically review the currently available validated owner-reported outcome measures (OROMs) for assessing pain and function in dogs with osteoarthritis and other joint diseases.

STUDY DESIGN

Systematic review.

METHODS

A systematic literature search of PubMed and Web of Science was performed in December, 2019, using search terms relevant to OROMs for pain and function in dogs with osteoarthritis and other joint diseases. The measurement properties of the resulting outcome instruments and validation studies were evaluated with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN).

RESULTS

Seventeen publications describing the validation of 6 OROMs were selected and evaluated with the COSMIN. The Canine Brief Pain Inventory (CBPI), Canine Orthopedic Index (COI), and Liverpool Osteoarthritis in Dogs (LOAD) provided evidence of sufficient content validity. Internal consistency, reliability, construct validity, and responsiveness were the most frequently validated other properties. Both CBPI and COI had sufficient internal consistency; LOAD, being formative in construct, need not be assessed for internal consistency. No instruments provided information on measurement errors.

CONCLUSION

The CBPI, COI, and LOAD can be recommended for use in dogs with osteoarthritis. Further evidence is necessary to increase the interpretability of these instruments or expand their application into other canine orthopedic conditions. Further evidence is also needed before the other 3 instruments can be recommended.

CLINICAL SIGNIFICANCE

This systematic evaluation of 6 OROMs provides clinicians and researchers with a tool that facilitates and improves evidence-based selection of outcome measures for evaluating canine osteoarthritis and other joint disease treatments.

Multimorbidity measures from health administrative data using ICD system codes: A systematic review

BACKGROUND

We aimed to identify and characterize adult population-based multimorbidity measures using health administrative data and the International Classification of Diseases (ICD) codes for disease identification.

METHODS

We performed a narrative systematic review of studies using or describing development or validation of multimorbidity measures. We compared the number of diseases included in the measures, the process of data extraction (case definition) and the validation process. We assessed the methodological robustness using eight criteria, five based on general criteria for indicators (AIRE instrument) and three multimorbidity-specific criteria.

RESULTS

Twenty-two multimorbidity measures were identified. The number of diseases they included ranged from 5 to 84 (median = 20), with 19 measures including both physical and mental conditions. Diseases were identified using ICD codes extracted from inpatient and outpatient data (18/22) and sometimes including drug claims (10/22). The validation process relied mainly on the capacity of the measures to predict health outcome (5/22), or on the validation of each individual disease against a gold standard (8/22). Six multimorbidity measures met at least six of the eight robustness criteria assessed.

CONCLUSION

There is significant heterogeneity among the measures used to assess multimorbidity in administrative databases, and about a third are of low to moderate quality. A more consensual approach to the number of diseases or groups of diseases included in multimorbidity measures may improve comparison between regions, and potentially provide better control for multimorbidity-related confounding in studies.

Estimating sexual knowledge of people with mild intellectual disability through a valid and reliable assessment scale: The ISK-ID

BACKGROUND

Despite the relevance of assessing sexual knowledge in people with Intellectual Disability, there is a lack of appropriate assessment tools to measure this domain. The current study tests the psychometric properties of the new 'Inventory of Sexual Knowledge of people with Intellectual Disability' (ISK-ID).

METHOD

345 individuals with mild intellectual disability completed the ISK-ID before and after the implementation of a sexual education program. Psychometric properties of the ISK-ID were analysed according to Multidimensional Item Response Theory (MIRT).

RESULTS

Its underlying factorial structure, along with parameters derived from the MIRT (item discrimination, difficulty, and participant's ability), support the use of the ISK-ID as a measure of sexual knowledge. Moreover, the ISK-ID was able to detect changes in the level of sexual knowledge resulting from educational interventions (i.e., responsiveness).

CONCLUSIONS

The ISK-ID is an appropriate assessment tool to measure sexual knowledge in men and women with mild intellectual disability.