Evaluating test-retest reliability in patient-reported outcome measures for older people: A systematic review

The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10) in post-acute patients with stroke

OBJECTIVE

To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores.

SETTING

A post-acute stroke rehabilitation ward in the East of England.

PARTICIPANTS

A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia.

MAIN MEASURES

Alongside the CORE-10, the Patient Health Questionnaire - 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures.

RESULTS

To assess reliability, the internal consistency and test-retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test-retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach's alpha) for the CORE-10 was .80, and test-retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported.

CONCLUSIONS

This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.

Reliability of the Two-dimensional Mood Scale for self-reported mood assessment by older adults with dementia

The purpose of this study was to evaluate the reliability of the Two-dimensional Mood Scale (TDMS) for mood assessment among older adults with dementia. The study included 100 elderly patients with dementia admitted to two hospitals. For each mood state measured by the TDMS, the intraclass correlation coefficient of agreement (ICCagreement) was calculated to evaluate test-retest reliability. Scores corresponding to the minimal detectable change (MDC) in each mood state at the individual level (MDCind) was also calculated to evaluate measurement error, while McDonald's omega was calculated to evaluate internal consistency. The TDMS ICC was 0.54 for vitality, 0.74 for stability, 0.70 for pleasure, and 0.55 for arousal. The MDCind was 6.89 for vitality, 5.88 for stability, 9.96 for pleasure, and 4.11 for arousal. McDonald's omega ranged from 0.60 to 0.84. The TDMS has generally acceptable reliability for the self-assessment of mood states by older adults with dementia.

Validation of the Korean version of the Summated Xerostomia Inventory among older adults residing in nursing homes

BACKGROUND

Xerostomia is commonly experienced by older individuals. We sought to develop and evaluate the reliability and validity of the Korean version of the Summated Xerostomia Inventory (K-SXI) among older adults residing in long-term care facilities (LTCFs) in Korea.

METHODS

In this secondary data analysis study using cross-sectional data, a cross-cultural adaptation process was conducted for the Korean version before data collection. Data collection was conducted from July 2021 to January 2022, targeting 544 older adults in 16 LTCFs. Data analysis included intraclass correlation coefficient (ICC) for test-retest reliability, and Cronbach's α for internal consistency reliability. Exploratory and confirmatory factor analyses were used to verify construct and convergent validity. Test-retest analysis was performed 6 weeks after baseline. Convergent and concurrent validities were assessed with age group and the xerostomia standard single question, respectively.

RESULTS

A total of 544 older adults participated in this study. The mean of total K-SXI score was 11.70 (standard deviation, 4.96) points. The ICC value was calculated to be 0.90, and Cronbach's α of K-SXI was 0.92. Exploratory factor analysis revealed a single factor, explaining 74.8% of the total variance, however, some goodness-of-fit indices of the single factor model were found to be unsuitable in confirmatory factor analysis. The convergent and concurrent validity were supported.

CONCLUSION

The present study provides evidence supporting the validity and reliability of the K-SXI for measuring xerostomia in institutionalized older adults in Korea.

Development and Validation of the Combined Action Observation and Motor Imagery Ability Questionnaire

Combined use of action observation and motor imagery (AOMI) is an increasingly popular motor-simulation intervention, which involves observing movements on video while simultaneously imagining the feeling of movement execution. Measuring and reporting participant imagery-ability characteristics are essential in motor-simulation research, but no measure of AOMI ability currently exists. Accordingly, the AOMI Ability Questionnaire (AOMI-AQ) was developed to address this gap in the literature. In Study 1, two hundred eleven participants completed the AOMI-AQ and the kinesthetic imagery subscales of the Movement Imagery Questionnaire-3 and Vividness of Motor Imagery Questionnaire-2. Following exploratory factor analysis, an 8-item AOMI-AQ was found to correlate positively with existing motor-imagery measures. In Study 2, one hundred seventy-four participants completed the AOMI-AQ for a second time after a period of 7-10 days. Results indicate a good test-retest reliability for the AOMI-AQ. The new AOMI-AQ measure provides a valid and reliable tool for researchers and practitioners wishing to assess AOMI ability.

Validation of the brain injury associated visual impairment - impact questionnaire (BIVI-IQ)

PURPOSE

The Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to assess the impact of post-stroke visual impairment. The development of the questionnaire used robust methods involving stroke survivors and clinicians. The aim of this study was to assess the validity of the BIVI-IQ in a stroke population.

METHODS

Stroke survivors with visual impairment were recruited from stroke units, outpatient clinics and non-healthcare settings. Participants were asked to complete questionnaire sets on three separate occasions; the BIVI-IQ at each visit with additional questionnaires at baseline and visit 2. Vision assessment and anchor questions from participants and clinicians were collected. The analysis included assessment of missing data, acceptability, Rasch model analysis, test-retest reliability, construct validity (NEI VFQ-25, EQ-5D-5L) and responsiveness to change.

RESULTS

316 stroke survivors completed at least one questionnaire of the 326 recruited. Mean age was 67 years and 64% were male. Adequate fit statistics to the Rasch model were reached (χ2 = 73.12, p = 0.02) with two items removed and thresholds of two adjusted, indicating validity and unidimensionality. Excellent test-retest reliability was demonstrated (ICC = 0.905) with a 3-month interval. Construct validity was demonstrated with a strong significant correlation to the NEI VFQ-25 (r = 0.837, p < 0.01). The BIVI-IQ also demonstrated responsiveness to change with significant differences identified between groups based on participant and clinician anchor questions (X2 = 23.29, p < 0.001; X2 = 24.56, p < 0.001).

CONCLUSION

The BIVI-IQ has been shown to be valid and practical for 'everyday' use by clinicians and researchers to monitor vision-related quality of life in stroke survivors with visual impairment.

Development and Testing of the School Healthcare Partnership Scale for Parents

BACKGROUND

Cooperation between parents and school nurses is essential for the successful completion of school courses and a healthy school life for children with long-term conditions. Therefore, this study aimed to develop and test a scale to measure parental perceptions of partnerships between school nurses and parents in the school health care (SHC) system for children with type 1 diabetes (T1D).

METHODS

The content validity, factorial structure validity, convergent validity, discriminant validity, known-group validity, internal consistency reliability, and test-retest reliability of the School Healthcare Partnership Scale for Parents (SHCPS-P) were evaluated. Data were analyzed by performing exploratory factor analysis (EFA), Pearson's correlation, Cronbach's α, and independent t-tests. The total sample included 155 parents for the EFA and 49 parents for the stability test. Seventeen items, grouped into 3 dimensions, were extracted through principal axis factoring.

RESULTS

The total variance explained by these factors was 53.57%. The scale demonstrated a high correlation with parental satisfaction regarding school nursing and a moderate correlation with diabetes-related safety, thereby showing convergent validity. A low correlation with empathy demonstrated discriminant validity. A significant difference existed in the partnership scores in known-group comparisons. Cronbach's α was 0.95, and the test-retest correlation coefficient was 0.95, which showed reliability.

CONCLUSIONS

This study suggests that the SHCPS-P is a reliable and valid tool for measuring the perception of SHC partnership among parents of children with T1D and can be used as an indicator to measure parents' perspectives about SHC.

Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes

BACKGROUND AND OBJECTIVES

The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C).

RESEARCH DESIGN AND METHODS

Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability.

RESULTS

A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70).

DISCUSSION AND IMPLICATIONS

This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.

Measuring residual limb health in persons with upper limb amputation: Modifications of the Prosthetic Evaluation Questionnaire residual limb health scale

BACKGROUND

Assessing the user perspective on residual limb health problems is particularly important for amputation care, given the relationship between residual limb health and prosthetic satisfaction. Only 1 measure, the Residual Limb Health scale of the Prosthetic Evaluation Questionnaire (PEQ) has been validated for use in lower limb amputation, but not examined in persons with upper limb amputation (ULA).

OBJECTIVES

The objective of this study was to examine the psychometric properties of a modified PEQ Residual Limb Health scale in a sample of persons with ULA.

STUDY DESIGN

The study involved a telephone survey of 392 prosthesis users with ULA, with a 40-person retest sample.

METHODS

The PEQ item response scale was modified to a Likert scale. The item set and instructions were refined in cognitive and pilot testing. Descriptive analyses characterized the prevalence of residual limb issues. Factor analyses and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning, and reliability. Test-retest reliability was assessed by an intraclass correlation coefficient.

RESULTS

Sweating and prosthesis odor were prevalent at 90.7% and 72.5%, respectively; blisters/sores (12.1%) and ingrown hairs (7.7%) were the least prevalent problems. Response categories were dichotomized for 3 items and trichotomized for 3 items to improve monotonicity. After adjusting for residual correlations, confirmatory factor analyses showed acceptable fit (comparative fit index = 0.984, Tucker-Lewis index = 0.970, and root mean square error approximation = 0.032). Person reliability was 0.65. No items had moderate-to-severe differential item functioning by age or sex. Intraclass correlation coefficient for test-retest reliability was 0.87 (95% CI, 0.76-0.93).

CONCLUSIONS

The modified scale had excellent structural validity, fair person reliability, very good test-retest reliability, and no floor or ceiling effects. The scale is recommended for use with persons with wrist disarticulation, transradial amputation, elbow disarticulation, and above-elbow amputation.

The supportive care needs survey short form 34 (SCNS-SF34): translation and cultural adaptation into the Nepali language among patients with cervical cancer in Nepal

BACKGROUND

A questionnaire developed in one language must be translated and adapted when it will be used with patients speaking a different language and care should be taken to maintain equivalence between the source language (SL) version and its translated version. The objective of this study was to test the linguistic and cultural validity of a Nepali language version of the Supportive Care Need Survey - Short Form 34 (SCNS-SF34) used with the Nepali population.

METHODS

Translation of the SCNS-SF34 was carried out by following Beaton's guidelines and Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) by a research team. The translated version was administered to patients with cervical cancer in Nepal. The following steps were performed as part of the study: translation, content validity assessment, reliability assessment and measurement of errors.

RESULTS

The study reports item content validity (I-CVI) was > 0.78 and scale content validity (S-CVI) was - 0.89, 0.91 and 0.90 respectively in semantic, cultural, and conceptual aspects. The study found a content validity ratio (CVR) of 0.9 to 1, Cronbach's α of 0.90, correlation significant at the 0.01 level (2-tailed), and clarity of the questionnaire at 91.29%. The standard error of measurement (SEM) and small detectable changes (SDC) for overall care need scores were measured 2.70 and 7.47 respectively. All items were accepted as per the original SCNS-SF34. Following the respondents' suggestions, simpler Nepali words were chosen in some items to replace the words in the preliminary Nepali version of SCNS-SF34.

CONCLUSION

Preliminary findings show that the Nepali translation of SCNS-SF34 is practical and applicable to the Nepali population. Financial supportive care needs, supportive care for caretakers and problems during patient hospital stays are essential to include in the questionnaire to further explore supportive care needs.

Development and psychometric properties of the social adjustment scale for youth cancer survivors in South Korea

Objective

We developed a new scale-the Social Adjustment Scale for Youth Cancer Survivors-and examined its psychometric properties.

Methods

In the scale's development stage, preliminary items were constructed based on the results of a concept analysis of the hybrid model, literature review, and interviews. These items were then reviewed through content validity and cognitive interviews. In the validation stage, 136 survivors were recruited from two children's cancer centers in Seoul, South Korea. An exploratory factor analysis was performed to identify a set of constructs, and validity and reliability were tested.

Results

Starting with 70 items constructed through literature review and interviews with youth survivors, the final scale comprised 32 items. The exploratory factor analysis identified four domains-namely, role achievement in one's present position, harmony in relationships, disclosure and acceptance of cancer history, and preparation and expectation for future roles. Correlations with quality of life indicated good convergent validity (r ​= ​0.82, P ​< ​0.001). The Cronbach's α of the overall scale was 0.95, indicating excellent internal consistency; and the intraclass correlation coefficient was 0.94 (P ​< ​0.001), suggesting high test-retest reliability.

Conclusions

The Social Adjustment Scale for Youth Cancer Survivors exhibited acceptable psychometric properties in measuring the social adjustment of youth cancer survivors. It can be used to identify youths facing difficulty in adjusting to society after treatment and to investigate the effect of interventions implemented to promote social adjustment among youth cancer survivors. Future research is needed to examine the applicability of the scale in patients across diverse cultural backgrounds and healthcare systems.

Psychometric properties of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery: A translation and validation study

Objective

The purpose of this study was to translate and verify the reliability and validity of the Chinese version of the self-care scale for older adults undergoing hip fracture surgery.

Methods

A total of 502 older adult/adults patients after hip fracture surgery were recruited from Liaoning, Shanxi, and Beijing, China. The reliability of the Chinese version of the scale was measured by internal consistency, split-half reliability, and retest reliability, and the validity was evaluated by the content validity index and structure validity index.

Results

The Chinese version of the HFS-SC scale had a Cronbach's alpha coefficient of 0.848, and the Cronbach's alpha coefficients for the five dimensions ranged from 0.719 to 0.780. The split-half reliability of the scale was 0.739, and the retest reliability was 0.759. The content validity index (S-CVI) was 0.932. The five-factor structure, supported by the eigenvalues, total variance explained, and the scree plot accounted for 66.666% of the total variance. In confirmatory factor analysis, the model fit results were as follows, X2/df = 1.847, GFI = 0.914, AGFI = 0.878, PGFI = 0.640, IFI = 0.932, TLI = 0.912, CFI = 0.931, RMSEA = 0.058, PNFI = 0.679. The indicators of the model's fit were within reasonable bounds.

Conclusion

The Chinese version of the self-care scale for older adults undergoing hip fracture surgery has suitable reliability and validity. The scale can be used to assess the level of older adult/adults self-care in China following hip replacement surgery and serves as a useful benchmark for identifying potential intervention targets to raise the level of older adult/adults self-care following hip replacement surgery.

Cross-cultural adaptation, validity and reliability of the Persian translation of the Western Ontario Shoulder Instability Index (WOSI)

PURPOSE

The Western Ontario Shoulder Instability Index (WOSI) is the most commonly used patient-reported outcome measure to record the quality of life in patients with shoulder instability. The current study aimed to translate the WOSI into the Persian language and evaluate its psychometric properties.

METHODS

The translation procedure of the WOSI was performed according to a standard guideline. A total of 52 patients were included in the study and responded to the Persian WOSI, Oxford shoulder score (OSS), Oxford shoulder instability score (OSIS), and disabilities of arm, shoulder and hand (DASH). A sub-group of 41 patients responded for the second time to the Persian WOSI after an interval of 1-2 weeks. The internal consistency, test-retest reliability using intraclass correlation coefficient (ICC), measurement error, minimal detectable change (MDC), and floor and ceiling effect were analyzed. The hypothesis testing method was used to assess construct validity by calculating Pearson correlation coefficient between WOSI and DASH, OSS, and OSIS.

RESULTS

Cronbach's alpha value was 0.93, showing strong internal consistency. Test-retest reliability was good to excellent (ICC = 0.90). There was no floor and ceiling effect. The standard error of measurement and MDC were 8.30% and 23.03%, respectively. Regarding construct validity, 83.3% of the results agreed with hypotheses. High correlations were observed between WOSI and DASH, OSS and OSIS (0.746, 0.759 and 0.643, respectively) indicating excellent validity for the Persian WOSI.

CONCLUSION

The current study results demonstrated that the Persian WOSI is a valid and reliable instrument and can be used in the clinic and research for Persian-speaking patients with shoulder instability.

Test-Retest Reliability and Internal Consistency of a Newly Developed Questionnaire to Assess Explanatory Variables of 24-h Movement Behaviors in Adults

A questionnaire on explanatory variables for each behavior of the 24-h movement behaviors (i.e., physical activity, sedentary behavior, sleep) was developed based on three levels of the socio-ecological model, i.e., the intrapersonal level, interpersonal level and the physical environmental level. Within these levels, different constructs were questioned, i.e., autonomous motivation, attitude, facilitators, internal behavioral control, self-efficacy, barriers, subjective norm, social modeling, social support, home environment, neighborhood, and work environment. The questionnaire was tested for test-retest reliability (i.e., intraclass correlation (ICC)) for each item and internal consistency for each construct (i.e., Cronbach's Alpha Coefficient) among a group of 35 healthy adults with a mean age of 42.9 (±16.1) years. The total questionnaire contained 266 items, consisting of 14 items on general information, 70 items on physical activity, 102 items on sedentary behavior, 45 items on sleep and 35 items on the physical environment. Seventy-one percent of the explanatory items showed moderate to excellent reliability (ICC between 0.50 and 0.90) and a majority of constructs had a good homogeneity among items (Cronbach's Alpha Coefficient ≥ 0.70). This newly developed and comprehensive questionnaire might be used as a tool to understand adults' 24-h movement behaviors.

Turkish Adaptation of the Executive Functions and Occupational Routines Scale: Validity and Reliability Among Children with Dyslexia

The purpose of the present study was to provide a Turkish cultural adaptation (EFORTS-T) of the Executive Functions and Occupational Routines Scale (EFORTS) and to investigate its psychometric quality in children with dyslexia. We culturally adapted the original English version of this instrument with internationally suggested methods. Participants included the mothers of either randomly selected children with dyslexia (study group, n = 158) or age and sex-matched typically developing children (control group, n = 167). These participants completed a demographic form, the EFORTS-T, and the Behavior Rating Inventory of Executive Function-Parent form (BRIEF-P). For internal consistency, the alpha coefficient of the new instrument was excellent (.93), and it showed satisfactory test-retest reliability over a 14-day interval (.91). The criterion-related validity between the EFORTS-T and the BRIEF-P was moderate (.73). Fit indices of the model supported its factor structure. In conclusion, our findings support the validity and reliability of the new Turkish version of EFORTS for evaluating EF and contributing to the daily occupational routines of children with dyslexia for Turkish respondents. Further studies are needed to apply this instrument to children of different age groups and psychiatric conditions.

Validity and reliability of the Turkish Occupational Balance Questionnaire (OBQ11-T) in mental health

BACKGROUND

People with psychiatric disabilities often find it difficult to maintain a satisfactory occupational balance.

AIMS/OBJECTIVES

This study aimed to investigate the validity and reliability of the Turkish version of the Occupational Balance Questionnaire (OBQ11-T) in mental health.

MATERIAL AND METHODS

OBQ11-T was applied to 149 people for construct validity analysis and to 61 of them for reliability analysis. Validity was determined using factor analyses. The reliability of the OBQ between the first and second evaluations was assessed using the intraclass correlation coefficient (ICC) for each item and the total OBQ11-T score. Internal consistency was assessed using Cronbach's alpha.

RESULTS

The results of factor analysis revealed one factor that explains 35.94% of the total variance in the model. OBQ11-T item 1 had the lowest and OBQ11-T item 4 had the highest factor loadings. The model fits the data according to the indices of relative fit (RMSEA = 0.087, CMIN/DF = 2.129, CFI = 0.901). There was an excellent correlation between test and retest OBQ11-T total scores (ICC = 0.905). All items of the OBQ11-T showed good reliability. Cronbach's alpha for the OBQ11-T total score was 0.839, indicating acceptable internal consistency.

CONCLUSIONS AND SIGNIFICANCE

The current study showed that OBQ11-T is a valid and reliable tool for measuring the self-rated occupational balance of people with mental illness.

Test-retest reliability of the single leg stance on a Lafayette stability platform

The validity and reliability of the Lafayette stability platform are well-established for double leg testing. However, no evaluation of single leg (SL) stance on the platform was discovered yet. Therefore, this study aimed to investigate the reliability of conducting the SL stance on the Lafayette platform. Thirty-six healthy and active university students (age 23.2 ± 3.2 years; BMI 21.1 ± 3.1 kg/m2) were tested twice, one week apart (week 1; W1, week 2; W2). They stood on their dominant leg with eyes-open (EO) and eyes-closed (EC) in random order. Three successful trials of 20 seconds each were recorded. The duration during which the platform was maintained within 0° of tilt was referred to as time in balance (TIB). At all-time points, TIB was consistently longer in EO (EOW1: 17.02 ± 1.04s; EOW2: 17.32 ± 1.03s) compared to EC (ECW1: 11.55 ± 1.73s; ECW2: 13.08 ± 1.82s). A ±10 seconds difference was demonstrated in the Bland-Altman analysis in both EO and EC. Lower standard error of measurement (SEM) and coefficient of variation (CV) indicated consistent output. High intraclass correlation coefficient (ICC) values were seen between weeks (EO = 0.74; EC = 0.76) and within weeks (EOW1 = 0.79; EOW2 = 0.86; ECW1 = 0.71; ECW2 = 0.71). Although statistical measures (i.e., SEM, CV, and ICC) indicated good reliability of Lafayette for SL tasks, the wide agreement interval is yet to be clinically meaningful. Factors underlying the wide variation need to be identified before Lafayette is used for TIB assessment.

Psychometric evaluation of the healthy aging activity engagement scale

Objective

The aim of this study was to translate the Healthy Aging Activity Engagement Scale (HAAE) into Chinese and validate its psychometric properties in the middle-aged and elderly population.

Methods

A total of 424 middle-aged and elderly people were recruited from China's Jiangsu Province, Liaoning Province, Shandong Province, and Heilongjiang Province. Cronbach's α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Expert consultation was used to evaluate the content validity of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale.

Results

The Cronbach's α co-efficient of the Chinese version of HAAE was 0.965 and the Cronbach's α co-efficient of the dimensions ranged from 0.898 to 0.957. The split-half reliability was 0.807, and the test-retest reliability was 0.850. The content validity index of the scale (S-CVI) was 0.969. A total of three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators were fitted well (χ²/df = 1.393, comparative fit index = 0.982, goodness- of- fit index = 0.911. Tucker-Lewis Index = 0.981 and root mean square error of approximation = 0.030).

Conclusion

The translated Chinese version of HAAE had suitable reliability and validity in the middle-aged and elderly population. The translated scale will be used to evaluate the level of healthy aging among middle-aged and elderly people in Chinese mainland. Furthermore, it also can provide some health advice for clinical patients.

Psychometric properties of the Chinese version of the Positive Thinking Scale in individuals after hip fracture surgery

Positive thinking is a form of positive cognition and a coping strategy. The Positive Thinking Scale (PTS) is used to measure positive thinking, but the reliability and validity of the PTS-Chinese have yet to be tested. This study aims to examine the psychometric properties of the PTS-Chinese. A total of 154 patients post-hip fracture surgery completed the questionnaire in a hospital in Taiwan between April 2020 and December 2020. The scales in the questionnaire included the PTS, Automatic Thoughts Questionnaire-Positive, Automatic Thoughts Questionnaire-Negative, Barthel Index, and items related to happiness, demographics, and disease treatment. The results of the confirmatory factor analysis and average variance extracted show that the PTS-Chinese version exhibits construct validity. Scores on the PTS-Chinese version are positively related to scores on the Automatic Thoughts Questionnaire-Positive and happiness items and negatively related to scores on the Automatic Thoughts Questionnaire-Negative. This finding indicates that the PTS-Chinese demonstrates concurrent, predictive, and discriminant validity. The scale also presents acceptable reliability and test–retest reliability. Overall, the PTS-Chinese can be used to evaluate and track the positive thinking of patients. Further studies are needed to assess the psychometric properties of the PTS-Chinese in different cultures and ethnic groups.

The German version of the Nottingham Clavicle Score is a reliable and valid patient-reported outcome measure to evaluate patients with clavicle and acromioclavicular pathologies

PURPOSE

The Nottingham Clavicle Score (NCS) is a patient-reported outcome measure developed to evaluate treatment results of clavicle, acromioclavicular and sternoclavicular joint pathologies. Valid, reliable and user-friendly translations of outcome measure instruments are needed to allow comparisons of international results. The aim of this cross-sectional study was to translate and adapt the NCS into German and evaluate the psychometric properties of the German version.

METHODS

The translation and cross-cultural adaptation of the NCS were completed using a 'translation-back translation" method and the final version was administered to 105 German-speaking patients. The psychometric properties of this version (NCS-G) were evaluated in terms of feasibility, reliability, validity and sensitivity to change.

RESULTS

No major differences occurred between the NCS translations into German and back into English, and no content- or linguistic-related difficulties were reported. The Cronbach's alpha for the NCS-G was 0.885, showing optimal internal consistency. The Intraclass Correlation Coefficient for test-retest reliability was 0.907 (95% CI 0.844-0.945), with a standard error of measurement of 5.59 points and a minimal detectable change of 15.50 points. The NCS-G showed moderate to strong correlation with all other investigated scales (Spearman correlation coefficient: qDASH: ρ =  - 0.751; OSS: ρ = 0.728; Imatani Score: ρ = 0.646; CMS: ρ = 0.621; VAS: ρ =  - 0.709). Good sensitivity to change was confirmed by an effect size of 1.17 (95% CI 0.89-1.47) and a standardized response mean of 1.23 (95% CI 0.98-1.45).

CONCLUSIONS

This study demonstrated that NCS-G is reliable, valid, reproducible and well accepted by patients, showing analogous psychometric properties to the original English version.

LEVEL OF EVIDENCE

Level III.

Reliability of fr-AGILE tool to evaluate multidimensional frailty in hospital settings for older adults with COVID-19

Aims

The study assesses the reliability of fr-AGILE, a validated rapid tool used for the evaluation of multidimensional frailty in older adults hospitalized with COVID-19.

Methods

Two different staff members independently assessed the presence of frailty in 144 patients aged ≥ 65 years affected by COVID-19 using the fr-AGILE tool. The internal consistency of fr-AGILE was evaluated by examining the item-total correlations and the Kuder–Richardson (KR) formula. The inter-rater reliability was evaluated using linear weighted kappa.

Results

Multidimensional frailty severity increases with age and is associated to higher use of non-invasive ventilation (p = 0.025), total severity score on chest tomography (p = 0.001) and in-hospital mortality (p = 0.032). Fr-AGILE showed good internal consistency (KR-20 = 0.742) and excellent inter-rater reliability (weighted kappa = 0.752 and 0.878 for frailty score and frailty degree, respectively).

Conclusions

fr-AGILE tool can quickly identify and quantify multidimensional frailty in hospital settings for older patient affected by COVID-19.

Validation and reliability of the Care Vulnerability Index: A study by interrater agreement and test-retest method

Aim

The aim of this study is to determine the validity and reliability of the Care Vulnerability Index (CVI) as a tool to estimate the need and competence of care.

Design

A cross‐sectional survey including a longitudinal component.

Methods

Content validity ratio (CVR) was calculated by interrater agreement of a group of 11 experts in two rounds. The test–retest analysis was measured in an urban population of Colombia with 96 participants through two statistical tests: Pearson's correlation coefficient and the difference in means.

Results

Care Vulnerability Index turned out to be valid with a CVR of 0.879. Reliability by Pearson correlation between test–retest was 0.912 (CI95: 0.872–0.941; p‐value <.01) and there was no significant mean difference between test and retest in global score and in clustered groups of variables. Validating CVI will make it possible to prioritize healthcare resources in the population and identify people susceptible to care problems.

The University of California-Los Angeles (UCLA) shoulder scale: translation, reliability and validation of a Thai version of UCLA shoulder scale in rotator cuff tear patients

Background

UCLA Shoulder Scale is a useful evaluation tool to assess the functional outcome of shoulder after treatments. It has been translated into several languages. The objectives of this study were to translate UCLA Shoulder Scale into Thai language and validate the translated version in patients with rotator cuff tear.

Methods

This study consists of 2 phases: 1) Development of the Thai version of UCLA Shoulder Scale and 2) Validation of the translated version. The UCLA Shoulder Scale was translated into Thai according to the international guideline. Seventy-eight subjects with a mean age of 71 ± 11.5 took part in the study. All had shoulder pain and rotator cuff tear according to MRI from 2019 to 2020. Four patients were excluded due to incomplete questionnaires. The data from 21 patients whose symptoms in shoulder joint had not changed within 14 days were analyzed with the UCLA Shoulder Scale test-retest using intraclass correlation (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). The Thai version of UCLA Shoulder Scale was compared to the validated Thai versions of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC) and Shortened version of The Disability of the Arm, Shoulder and Hand (QuickDASH) shoulder scores.

Results

Thai version of UCLA Shoulder Scale was developed following the guideline. Moderate to strong correlations were found using Spearman’s correlation coefficient between pain, function and total score of Thai version of UCLA Shoulder Scale. The reliability of total UCLA Shoulder Scale was excellent (ICC = 0.99, 95% CI 0.97–1.00), whereas agreement assessed with SEM and MDC (0.18 and 0.50 respectively) demonstrated a positive rating. The validity analysis of total UCLA Shoulder Scale (Thai version) showed moderate to strong correlations with total ASES, total WORC and QuickDASH (Thai versions). The Thai version of UCLA Shoulder Scale showed no floor and ceiling effects from the results.

Conclusion

The Thai version of UCLA Shoulder Scale is a reliable and valid tool for assessing the function and disability of the shoulder in Thai patients who have rotator cuff tear.

A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index

BACKGROUND

Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce.

OBJECTIVE

Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being.

METHODS

In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations.

RESULTS

Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales.

CONCLUSIONS

The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs.

A voice recognition-based digital cognitive screener for dementia detection in the community: Development and validation study

INTRODUCTION

To facilitate community-based dementia screening, we developed a voice recognition-based digital cognitive screener (digital cognitive screener, DCS). This proof-of-concept study aimed to investigate the reliability, validity as well as the feasibility of the DCS among community-dwelling older adults in China.

METHODS

Eligible participants completed demographic, clinical, and the DCS. Diagnosis of mild cognitive impairment (MCI) and dementia was made based on the Montreal Cognitive Assessment (MoCA) (MCI: MoCA < 23, dementia: MoCA < 14). Time and venue for test administration were recorded and reported. Internal consistency, test-retest reliability and inter-rater reliability were examined. Receiver operating characteristic (ROC) analyses were conducted to examine the discriminate validity of the DCS in detecting MCI and dementia.

RESULTS

A total of 103 participants completed all investigations and were included in the analysis. Administration time of the DCS was between 5.1-7.3 min. No significant difference (p > 0.05) in test scores or administration time was found between 2 assessment settings (polyclinic or community center). The DCS showed good internal consistency (Cronbach's alpha = 0.73), test-retest reliability (Pearson r = 0.69, p < 0.001) and inter-rater reliability (ICC = 0.84). Area under the curves (AUCs) of the DCS were 0.95 (0.90, 0.99) and 0.77 (0.67, 086) for dementia and MCI detection, respectively. At the optimal cut-off (7/8), the DCS showed excellent sensitivity (100%) and good specificity (80%) for dementia detection.

CONCLUSION

The DCS is a feasible, reliable and valid digital dementia screening tool for older adults. The applicability of the DCS in a larger-scale community-based screening stratified by age and education levels warrants further investigation.

Italian version of the anterior cruciate ligament-return to sport after injury scale (IT ACL-RSI): translation, cross-cultural adaptation, validation and ability to predict the return to sport at medium-term follow-up in a population of sport patients

PURPOSE

The timing of psychological and physical recovery after anterior cruciate ligament reconstruction represents an open issue in current orthopedic practice. Several tools have been developed to evaluate these factors, with the most recent being represented by the anterior cruciate ligament (ACL) return to sport injury scale (ACL-RSI). The aims of this study were to provide a validated Italian translation of the ACL-RSI in a population of sport patients, and to identify a possible correlation of the ACL-RSI score with the return to sport (RTS) time and the level of sport participation in comparison to the pre-injury one.

METHODS

The Italian translation and cultural adaptation of the scale were completed using a using the "translation-back translation" method. A total of 130 patients were enrolled and completed the study questionnaires 6 months after ACL reconstruction. Randomly, 65 of them were re-tested for the ACL-RSI within 2 weeks. The internal consistency, reliability, feasibility, and construct validity of the Italian version of ACL-RSI were assessed and compared to Italian version of the KOOS, the Lysholm Score, the AKPS and the IKDC subjective score. Responsiveness was tested comparing patients returning to sport at 6 and 12 months. The Tegner activity scale was collected at baseline, 6 and 12 months to identify the level of activity after return to sport, in relation to the ACL-RSI score.

RESULTS

The Italian adaptation of the ACL-RSI demonstrated excellent internal consistency (Cronbach's alpha = 0.953), reliability (test-retest ICC = 0.916) and feasibility, with no ceiling or floor effect. Construct validity was confirmed by the moderate to strong correlation with all the other scales (p < 0.0001). Slight and non-significant higher ACL-RSI score was shown by patients returned to sport at 6 or 12 months after surgery. Nevertheless, the ACL-RSI score at 6 months was significantly different between patients who returned and those who did not returned to the same level of sport activity 12 months after the procedure.

CONCLUSIONS

This study demonstrated that the Italian ACL-RSI is a reliable tool for evaluating the psychological readiness for return to sports of athletes who underwent ACL reconstruction, especially when collected at the end of the rehabilitation process. Since the IT ACL-RSI used in this study is a faithful translation of the original English version, this finding can be generalized to other cultural contexts and languages too.

LEVEL OF EVIDENCE

Level II.

Apathy Measures in Older Adults and People with Dementia: A Systematic Review of Measurement Properties Using the COSMIN Methodology

BACKGROUND

Apathy is highly prevalent in dementia and is also seen in mild cognitive impairment and the general population. Apathy contributes to failure to undertake daily activities and can lead to health problems or crises. It is therefore important to assess apathy. However, there is currently no gold standard measure of apathy. A comprehensive systematic review of the measurement properties of apathy scales is required.

METHODS

A systematic review was registered with PROSPERO (ID: CRD42018094390). MEDLINE, Embase, PsycINFO, and CINAHL were searched for studies that aimed to develop or assess the validity or reliability of an apathy scale in participants over 65 years, living in the community. A systematic review was conducted in line with the COnsensus-based Standards for the selection of health Measurement INstruments procedure for reviewing patient-reported outcome measures. The studies' risk of bias was assessed, and all relevant measurement properties were assessed for quality. Results were pooled and rated using a modified Grading of Recommendations Assessment, Development, and Evaluation procedure.

RESULTS

Fifty-seven publications regarding 18 measures and 39 variations met the eligibility criteria. The methodological quality of individual studies ranged from inadequate to very good and measurement properties ranged from insufficient to sufficient. Similarly, the overall evidence for measurement properties ranged from very low to high quality. The Apathy Evaluation Scale (AES) and Lille Apathy Rating Scale (LARS) had sufficient content validity, reliability, construct validity, and where applicable, structural validity and internal consistency.

CONCLUSION

Numerous scales are available to assess apathy, with varying psychometric properties. The AES and LARS are recommended for measuring apathy in older adults and people living with dementia. The apathy dimension of the commonly used Neuropsychiatric Inventory should be limited to screening for apathy.

The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation

BACKGROUND AND OBJECTIVES

Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, health care providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity.

RESEARCH DESIGN AND METHODS

Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data were used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity.

RESULTS

The refined scale contains 27 items consisting of 7 factors and 1 stand-alone item: (a) environmental, (b) physical health, (c) PA-related motivation, (d) emotional health, (e) time, (f) skills, (g) social, and (h) energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha = 0.91) and high test-retest reliability (intraclass correlation coefficient = 0.99). The IPAB's mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < .001).

DISCUSSION AND IMPLICATIONS

The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.

Translation, adaptation and validation of the Bulgarian version of the King's Parkinson's Disease Pain Scale

Background

The purpose of the present study was to translate and cross-culturally adapt the King’s Parkinson’s Disease Pain Scale (KPPS) into Bulgarian and to investigate its psychometric properties in order to provide a validated Parkinson’s disease-specific pain instrument in Bulgarian language (KPPS-BG).

Methods

Translation into Bulgarian and a cultural adaptation were performed to obtain KPPS-BG. A total of 162 patients with idiopathic Parkinson’s disease were screened for pain using the complementary to the KPPS questionnaire – King’s Parkinson’s Disease Pain Questionnaire (KPPQ). KPPS-BG domain and total scores were calculated and internal consistency, construct validity and test-retest reliability were examined for 129 patients having one or more positive items in the KPPQ-BG.

Results

79.6 % of the patients reported one or more types of pain. The most common type was musculoskeletal pain (83.7 %), followed by nocturnal pain (55.0 %), fluctuation-related pain (50.1 %), radicular pain (43.4 %), chronic pain (31.0 %), discoloration, edema/swelling (27.1 %) and, oro-facial pain (14.3 %). Mean KPPS-BG total score was 21.1 ± 17.3 SD. KPPS-BG showed a good reliability (Cronbach’s alpha 0.75). The test-retest reliability of the KPPS-BG was high and the intraclass correlation coefficient was 0.92, demonstrating а good repeatability. KPPS-BG total score was higher in patients with postural instability gait difficulty motor subtype, compared to tremor-dominant or indeterminate subtype. Significant positive correlations were found between KPPS-BG total score and modified H&Y, Movement Disorders Society Unified Parkinson’s Disease Rating Scale part III.

Conclusions

The KPPS-BG constitutes a reliable, comprehensive and useful tool for pain assessment in native Bulgarian patients with Parkinson’s disease.

Measurement Properties of the EQ VAS Around the Globe: A Systematic Review and Meta-Regression Analysis

OBJECTIVES

This study aimed to synthesize and evaluate published evidence on the measurement properties of the EQ VAS, a component of all EQ-5D questionnaires.

METHODS

This systematic review followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Five electronic databases were searched for EQ-5D-3L and EQ-5D-5L validation articles published from January 1, 2009, to November 5, 2019. Evidence for construct validity, test-retest reliability, and responsiveness was extracted from individual studies before being aggregated for evaluation of the populations represented by the studied samples. Multivariable logistic meta-regression was conducted to explore the effects of potential covariates on construct validity.

RESULTS

A total of 50 articles containing 488 studies, using samples drawn from 12 different populations, were identified. Generally, the quality of evidence was high for construct validity studies (n = 397) but only moderate for both test-retest reliability studies (n = 21) and responsiveness studies (n = 70). "Sufficient" construct validity of EQ VAS was found in 8 of 12 populations, "sufficient" test-retest reliability was found in 3 of 11 populations, and "sufficient" responsiveness was found in 5 of 12 populations. Meta-regression analyses suggested that construct validity studies from the Asian-Pacific region were more likely to show a negative rating compared with studies from Europe and North America.

CONCLUSION

The EQ VAS exhibits "sufficient" construct validity, "inconsistent" test-retest reliability, and "inconsistent" responsiveness across a broad range of populations. Additional studies are needed to explore the suboptimal validity of the EQ VAS in the Asian-Pacific region, whereas more high-quality validation studies are needed to assess its reliability and responsiveness.

Measuring Stakeholder Perceptions: A Review of Social Validity Reporting in ASHA Journals

Purpose Intervention research in speech-language pathology is growing; however, there remains a gap between research and clinical practice. To promote evidence-based practice, stakeholder input may be solicited during the development and evaluation of treatments. One method of evaluating stakeholder input is by subjectively measuring social validity. Social validity probes end users' satisfaction and acceptability of a treatment. Method This review article explores the type and frequency of subjective social validity measures reported in speech-language pathology treatment literature published in American Journal of Speech-Language Pathology; Journal of Speech, Language, and Hearing Research; and Language, Speech, and Hearing Services in Schools from January 2017 through April 2019. In total, 93 treatment studies were included and coded descriptively. Results Of the 93 treatment studies included in this review, 20 reported subjective measures of social validity. The most common method of measurement was questionnaires (n = 19), followed by interviews (n = 5), and direct observation (n = 1). Conclusions Only 21.5% of reviewed speech-language pathology treatment articles from American Speech-Language-Hearing Association journals reported measures of social validity, although it is a crucial component of implementation of evidence-based practice. We urge researchers and journal editors to include social validity measures in treatment literature as we promote the uptake of evidence-based practices and the involvement of stakeholders during the development of evidence-based practices. We also encourage the development of social validity measures that can be validated on individuals with communication disorders.

Psychometric properties of a short version of the Activities-specific Balance Confidence scale-Japanese (Short ABC-J) in community-dwelling people with stroke

Background and Purpose: The Activities-specific Balance Confidence (ABC) scale has been widely used as patient-reported outcome measures for community stroke rehabilitation and its short version is beginning to be used. This study aimed to assess the psychometric properties of the short version of the ABC scale-Japanese (Short ABC-J).Methods: Eighty-four participants with chronic stroke (mean age was 66.4 ± 9.7 years, mean time post stroke was 4.7 ± 3.5 years) including 66 test-retest samples were analyzed. The Short ABC-J was assessed with the ABC-J, the Falls Efficacy Scale-International (FES-I), the Berg Balance Scale (BBS), and the Timed Up and Go Test (TUG-T). Results: The internal consistency was good (Cronbach's alpha 0.90), reproducibility was excellent [intra-class correlation coefficient (ICC2,1) 0.92], and levels of absolute reliability were acceptable (standard error of measurement and minimal detectable change 8.32 and 23.07, respectively). Concurrent, convergent, and discriminative validity were supported for the FES-I, ABC-J, BBS, and TUG-T (all |rho| > 0.60, p < .001), and identifying balance and mobility (the area under the curve estimates ≥ 0.80) and discriminative power of the Short ABC-J were better than those of the FES-I and equal to or better than those of ABC-J. Conclusion: The Short ABC-J has good psychometric properties and is a valid and reliable measure of balance self-efficacy in Japanese community-dwelling people with chronic stroke. Further replication studies as well as other psychometric studies are needed.

Mediterranean diet assessment challenges: Validation of the Croatian Version of the 14-item Mediterranean Diet Serving Score (MDSS) Questionnaire

Mediterranean diet (MD) is among the most commonly investigated diets and recognized as one of the healthiest dietary patterns. Due to its complexity, geographical and cultural variations, it also represents a challenge for quantification. The aim of this cross-sectional study was to assess reliability and validity of the Croatian version of the 14-item Mediterranean Diet Serving Score (MDSS), using the Mediterranean Diet Adherence Screener (MEDAS) as the referent test. We included the exploratory sample of 360 medical students, and a confirmatory sample of 299 health studies students from the University of Split, Croatia. Test-retest reliability and validity of the MDSS were tested using intra-class correlation coefficients (ICC), while Cohen's kappa statistic was used to test correct classification of subjects into MD adherent/non-adherent category. A very good reliability was shown for the overall MDSS score (ICC = 0.881 [95% CI 0.843-0.909]), and a moderate reliability for the binary adherence (κ = 0.584). Concurrent validity of the MDSS was also better when expressed as a total score (ICC = 0.544 [0.439-0.629]) as opposed to the adherence (κ = 0.223), with similar result in the confirmatory sample (ICC = 0.510 [0.384-0.610]; κ = 0.216). Disappointingly, only 13.6% of medical students were adherent to the MD according to MDSS, and 19.7% according to the MEDAS questionnaire. Nevertheless, MDSS score was positively correlated with age (ρ = 0.179: P = 0.003), self-assessed health perception (ρ = 0.123; P = 0.047), and mental well-being (ρ = 0.139: P = 0.022). MDSS questionnaire is a short, reliable and reasonably valid instrument, and thus useful for assessing the MD adherence, with better results when used as a numeric score, even in the population with low MD adherence.

Is E-Version Transition of the Medication Adherence Scale Feasible for CKD Management? A Pilot Study

BACKGROUND

To transfer a paper-version Chinese and Western medication adherence scale for CKD into an electronic scale, and evaluate its validity, internal consistency and clinical implementation, and assess whether the transition is feasible in clinic.

METHODS

We built an e-version Chinese and Western medication adherence scale based on the Wen-JuanXing platform. CKD subjects' responses were applied to test the scale's validity and internal consistency. We retested some of the participants two weeks later randomly. We also tested the clinical application.

RESULTS

Of the 434 recruited patients, 228 responded. In exploratory factor analysis (EFA), the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy = 0.8 and Bartlett's approx. Chi-Square = 1340.0 (df = 105, p < 0.001). We extracted four common factors which could explain 61.47% of the variance. However, Item 15 "Have you changed a traditional Chinese medicine prescription yourself within the past month?" had factor loading = 0.3 and measure of sampling adequacy (MSA) = 0.5, meaning we could not enter it into the factor analysis. The internal consistency reliability for medication adherence was 0.9, with a Guttman split-half coefficient = 0.5 and a Spearman-Brown coefficient = 0.6. Cronbach's α was 0.9, 0.4 and 0.5 for the knowledge, belief and behavior domains, respectively. The correlation coefficient r of the test-retest reliability was -0.8 and was -0.8, 0.4, -0.3 in the knowledge, belief and behavior domains, respectively. Patients with comorbidities were more likely to respond. We detected no other significant differences in the clinical profiles between respondents and non-respondents.

CONCLUSION

The e-version Chinese and Western medication adherence scales have undesirable construct validity and internal consistency. Thus, caution is needed in transitioning the paper-version scale into an e-version.

Reliability and Validity of the Turkish Version of the Oxford Participation and Activities Questionnaire in Older People

Background

Activities and participation play important roles in the maintenance of healthy aging. The maintenance of these factors optimizes social life to increase the quality of life with aging. However, there is a lack of questionnaires in Turkish to evaluate activity and participation among older people. This study translated and cross-culturally adapted the Oxford Participation and Activities Questionnaire (Ox-PAQ) into Turkish and investigated its psychometric properties in the older adult population.

Methods

The Turkish version of the Ox-PAQ was produced after a translation and back-translation process. The Ox-PAQ was administered to 230 and 60 individuals for construct validity and reliability analyses, respectively. To assess the test-retest reliability of the Turkish Ox-PAQ, the questionnaire was reapplied 7 days after the first interview. Cronbach’s alpha (α) was used to evaluate the internal consistency. The Ox-PAQ was compared to the Short Form-12 and the Katz Index of Independence in Activities of Daily Living Scale to determine its validity.

Results

The Turkish Ox-PAQ showed excellent internal consistency (α=0.98) and test-retest reliability (intraclass correlation coefficient=0.98, 0.96, and 0.97 for the subscales of routine activity level, social engagement, and emotional well-being, respectively). In the validity analysis, factor analysis demonstrated a probable structure of the three factors that together explained 66.35% of the total variance. The Turkish Ox-PAQ was correlated with the other comparison measures used in this study.

Conclusion

The Turkish Ox-PAQ is a reliable and valid questionnaire to evaluate the participation and activity levels of older people (Clinical Trial Number: NCT04368754).

Refinement and Evaluation of a Chinese and Western Medication Adherence Scale for Patients with Chronic Kidney Disease: Item Response Theory Analyses

PURPOSE

This study aimed to simplify the version-1 Chinese and Western medication adherence scale for patients with chronic kidney disease (CKD) to a version-2 scale using item response theory (IRT) analyses, and to further evaluate the performance of the version-2 scale.

MATERIALS AND METHODS

Firstly, we refined the version-1 scale using IRT analyses to examine the discrimination parameter (a), difficulty parameter (b) and maximum information function peak (Imax). The final scale refinement from version-1 to version-2 scale was also decided upon clinical considerations. Secondly, we analyzed the reliability and validity of version-2 scale using classical test theory (CTT), as well as difficulty, discrimination and Imax of version-1 and version-2 scale using IRT in order to conduct scale evaluation.

RESULTS

For scale refinement, the 26-item version-1 scale was reduced to a 15-item version-2 scale after IRT analyses. For scale evaluation using CTT, internal consistency reliability (total Cronbach α = 0.842) and test-rest reliability (r = 0.909) of version-2 scale were desirable. Content validity indicated 3 components of knowledge, belief and behaviors. We found meritorious construct validity with 3 detected components as the same construct of medication knowledge (items 1-9), medication behavior (items 13-15), and medication belief (items 10-12) based upon exploratory factor analysis. The correlation between the version-2 scale and Morisky, Green and Levine scale (MGL scale) was weak (Pearson coefficient = 0.349). For scale evaluation with IRT, the findings showed enhanced discrimination and decreased difficulty of most retained items (items 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15), decreased Imax of items 1, 2, 3, 4, 6, 11, 14, as well as increased Imax of items 5, 7, 8, 9, 10, 12, 13, 14, 15 in the version-2 scale than in the version-1 scale.

CONCLUSION

The original Chinese and Western medication adherence scale was refined to a 15-item version-2 scale after IRT analyses. The scale evaluation using CTT and IRT showed the version-2 scale had the desirable reliability, validity, discrimination, difficulty, and information providedoverall. Therefore, the version-2 scale is clinically feasible to assess the medication adherence of CKD patients.

Cross-cultural adaptation and psychometric validation of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in French

BACKGROUND

The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire allows capture of the beliefs and attitudes of older adults and caregivers towards deprescribing.

OBJECTIVES

To translate and validate the rPATD questionnaire into French.

METHODS

The French rPATD was translated using forward-backward translation. Psychometric properties were evaluated in both older adults ≥65 years living in the community or in institutions and who were taking at least one chronic medication and in caregivers of older adults with similar characteristics. Participants were recruited in four French-speaking countries (Belgium, Canada, France and Switzerland). Face and content validity were assessed during the translation process. Construct validity (exploratory factor analysis (EFA)) and internal consistency (Cronbach's alpha) were investigated in questionnaires without missing data. Test-retest reliability was evaluated using intra-class correlation coefficient (ICC) in a sample of participants.

RESULTS

In total, 320 questionnaires from older adults and 215 questionnaires from caregivers were included to evaluate construct validity and internal consistency. EFA extracted four factors in the older adults' and caregivers' versions of the questionnaire consistent with the English rPATD. The extracted factors related to the perceived burden of medication taking, the beliefs in appropriateness of medications, concerns about stopping medications and the level of involvement in making decisions and of knowledge of medications. Internal consistency was satisfactory for three factors for both versions (Cronbach's alpha >0.70), with lower internal consistency in the concerns about stopping factor. Test-retest reliability was overall good for all factors in the caregivers' version (ICC > 0.75) while for the older adults' version, moderate (ICC range: 0.75-0.50) to good ICC values were found.

CONCLUSIONS

The French rPATD presents globally good psychometric properties and can be used to explore attitudes towards deprescribing in French-speaking older adults and caregivers.

A Systematic Review of the Psychometric Properties of the Geriatric Anxiety Inventory

The Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) are self-reported scales used internationally to assess anxiety symptoms in older adults. In this study, we conducted the first critical comprehensive review of these scales' psychometric properties. We rated the quality of 31 relevant studies with the COSMIN checklist. Both the GAI and GAI-SF showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with generalized anxiety measures; lowest with instruments relating to somatic symptoms. We detected substantial overlap with depression measures. While there was no consensus on the GAI's factorial structure, we found the short version to be unidimensional. Although we found good sensitivity and specificity for detecting anxiety, cut-off scores varied. The GAI and GAI-SF are relevant instruments showing satisfactory psychometric properties; to broaden their use, however, some psychometric properties warrant closer examination. This review calls attention to weaknesses in the methodological quality of the studies.

Validity, reliability, and application of the electronic version of a chronic kidney disease patient awareness questionnaire: a pilot study

OBJECTIVES

A questionnaire which provides desirable reliability and validity has been previously developed to assess the disease awareness of diagnosed chronic kidney disease (CKD) patients. However, conventional paper questionnaires often have disadvantages, including recall bias. To substantially improve this, we therefore aimed to explore the feasibility of developing a smartphone-based electronic version (e-version) based upon its original paper version and subsequently tested its validity, reliability, and applicability.

METHODS

A pilot study was conducted at Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, China, during August 2019. The e-version had identical content to the paper version and was adapted in terms of layout and assisted functions via the Wechat-incorporated Wen-Juan-Xing platform. Eligible patients with diagnosed CKD were invited to participate and were assigned the e-version. Randomly selected respondents received a test-retest of the same e-version 2 weeks after their first completion. In some instances, psychometric properties, including validity and reliability of the e-version, were examined. In others, its clinical application was also tested, which included comparisons among the clinical profiles of patients who had/had not responded to the questionnaire as well as patients with above or below average questionnaire scores.

RESULTS

Of the 225 patients screened, 217 were enrolled to participate, with a response rate of 52.5%. Desirable reliability (Cronbachα = 0.962, ICC for total scores = 0.948), while good convergent validity (Cronbachα = 0.962) and low discriminant validity (one extracted component), of the e-version were detected. Performing inter-group comparisons highlighted statistical differences in terms of higher education level (z = -2.436, P = 0.015) and earlier CKD stages (z = -1.978, P = 0.048), with these patients often preferring to respond. No significant differences were detected in the clinical profiles between respondents who obtained an above or below average questionnaire score.

CONCLUSION

The e-version is reliable but was not shown to be a valid approach. Audiences with higher education levels and less advanced disease condition may prefer to respond to the e-version. Adaptation of this e-questionnaire, from its original paper version, may not be a direct transition and meticulous modifications may be required during the transition process.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR1900024633).

Health-related quality of life in facial palsy: translation and validation of the Dutch version Facial Disability Index

Purpose

Patient-reported outcome measures are essential in the evaluation of facial palsy. Aim of this study was to translate and validate the Facial Disability Index (FDI) for use in the Netherlands.

Methods

The FDI was translated into Dutch according to a forward-backward method. Construct validity was assessed by formulating 22 hypotheses regarding associations of FDI scores with the Facial Clinimetric Evaluation scale, the Synkinesis Assessment Questionnaire, the Short Form-12 and the Sunnybrook Facial Grading System. Validity was considered adequate if at least 75% (i.e. 17 out of 22) of the hypotheses were confirmed. Additionally, confirmatory factor analysis was performed. Cronbach’s α was calculated as a measure of internal consistency. Participants were asked to fill out the FDI a second time after 2 weeks to analyse test-retest reliability. Lastly, smallest detectable change was calculated.

Results

In total, 19 hypotheses (86.4%) were confirmed. Confirmatory factor analysis showed acceptable fit for the two factor structure of the original FDI (root mean square error of approximation = 0.064, standardized root mean square residual = 0.081, comparative fit index = 0.925, Chi-square = 50.22 with 34 degrees of freedom). Internal consistency for the FDI physical function scale was good (α > 0.720). Internal consistency for the FDI social/well-being scale was slightly less (α > 0.574). Test-retest reliability for both scales was good (intraclass correlation coefficients > 0.786). Smallest detectable change at the level of the individual was 17.6 points for the physical function and 17.7 points for the social/well-being function, and at group level 1.9 points for both scales.

Conclusion

The Dutch version FDI shows good psychometric properties. The relatively large values for individual smallest detectable change may limit clinical use. The translation and widespread use of the FDI in multiple languages can help to compare treatment results internationally.

Reliability and Validity of the Activity Diversity Questionnaire for Older Adults in Japan

Recent research has suggested that the breadth and evenness of activity and activity diversity contribute to health outcomes among older adults. However, few established assessment tools for activity diversity have been developed. This study developed an Activity Diversity Questionnaire (ADQ) for older adults through expert consultation and a preliminary survey among 18 community-dwelling older adults. The diversity score was calculated according to Shannon’s entropy. In study 1, the intraclass correlation coefficients (ICC) of the diversity scores were determined for community-dwelling older adults (n = 30). In study 2, concurrent validity was tested with participants receiving comprehensive health checkups at the Itabashi ward in Japan in 2018 (n = 766). The correlation coefficients of the diversity scores were then calculated in reference to the Tokyo Metropolitan Institute of Gerontology Index of Competence and Japan Science and Technology Agency Index of Competence. The final version of the ADQ consisted of 20 total items with excellent test-retest reliability (ICC = 0.84) and moderate correlations with both the Tokyo Metropolitan Institute of Gerontology Index of Competence and Japan Science and Technology Agency Index of Competence (r = 0.48 and 0.60, respectively). The ADQ was developed through scientific procedures and revealed sufficient reliability and validity. As such, it is a scientifically validated tool for assessing activity diversity among older adults.

Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT‐CL)

Aim

Background

Methods

Results

Conclusions

Implications for nursing management

Functional health literacy in a population-based sample in Florence: a cross-sectional study using the Newest Vital Sign

OBJECTIVES

To assess the level of functional health literacy (HL) and its antecedents and consequences in an adult population-based sample, using the Italian version of Newest Vital Sign (NVS-IT).

DESIGN

Cross-sectional study.

SETTING

General population.

PARTICIPANTS

984 people were randomly selected from the resident registers of 11 general practitioners; a total of 452 (46.2%) of the selected people completed the study. Inclusion criteria were the following: 18-69 years of age and Italian speaking. Exclusion criteria included cognitive impairment, severe psychiatric diseases and end-stage diseases.

OUTCOME MEASURES

HL levels as assessed by the NVS-IT and the following potential HL predictors and consequences were assessed using logistic regression models: sociodemographic characteristics, body mass index, presence of long-term illnesses, self-reported health status, health services use in the last 12 months.

RESULTS

High likelihood of limited HL, possibility of limited HL and adequate HL were found in 11.5%, 24.6% and 63.9% of the sample, respectively. The results of the multivariate logistic model for the antecedents showed that the risk of having high likelihood or possibility of limited HL levels increases with age (OR 1.07, 95% CI 1.05 to 1.09), lower educational level (OR 4.03; 95% CI 3.41 to 7.49) and with worse financial situation (OR 1.64; 95% CI 1.17 to 2.63). As far as health outcomes are concerned, HL resulted to be positively associated with self-reported health status (OR 2.25, 95% CI 1.75 to 2.75).

CONCLUSIONS

Findings show a good level of functional HL in the population. However, older, less educated and poorer population groups showed to have a higher likelihood of suffering from limited or inadequate HL. Efforts should be made to design and implement public health policies and interventions tailored to different HL levels.

TRIAL REGISTRATION NUMBER

CEAVC:10113.

Development and Validation of the MiPrep Survey: An Instrument Assessing Patients' Perceived Preparation for Medical Interventions Including Medical Imaging, Radiotherapy, and Surgery

BACKGROUND

Adequately preparing patients for medical interventions is an important component of quality healthcare. Nevertheless, few instruments for assessing patients' preparation exist.

OBJECTIVES

To develop a psychometrically rigorous instrument to assess patients' perceptions of the quality of preparation.

METHODS

An instrument to measure patients' preparation for medical interventions (MiPrep) was developed and tested with patients undergoing medical imaging, radiotherapy, or surgery. Patients were recruited and asked to complete 2 surveys. Survey A assessed patient and intervention characteristics. Survey B (postintervention) contained MiPrep to assess validity (face, content, and construct) and reliability (internal consistency and test-retest).

RESULTS

A total of 869 (85%) patients consented to participate and 551 (63%) returned the postintervention survey. Face and content validity were demonstrated. Exploratory factor analysis identified 2 survey modules: receipt and adequacy of information (2 domains) and overall appraisal of patient-centered care (1 domain). Reliability was evidenced by adequate internal consistency (Cronbach α 0.81-0.89) and item-total correlations higher than 0.20. Nevertheless, individual item test-retest reliability requires further confirmation. The final instrument contained 27 items.

CONCLUSIONS

The MiPrep instrument has evidence of being a valid and reliable instrument of preparation for medical interventions. Healthcare providers can use the instrument as a quality assurance tool to identify areas for improvement and areas of excellence in patients' preparation. Future studies should verify these findings in other populations and examine the divergent and predictive validity of the instrument.

Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]

BACKGROUND

Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study.

METHODS/DESIGN

This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation.

DISCUSSION

We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals.

TRIAL REGISTRATION

DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.

Secondhand smoking, knowledge/attitudes and socioeconomic status among married Bangladeshi women: a cross-sectional study

BACKGROUND

There is a paucity of research on knowledge/attitudes regarding the dangers of exposure to secondhand smoking (SHS) among women. The relationship between exposure to SHS, socioeconomic status (SES) and knowledge/attitudes regarding the risks of SHS has often been ignored. We therefore aimed to examine (1) whether SES and exposure to SHS were independently associated with knowledge/attitudes regarding the risks of SHS; and (2) whether women with low SES and exposure to SHS were uniquely disadvantaged in terms of deficient knowledge and more dismissive attitudes towards the risks of SHS.

DESIGN AND SETTING

Cross-sectional study in the Rajshahi district, Bangladesh.

METHODS

A total of 541 women were interviewed. Knowledge of and attitudes towards the risks of SHS were the outcomes of interest.

RESULTS

A majority of the respondents were exposed to SHS at home (49.0%). Only 20.1% had higher levels of knowledge, and only 37.3% had non-dismissive attitudes towards the risks of SHS. Participants in the low SES group and those exposed to SHS had lower odds of higher knowledge and their attitudes towards the risks of SHS were more dismissive. Regarding deficient levels of knowledge and scores indicating more dismissive attitudes, women in the low SES group and who were exposed to SHS were not uniquely disadvantaged.

CONCLUSIONS

Exposure to SHS and low SES were independently associated with deficient knowledge and scores indicating more dismissive attitudes. Regarding knowledge/attitudes, the negative effect of exposure to SHS extended across all socioeconomic backgrounds and was not limited to women in either the low or the high SES group.

Factor mixture analysis of paranoia in young people

BACKGROUND

Paranoid thoughts are relatively common in the general population and can increase the risk of developing mental health conditions. In this study, we investigate the latent structure of paranoia in a sample of young people.

METHODS

Cross-sectional survey; 243 undergraduate students (males: 44.9%) aged 24.3 years (SD 3.5). The participants completed the Green et al. Paranoid Thought Scales GPTS, a 32-item scale assessing ideas of social reference and persecution; the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Confirmatory factor analysis (CFA) was used to confirm the two-factor structure of the GPTS. Factor mixture modeling analysis (FMMA) was applied to map the best combination of factors and latent classes of paranoia.

RESULTS

The GPTS showed excellent internal reliability and test-retest stability. Convergent validity was good, with stronger links with measures of ideas of reference and of suspiciousness than with other measures of psychosis-proneness. CFA showed excellent fit for the two-factor solution. FMMA retrieved a three-class solution with 176 subjects (72.5%) assigned to a baseline class, 54 (22.2%) to a "suspicious and mistrustful" class, and 13 (5.3%) to a "paranoid thinking" class. Compared to the baseline class, the other two classes had a higher risk of psychological distress and psychosis-proneness.

CONCLUSIONS

The latent structure of paranoid thinking in young people appears dimensional. Although caution is advised when generalizing from studies on college students, screening for paranoid ideation in young people who complain about psychological distress might prove useful to prevent the development of severe and potentially debilitating conditions.

Development and Validation of a Questionnaire to Assess Barriers to Physical Activity After Stroke: The Barriers to Physical Activity After Stroke Scale

OBJECTIVE

To develop and validate a self-reported questionnaire assessing the barriers to physical activity (PA) among stroke survivors.

DESIGN

Psychometric study.

SETTING

Ambulatory stroke care.

PARTICIPANTS

A total of one hundred and forty-six (N=146) individuals were included in this study. In stage 1, community-living stroke survivors (n=37; 13 women) with low-moderate disability (modified Rankin Score 0-3, stroke >3mo) were included. In stage 2, participants (n=109; 40 women) with same characteristics were included. Nine professionals experienced in PA for poststroke patients formed an expert panel.

INTERVENTIONS

In stage 1, semistructured interviews identified perceived barriers to PA, which were then selected by the expert panel and grouped on a Barriers to Physical Activity After Stroke (BAPAS) scale. In stage 2, stroke participants completed a personal information questionnaire and the BAPAS scale.

MAIN OUTCOME MEASURES

An item selection process with factor analysis was carried out. The suitability of the data set was analyzed using the Kaiser-Meyer-Olkin coefficient, internal consistency was evaluated by Cronbach α, and concurrent validity was assessed with Spearman correlation coefficients between the BAPAS scale and the modified Rankin Scale. Test-retest repeatability was estimated using 2-way random effects intraclass correlation coefficient model 2,1 at 4-6 day follow-up (n=21).

RESULTS

Factor analysis supported a 14-item BAPAS that explained 62% of total variance (Kaiser-Meyer-Olkin=0.82) and total score calculated higher than 70 (higher scores for higher barriers). Cronbach α was 0.86, Spearman correlation with the modified Rankin Scale was r=0.65 (P<.001), and test-retest intraclass correlation coefficient was 0.91 (95% CI, 0.79-0.97). The BAPAS scores were higher in patients with greater disabilities and in those with a longer time since the stroke event (P<.01).

CONCLUSION

We developed and validated the BAPAS scale to assess barriers to PA in stroke survivors with low-moderate disability with promising psychometric properties.