Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review

Instruments used to measure knowledge and attitudes of healthcare professionals towards antibiotic use for the treatment of urinary tract infections: A systematic review

BACKGROUND

Urinary tract infections (UTIs) are the second most common condition (after upper respiratory tract infections) for which adults receive antibiotics, and this prevalence may contribute to antibiotic resistance. Knowledge and attitudes have been identified as potential determinants of antibiotic prescribing behaviour among healthcare professionals in the treatment and management of UTIs. An instrument that captures prescribers' baseline knowledge of and attitudes towards antibiotic prescribing for UTIs could inform interventions to enhance prescribing. The current systematic review evaluates the psychometric properties of instruments already available and describes the theoretical constructs they measure.

METHODS

Five electronic databases were searched for published studies and instruments. The Consensus-based Standards for the selection of health status Measurement Instruments checklist was used to assess the psychometric quality reporting of the instruments. The items included in each instrument were mapped onto the theoretical constructs underlying knowledge and attitudes using a mixed-theoretical model developed for this study.

RESULTS

Fourteen studies met the review inclusion criteria. All instruments were available for review. None of the instruments had all the psychometric properties evaluated. Most of the instruments sought to identify knowledge and/or attitude factors influencing antibiotic prescribing for UTIs rather than to measure/assess knowledge and attitudes.

CONCLUSIONS

Few instruments for the assessment of knowledge and attitudes of healthcare professionals towards antibiotic use and UTI treatment are available. None of the instruments underwent the full development process to ensure that all psychometric properties were met. Furthermore, none of the instruments assessed all domains of knowledge and attitudes. Therefore, the ability of the instruments to provide a robust measurement of knowledge and attitudes is doubtful. There is a need for an instrument that fully and accurately measures the constructs of knowledge and attitude of healthcare professionals in the treatment of UTIs.

Cultural adaptation and psychometric assessment of the Persian version of the lumbar spine instability questionnaire

BACKGROUND

The Lumbar Spine Instability Questionnaire (LSIQ) is a self-reported measure of clinical instability of the lumbar spine. This study aimed to translate and culturally adapt the LSIQ into Persian language (LSIQ-P) and to evaluate its reliability and validity in a sample of patients with chronic non-specific low back pain (LBP).

METHODS

In a cross-sectional study, the LSIQ was translated using guidelines. Participants with chronic non-specific LBP, aged ≥ 18 years old, answered an online survey consisting of LSIQ-P, the Persian Functional Rating Index (FRI), and the pain Numeric Rating Scale (NRS). Construct validity, internal consistency reliability, test-retest reliability, standard error of measurement (SEM), smallest detectable change (SDC), discriminant validity, and factor analysis were evaluated.

RESULTS

The LSIQ was successfully adapted into Persian. A sample of 100 participants with LBP and 100 healthy subjects completed the survey. Floor and ceiling effects were not observed. Cronbach's alpha = 0.767 and ICC_agreement = 0.78 indicated good internal consistency and test-retest reliability. The SEM and SDC were 1.53 and 4.24, respectively. Construct validity of LSIQ-P was confirmed with significant correlation with Persian FRI (r = 0.44, p < 0.001) and pain NRS (r = 0.30, p = 0.003). An evidence of discriminant validity was demonstrated by significant difference in LSIQ-P total scores between the patients with LBP and healthy subjects, and between the patients with high total score ≥ 9 and those with low total score < 9 on the LSIQ-P. The LSIQ-P was found a multidimensional instrument with eight items appeared being redundant.

CONCLUSIONS

The Persian LSIQ showed satisfactory metric characteristics of reliability and validity. Further studies are required to elucidate the internal structure of the LSIQ-P.

Development of a patient-reported outcome measure for neck pain in military aircrew: qualitative interviews to inform design and content

INTRODUCTION

The prevalence of flight-related neck pain is 70% in UK fast jet pilots; much higher than the general population. The Aircrew Conditioning Programme and direct access physiotherapy exist to minimise the impact on military capability, but a population specific patient-reported outcome measure (PROM) is required to investigate the effectiveness of these. We aimed to explore the experiences of flight-related neck pain to inform the content validity and development of a population specific PROM.

METHODS

Qualitative semistructured interviews combining phenomenological and grounded theory methods, reported using Consolidated criteria for Reporting Qualitative research guidelines. A purposive sample of 10 fast jet pilots with neck pain was recruited. Concept elicitation interviews were audio recorded, transcribed verbatim along with field notes. Data analysis involved subject and methodological expertise used a concept elicitation approach.

RESULTS

Participants included 10 male fast jet pilots, age 34.7 years. Identified themes included: (1) physical symptoms associated with flying activities; (2) occupational effects revealed modifications of flying, or 'suboptimal' performance owing to neck pain; (3) psychological effects revealed feelings or worry and (4) social and activity effects showed impact on out of work time.

CONCLUSION

Population-specific occupational, psychological and social factors should be considered alongside physical symptoms when managing neck pain in military aircrew. Findings support the development of a PROM specifically designed for military aircrew with neck pain.

The development of a novel patient-derived recovery scale for open tibial fractures

AIMS

The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an open tibial fracture.

METHODS

An initial pool of 109 items was generated from previous qualitative data relating to recovery following an open tibial fracture. These items were field tested in a cohort of patients recovering from an open tibial fracture. They were asked to comment on the content of the items and structure of the scale. Reduction in the number of items led to a refined scale tested in a larger cohort of patients. Principal components analysis permitted further reduction and the development of a definitive scale. Internal consistency, test-retest reliability, and responsiveness were assessed for the retained items.

RESULTS

The initial scale was completed by 35 patients who were recovering from an open tibial fracture. Subjective and objective analysis permitted removal of poorly performing items and the addition of items suggested by patients. The refined scale consisted of 50 Likert scaled items and eight additional items. It was completed on 228 occasions by a different cohort of 204 patients with an open tibial fracture recruited from several UK orthoplastic tertiary referral centres. There were eight underlying components with tangible real-life meaning, which were retained as sub-scales represented by ten Likert scaled and eight non-Likert items. Internal consistency and test-retest reliability were good to excellent.

CONCLUSION

The Wales Lower Limb Trauma Recovery (WaLLTR) Scale is the first tool to be developed from patient data with the potential to assess recovery following an open tibial fracture. Cite this article: Bone Joint J 2020;102-B(1):17-25.

Validity and reliability of the Health Literacy Assessment Scale for adherence to drug treatment among diabetics

OBJECTIVE

To prepare an instrument to evaluate health literacy with regard to adherence to drug treatment among diabetics, identify the validity of its content, and estimate its reliability.

METHODS

Pilot study, with the following stages of instrument construction: literature review, content validation, reliability estimation (internal consistency/Cronbach's alpha and reproducibility/Kappa).

RESULTS

The validity of content was completed and presented alpha=0.77 and Kappa values ranged from 0.31 to 1.00.

CONCLUSION

The instrument was approved regarding content validity, presented acceptable internal consistency and reproducibility. However, when applied, measurement errors it can produce must be considered.

Measuring outcomes following tibial fracture

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Validation of the single-items Spanish-School Science Attitude Survey (S-SSAS) for elementary education

The development of positive attitudes toward science is one of the main priorities in science education. However, there is a lack of reliable and valid instruments to measure Spanish-speaking elementary students’ attitudes towards school science. In this study, the translation and validation of the Spanish School-Science Attitude Survey (S-SSAS) is reported. The instrument was administered to 643 students enrolled in 3^rd to 6^th elementary grades. Psychometric evaluation of the S-SSAS provided sound evidence for validity (face, content, construct and criterion) and reliability (internal consistency and temporal stability). Content validity was confirmed through a panel of experts who reached great consensus in linking items to attitudinal constructs, with an ICC = .956. Think-aloud interviews confirmed that students have easily understood and correctly interpreted all items included, thus providing face validity for the S-SSAS. Consistent with theoretical expectations, predictive validity ranged between -.334 to 543 and concurrent validity was examined through S-SSAS correlation with two external measures of conceptual convergence that ranged from.301 to .560, thus confirming criterion validity. Construct validity was assessed by obtaining consistent results with the original scale in terms of reporting no statistically significant differences in attitudinal profiles towards school science between girls and boys and between students from urban and rural schools. Cronbach αfor the entire scale was .704, with item-total correlation ranging from .243 to .560, which reports acceptable internal consistency. Temporal stability with a 10-days span was good, with ICC = .873 and r = .464–790. Taken together, these results indicate that the Spanish single-items School-Science Attitude Survey is easy to administer and equally interpreted by both girls and boys enrolled in rural and urban elementary schools, thus being a valid and reliable instrument for measuring attitudes towards school science.

AVALIAÇÃO DA APLICABILIDADE DA VERSÃO PORTUGUESA DE UM QUESTIONÁRIO DE COMPETÊNCIAS PARA ENFERMEIROS HOSPITALARES

RESUMO Objetivo: realizar avaliações psicométricas da versão adaptada do Competence Evaluation Questionnaire para enfermeiros brasileiros no contexto hospitalar, avaliando a confiabilidade da estrutura interna desta versão. Método: trata-se de um estudo metodológico, no qual a amostra constituiu-se de 273 enfermeiros pertencentes a duas instituições hospitalares públicas. O instrumento é composto por 27 itens distribuídos em cinco domínios de competências. Para validade de constructo da versão adaptada do instrumento, verificou-se Alpha de Cronbach, Análise Fatorial Confirmatória e Exploratória e calculado novamente o Alpha de Cronbach dos domínios do instrumento, a fim de validar seu novo arranjo estrutural. Resultados: foi verificado Alpha de Cronbach total de 0,923 e por domínios variando de 0,397 (Gerenciamento) a 0,833 (Processo de enfermagem). Na análise fatorial foram encontrados valores de Índice de Ajuste Comparativo e Índice de Tucker-Lewis, respectivamente, 0,808 e 0,783, demonstrando valores aceitáveis e próximos do ideal. Na análise fatorial exploratória, o índice de Kaiser-Meyer-Okin foi de 0,918 e o teste de esfericidade de Bartlett teve valor p<0,00, ocorrendo uma nova disposição estrutural do instrumento que posteriormente se pode confirmar a consistência interna dos novos domínios variando de 0,732 a 0,845 e, portanto, todos os valores consistentes. Conclusão: a versão para o português brasileiro do Questionário de Avaliação de Competências ficou composta por 27 itens agrupados aos domínios a que pertencem obedecendo aos critérios da Análise Fatorial exploratória realizada, revelando-se instrumento adequado, válido e confiável.

[Construction of measurement instruments in the area of health]

Measurement instruments are an integral part of clinical practice, health evaluation and research. These instruments are only useful and able to present scientifically robust results when they are developed properly and have appropriate psychometric properties. Despite the significant increase of rating scales, the literature suggests that many of them have not been adequately developed and validated. The scope of this study was to conduct a narrative review on the process of developing new measurement instruments and to present some tools which can be used in some stages of the development process. The steps described were: I-The establishment of a conceptual framework, and the definition of the objectives of the instrument and the population involved; II-Development of the items and of the response scales; III-Selection and organization of the items and structuring of the instrument; IV-Content validity, V-Pre-test. This study also included a brief discussion on the evaluation of the psychometric properties due to their importance for the instruments to be accepted and acknowledged in both scientific and clinical environments.

Health-related quality-of-life outcome measures in paediatric palliative care: A systematic review of psychometric properties and feasibility of use

BACKGROUND

The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care.

AIM

To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties.

DESIGN

A systematic literature review and analysis of psychometric properties.

DATA SOURCES

PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed.

RESULTS

From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly.

CONCLUSION

There is currently no 'ideal' outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field.

Cross-cultural adaptation and validation of the Injury-Psychological Readiness to Return to Sport scale to Persian language

The aim of the present study was to develop and provide validation statistics for the Persian Injury-Psychological Readiness to Return to Sport scale (I-PRRS) following a cross-sectional and prospective cohort study design. The I-PRRS was forward/back-translated and culturally adapted into Persian language. The Persian I-PRRS was administered to 100 injured athletes (93 male; age 26.0 ± 5.6 years; time since injury 4.84 ± 6.4 months) and 50 healthy athletes (36 male; mean age 25.7 ± 6.0 years). The Persian I-PRRS was re-administered to 50 injured athletes at 1 week to examine test-retest reliability. There were no floor or ceiling effects confirming the content validity of Persian I-PRRS. The internal consistency reliability was good. Excellent test-retest reliability and agreement were demonstrated. The statistically significant difference in Persian I-PRRS total scores between the injured athletes and healthy athletes provides an evidence of discriminative validity. The Persian I-PRRS total scores were positively correlated with the Farsi Mood Scale (FARMS) total scores, showing construct validity. The principal component analysis indicated a two-factor solution consisting of "Confidence to play" and "Confidence in the injured body part and skill level". The Persian I-PRRS showed excellent reliability and validity and can be used to assess injured athletes' psychological readiness to return to sport among Persian-speaking populations.

Responsiveness and minimal important change for the ProFitMap-neck questionnaire and the Neck Disability Index in women with neck-shoulder pain

Purpose

The aim was to determine the responsiveness and minimal important change (MIC) of the questionnaire ProFitMap-neck that measures symptoms and functional limitations in women with neck pain. The same measurement properties were determined for Neck Disability Index (NDI) for comparison purposes.

Methods

Longitudinal data were derived from two randomized controlled trials, including 103 and 120 women with non-specific neck pain, with questionnaire measurements performed before and after interventions. Sensitivity and specificity to discriminate between improved and not or little changed participants, based on categorization of a global rating of change scale (GRCS), were determined for the ProFitMap-neck indices and NDI by using area under receiver operating characteristic curves (AUC). Correlations between the GRCS anchor and change scores of the questionnaires were also used to assess responsiveness. The change score that showed the highest combination of sensitivity and specificity was set for MIC.

Results

The ProFitMap-neck indices showed similar responsiveness as NDI with AUC exceeding 0.70 (Range: ProFitMap-neck, 0.74–0.83; NDI, 0.75–0.86). The MIC in the two samples ranged between 6.6 and 13.6 % for ProFitMap-neck indices and 5.2 and 6.3 % for NDI. Both questionnaires had significant correlations with GRCS (Spearman’s rho 0.47–0.72).

Conclusions

Validity of change scores was endorsed for the ProFitMap-neck indices and NDI with adequate ability to discriminate between improved and not or little changed participants. Values of minimal important change were presented.

Evaluation of the Measurement Properties of Self-reported Medication Adherence Instruments Among People at Risk for Metabolic Syndrome: A Systematic Review

PURPOSE

The purpose of this study was to present a systematic review of available published studies that evaluated the measurement properties of self-reported instruments assessing global medication adherence in adults at risk for metabolic syndrome.

METHODS

The authors searched PubMed, EMBASE, PsycINFO, and CINAHL in January 2015 for appropriate studies. The methodological quality (based on reliability, validity, responsiveness, and interpretability) of selected studies was assessed with the COSMIN checklist (Consensus-Based Standards for the Selection of Health Measurement Instruments).

RESULTS

Of the 44 studies reviewed, 32 used classical test theory, and 14 used self-reported medication adherence instruments. More than half the studies included patients with hypertension, followed by diabetes, dyslipidemia, and increased body mass index. Among the measurement properties, internal consistency, hypothesis testing, and structural validity were frequently assessed items, whereas only 1 study evaluated responsiveness, and none evaluated measurement error. The MMAS-8 (Morisky Medication Adherence Scale-8 items) and the Hill-Bone scale were the most frequently used instruments. They were found to be well validated, with strong evidence for internal consistency and strong positive evidence for reliability, structural validity, hypothesis testing, and criterion validity.

CONCLUSIONS

The MMAS-8 and Hill-Bone scale seem to be well-validated instruments for assessing medication adherence in adults at risk for metabolic syndrome. These findings may assist clinicians with selecting the appropriate instruments for assessing medication adherence in this population. However, further studies might be needed to define concepts to better understand the dimensions of each medication adherence instrument.

Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and "activity limitations": a systematic review

OBJECTIVE

To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures (PROMs) focussing on the shoulder, assessing "activity limitations."

STUDY DESIGN

Systematic review. The study population had to consist of patients with shoulder pain. We excluded postoperative patients or patients with generic diseases. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist.

RESULTS

Out of a total of 3427 unique hits, 31 articles, evaluating 7 different questionnaires, were included. The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity.

CONCLUSION

For English, Norwegian and Turkish users, we recommend to use the SPADI. Dutch users could use either the SDQ or the SST. In German, we recommend the DASH. In Tamil, Slovene, Spanish and the Danish languages, the evaluated PROMs were not yet of acceptable validity. None of these PROMs showed strong positive evidence for all measurement properties. We propose to develop a new shoulder PROM focused on activity limitations, taking new knowledge and techniques into account.

The measurement properties of the IKDC-subjective knee form

PURPOSE

To evaluate the methodological quality of studies reporting on the measurement properties of the International Knee Documentation Committee subjective knee form (IKDC-SKF) and to evaluate their results following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines.

METHODS

Systematic search of articles published about the measurement properties of the IKDC-SKF, review of the studies' methodological quality, and synthesis of the results using the COSMIN guidelines.

RESULTS

Twenty-six studies were identified and reviewed. There was strong evidence for good internal consistency, test-retest reliability, and responsiveness. There was moderate evidence for good content and structural validity. With the SF36 as a gold standard, the level of evidence for criterion validity was indeterminate. There was conflicting evidence for hypothesis testing and not enough evidence to evaluate measurement error and cross-cultural validity. There were no floor or ceiling effects.

CONCLUSIONS

This review shows that the IKDC-SKF is a measurement instrument with good internal consistency, test-retest reliability, content and structural validity, and responsiveness and interpretability (no floor and ceiling effects). Further evaluation of measurement error, minimal important change, and hypotheses testing is recommended. The IKDC-SKF seems to be useful as a general instrument for all kinds of knee injuries, which might facilitate its clinical use in situations in which time is a factor.

LEVEL OF EVIDENCE

Systematic review, Level III.

Patient-Reported Outcome (PRO) questionnaires for people with pain in any spine region. A systematic review

BACKGROUND/OBJECTIVE

This systematic review investigates the measurement properties of Patient-Reported Outcome (PRO) questionnaires which evaluate disability associated with pain in any area of the spine.

METHOD

PRO questionnaires for people with pain in any spinal region were identified from existing systematic reviews and recent studies. Databases were searched for studies which evaluated the measurement properties of the included questionnaires to August 2015. Data synthesis used a levels of evidence approach which considered study methodological quality.

RESULTS

The Extended Aberdeen Back Pain Scale (EA), Functional Rating Index (FRI) and Spine Functional Index (SFI) were identified as eligible for this review. The FRI was evaluated in 15 studies, with positive results for internal consistency, structural validity, hypothesis testing and responsiveness, negative results for measurement error and conflicting results for reliability. The SFI was evaluated in 3 studies with positive results for internal consistency, reliability, content validity, and structural validity. Conflicting results were found for hypothesis testing. The EA was evaluated in 3 studies which found negative results for internal consistency and structural validity.

CONCLUSIONS

The FRI is provisionally recommended for the assessment of disability in people with multi-area spinal pain. This conclusion is based on studies of mainly fair methodological quality.

A Systematic Review of the Psychometric Properties of Patient-Reported Outcome Instruments for Use in Patients With Rotator Cuff Disease

BACKGROUND

Many patient-reported outcome instruments (or questionnaires) have been developed for use in patients with rotator cuff disease. Before an instrument is implemented, its psychometric properties should be carefully assessed, and the methodological quality of papers that investigate a psychometric component of an instrument must be carefully evaluated. Together, the psychometric evidence and the methodological quality can then be used to arrive at an estimate of an instrument's quality.

PURPOSE

To identify patient-reported outcome instruments used in patients with rotator cuff disease and to critically appraise and summarize their psychometric properties to guide researchers and clinicians in using high-quality patient-reported outcome instruments in this population.

STUDY DESIGN

Systematic review.

METHODS

Systematic literature searches were performed to find English-language articles concerning the development or evaluation of a psychometric property of a patient-reported outcome instrument for use in patients with rotator cuff disease. Methodological quality and psychometric evidence were critically appraised and summarized through 2 standardized sets of criteria.

RESULTS

A total of 1881 articles evaluating 39 instruments were found per the search strategy, of which 73 articles evaluating 16 instruments were included in this study. The Constant-Murley score, the DASH (Disability of the Arm, Shoulder, and Hand), and the Shoulder Pain and Disability Index were the 3 most frequently evaluated instruments. In contrast, the psychometric properties of the Korean Shoulder Scoring System, Shoulder Activity Level, Subjective Shoulder Value, and Western Ontario Osteoarthritis Shoulder index were evaluated by only 1 study each. The Western Ontario Rotator Cuff Index was found to have the best overall quality of psychometric properties per the established criteria, with positive evidence found in internal consistency, reliability, content validity, hypothesis testing, and responsiveness. The DASH, Shoulder Pain and Disability Index, and Simple Shoulder Test had good evidence in support of internal consistency, reliability, structural validity, hypothesis testing, and responsiveness. Inadequate methodological quality was found across many studies, particularly in internal consistency, reliability, measurement error, hypothesis testing, and responsiveness.

CONCLUSION

More high-quality methodological studies should be performed to assess the properties in all identified instruments.

Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. From 50 articles, 54 method names were identified and categorized into three groups: (1) Static positioning assessment (n = 19); (2) Semi-dynamic (n = 13); and (3) Dynamic functional assessment (n = 22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was "fair" (57%) to "poor" (43%), with only one study rated as "good". The reliability domain was most often investigated. Few of the assessment methods in the included studies that had "fair" or "good" measurement property ratings demonstrated acceptable results for both reliability and validity. We found a substantially larger number of clinical scapular assessment methods than previously reported. Using the COSMIN checklist the methodological quality of the included measurement properties in the reliability and validity domains were in general "fair" to "poor". None were examined for all three domains: (1) reliability; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase utility for clinical practice.

Reliability and responsiveness of the Norwegian version of the Neck Disability Index

Background and aim

The Norwegian version of the Neck Disability Index (NDI) has been widely used in previous studies. To our knowledge, the test–retest reliability and responsiveness of the NDI have not been investigated. Thus, the aim of the present study was to investigate the test–retest reliability and responsiveness of the Norwegian version of the NDI in neck pain patients seen in a specialized outpatient clinic.

Methods

This study included patients referred to the neck and back outpatient clinic at Oslo University Hospital. A total of 255 patients were included in the study, of which 42 participated in the test–retest portion of the study. The intraclass correlation coefficient (ICC) was used to assess test-retest reliability. A total of 113 patients participated in the responsiveness analyses. Based on their responses on the Global Rating Scale of Change (GRS), patients were categorized into the following groups: worsened (n = 24), unchanged (n = 7) and improved (n = 62). The minimal detectable change (MDC) for the NDI was calculated. Responsiveness was assessed by constructing a Receiver Operating Characteristic curve (ROC curve) to distinguish patients who had improved or worsened from those who remained unchanged. The minimum clinically important difference (MCID) was estimated.

Results

The test–retest reliability between the baseline scores and the retest NDI scores was very good (ICC = 0.84; 95% CI 0.72–0.91). The ability of the NDI to discriminate between improved and unchanged patients (responsiveness) over time was acceptable based on the ROC curve analysis (AUC = 0.70; 95% CI 0.58–0.82). The estimated MDC for the Norwegian version of the NDI is 12.3%, and the MCID is 16.6%.

Conclusion

The Norwegian version of the NDI proved to be an instrument with good test–retest reliability and acceptable responsiveness for assessing neck pain-related disability among neck pain patients in a specialized outpatient clinic

Translation and validation of the German version of the Bournemouth questionnaire for low back pain

BACKGROUND

Finding the best outcome measures for research and quality assurance purposes in terms of validity, sensitivity to change, length and ease of completion is crucial. The Bournemouth questionnaire for neck pain patients was recently translated and validated into German and found to be more sensitive to change than other commonly used questionnaires. However, the low back pain version is not yet available in German. Therefore the purpose of this study was to translate and validate the Bournemouth Questionnaire (BQ) for low back pain (LBP) into German.

METHODS

The translation was done in 4 steps, translated and back-translated by two independent people and adapted and approved by an expert committee. Face validity was then done by 30 people who checked the questionnaire for comprehension. Test-retest reliability (reproducibility) was tested using 30 stable back pain patients. Internal consistency was tested using 108 low back patients. External construct validity, external longitudinal validity and responsiveness was tested against the German versions of the Oswestry Disability Index (ODI) and the SF-36 questionnaire using 108 patients from 5 different chiropractic clinics.

RESULTS

The BQ showed high test-retest reliability (ICC > 0.91) for all items and strong internal consistency (Cronbachs alpha = 0.86 at baseline and 0.94 at 4 weeks).

CONCLUSION

The BQ for LBP was successfully translated and adapted into German. It was successfully tested for validity, consistency, and responsiveness against the German versions of the ODI and the SF-36. It is shorter, covers more domains than the ODI and is more sensitive to change than the other questionnaires.

Measuring Pain in Outpatient Surgical Patients: Variation Resulting from Instrument Choice

Our hypothesis is that the type of instrument will affect variation in pain assessment. A sample of 269 patients administered the visual analog pain scale (VAS) and the generic quality-of-life instrument, and the SF-36 were evaluated for gender, age, the VAS score and the bodily pain domain of the SF-36 (BP-SF-36) score, primary surgical diagnosis, preoperative or postoperative status, and type of operation. Patients were grouped into preoperative (Preop) and postoperative (postop) status and those with chronic pain (CP) conditions and acute/no pain (AP) conditions. Linear regression analysis showed statistically significant (all P value ≤ 0.0006) correlations between the VAS and BP-SF-36 scores all patients, preoperative patients, postoperative patients, acute pain patients, and chronic pain patients. However, the strength of these correlations were moderate (r values between 0.51 and 0.61). Preoperative had more pain compared with postoperative patients as measured by both the VAS and BP-SF-36 ( P = 0.05). Similarly, chronic pain patients had more pain compared with acute pain patients as measured by both scales ( P < 0.0001). Although there are statistically significant associations between the BP-SF-36 and VAS, the correlations are moderate. Different instruments may measure different aspects of pain and the precision with which pain is measured in surgical patients.

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

PURPOSE

To critically appraise and compare the measurement properties of the original versions of neck-specific questionnaires.

METHODS

Bibliographic databases were searched for articles concerning the development or evaluation of the measurement properties of an original version of a self-reported questionnaire, evaluating pain and/or disability, which was specifically developed or adapted for patients with neck pain. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using a checklist, specifically designed for evaluating studies on measurement properties.

RESULTS

The search strategy resulted in a total of 3,641 unique hits, of which 25 articles, evaluating 8 different questionnaires, were included in our study. The Neck Disability Index is the most frequently evaluated questionnaire and shows positive results for internal consistency, content validity, structural validity, hypothesis testing, and responsiveness, but a negative result for reliability. The other questionnaires show positive results, but the evidence for each measurement property is mostly limited, and at least 50% of the information on measurement properties per questionnaire is lacking.

CONCLUSIONS

Our findings imply that studies of high methodological quality are needed to properly assess the measurement properties of the currently available questionnaires. Until high quality studies are available, we recommend using these questionnaires with caution. There is no need for the development of new neck-specific questionnaires until the current questionnaires have been adequately assessed.

Translation and validation of the German version of the Bournemouth Questionnaire for Neck Pain

Background

Clinical outcome measures are important tools to monitor patient improvement during treatment as well as to document changes for research purposes. The short-form Bournemouth questionnaire for neck pain patients (BQN) was developed from the biopsychosocial model and measures pain, disability, cognitive and affective domains. It has been shown to be a valid and reliable outcome measure in English, French and Dutch and more sensitive to change compared to other questionnaires. The purpose of this study was to translate and validate a German version of the Bournemouth questionnaire for neck pain patients.

Methods

German translation and back translation into English of the BQN was done independently by four persons and overseen by an expert committee. Face validity of the German BQN was tested on 30 neck pain patients in a single chiropractic practice. Test-retest reliability was evaluated on 31 medical students and chiropractors before and after a lecture. The German BQN was then assessed on 102 first time neck pain patients at two chiropractic practices for internal consistency, external construct validity, external longitudinal construct validity and sensitivity to change compared to the German versions of the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD).

Results

Face validity testing lead to minor changes to the German BQN. The Intraclass Correlation Coefficient for the test-retest reliability was 0.99. The internal consistency was strong for all 7 items of the BQN with Cronbach α's of .79 and .80 for the pre and post-treatment total scores. External construct validity and external longitudinal construct validity using Pearson's correlation coefficient showed statistically significant correlations for all 7 scales of the BQN with the other questionnaires. The German BQN showed greater responsiveness compared to the other questionnaires for all scales.

Conclusions

The German BQN is a valid and reliable outcome measure that has been successfully translated and culturally adapted. It is shorter, easier to use, and more responsive to change than the NDI and NPAD.

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

Background

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

Methods

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

Results

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

Conclusions

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