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Balparda K, García-Onrubia L, Valentín-Bravo FJ, Escobar-Giraldo M, Caro Magdaleno M, Acera Osa A, Merayo-Lloves J, Galarreta DJ. Rasch validation of the Keratoconus End-Points Assessment Questionnaire in a Spanish population with keratoconus. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:323-330. [PMID: 38768852 DOI: 10.1016/j.oftale.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To carry out a methodologically complete validation of the Spanish version of the Keratoconus End-Points Assessment Questionnaire (KEPAQ) in a Spanish population with keratoconus. METHODS Analytical, prospective study, including patients with keratoconus without previous surgical history, in which a measurement of quality of life was performed using the KEPAQ questionnaire, a complete exploration of the anterior pole and a corneal elevation topography with the Galilei G6 topographer. The evaluation of the psychometric characteristics of the scale in the studied population was carried out using Rasch modeling. RESULTS A total of 140 patients with keratoconus were included, with a median age of 26.0 years, the majority (57.6%) being men. For the KEPAQ-E subscale, the median score was 69.3, with a reliability of 0.85 and an eigenvalue of the first contrast of 2.34. For the KEPAQ-F, the median score was 56.4, with a reliability of 0.88 and an eigenvalue of 2.00. All infit and outfit parameters were within normal limits for both subscales. A significant evaluation was found between the evaluations of both subscales (rho = 0.696; p < 0.001). The evaluations of the subscales and various clinical and tomographic characteristics showed a significant classification between them (p value between 0.048 y 0.001). CONCLUSION The KEPAQ is a psychometrically robust and valid scale to evaluate quality of life in the Spanish population with keratoconus. This questionnaire can be easily used for both clinical and research aims.
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Affiliation(s)
- K Balparda
- Práctica Privada, Medellín, Colombia; The affiliation of K. Balparda, L. García-Onrubia, and F.J. Valentín-Bravo at the time of this article was the Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - L García-Onrubia
- Fundación Jiménez Díaz, Madrid, Spain; The affiliation of K. Balparda, L. García-Onrubia, and F.J. Valentín-Bravo at the time of this article was the Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - F J Valentín-Bravo
- Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; The affiliation of K. Balparda, L. García-Onrubia, and F.J. Valentín-Bravo at the time of this article was the Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M Escobar-Giraldo
- Departamento de Oftalmología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - M Caro Magdaleno
- Hospital Universitario Virgen Macarena, Sevilla, Spain; Red de Enfermedades Inflamatorias REI-RICORS RD21/0002/0011, Instituto de Salud Carlos III, Madrid, Spain
| | - A Acera Osa
- Red de Enfermedades Inflamatorias REI-RICORS RD21/0002/0011, Instituto de Salud Carlos III, Madrid, Spain; Grupo de Oftalmobiología Experimental (GOBE), Universidad del País Vasco, Leioa, Vizcaya, Spain; Ikerbasque, Fundación Vasca para la Ciencia, Bilbao, Vizcaya, Spain
| | - J Merayo-Lloves
- Red de Enfermedades Inflamatorias REI-RICORS RD21/0002/0011, Instituto de Salud Carlos III, Madrid, Spain; Instituto Fernández Vega, Oviedo, Asturias, Spain
| | - D J Galarreta
- Red de Enfermedades Inflamatorias REI-RICORS RD21/0002/0011, Instituto de Salud Carlos III, Madrid, Spain; Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Pomberger L, Tasch L, Lundström M, Waser K, Khalil H, Kronschläger M, Hirnschall N, Bolz M. Evaluation of the German Version of the Keratoconus Outcomes Research Questionnaire. Cornea 2024:00003226-990000000-00492. [PMID: 38381057 DOI: 10.1097/ico.0000000000003506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/07/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE To translate, validate, and evaluate the psychometric properties of the German version of Keratoconus Outcomes Research Questionnaire (KORQ). METHODS This prospective study included 3 phases. In phase 1, the KORQ was translated in a standardized way; in phase 2, Rasch validation was performed; in phase 3, the validated questionnaire was evaluated in a separate patient cohort. All patients answered the German KORQ. Scheimpflug imaging (Pentacam) and optical coherence tomography scans (MS-39) were conducted. Corneal imaging measurements were correlated with patient-reported outcome measures. RESULTS After standardized translation, 100 patients self-administered the German KORQ. Rasch analysis was conducted for psychometric testing of the KORQ. Based on the results of the Rasch analysis, the original German version of the KORQ was modified and any items showing a misfit were excluded. This resulted in a new shortened version of the KORQ, which was evaluated in 30 patients. The revised German KORQ met the criteria of Rasch analysis and showed excellent internal consistency reliability and convergent validity. The correlation between the KORQ score and various clinical measurements was examined using Spearman correlation. A significant moderate correlation was observed between the D (r = 0.237; P = 0.006) and Kmax (r = 0.162; P = 0.065) values of Pentacam. Inverse correlations were observed for thinnest pachymetry measured with MS-39 (r = -0.167; P = 0.058) and best corrected visual acuity (r = -0.210; P = 0.016). CONCLUSIONS The shortened German KORQ met the assumptions of the Rasch model and displayed satisfactory psychometric properties. The German KORQ could be adopted as a powerful patient-reported outcome measures tool for German-speaking patients with keratoconus in the future.
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Affiliation(s)
- Leon Pomberger
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
| | - Lisa Tasch
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
| | - Mats Lundström
- Department of Ophthalmology, Lund University, Lund, Sweden; and
| | - Klemens Waser
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
| | - Haidar Khalil
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
| | | | - Nino Hirnschall
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
| | - Matthias Bolz
- Department of Ophthalmology, Kepler University Clinic, Linz, Austria
- Department of Ophthalmology, Johannes Kepler University, Linz, Austria
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Torras-Sanvicens J, Rodríguez-Calvo-de-Mora M, Figueras-Roca M, Amescua G, Carletti P, Casaroli-Marano RP, Patel SV, Rocha-de-Lossada C. Translation and validation of the Visual Function and Corneal Health Status (V-FUCHS) questionnaire into Spanish language. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:9-15. [PMID: 37944642 DOI: 10.1016/j.oftale.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To translate and validate the V-FUCHS questionnaire into Spanish in a population of patients with Fuchs endothelial dystrophy (DEF). METHODS The V-FUCHS consists of 15 short, easily understandable questions that assess visual aspects of quality of life in patients with DEF, which can be gathered into a group of seven that assess the "Visual Difficulty" factor and another group of eight that assess the "Glare Factor". For the translation and cultural adaptation, the standardized norms for this process were followed, among other phases, a translation, a back-translation and an application in patients with DEF. RESULTS In the first phase, consensus was reached on the Spanish translation of the V-FUCHS. Subsequently, 25 patients were included to carry out the pre-test phase with the aim of assessing the applicability and feasibility of the test. The score obtained a minimum value of -0.88 and a maximum value of +2.44, according to the Rasch probabilistic scale. The mean value obtained from the Visual Difficulty factor was 0.61 (±0.71), while the mean for the Glare Factor was 0.41 (±0.51). CONCLUSION The validation of the V-FUCHS questionnaire, after its translation and adaptation into Spanish, proved to be a useful tool for assessing the visual quality of patients with DEF. Patients with a more advanced stage of the disease presented a greater severity in the test result. Likewise, the Glare Factor (Glare) correlates better with the pachymetric increase than with the visual acuity of the patient.
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Affiliation(s)
- J Torras-Sanvicens
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - M Rodríguez-Calvo-de-Mora
- Qvision, Ophthalmology Department, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga, Málaga, Spain
| | - M Figueras-Roca
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, United States; University of Miami-Miller, School of Medicine, Miami, FL, United States
| | - P Carletti
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, United States; University of Miami-Miller, School of Medicine, Miami, FL, United States
| | - R P Casaroli-Marano
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - S V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - C Rocha-de-Lossada
- Qvision, Ophthalmology Department, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga, Málaga, Spain; Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Sevilla, Spain.
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Al Bdour M, AlRyalat SA, Salameh R, Alomari L, Riyalat A, Fakhouri Z, Al-Abdallat L, Naser K, Alshrouf MA, Al-Amer A. Quality of life and tomography indices in patients with keratoconus. J Int Med Res 2023; 51:3000605231170549. [PMID: 37115037 PMCID: PMC10155020 DOI: 10.1177/03000605231170549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Keratoconus is a corneal ectasia that leads to thinning and steepening of the corneal surface. We aimed to assess the relationship between quality of life and corneal tomography indices, irrespective of visual acuity. METHODS This was a cross-sectional study using a translated and validated Keratoconus Outcomes Research Questionnaire (KORQ) in Arabic language. We screened patients with keratoconus using the Belin/Ambrósio D-Index. We included the best-seeing eye in each patient with keratoconus, with a best corrected visual acuity better than 0.5. We collected variables including KORQ scores, flattest meridian keratometry, steepest meridian keratometry, mean keratometry front, maximum simulated keratometry, astigmatism front, Q value front, and thickness at the thinnest location. We performed linear regression analysis to identify predictors of the visual function score and symptom score. RESULTS Sixty-nine patients were included in this study, 43 (62.3%) male and 26 (37.7%) female patients, with a mean age 34.0 ± 11.50 years. The only predictor for visual function score was sex (β = 11.64, 95% confidence interval: 3.50-19.78). None of the topographic indices were related to quality of life. CONCLUSION In this study, quality of life in patients with keratoconus was not related to specific tomography indices and might be related to visual acuity itself.
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Affiliation(s)
- Muawyah Al Bdour
- Department of Ophthalmology, The University of Jordan, Amman, Jordan
| | | | - Razan Salameh
- Department of Ophthalmology, The University of Jordan, Amman, Jordan
| | - Laith Alomari
- The School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad Riyalat
- The School of Medicine, The University of Jordan, Amman, Jordan
| | - Zaid Fakhouri
- The School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Kamal Naser
- The School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Ahmad Al-Amer
- Department of Ophthalmology, The University of Jordan, Amman, Jordan
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Balparda K, Herrera-Chalarca T, Cano-Bustamante M. Standardizing the measurement and classification of quality of life using the Keratoconus End-Points Assessment Questionnaire (KEPAQ): the ABCDEF keratoconus classification. EYE AND VISION 2022; 9:17. [PMID: 35526027 PMCID: PMC9080176 DOI: 10.1186/s40662-022-00288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/17/2022] [Indexed: 12/02/2022]
Abstract
Background Measuring quality of life is of importance in keratoconus. So far, the Keratoconus End-Points Assessment Questionnaire (KEPAQ) is the only keratoconus-specific scale to measure emotional well-being along with functional compromise in this population. Nevertheless, there is still a lack of clarity and standardization as to how KEPAQ scores should be computed and reported. There are also no guidelines for interpretation of classification of quality of life when using this instrument. The purpose of this study is to provide a specific framework on how to grade and classify keratoconus by using the KEPAQ and propose an extension of current classification to encompass subjective compromise. Methods A group of patients with a confirmed diagnosis of keratoconus underwent application of the KEPAQ. First, a Rasch modeling was performed to evaluate the psychometric characteristics of both sub-scales of the instrument. Then, a linear transformation was performed to turn data into a more relatable scale ranging from 0 to 100. Finally, by using Tukey’s Hinges, scores of the KEPAQ were divided in a 1-to-4 scale, allowing for an easy E&F classification system. Results A total of 386 applications of the KEPAQ were included. Analysis provided evidence of the KEPAQ being unidimensional, well-fitted to the Rasch Model, and provided adequate interval-level scores. Linear transformation resulted in a user-friendly final score ranging from 0 to 100, where a higher score translates to having a better quality of life. Two methods of easily computing final score, one by hand and the other one by an Excel file, were constructed. An E&F 1-to-4 classification was proposed, which may work well with the current ABCD classification of keratoconus. Conclusions The KEPAQ is a psychometrically robust scale, which confidently measures both emotional-related and functional-related quality of life in patients with keratoconus. It can be easily computed, and the results are interpretable and classified in a manner similar to that used in the ABCD keratoconus classification, by adding letters ‘E’ for emotional and ‘F’ for functional compromise.
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Balparda K, Galarreta DJ, Vanegas-Ramirez CM, Silva-Quintero LA, Botero-Giraldo M, Maya-Naranjo MI, Pizarro-Marín PA. Both subscales of the Keratoconus End-Points Assessment Questionnaire have excellent test-retest reliability. Indian J Ophthalmol 2021; 69:2430-2435. [PMID: 34427237 PMCID: PMC8544075 DOI: 10.4103/ijo.ijo_3569_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: The keratoconus end-points assessment questionnaire (KEPAQ) is a disease-specific scale designed to evaluate the quality of life in keratoconus patients and provides the measurement of both functional and emotional compromise in keratoconus. It was previously developed, tested, and validated and now we want to evaluate the test-retest reliability of the KEPAQ, in an effort to contribute evidence on its internal consistency and capability of measuring clinical state with minimal inference of random chance. Methods: This is a prospective analytical study, designed to evaluate the test-retest reliability of the KEPAQ through the repeated application of the questionnaire to a group of clinically stable individuals. A number of patients with a confirmed diagnosis of keratoconus underwent double application of the KEPAQ, seven days apart. Mean KEPAQ score was obtained through Rasch analysis, while test-retest reliability was evaluated through Spearman rank-order correlation and intraclass correlation coefficient. Rasch analysis was performed in JMetrik version 4.1.1 (Psychomeasurement Systems LLC; Charlottesville, VA, USA) in a MacBook Air computer running macOS Catalina version 10.15.2 (Apple Inc.; Cupertino, CA, USA). Results: A total of 100 patients were included. For KEPAQ-E, Spearman correlation was R = 0.963 while ICC was 0.981 (95% confidence interval 0.972–0.987). For KEPAQ-F, Spearman correlation was R = 0.921 while ICC was 0.952 (95% confidence interval 0.929–0.968). Conclusion: The KEPAQ is a robust, well-developed, extremely reliable scale which can be confidently used for clinical and research endeavors.
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Affiliation(s)
- Kepa Balparda
- Department of Cornea and Refractive Surgery, Black Mammoth Surgical, Medellín, Colombia
| | - David J Galarreta
- Department of Cornea and Refractive Surgery, Instituto Oftalmológico Recoletas, Valladolid, Spain
| | | | | | | | - Maria I Maya-Naranjo
- Department of Ophthalmology, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Paula A Pizarro-Marín
- Department of General Medicine, Hospital San Juan de Dios, Santa Fe de Antioquia, Colombia
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Ferrini E, Aleo D, Posarelli C, Albert T, Miccoli M, Orrù G, Figus M. The Italian version of the Keratoconus Outcomes Research Questionnaire (KORQ): Translation and validation of psychometric properties. Eur J Ophthalmol 2021; 31:3511-3517. [PMID: 34180256 DOI: 10.1177/11206721211028044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop and validate the Italian version of the Keratoconus Outcomes Research Questionnaire (KORQ). METHODS Cross-sectional validation study. Keratoconus patients with routine appointments at the outpatient clinic were consecutively enrolled in conjunction with a sample of non-keratoconus controls for comparison. The Italian translation from the original English version of the KORQ was administered to the patients together with the Italian version of the 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The reliability and validity of the Italian KORQ were assessed using standardized internationally accepted methods for cultural adaptation and validation of health-related quality of life measures. RESULTS One hundred patients were deemed eligible and completed the questionnaires. The Cronbach's alpha coefficient for internal consistency ranged from 0.71 to 0.956 across the subscales. Spearman correlation coefficient and intraclass correlation coefficient of 0.98 showed excellent test-retest reliability. The control group had better scores on every subscale. Statistically significant correlations were found between the KORQ and analogous domain of the NEI VFQ-25 and with disease severity indicators, such as visual acuity, maximum keratometry, and steepest keratometry, thus demonstrating good construct and concurrent validity. CONCLUSION The Italian version of the KORQ exhibited excellent internal consistency, test-retest reliability, validity, discriminatory power, and psychometric properties comparable with those of the original English version, and thus may be adopted as a powerful vision-targeted quality of life assessment tool for Italian keratoconus patients.
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Affiliation(s)
- Erica Ferrini
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Davide Aleo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Timothy Albert
- Optometry and Vision Sciences Department, University of Minho, Braga, Portugal.,Visiting Fellow at Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Michele Figus
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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