Fiabilidad de los instrumentos de medición en ciencias de la salud

[Validation of the EDMUR scale, a tool to quantify the evolution of neurogenic dysphagia]

INTRODUCTION

dysphagia is a frequent and serious symptom in people with brain damage and a tool is needed to quantify and objectify its evolution.

OBJECTIVE

to develop and validate an instrument to measure the evolution of dysphagia in a patient with acquired brain damage in order to facilitate decision-making during multidisciplinary treatment.

METHODS

a longitudinal, retrospective cross-sectional study that consists of two phases with the aim of developing a new tool. In the first phase the instrument is developed and in the second psychometric properties, after application to 83 patients, is analyzed together with content validity, convergent validity, validity of known groups, reliability, and sensitivity to change.

RESULTS

an instrument, the EDMUR scale, composed of 5 domains and 46 items was obtained. After expert judgment, all the items proposed in the scale design phase reached the minimum values of Aiken's V and CRV'. Cronbach's alpha (α) showed a good internal consistency. The correlation between the FOIS scale and the EDMUR obtained through Spearman's coefficient (rho) was direct and significant. The Kruskal-Wallis H-test revealed statistically significant differences between all the groups established according to the levels of the FOIS. For internal sensitivity, the Wilcoxon signed rank sum test was used, obtaining a significant difference between the two assessments. The external sensitivity of the scale obtained a direct and significant correlation.

CONCLUSIONS

the EDMUR scale is a reliable, valid, and sensitive instrument for quantifying the evolution of dysphagia, thus improving the quality of treatments.

Validation of the LESS-CHRON criteria: reliability study of a tool for deprescribing in patients with multimorbidity

Objective

The 'LESS-CHRON criteria' (List of Evidence-Based Deprescribing for Chronic Patients criteria) is a newly created tool with 27 criteria to guide deprescribing. It was developed using a Delphi methodology. Each criterion consists of drugs and their indications, conditions under which deprescribing would be considered, a health variable to be monitored after deprescribing and a follow-up period. The aim of our study was to evaluate the reliability of the LESS-CHRON criteria in a population of patients with multimorbidity to determine the possible usefulness of this tool in clinical practice.

Methods

We selected chronic patients with multimorbidity from an internal medicine unit who were older than 80 years old and were alive at the time of the study. To determine interobserver reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intraobserver reliability, each health professional applied the tool at baseline and 2 months later. We measured interobserver and intraobserver reliability using the kappa coefficient. The proportion of overall agreement was also determined.

Results

We obtained a moderate overall kappa (ĸ=0.46, 95% CI 0.36 to 0.55) for interobserver reliability, and good (ĸ=0.65, 95% CI 0.57 to 0.78) and moderate (ĸ=0.59, 95% CI 0.49 to 0.74) values for intraobserver reliability for the internist and pharmacist, respectively. The proportion of overall agreement was very high: 92% (range: 62%-100%) for the interobserver, and 94% (80%-100%) and 93% (63%-100%) for the internist and pharmacist, respectively.

Conclusions

The LESS-CHRON criteria shows early promise as a reliable method to help guide deprescribing in patients with multimorbidity. Further, more complete testing with a larger sample of prescribers is needed.

Cross-cultural adaptation of the Work Role Functioning Questionnaire to Spanish spoken in Spain

PURPOSE

The Work Role Functioning Questionnaire (WRFQ) is a tool developed in the United States to measure work disability and assess the perceived impact of health problems on worker ability to perform jobs. We translated and adapted the WRFQ to Spanish spoken in Spain and assessed preservation of its psychometric properties.

METHODS

Cross-cultural adaptation of the WRFQ was performed following a systematic 5-step procedure: (1) direct translation, (2) synthesis, (3) back-translation, (4) consolidation by an expert committee and (5) pre-test. Psychometric properties were evaluated by administering the questionnaire to 40 patients with different cultural levels and health problems. Applicability, usability, readability and integrity of the WRFQ were assessed, together with its validity and reliability.

RESULTS

Questionnaire translation, back translation and consolidation were carried out without relevant difficulties. Idiomatic issues requiring reformulation were found in the instructions, response options and in 2 items. Participants appreciated the applicability, usability, readability and integrity of the questionnaire. The results indicated good face and content validity. Internal consistency was satisfactory for all subscales (Cronbach's alpha between 0.88 and 0.96), except for social demands (Cronbach's alpha = 0.56). Test-retest reliability showed good stability, with intraclass correlation coefficients between 0.77 and 0.93 for all subscales. Construct validity was considered preserved based on the comparison of median scores for each patient group and subscale.

CONCLUSIONS

Our results indicate the cross-cultural adaptation of the WRFQ to Spanish was satisfactory and preserved its psychometric properties, except for the subscale of social demands, whose internal consistency should be interpreted with caution.

[Review of the attributes of patient-based health outcomes instruments]

Study of the quality and use of patient-based outcomes instruments has been and still is an area of growing interest in many health disciplines, including nursing. In the last 30 years, the number of measures has greatly increased. However, there is enormous disparity in their contents, hampering selection of one or other of these instruments for use in clinical medicine or research. The aim of this article was to describe the quality attributes that patient-based health instruments should meet before being used. For that purpose, we provide a detailed description of the attributes on which there is both national and international consensus. These instruments are grouped in 3 main axes: conceptual adequacy, applicability, and psychometric properties.