COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study

Psychometric properties of the Turkish version of the Fluid Intake Appraisal Inventory in adults receiving hemodialysis

INTRODUCTION

Effective self-management of fluid intake in hemodialysis relies on self-efficacy. Although regular assessments with valid tools are crucial, no suitable measurement exists for the Turkish population. This study evaluates the reliability, validity, and interpretability of the Turkish version of the Fluid Intake Appraisal Inventory.

METHODS

This cross-sectional study collected data from December 2021 to November 2022. It analyzed reliability, validity, and interpretability.

RESULTS

The 202 adults receiving hemodialysis were evaluated. The scale showed high internal consistency with Cronbach α = 0.954 and good test-retest reliability with intraclass correlation coefficients = 0.975, 95% confidence interval: 0.786-0.992, and no measurement error. It demonstrated excellent content validity with scale level content validity index ≥0.90 and good construct validity with a negative moderate correlation to interdialytic weight gain. For structural validity, the model fit indices were χ2/df = 5.7, root mean square error of approximation = 0.15, goodness of fit indexes = 0.58, Tucker-Lewis Index = 0.57, comparative fit index = 0.6, and standardized root mean square residual = 0.10.

CONCLUSION

This inventory is a valid and reliable tool for assessing self-efficacy in fluid intake among the Turkish hemodialysis population.

Performance Quality Assessment in Ballet, Modern and Contemporary Dance: A Two-Step Systematic Review

Introduction: Measurement of performance quality in dance is important but challenging and few dance performance quality measures exist. This study aims to (1) identify and (2) assess the quality of dance performance outcome measures for ballet, modern and contemporary dance. Methods: A 2-step systematic review with two separate literature searches was conducted. Step 1 involved a systematic review to identify all ballet, modern and contemporary dance performance quality outcome measures. Step 2 involved a systematic review to identify studies that reported measurement properties (eg, validity, reliability) of the tools identified in Step 1. A comprehensive electronic search of MEDLINE, SPORTSDiscus, CINHAL, Embase and IADMS Bibliography was conducted from inception to November 2020 (Part 1) and February 2021 (Part 2). To evaluate the quality of each dance performance outcome measure, three steps were conducted (1) assessment of methodological quality using the COSMIN checklists, (2) evaluation of results against criteria of good measurement properties and (3) summary of the evidence and an overall rating of evidence using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Fifteen dance performance quality outcome measures were identified (Step 1). Seventeen studies reported measurement property data for 14 of 15 identified outcome measures (Step 2). The majority of the 34 measurement property outcomes were rated as doubtful (COSMIN checklists), and demonstrated sufficient measurement properties. Only one outcome measure, the Radell Evaluation Scale for Dance Technique (RESDT), was assessed as having low and moderate quality evidence for validity and reliability respectively. The remaining 13 tools were rated as having very low-quality evidence (GRADE criteria). Conclusions: Due to low quality, the 15 dance performance quality tools cannot be confidently recommended for use at this time. Dance teachers, clinician and researchers should consider feasibility issues and use the tools with caution until adequate high-quality evidence is available.

Reliability of physical performance tests for the upper extremity and trunk using telehealth in athletes

INTRODUCTION

Physical performance tests (PPTs) are commonly used in in-person evaluations, with the rater setting up, supervising, and demonstrating the proper execution of the tests. However, some situations require physical distancing, and it is unknown whether those tests via telehealth are reliable. Therefore, the purpose of this study was to evaluate the reliability of upper extremity and trunk PPTs using telehealth in athletes.

METHOD

Fifty-four athletes (27 male and 27 female athletes; mean age of 25.30 ± 6.20 years) were included in this study. The inter-session reliability of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Line Hops Test, and the Prone and Side Bridge Test via telehealth was verified. Reliability was assessed with intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC).

RESULTS

CKCUEST showed good reliability, with SEM and MDC95 of 1.68 and 4.66repetitions, respectively. Line Hops Test showed good reliability, with SEM and MDC95 ranging from 6.12 to 7.46 s and 16.95-20.69 s, respectively. Side Bridge Test showed good to excellent reliability, with SEM and MDC95 ranging from 7.46 to 9.46 s and 20.69-26.22 s, respectively. Prone Bridge Test showed excellent reliability, with SEM and MDC95 of 17.13 and 47.48 s, respectively.

CONCLUSION

Upper extremity and trunk PPTs using telehealth were considered reliable to assess athletes. The use of PPTs via telehealth may be a reliable alternative when social distancing is required, and clinicians should consider the SEM and MDC95 for interpreting PPTs scores.

Translation and validation of Malay version of NIOSH worker well-being questionnaire (WellBQ)

The NIOSH Worker Well-Being Questionnaire (WellBQ) offers a comprehensive framework to evaluate worker well-being across five domains: work evaluation, workplace policies, physical environment and safety, health status, and home/community influences. In Malaysia, traditional occupational safety and health (OSH) initiatives have primarily focused on workplace hazards, often neglecting broader psychosocial and organizational factors. To address this gap, this study adapted and validated the Malay version of the WellBQ for healthcare workers, ensuring cultural and contextual relevance. A rigorous translation process, including forward and backward translation, expert panel reviews, and pilot testing, was conducted to retain the original framework while addressing local nuances. Psychometric evaluation involved 366 healthcare workers from Hospital Universiti Sains Malaysia, employing Confirmatory Factor Analysis (CFA) to assess model fit, internal consistency, and construct validity. The Malay WellBQ demonstrated robust psychometric properties, with a Content Validity Index (CVI) of 0.92 and a Face Validity Index (FVI) of 0.98, reflecting high relevance and clarity. CFA confirmed an acceptable model fit (RMSEA = 0.050, CFI = 0.887, TLI = 0.877) and strong internal consistency (CR > 0.7). Convergent validity was observed across most subdomains, although some Average Variance Extracted (AVE) scores fell below 0.5, highlighting areas for refinement. Discriminant validity was achieved within domains but revealed overlaps between some domains, suggesting interconnected constructs. The Malay WellBQ is a reliable and culturally relevant tool for assessing worker well-being, offering actionable insights for workplace policy and intervention development. Further refinements are recommended to enhance construct validity across domains.

Intra- and inter-rater reliability of anterior and posterior drawer tests for the assessment of people with shoulder instability

BackgroundThe well-known drawer tests to assess glenohumeral laxity and instability have shown appropriate reliability, although analysed mainly in healthy subjects.ObjectiveTo evaluate the intra- and inter-rater reliability of anterior and posterior drawer tests in subjects with symptoms of shoulder instability.DesignClinometric study of intra- and inter-rater reliability of drawer tests was carried out following COSMIN recommendations and GRRAS checklist.SettingCentres with equipped facilities for assessments.ParticipantsThere were 105 participants (69 male/36 female) aged 18 to 60 years with instability symptoms in at least one shoulder. Each participant underwent bilateral assessments. The sample consists of 210 shoulders, unstable and healthy.InterventionAnterior and posterior drawer tests.Main measuresHumeral translations were assessed using drawer tests and graded with Hawkins scale, modified Hawkins and dichotomising (positive/negative). Two sessions were performed (seven to fourteen-day washout period): Each patient was evaluated by two examiners in the first session and by one of them in the second. Weighted Kappa analysed the reliability.ResultsThe intra-rater reliability of the anterior and posterior drawer tests was excellent (weighted Kappa = 1) with the Hawkins scale. Inter-rater reliability was good for the anterior drawer: weighted Kappa = 0.76 (95%confidence interval: 0.67-0.85) with the Hawkins scale, weighted Kappa = 0.78 (95%confidence interval: 0.69-0.87) with modified Hawkins, and weighted Kappa = 0.80 (95%confidence interval: 0.71-0.89) dichotomising; and for the posterior drawer: weighted Kappa = 0.62 (95%confidence interval: 0.52-0.72), weighted Kappa = 0.67 (95%confidence interval: 0.57-0.78), and weighted Kappa = 0.70 (95%confidence interval: 0.59-0.80), respectively.ConclusionDrawer tests demonstrated excellent intra-rater and good inter-rater reliability in subjects with symptoms of shoulder instability.

The reliability and validity of brief cognitive screening tools used in traumatic brain injury: A systematic review

Reliable and valid cognitive screening tools are essential in the assessment of those with traumatic brain injury (TBI). Yet, there is no consensus about which tool should be used in clinical practice. This systematic review assessed psychometric properties of cognitive screening tools for detecting cognitive impairment in TBI. Inclusion criteria were: peer-reviewed validation studies of a cognitive screening tool(s); with a sample of adults aged 18-80 diagnosed with TBI (mild-severe); and with psychometrics consistent with COSMIN guidelines. Published literature was retrieved from MEDLINE, Web of Science Core Collection, EMBASE, CINAHL, and PsycINFO on 27 January 2022. A narrative synthesis was performed. Thirty-four studies evaluated the psychometric properties of a total of 22 cognitive screening tools, in a variety of languages. Properties assessed included structural validity, internal consistency, reliability, criterion validity (or diagnostic test accuracy), convergent/divergent validity, and discriminant validity. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) were the most widely validated cognitive screening tools for use in TBI. The MoCA had the most promising evidence of its psychometric properties, which has implications for clinical practice. Future research should aim to follow standard criteria for psychometric studies to allow meaningful comparisons across the literature.

Tele-assessment of trunk control in children with cerebral palsy: Intra- and inter-rater reliability, and validity of the trunk control measurement scale

IntroductionThe aim of the study was to evaluate the intra- and inter-rater reliability, and validity of the Trunk Control Measurement Scale (TCMS) for tele-assessment in children with cerebral palsy (CP).MethodA cross-sectional study was conducted with 36 children aged 4-18 years, diagnosed with hemiplegic CP. Participants underwent four TCMS assessments: in-person assessment, tele-assessment via videoconferencing, and two video-based tele-assessments scored by same rater and by a second rater. Reliability was analyzed using intraclass correlation coefficients (ICC). Discriminant validity was assessed by comparing TCMS tele-assessment scores between children with Gross Motor Function Classification System (GMFCS) levels I and II, while criterion validity was evaluated by examining the correlation between face-to-face and tele-assessment TCMS scores.ResultsExcellent reliability was observed between face-to-face and tele-assessment (ICC: 0.91; 95%CI: 0.83-0.95). TCMS tele-assessment also demonstrated excellent intra-rater reliability (ICC: 0.90, 95%CI: 0.80-0.94) and high inter-rater reliability (ICC: 0.82, 95%CI: 0.66-0.90). Criterion validity was confirmed by strong correlations between face-to-face and tele-assessment scores (r = 0.925, and r = 0.892, p < 0.001 for rater-1 and rater-2, respectively). The TCMS successfully discriminated children by functional levels, demonstrating discriminative validity (p = 0.002). Bland-Altman analysis revealed minimal systematic error, with internal consistency remaining high across all assessments (>0.88).DiscussionTCMS is a valid and reliable tool for teleassessing trunk control in children with hemiplegic CP. These results may pave the way for developing child-specific, targeted telerehabilitation programs, bringing telerehabilitation closer to its primary aim of ensuring equal opportunities.This study was registered as a clinical trial (NCT06707831). https://clinicaltrials.gov/study/NCT06707831.

Explanation & Elaboration document of the COSMIN Reporting Guideline 2.0 for studies on measurement properties of patient-reported outcome measures

PURPOSE

We aimed to develop an Explanation & Elaboration document to provide explanations, rationales, and good examples of reporting for each item in the COSMIN Reporting Guideline 2.0.

METHODS

The development of the Explanation & Elaboration document was conducted in four phases. In phase 1, experts on measurement properties were invited as writers to draft explanations and examples for each item. The original COSMIN Reporting Guideline items into 22 clusters, each containing two to six items, which were self-assigned by writers based on expertise. In phase 2, a draft of the Explanation & Elaboration document was created. For each item, an 'Explanation', 'Essential elements', and 'Item examples' were written. The draft was reviewed by a team of reviewers for grammar, conciseness, and consistency with other COSMIN tools. In phase 3, the Explanation & Elaboration document was extensively revised considering the newly created COSMIN reporting guidelines 2.0. In phase 4, the final version incorporated feedback from all writers and final approval.

RESULTS

Eighteen writers drafted the item explanations and provided examples of good reporting. The Explanation & Elaboration document contains explanations of the General and Specific items. We explain the reasons why reporting of the item is recommended and how to report the items with examples of good reporting.

CONCLUSION

The Explanation & Elaboration document of the COSMIN Reporting Guideline 2.0 facilitates comprehensive reporting of studies on measurement properties of PROMs and should be used in conjunction with the COSMIN Reporting Guideline 2.0.

Operator variation in applying a knee loading device for evaluation of tibial component loosening in total knee arthroplasty

BACKGROUND

A CT-based method has been developed to aid diagnosis of aseptic loosening of the tibial component by scanning the knee in a loading device, and subsequent 3D-image analysis to quantify component displacement. This study evaluated the effect of operator differences in applying the loading device on the component displacement variables, using two image analysis protocols.

METHODS

Sixteen subjects underwent repeated CT examinations with valgus and varus loading. Two operators applied the loading device to each patient. With each load, a CT scan was made, and tibial component displacement relative to the tibia was quantified as rotation about the screw-axis, Maximum Total Point Motion and mean Target Registration Error. Two protocols were used: (1) analyzing the entire tibia (100 %) and (2) the proximal tibia (20 %) to mitigate tibia deformation. Inter-operator reliability and measurement error were assessed using intraclass correlation coefficient (ICCagreement), standard error of measurement, standard error of operator and smallest detectable change.

FINDINGS

The 100 % tibia protocol showed moderate-to-good ICCagreement(0.64- 0.84 for the different displacement variables) with standard error of measurement around 0.15 mm or degree. The 20 % tibia protocol showed poor-to-moderate ICCagreement, ranging from 0.17 to 0.31, with the standard error of measurement around 0.10 mm or degree. This protocol showed smaller measurement errors but poorer ICCagreement due to reduced subject variance explained by smaller apparent implant displacements. Operator related error was statistically and clinically negligible. The smallest detectable change values ranged between 0.27 and 0.44 mm or degree.

INTERPRETATION

The 100 % tibia protocol showed moderate-to-good reliability, whereas the 20 % protocol reduced reliability but lower measurement error.

LEVEL OF EVIDENCE

Level II.

Clinical rating scales for assessing pain in newborn infants

BACKGROUND

Six to nine per cent of all newborn infants require admission to a neonatal intensive care unit (NICU) due to either illness or prematurity. During their stay, these infants are often subjected to many painful procedures that can cause negative long-term consequences. To reduce the negative effects of pain exposure and ensure optimal and safe pain treatment, accurate assessment of pain is necessary. To achieve this, clinicians are dependent on the use of reliable, objective, and standardised clinical rating scales of pain, henceforth referred to as 'rating scales'. Numerous rating scales have been published; however, discrepancies in validity limit their overall applicability in clinical practice and research. Such limitations may lead to an over- or underestimation of pain, resulting in unnecessary sedation or inadequately treated pain, potentially jeopardising infant safety through treatment side effects, including withdrawal symptoms or prolonged discomfort. To date, the majority of rating scales have been developed to assess procedural pain, whilst fewer scales for prolonged pain are available. Premature infants further complicate matters, as they often have a reduced ability to display robust pain behaviour due to their immaturity. Research has also shown that the use of rating scales in clinical practice is suboptimal, due to both inadequate and infrequent implementation alongside inappropriate choice of scale for the specific pain, population, or setting under evaluation. Despite numerous studies investigating the burden of pain in newborn infants, little work has been done to summarise the current evidence on the appropriateness of rating scales for specific types of pain or infant conditions. This has likely been limited by the subjectivity of pain assessment and further complication of assessing such a non-verbal and immature patient population. The immense burden of neonatal pain worldwide has also led to the development of numerous rating scales in various languages, further hindering evidence summation.

OBJECTIVES

To systematically review the literature to compile and describe the development, content, and measurement properties of clinical rating scales for the assessment of pain in newborn infants.

SEARCH METHODS

An Information Specialist systematically searched CENTRAL, PubMed, Embase, and CINAHL. The latest update search is current to July 2023.

SELECTION CRITERIA

We included all study designs that involved the development or testing of a rating scale for assessing pain in newborn infants. We included preterm (born before week 37) and term (born at week 37 or beyond) infants undergoing pain assessment for any medical indication. We also included studies that included healthcare professionals.

DATA COLLECTION AND ANALYSIS

We evaluated clinical rating scales assessing pain in newborn infants using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology evaluating content validity, structural validity, internal consistency, reliability, measurement error, hypothesis testing, and cross-cultural validation. We used a modified GRADE approach to assess risk of bias, inconsistency, imprecision, and indirectness.

MAIN RESULTS

We included 79 studies involving a total of 7197 infants, 326 nurses, and 12 physicians. Twenty-seven clinical rating scales were used in 26 countries, with 14 studies evaluating preterm infants, 11 on term infants, 46 on both preterm and term infants, four solely on medical staff, and four on preterm and/or term infants plus medical staff. Following the COSMIN checklist, we found all rating scales to be of very low-certainty evidence, raising concerns regarding their validity, reliability, and applicability in this vulnerable population across diverse clinical settings.

AUTHORS' CONCLUSIONS

Clinical staff should be vigilant when applying the currently available neonatal rating scales. Further development of rating scale content and testing for structural validity are necessary and should be prioritised. Together, they determine the content and structure of rating scales, underpin further testing, including reliability, and their prioritisation will make the greatest contribution to the evidence base for rating scales to assess neonatal pain. Collaborative efforts between clinicians and methodology experts will prevent methodological pitfalls and contribute to improving the validity and reliability of pain-rating scales in neonatology.

The medication-related burden quality of life (MRB-QoL) Arabic tool: Exploratory factor analysis and psychometric evaluation

BACKGROUND

The Medication-Related Burden Quality of Life (MRB-QoL) is a patient-reported measure of medicines burden on functioning and well-being in people with long-term conditions (LTCs). The Arabic version has demonstrated good content validity; however, no data is available on its other psychometric properties.

OBJECTIVES

To evaluate the reliability and validity of the Arabic MRB-QoL tool.

METHODS

Four hundred patients (≥18 years) with LTCs were recruited from a tertiary hospital in the United Arab Emirates. Exploratory factor analysis (EFA) was performed using Principal Axis Factoring for extraction and Oblimin rotation. Cronbach's alpha, intraclass correlation coefficient (ICC), and minimum detectable change (MDC) assessed internal consistency, test-retest reliability, and measurement error, respectively. Structural, Known-group, convergent, and discriminant validity were evaluated using EFA, Mann Whitney U test, and Spearman's rank correlations tests, respectively. Convergent validity (r > 0.3, moderate to high correlations) and discriminant validity (r < 0.3, weak correlations) were examined through correlation with the Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and 12-item Short Form Health Survey (SF-12) measures. Known-group validity was assessed by comparing MRB-QoL scores across clinically diverse groups.

RESULTS

EFA revealed a 31-item, four-factor structure accounting for 78.5 % of the variance. Reliability results showed good internal consistency (Cronbach's α = 0.973) and test-retest reliability (ICC = 0.994). The MDC for the total MRB-QoL was 3.89, indicating that a change of more than 4 points between 2 measurements reflects a true difference with 95 % confidence. There were weak correlations between domains of MRB-QoL and MRCI (r 0.120 to 0.152) indicating discriminant validity. Correlations between the mental component summary of the SF-12 and MRB-QoL (r = -0.387) and its domains (r -0.357 to -0.374) suggested convergent validity. Patients with polypharmacy and multimorbidity had higher median MRB-QoL scores, showing known-group validity.

CONCLUSION

This study demonstrated that the Arabic MRB-QoL is a valid and reliable medication-related burden (MRB) measure with good construct validity, including structural, known-group, convergent, and discriminant validity. It also shows excellent reliability, with high internal consistency, low measurement error, and good test-retest reliability. These findings support its use as a psychometrically robust measure for assessing MRB and facilitating person-centred medicines optimisation services in Arabic-speaking populations.

Methods to discriminate between nociceptive, neuropathic and nociplastic in children & adolescents: A systematic review of psychometric properties and feasibility

The aim of this systematic review was to identify and critically analyse the tools available for categorising pain as nociceptive, neuropathic and nociplastic pain in children and adolescents. Studies were included if they (i) included children and adolescents with a mean age of 0-24 years old, (ii) examined assessment tools that categorise pain as nociceptive, neuropathic or nociplastic, and (iii) examined the psychometric properties of the tools. Sensitive searches were conducted in five online databases in March 2024. Eligible studies were assessed for risk of bias and quality by two authors using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The search yielded 26 studies for 11 tools. No assessment tool had evidence for all nine recommended psychometric properties. Quantitative Sensory Testing, a tool used to identify signs and symptoms of nociplastic and neuropathic pain, was the most studied tool and had moderate evidence for construct validity, criterion validity and reliability. Three self-reported questionnaires, the Self-reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), Central Sensitisation Inventory (CSI) and PainDETECT, had moderate evidence for construct validity and show promise as preliminary tools to identify possible neuropathic or nociplastic pain. However, they had low specificity when used in isolation. All assessment methods would benefit from further psychometric evaluation and validation in children and adolescents. PERSPECTIVE: This systematic review highlights the limited validation of pain assessment tools for children and adolescents. While Quantitative Sensory Testing and self-reported questionnaires show promise in identifying pain mechanisms, their applicability remains uncertain. Further psychometric validation is crucial to improve pain assessment and guide personalized treatment in young populations.

Reliability, validity, and responsiveness of pinch strength assessment: a systematic review

PURPOSE

To summarize and critically appraise the quality of studies investigating psychometric properties of pinch strength assessment.

METHODS

Medical literature up to February 2024 was searched for studies reporting on at least one measurement property of pinch strength assessment. The quality of the evidence and the risk of bias were rated using COSMIN 2018 guidelines.

RESULTS

Thirty-three studies (1962 participants) were included. The majority (16/19) of reliability studies were of adequate to very good quality. Seven of 12 studies of validity were rated as adequate or very good. The quality of the eight responsiveness studies was adequate. Reliability was good to excellent (ICC > 0.75) for neurological conditions, and excellent (ICC > 0.90) for musculoskeletal disorders and healthy participants. Pinch strength showed strong to very strong correlations with grip strength (r = 0.72-0.92), moderate to strong correlations with assessments of dexterity (r = 0.78-0.80), and weak to moderate correlation with patient-reported outcome measures (r = 0.03-0.50). Varied results were found for pinch strength responsiveness in a small number of studies.

CONCLUSIONS

Pinch strength assessment is reliable. Validity and responsiveness are less reported, but there is a strong correlation between pinch and grip strength, and a moderate correlation with dexterity.

Digital hand-held arthrometry is a reliable and accurate adjunct for diagnosing acute anterior cruciate ligament tears

Purpose

To evaluate the intrarater reliability and predictive validity of Lachmeter® measurements for diagnosing acute anterior cruciate ligament (ACL) tears, and to propose diagnostic thresholds.

Methods

Lachmeter® measurements were recorded during the stabilised Lachman test for consecutive participants presenting to an acute knee injury clinic within 21-days of injury. Intrarater reliability for individual limb and side-to-side (STS) difference (injured limb minus uninjured limb) measurements was investigated using a cross-sectional, repeated-measures design and the intraclass correlation coefficient (ICC). The predictive validity of STS difference and injured limb measurements was investigated using a prospective cohort design; sensitivity, specificity, negative (LR-) and positive likelihood ratios (LR+) were calculated using magnetic resonance imaging as the reference standard.

Results

Intrarater reliability was excellent for individual limb and STS difference measurements in 102 participants. Of the 63 participants included in the validity analysis, 31 had a normal ACL and 32 had an ACL tear. LR- point estimates for STS differences <1.4 mm (0.07 [95% confidence interval [CI]: 0.02-0.29]) or injured limb measurements <7.5 mm (0.09 [95% CI: 0.02-0.34] produced 'large' shifts in the probability of ruling out an ACL tear. LR+ point estimates for STS differences ≥3.8 mm (10.67 [95% CI: 2.68-42.51]) or injured limb measurements ≥11.8 mm (10.67 [95% CI: 1.42-80.26]) produced 'large' shifts in the probability of ruling in a full-thickness ACL tear.

Conclusion

In participants presenting within 21-days of knee injury, intrarater reliability was excellent for Lachmeter® measurements recorded during the stabilised Lachman test. Based on predictive validity estimates, Lachmeter® measurements can be used to differentiate normal from torn ACLs in acute presentations, but not partial from full-thickness ACL tears. Diagnostic thresholds are proposed based on STS difference and injured limb measurements, and with consideration of the Lachman end point. Level of Evidence: Level I.

Psychometric Properties of the Wolf Motor Function Test (WMFT) and Its Modified Versions: A Systematic Review With Meta-Analysis

BackgroundThe Wolf Motor Function Test (WMFT) and its modified versions are widely used to assess upper limb (UL) function in stroke survivors. However, comprehensive evaluations of its psychometric properties are lacking.ObjectiveTo perform a systematic review with meta-analysis on the psychometric properties (following the COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] taxonomy) of the WMFT and modified versions in stroke survivors.MethodsSix databases were searched until May 2024 for studies examining at least one WMFT measurement property in stroke patients. Two independent reviewers conducted study selection, data extraction, and quality assessment using the COSMIN Risk of Bias checklist and quality of evidence (QoE) with the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analyses synthesized psychometric properties reported in at least two studies.ResultsTwenty-five studies (N = 2044) were included. Regarding the WMFT Functional Ability Scale (FAS) and TIME scales, internal consistency (alpha ≥ .88), intra-rater (intraclass correlation coefficient [ICC] ≥ .97) and inter-rater (ICC ≥ .92) reliability, measurement error for TIME, construct validity (strong correlations [r ≥| .64|] with Fugl-Meyer Assessment and Action Research Arm Test), and responsiveness (ES ≥ 0.48) were rated sufficiently with QoE from very low to high. Measurement error for FAS was assessed as inconsistent with moderate QoE, and cross-cultural validity was rated as indeterminate with very low QoE. Content validity was not assessed. Few studies investigated the psychometric properties of the modified versions.ConclusionsWMFT demonstrates robust psychometric properties in assessing UL function in stroke survivors. While the WMFT-modified versions showed promising properties, further research is needed to use them. Future studies should focus on WMFT measurement error, content, and cross-cultural validity.Trial Review Registration:PROSPERO: CRD42021237425.

A systematic review of assessment tools for cognitive frailty: Use, psychometric properties, and clinical utility

BACKGROUND

The concept of 'cognitive frailty' (CF) was first developed by an international consensus group in 2013 and defined as evidence of both physical frailty and cognitive impairment without a clinical diagnosis of AD or another dementia. CF has been associated with adverse health outcomes and early identification is vital. Difficulty in the assessment of CF however is the lack of a diagnostic gold standard.

OBJECTIVES

This review aimed to identify assessment tools used to diagnose cognitive impairment in the diagnosis of cognitive frailty, their psychometric qualities and clinical utility.

RESEARCH DESIGN AND METHODS

Six databases were searched between 2013-2024. Studies were eligible if they reported a method of defining cognitive frailty, named the assessment tools, and stated cutoff values used to define cognitive impairment.

RESULTS

In the 116 included studies, large heterogeneity was found in the tools utilised, and cutoff scores applied, to diagnose cognitive impairment in the diagnosis of cognitive frailty. This review has demonstrated that diagnosis of CF relies predominantly on the use of three cognitive assessment tools (Mini Mental State Examination, Montreal Cognitive Assessment, Clinical Dementia Rating) from a total of 22 different tools identified in the literature. For assessment of physical frailty, 11 different tools were identified, with the Fried Frailty Index and FRAIL Scale predominantly utilised.

DISCUSSION AND IMPLICATIONS

The variation in the tools used to identify the diagnosis of CF means there is inconsistency in reporting, potentially impacting both the understanding of the prevalence, and the appropriate direction of intervention strategies.

Italian translation, cultural adaptation, and validation of the Action Research Arm Test (ARAT) and the Stroke Upper Limb Capacity Scale (SULCS) for individuals post-stroke

PURPOSE

This study aims to culturally adapt and validate the Stroke Upper Limb Capacity Scale (SULCS) and Action Research Arm Test (ARAT) for use with post-stroke patients in Italy.

METHODS

The original scales were translated and culturally adapted following the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines. We assessed internal consistency and test-retest reliability, while concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Disability Arm Shoulder and Hand (DASH).

RESULTS

A total of 56 participants were recruited for the study. The Italian versions of the scales demonstrated excellent stability and reliability both within and between raters. The Cronbach's alpha coefficients were 0.904 for SULCS and 0.998 for ARAT, indicating strong internal consistency among items. The interclass correlation coefficients were 0.998 (95% C.I.: 0.993-0.990) for inter-rater reliability and 0.987 (95% C.I.: 0.984-0.995) for intra-rater reliability for SULCS, and 0.998 (95% C.I.: 0.999-0.996) for inter-rater reliability and 0.992 (95% C.I.: 0.998-0.987) for intra-rater reliability for ARAT.

CONCLUSIONS

Both scales exhibit robust validity and reliability, making them valuable tools for clinical assessment and functional evaluation of upper limb capacity in post-stroke patients. We recommend the integration of the ARAT and SULCS into initial patient assessments and ongoing monitoring to enhance rehabilitation outcomes.

Identifying spatial neglect - an updated systematic review of the psychometric properties of assessment tools in adults post-stroke

Spatial neglect commonly occurs after a stroke, resulting in diverse impacts depending on the type and severity. There are almost 300 tools for assessing neglect, yet there is a lack of knowledge on the psychometric properties of these tools. The objective of this systematic review, registered on Prospero (CRD42021271779), was to determine the quality of the evidence for assessing spatial neglect, categorized by neglect subtype. The following databases were searched on 3rd May 2022 from database inception: Ovid Emcare, Embase, Ovid MEDLINE, APA PsycINFO, Web of Science (SCI-EXPANDED; SSCI; A&HCI; ESCI) and Scopus. All primary peer-reviewed studies (>5 participants) of adults post stroke, reporting any psychometric property of 33 commonly used neglect assessment tools were included. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) risk of bias tool was used to assess the methodological quality of the studies and summarize the psychometric properties of each tool. 164 articles were included, with a total of 12,463 people with stroke. The general quality of the evidence was poor and no one tool had high-quality evidence of both validity and reliability. Eleven tools show some promise as they meet the minimum criteria for good measurement properties for both validity and reliability.

Psychometric properties of performance based tests in patients with Fibromyalgia: A systematic review

Fibromyalgia (FM) impacts patients' health status, functioning and quality of life. Accurate diagnosis and effective treatment planning require reliable, valid and responsive measures of these domains. This study aimed to assess the psychometric properties of performance based tests (PBTs) in FM and to quantify the availability of reliable, valid and responsive PBTs linked to key International Classification of Functioning, Disability and Health (ICF) categories related to functional impact. A systematic review was conducted following the PRISMA checklist, and four databases (PubMed, EMBASE, Cochrane Library and Web of Science) were searched. Eligible studies contained information on population, intervention (assessment), and outcomes (PBTs and their psychometric properties). The risk of bias and the methodological quality were assessed according to the COSMIN criteria. Twenty-two studies evaluating twenty-six PBTs were included. PBTs were linked to five ICF categories: exercise tolerance, muscle power and muscle endurance and changing basic body position and walking. The psychometric properties assessed were reliability, validity and responsiveness. The 6 min walking test was the most often assessed PBT with moderate quality of evidence for reliability, and very good methodological quality for validity. Overall, the methodological quality for reliability was rated as doubtful with very low to moderate evidence, for validity we found very good methodological quality with low to high evidence. No studies investigated criterion validity, and construct validity and responsiveness were seldom determined. Clinicians assessing FM patients should carefully select PBTs. Future research on PBTs psychometrics in FM should follow COSMIN recommendations, ensuring control of symptom variability. PERSPECTIVE: This review confirms that the current understanding of the psychometric properties of PBTs for FM patients is limited, hindered by heterogeneous tests and insufficient evidence, complicating outcome comparisons across studies. This gap underscores the need for future research to enhance methodological quality and address missing ICF categories related to FM. REGISTERED PROTOCOL AT PROSPERO: Registration number: CRD42022380709.

Intra- and inter-rater reliability, standard error of measurement, and minimal detectable change of the cranio-cervical flexion test in individuals with non-specific chronic neck pain

BACKGROUND

The cranio-cervical flexion test (CCFT) is used in clinical practice to measure the activation of deep cervical flexor muscles. However, the reliability of the test has not been conducted on an adequate sample size, specifically in individuals with non-specific chronic neck pain (CNP).

OBJECTIVE

The aim of the present study is to investigate the intra- and inter-rater reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the CCFT in individuals with non-specific CNP.

METHODS

A cross-sectional study of reliability conducted at the UFSCar. Fifty-one individuals (17 men and 31 women) with non-specific CNP and aged over 18 years participated in this study. The CCFT was assessed with the Stabilizer pressure biofeedback device. Two raters conducted the test over two days, with a 5-7-days interval and a 10-min rest between raters. The activation score was determined by the level at which the participant kept activation for 10 s in a single stage (22, 24, 26, 28 and 30 mmHg). Appropriate statistical analysis was performed to calculate the intraclass correlation coefficient (ICC), SEM and MDC.

RESULTS

Both intra-rater (ICC = 0.65; 95% CI = 0.46-0.78) and inter-rater reliability (ICC = 0.72; 95% CI = 0.55-0.83) were considered moderate. The SEM was 1.73 and 1.66 for intra-rater and inter-rater reliability, and the MDC was 4.81 to 4.60, respectively.

CONCLUSION

The results of the present study indicate that CCFT is a reliable test to evaluate the activation score in individuals with chronic neck pain.

Measurement properties of the 5-repetition sit-to-stand test in patients with lumbar degenerative disorders: COSMIN systematic review

BACKGROUND CONTEXT

There has been no recent updated comprehensive review of measurement properties focused on the 5-repetition sit-to-stand test (5R-STS) in patients with lumbar degenerative disorders (LDD) that could aid in better understanding of its clinical and research applicability.

PURPOSE

The aim of this systematic review was to summarize evidence on measurement properties of the 5R-STS in patients with LDD according to COnsensus Based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines.

DESIGN

Systematic review and meta-analysis.

PATIENT SAMPLE

In Step 1 and 2, 3,363 and 1,287 adult patients with suspected or diagnosed either clinically and/or radiologically LDD were included, respectively. Step 2 involved screening studies from Step 1 that passed the full text-stage and including only those that assessed at least 1 COSMIN measurement property.

OUTCOME MEASURES

Functional Measures (5R-STS, Timed Up and Go Test). Self-report Measures (including Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire, pain scores eg, Visual Analogue Scale) and healthcare quality of life questionnaires (eg, EQ-5D-3L)).

METHODS

In December 2022 Embase, PubMed/Medline, Web of Science and Scopus were searched for studies of 5R-STS of patients with LDD (PROSPERO: CRD42022383095). Quality of evidence was assessed using GRADE and COSMIN Checklist. Results for measurement error were pooled using the weighted mean method. Random effect meta-analysis was performed for studies on reliability and criterion validity.

RESULTS

Thirty-eight full-text articles were included in Step 1 and 19 in Step 2. The overall intraclass correlation coefficient (ICC) of test-retest reliability and inter-rater reliability of the 5R-STS was 0.93 (95% CI 0.37-1.00) and 0.99 (95% CI 0.83-1.00), respectively. The weighted standard error of measurement (SEM) mean value was 2.8s. Estimated r of 5R-STS and ODI, reflecting insufficient criterion validity (since r <0.70), was 0.53 (95% CI 0.17-0.88). Hypothesis testing for construct validity was confirmed for 40% of predefined hypothesis (graded as insufficient since overall, not >70% hypothesis confirmed). Accounting for limited evidence, responsiveness of the test was adequate.

CONCLUSION

This COSMIN systematic review summarizes 5R-STS measurement properties in patients with LDD, including pooled estimates of ICC for reliability, SEM, and correlation between 5R-STS and ODI. The 5R-STS is a reliable and responsive instrument reflecting a new dimension of functional impairment in patients with LDD.

Psychometric Evaluation of the Turkish Version of the Heart Failure Somatic Perception Scale

BACKGROUND

The Heart Failure Somatic Perception Scale (HFSPS) is an 18-item scale used to evaluate the severity of common signs and symptoms of heart failure (HF) in patients. To date, psychometric properties of the HFSPS have been tested in samples of Japanese, Spanish, Farsi, Italian, and Arabic speakers.

OBJECTIVE

In this study, our aim was to determine the validity and reliability of the HFSPS in a Turkish population of patients with HF.

METHODS

This study was a cross-cultural adaptation of the HFSPS to evaluate its psychometric properties in a Turkish population diagnosed with HF, in accordance with the methodology and recommendations of the International Commission on Testing.

RESULTS

A total of 228 patients were included. The mean age of patients was 67.08 ± 8.53 years, and the mean duration of disease was 4.3 ± 2.9 years. Confirmatory factor analysis testing of the 4-factor (dyspnea, chest discomfort, early and subtle, edema) structure of the original HFSPS resulted in supportive fit indices. Confirmatory factor analysis findings showed that the factor loadings of the model indicated that the items had strong and significant relationships with relevant factors (P < .001 for all items). Cronbach's α reliability coefficients of the scale were calculated as 0.92. A positive moderate correlation of r = 0.887 (P < .001) was found between the HFSPS and the Minnesota Living With Heart Failure Questionnaire.

CONCLUSION

The findings of this study indicate that the scale is valid and reliable for use in Turkish patients with HF.

Using 3D and 4D digital human modeling in extended reality-based rehabilitation: a systematic review

Introduction

Extended reality (XR) is increasingly used in rehabilitation, showing potential to enhance clinical outcomes. Recently, integrating digital human modeling (DHM) with XR has gained attention. This systematic review aimed to evaluate the effectiveness of combining 3D and 4D DHM with XR in rehabilitation.

Methods

A systematic literature search was conducted according to PRISMA 2020 guidelines on the 28th of May 2024 in five databases (PubMed, IEEE Database, Cochrane Library, Web of Science, and Science Direct). All types of experimental studies investigating the effectiveness of XR using 3D and 4D DHM in rehabilitation were included. Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Evidence-Based Guideline Development (EBRO) were used to evaluate the methodological quality of the studies included.

Results

Of the 1048 articles found, 16 were included in this review. These studies focused on 3D DHM in XR-based rehabilitation across various conditions and demonstrated superior effectiveness, especially in individuals with neglect, anorexia nervosa, bulimia nervosa, and type 2 diabetes in comparison with conventional therapy. DHM, captured via 3D cameras and combined with motion analysis or Wii remotes, was integrated into XR systems like VR games and avatar therapy. The studies reveal positive impacts on functional (e.g., upper limb function, gait, balance, quality of life), physical (e.g., pain reduction, spasticity, joint range), psychological (e.g., depression, emotional regulation, body image), and general health outcomes (e.g., body composition, metabolic health).

Conclusion

Despite variability in study parameters, limited evidence suggests that 3D DHM in XR-based rehabilitation may enhance physical and psychological recovery across various pathologies. This review highlights the potential of DHM and XR integration but underscores the need for further research with larger samples, longer follow-ups, and standardized measures to confirm these technologies' reliability and effectiveness in rehabilitation.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024553551, identifier CRD42024553551.

Reliability and Validity of Instrumented Timed Up and Go Test in Typical Adults and Elderly: A Systematic Review

OBJECTIVE

To summarize the available literature investigating the reliability and validity of the instrumented Timed Up and Go (iTUG) in typical adults and elderly.

DATA SOURCES

Data were collected from PubMed, Web of Science, and hand searching up until July 15, 2024.

STUDY SELECTION

English-language studies investigating the reliability and validity of the 3-meter version of the iTUG in typical adults and elderly were included. Eligibility was blindly reviewed by 2 reviewers.

DATA EXTRACTION

Data on demographics, settings, reliability, and validity of the iTUG were independently extracted by 2 reviewers. The methodological quality was blindly assessed by 2 reviewers using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments tools, and the certainty of evidence was evaluated by the modified Grading of Recommendations Assessment, Developement and Evaluation (GRADE) approach.

DATA SYNTHESIS

Nineteen studies were included investigating 1729 participants, of which 334 were typical adults and 1395 typical elderly. For intrarater reliability (n=1 study), intraclass correlation coefficient ranged from 0.39 (95% CI, 0.30-0.50) to 0.97 (95% CI, 0.95-0.98), test-retest reliability (n=2 studies) from 0.27 (95% CI, -0.47 to 0.63) to 0.89 (95% CI, 0.78-0.95), and interrater reliability (n=1 study) generally sufficient from 0.929 to 0.99 (CI not reported). One study on criterion validity showed sufficient agreement (intraclass correlation coefficient >0.7) with the criterion standard for most outcome measures, except for 3 outcome measures measuring time of turn. Moreover, 12 studies used iTUG to predict cognitive decline (area under the curve [AUC] = 0.80), maximal mobility performance (R2=0.278), physical function (AUC ≤0.75), or falls [(AUC ≤0.853 (95% CI, 0.759-0.948)].

CONCLUSIONS

iTUG can be a reliable and valid tool for assessing mobility in adults and elderly. However, the complexity and nonstandardization of outcome measures reduce the reliability and validity of iTUG, which needs to be addressed in future research.

Assessing Shoulder Proprioceptive Sense of Force: Hand-Held Dynamometer Reliability and Comparison with Isokinetic Protocols

Background

Proprioception is crucial for shoulder stability, yet clinical methods for assessing all aspects, particularly the sense of force (SOF) -the ability to perceive, interpret, and reproduce force at a joint-are limited. The purpose of this study was to test a new SOF protocol with a handheld dynamometer (HHD) and examine its agreement with an isokinetic dynamometer (IKD), as well as its reliability and the effect of contraction intensity.

Design

Cross-sectional measurement study.

Methods

Fifty-one healthy participants were assessed for SOF using an Isokinetic dynamometer (IKD) and a HHD to evaluate the agreement between the two methods. Of the initial sample, 25 participants completed a second session with the HHD, enabling the evaluation of the protocol's reliability exclusively with this device. Error score were also compared between three different contraction intensities: 10%, 30% and 50% of maximal voluntary isometric contraction (MVIC). Intra-class correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC) for intra-rater (within-day and between-day) and inter-rater (within-day) reliability while agreement between the tools was assessed using regression line method.

Results

Agreement between devices was low with a poor correlation observed between measurements. The HHD SOF protocol showed low to moderate reliability for intra-rater between-day assessments, with ICCs from 0.44 to 0.64. The absolute reliability MDC95 ranged from 12% to 42%. Inter-rater within-day reliability was low, with ICCs from 0.007 to 0.43. Significant differences in error scores were observed between the HHD and IKD at 30% and 50% MVIC, and higher error scores were noted at Target 10% MVIC compared to 30% and 50%.

Conclusions

The SOF protocol using HHD demonstrates moderate reliability but low inter-rater reliability. Different tools yield varying results, with force intensity impacting SOF error scores, while rotation does not.

Level of evidence

2b.

Development of a Vaccine Advocacy Scale for Childhood Vaccines and Psychometric Evaluation: A Methodological Study

AIM

This study developed the Vaccine Advocacy Scale for childhood vaccines for adults and evaluated its psychometric properties.

METHOD

This methodological study involved 211 adults. A literature review was conducted to create the item pool of the scale, and 12 items were prepared. While evaluating the scale's psychometric properties, the researchers performed content validity, explanatory factor analysis (factor loadings of the items, eigenvalues of the sub-dimensions, and explained variance rates), confirmatory factor analysis (factor loadings and common fit indices), and criterion validity (predictive validity) in the validation phase. In the predictive validity assessment, the distribution of scores on the scale was examined according to some behaviours related to vaccine advocacy. Additionally, we analysed the item-total score correlation, Cronbach's alpha coefficient, and split-half test consistency in the reliability phase.

RESULTS

The study's calculated Kaiser-Meyer-Olkin value was 0.868, and Bartlett's test of sphericity resulted in significant results (X2 = 1724.166; p < 0.001). The explanatory factor analysis revealed that the items' factor loadings were between 0.451 and 0.949 and explained 58.29% of the total variance of the structure, which consisted of 12 items and two sub-dimensions. The confirmatory factor analysis found the factor loadings of the items between 0.62 and 0.85 and identified 'common fit indices' within acceptable ranges and close to the perfect fit values (X2/df, GFI, CFI, RMSEA, RMR, NFI, TLI and IFI were 1.906, 0.950, 0.952, 0.093, 0.059, 0.906, 940 and 0.953, respectively). The Cronbach's alpha value for the scale was 0.92, and the Spearman-Brown coefficient, Guttman's split-half coefficient, and split-half correlation coefficients were 0.843, 0.842 and 0.713, respectively. The study findings indicated that individuals who had talked to other parents about vaccines, recommended vaccinations, and communicated vaccine-related issues with medical professionals had significantly higher total scale scores (p < 0.005).

CONCLUSION

Considering the study findings and evaluations, the Vaccine Advocacy Scale was a valid and reliable measurement tool to assess adults' vaccine advocacy behaviour for childhood vaccines.

Utilisation of patient-centred outcome measures in age-related macular degeneration research and clinical practice: A systematic review

BACKGROUND

To identify the utilisation, type, and psychometric properties of patient-centered outcome measures (PCOMs) associated with the performance-based assessment of visual function (VF) in age-related macular degeneration (AMD) in clinical care and research.

METHODS

A systematic literature search identified studies, available in English, that used PCOMs to assess VF in patients with any AMD severity, published from January 2015 to November 2023. Two researchers screened studies for quality using the Mixed Methods Appraisal Tool (MMAT) 2018 and assessed the psychometric properties of the PCOMs with the guidance of Consensus-based Standards for the selection of health Measurement Instruments (COSMIN).

RESULTS

Of 514 studies shortlisted in the literature, 31 were eligible with the majority (77.4%) fulfilling all the MMAT criteria, indicating good quality. The most used PCOM was reading (14/31 = 45.1%), with 5 of the 14 studies (35.7%) showing that the increasing severity and/or progression of AMD were associated with a worsening reading ability. AMD also negatively affected mobility and physical activity levels (7/31 = 22.6%), and visual search and exploration (4/31 = 12.9%). Based on the COSMIN checklist, apart from reading and physical activity measured with the accelerometer, the other PCOMs had 'inadequate' psychometric properties.

CONCLUSIONS

Limited published studies include PCOMs as an assessment of VF in AMD patients. Apart from reading, there is a lack of robust validation data to support the widespread use of other PCOMs. Hence, well-designed, robustly validated, and simple to use PCOMs are required for more widespread implementation in AMD clinical care and research.

Evaluation of the measurement properties of online health information quality assessment tools: A systematic review

Objectives

This study aimed to evaluate the measurement properties and methodological quality of instruments developed to evaluate the quality of online health information.

Methods

In this study, a systematic search was conducted across a range of databases, including the China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal (VIP), SinoMed, PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, PsycINFO, and Scopus. The search period spanned from the inception of the databases to October 2023. Two researchers independently conducted the literature screening and data extraction. The methodological quality of the included studies was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias checklist. The measurement properties were evaluated using the COSMIN criteria. The modified Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to determine the quality grade.

Results

A total of 18 studies were included, and the measurement properties of 17 scales were assessed. Fifteen scales had content validity, three had structural validity, six had internal consistency, two had test-retest reliability, nine had interrater reliability, one had measurement error, six instruments had criterion validity, and three scales had hypotheses testing for construct validity; however, the evaluation of their methodological quality and measurement properties revealed deficiencies. Of these 17 scales, 15 were assigned a Level B recommendation, and two received a Level C recommendation.

Conclusions

The Health Information Website Evaluation Tool (HIWET) can be temporarily used to evaluate the quality of health information on websites. The Patient Education Materials Assessment Tool (PEMAT) can temporarily assess the quality of video-based health information. However, the effectiveness of both tools needs to be further verified.

Outcome measurement instruments for adult brachial plexus injury: a systematic review of development and measurement properties

PURPOSE

To review candidate outcome measurement instruments (OMIs) for the core outcome set (COS) for brachial plexus injury (BPI) and identify those with the strongest measurement properties.

METHODS

We conducted a PRISMA-compliant systematic review to identify studies on the measurement properties of domain-specific OMIs for adult BPI. OMIs with adequate content validity were further evaluated. Two independent reviewers assessed the methodological quality of each study using the COSMIN Risk of Bias checklist and assessed overall quality using a modified GRADE approach.

RESULTS

Nineteen development/validation studies concerning nine OMIs were identified. The Brachial Assessment Tool (BrAT) and the Impact of Brachial Plexus Injury Questionnaire (IMBPIQ) (both measuring carrying out daily routine) had sufficient content validity to proceed to full evaluation. The BrAT had moderate quality evidence to support its psychometric properties. The IMBPIQ needs further research to evidence structural validity and internal consistency. The Brief Pain Inventory has strong psychometric properties in other populations and is recommended for the core measurement set (CMS) for chronic pain.

CONCLUSIONS

The BrAT and the Brief Pain Inventory are recommended for inclusion in the BPI CMS. Further consensus work is needed to identify the most appropriate OMI for voluntary movement.

Systematic Review Registration: PROSPERO (CRD42022307564).

Cultural adaptation and validation in Italian of the Seated Postural Control Measure for Adults 2.0

OBJECTIVE

The aim of this study was to assess the cultural adaptation and validation in Italian of the Seated Postural Control Measure for Adults 2.0 (SPCMA 2.0).

METHODS

The original scale was translated and culturally adapted from French to Italian using the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice" guidelines. Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair use Confidence Scale and Wheelchair Skills Test 4.2.

RESULTS

Fifty-nine people were evaluated and re-evaluated after 48 h. Most of the items and subscale totals were stable in the 2 evaluations as they reported an intraclass correlation coefficient value of >0.77. The test-retest analysis of the dynamic evaluation was performed on the same patients 48 h apart. The analysis for construct validity showed statistically significant correlations with Wheelchair use Confidence Scale and Wheelchair Skills Test 4.2.

CONCLUSIONS

Seated Postural Control Measure for Adults 2.0 is one of the few tools that allow researchers to perform a quantitative and standardized posture assessment in a cost-effective and time-saving way. Furthermore, it has been demonstrated that it is an easy-to-administer scale and requires readily available tools. The limitations of this study highlighted above and the need to use quantitative and qualitative tools in clinical practice imply the need to conduct future studies.

Reliability and validity of instruments containing reported sleep measures among children from birth to <5 years of age: A systematic review

Valid and reliable sleep measures during the early years are crucial for practitioners and researchers seeking accurate evaluation methods. The authors in this review systematically examined the psychometric properties of instruments containing reported sleep measures in children from birth to <5 years of age. The search was conducted using several electronic databases, including MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL, SPORTDiscus, Scopus and HaPI, with the most recent update on August 30, 2022. The quality of the included studies was assessed using the COSMIN methodology. A total of 79 studies were analyzed. However, none of these measures had undergone a comprehensive evaluation of all psychometric properties. Unfortunately, suitable reported sleep measures for children aged 0-4.99 years could not be identified through this review. Further research is needed to develop and validate psychometrically robust sleep assessment tools for this specific age group.

Tele-patient-reported outcome measures (telePROM) in follow-up of endometriosis: a validity and test-retest reliability study of an endometriosis-specific questionnaire (EQ)

OBJECTIVE

Patient-Reported Outcome (PRO) measures supported by a severity algorithm may serve as a decision aid for triage and consultation in follow-up of patients with endometriosis. In a new follow-up regime, patients filled out an endometriosis-specific questionnaire (EQ) at home before outpatient consultation (tele-Patient-Reported Outcome Measures; telePROM). A severity algorithm was assigned patients' answers using a color code thereby reflecting the need of clinical attention. Our study aimed to assess the test-retest reliability of the severity algorithm and of the single items as well as to evaluate the face- and content validity of the EQ.

METHODS

The study was carried out in a referral endometriosis clinic at a Danish University Hospital. The validation was based on an initial version of the EQ, which was adjusted simultaneously with its severity algorithm, to meet the purpose of this study. Reliability was assessed by a test-retest setting of the questionnaire including patients with endometriosis, ≥ 18 years and Danish speaking. Kappa statistics and interclass correlation analyses were applied to assess test-retest reliability. Face- and content validity was explored by focus group interviewing of patients.

RESULTS

In total, 14 patients answered the questionnaire twice. Results indicate that the EQ demonstrated substantial reliability in three out of five domain indicators in the severity algorithm and 65% of items with kappa values above 0.60. Further, focus-group interview of five patients resulted in adding an open-ended question regarding important issues to discuss at the consultation.

CONCLUSION

TelePROM in outpatient follow-up of endometriosis is feasible as patients viewed the questionnaire relevant for their clinical follow-up. Yet, due to the small sample size results should be interpreted with caution. Further validation of the EQ is recommended.

Psychometric Properties of Self-Reported Financial Toxicity Measures in Cancer Survivors: An Overview of Systematic Reviews

AIM(S)

To assess the methodological quality and psychometric properties of self-reported financial toxicity measures for cancer survivors, to offer evidence-based guidance for the selection of these measures in clinical practice, and to supply methodological references for the enhancement and development of related measures in the future.

DESIGN

An overview of systematic reviews.

METHODS

Four academic databases were searched to conduct an overview of systematic reviews published from inception to August 2024. The Overview Quality Assessment Questionnaire (OQAQ) was employed to evaluate the methodological quality of the research included. The consensus-based standards for the selection of health measurement instruments checklist (COSMIN) and the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) system were employed to assess the methodological and psychometric quality of the financial toxicity measures included.

RESULTS

Six systematic reviews satisfied the inclusion criteria. The OQAQ results indicated that six studies exhibited significant methodological quality defects, each receiving a score of 3 points. COST-v1, COST-v2, HARDS, ENRICh, and FinTox were classified as level A. Ten measures were classified as level B, lacking evidence to support content validity and internal consistency as '+'. Seven measures were classified at level C, supported by high-quality evidence indicating certain domains as '-'.

CONCLUSION

COST is advised as the best appropriate measurement standard for research and clinical practice across many global contexts. HARDS and ENRICh were advised to select only after thoroughly evaluating the local socio-economic context. FinTox is particularly suggested for the assessment of severe FT. SFDQ and FIT are advised for selection following an evaluation of therapy alternatives and the cancer's location.

IMPLICATIONS FOR THE PATIENT CARE

Healthcare professionals can implement evidence-based measures in clinical practice to effectively assess the financial toxicity experienced by cancer survivors, offer policy-oriented interventions, and enhance patient-reported outcomes.

A systematic review of psychometric properties of questionnaires assessing activities of daily living among older adults with neurocognitive disorders

INTRODUCTION

Mild cognitive impairment (MCI) and Alzheimer's disease (AD) lead to decline in performance in activities of daily living (ADLs). Multiple questionnaires assess this construct among older adults. The objective of this study was to review existing literature studying psychometric properties of questionnaires assessing performance in ADLs of older adults living with MCI and AD specifically.

METHODS

A systematic review was conducted across Medline, CINAHL and PsychINFO using a combination of keywords related to ADLs, psychometrics, MCI and AD. Studies were included if they met the following criteria: assessments of performance of ADLs for older adults living with AD or MCI, reporting a minimum of one measurement property (e.g. internal consistency), primary research articles, published before June 2023 in English or French. Data extraction and analysis were conducted by two researchers. The methodological quality of psychometric properties was assessed using the COSMIN checklist.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumer or community involvement occurred.

RESULTS

A total of 2539 articles were screened and filtered down to 50 articles including 24 questionnaires respecting inclusion criteria. Of these questionnaires, the three most validated were the Amsterdam Instrumental activities of daily living, the disability assessment for dementia (DAD), and the Bayer ADL scale. Overall, for these three questionnaires, internal consistency, reliability and structural validity were the most studied psychometric properties while criterion validity and hypothesis testing were the least.

CONCLUSION

This study reveals the Amsterdam IADLs as the most validated questionnaire across psychometric properties and the DAD as the most validated across languages. Considering the increasing prevalence of older adults with MCI or AD, questionnaires established on strong measurement properties are valuable tools to evaluate decline in ADL performance and plan suitable interventions. This review provides evidence for clinicians and researchers for the selection of questionnaires to evaluate this population.

PLAIN LANGUAGE SUMMARY

Cognitive impairment affects memory and thinking. It makes tasks like dressing, bathing and eating harder. Health-care workers use questionnaires to find out where someone struggles. This helps them plan better care. We reviewed questionnaires for older adults with memory and thinking problems. We found good ones that give important information. Using these questionnaires helps health-care workers support people with daily tasks. This study suggests testing the questionnaires more to improve them.

Development of the Observer Scales of the Patient and Observer Scar Assessment Scale: An International Delphi Study

Background

This Delphi study aimed to develop the Observer Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0 for measurements of scar quality in patients with all types of scars. The POSAS 3.0 Patient Scale has been developed using an extensive qualitative study, which has been published separately.

Methods

An online, 3-round Delphi study was performed with 124 international scar experts from 23 countries spanning 7 continents. Panelists rated their (dis)agreement with proposals regarding the wording and relevance of scar characteristics on a 5-point scale ("strongly disagree" to "strongly agree"), and provided arguments for their decisions. Consensus was reached if ≥67% of the panelists agreed or strongly agreed to a proposal.

Results

Consensus was reached on the inclusion of 9 items. Two versions of the Observer Scale of the POSAS 3.0 have been developed, 1 generic version including 7 items, and 1 linear scar version, containing the same 7 items and 2 additional scar-specific items.

Conclusions

This is the first study using the Delphi process to develop an instrument for the assessment of scars. Panelists from all over the world reached a consensus on the content of 2 versions of the Observer Scale, the generic version and the linear scar version. By involving the potential end-user community of the new POSAS version in its development, we expect the developed instrument to have high content validity. For a comprehensive scar assessment, the Observer Scale should be used in combination with the Patient Scales of the POSAS 3.0.

Measurement properties of the Trunk Impairment Scale-modified Norwegian version among people with mild to moderate multiple sclerosis

PURPOSE

The Trunk Impairment Scale-modified Norwegian version (TIS-modNV) measures trunk control for clinical and research purposes. This study examined the validity and reliability of the TIS-modNV in people with multiple sclerosis (pwMS).

MATERIALS AND METHODS

Sixty-eight pwMS (mild to moderate) participated. The TIS-modNV and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scores were compared for construct validity using Spearman's rho (rs). TIS-modNV performance was videotaped and rated by four physiotherapists on two occasions. The inter- and intrarater reliability was analyzed via intraclass correlation coefficients (ICC), standard errors of measurement (SEM), Bland-Altman plots, and kappa statistics (k).

RESULTS

Validity was demonstrated (rs = 0.55-0.61). Interrater reliability for the total score was moderate to good (ICC(A,1) =0.67; ICC(C,1) = 0.78), and the SEM was 2 points (12.8%). Interrater reliability varied across the rater pairs (ICC(A,1) = 0.54-0.81) as displayed in the Bland-Altman plots. Item-level interrater agreement varied from poor to good (k = 0.10-0.79). Intrarater reliability of the total scores was moderate to good (ICC(A,1) = 0.67-0.82).

CONCLUSION

This study supports the construct validity and overall reliability of the TIS-modNV in pwMS with mild to moderate disability. However, variations in rater reliability need to be addressed.

Psychological, psychiatric, and behavioral sciences measurement scales: best practice guidelines for their development and validation

Psychiatric, psychological, and behavioral sciences scales provide quantitative representations of phenomena such as emotions, beliefs, functioning, and social role perceptions. Methodologists and researchers have criticized current scale development practices, emphasizing that inaccurate measurements can derail theory development and clinical decisions, thereby impeding progress in mental health research and practice. These shortcomings often stem from a lack of understanding of appropriate scale development techniques. This article presents a guide to scope, organize, and clarify the process of scale development and validation for psychological and psychiatric use by integrating current methodological literature with the authors' real-world experience. The process is divided into five phases comprising 18 steps. In the Preliminary Phase, the need for a new scale is assessed, including a review of existing measures. In the Item Development Phase, the construct is defined, and an initial pool of items is generated, incorporating literature reviews, expert feedback, and target population evaluation to ensure item relevance and clarity. During the Scale Construction Phase, the scale is finalized through the administration of surveys to a large sample, followed by parallel analysis, exploratory factor, and item descriptive statistics to identify functional items. In the Scale Evaluation Phase, the dimensionality, reliability, and validity of the scale are rigorously tested using both classical and modern psychometric techniques. Finally, in the Finalization Phase, the optimal item sequence is decided, and a comprehensive inventory manual is prepared. In sum, this structured approach provides researchers and clinicians with a comprehensive methodology for developing reliable, valid, and user-friendly psychological, psychiatric, and behavioral sciences measurement scales.

Measurement properties of the Traumatic Brain Injury Quality of Life (TBI-QoL) and Spinal Cord Injury Quality of Life (SCI-QoL) measurement systems: a systematic review

PURPOSE

Traumatic brain injury and spinal cord injury impact all areas of individuals' quality of life. A synthesis of available evidence for the Traumatic Brain Injury Quality of Life (TBI-QoL) and Spinal Cord Injury Quality of Life (SCI-QoL) measurement systems could inform evidence-based clinical practice and research. Thus, we aimed to systematically review the literature of existing evidence on the measurement properties of SCI-QoL and TBI-QoL among rehabilitation populations.

METHODS

We used the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) framework for evaluating measures to guide this systematic review. We searched nine electronic databases and registries, and hand-searched reference lists of included articles. Two independent reviewers screened selected articles and extracted the data. We used COSMIN's thresholds to synthesize measurement properties evidence (insufficient, sufficient), and the modified GRADE approach to synthesize evidence quality (very-low, low, moderate, high).

RESULTS

We included 16 studies for SCI-QoL and 14 studies for TBI-QoL. Both measurement systems have sufficient content validity, structural validity, internal consistency and construct validity across nearly all domains (GRADE: high). Most SCI-QoL domains and some TBI-QoL domains have sufficient evidence of cross-cultural validity and test-retest reliability (GRADE: moderate-high). Besides the cognition domains of TBI-QoL, which have indeterminate evidence for measurement error and sufficient evidence for responsiveness (GRADE: high), there is no additional evidence available for these measurement properties.

CONCLUSION

Rehabilitation researchers and clinicians can use SCI-QoL and TBI-QoL to describe and evaluate patients. Further evidence of measurement error, responsiveness, and predictive validity would advance the use and interpretation of SCI-QoL and TBI-QoL in rehabilitation.

Measurement properties of the Inclusion Body Myositis Functional Rating Scale

OBJECTIVES

To evaluate the validity, reliability, responsiveness and meaningful change threshold of the Inclusion Body Myositis (IBM) Functional Rating Scale (FRS).

METHODS

Data from a large 20-month multicentre, randomised, double-blind, placebo-controlled trial in IBM were used. Convergent validity was tested using Spearman correlation with other health outcomes. Discriminant (known groups) validity was assessed using standardised effect sizes (SES). Internal consistency was tested using Cronbach's alpha. Intrarater reliability in stable patients and equivalence of face-to-face and telephone administration were tested using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Responsiveness was assessed using standardised response mean (SRM). A receiver operator characteristic (ROC) curve anchor-based approach was used to determine clinically meaningful IBMFRS change.

RESULTS

Among the 150 patients, mean (SD) IBMFRS total score was 27.4 (4.6). Convergent validity was supported by medium to large correlations (rs modulus: 0.42-0.79) and discriminant validity by moderate to large group differences (SES=0.51-1.59). Internal consistency was adequate (overall Cronbach's alpha: 0.79). Test-retest reliability (ICCs=0.84-0.87) and reliability of telephone versus face-to-face administration (ICCs=0.93-0.95) were excellent, with Bland-Altman plots showing good agreement. Responsiveness in the worsened group defined by various external constructs was large at both 12 (SRM=-0.76 to -1.49) and 20 months (SRM=-1.12 to -1.57). In ROC curve analysis, a drop in at least two IBMFRS total score points was shown to represent a meaningful decline.

CONCLUSIONS

When administered by trained raters, the IBMFRS is a reliable, valid and responsive tool that can be used to evaluate the impact of IBM and its treatment on physical function, with a 2-point reduction representing meaningful decline.

TRIAL REGISTRATION NUMBER

NCT02753530.

Validity and Reliability of the Hungarian Version of the Pain Self-Efficacy Questionnaire Among Women with Endometriosis and Chronic Pelvic Pain

Background

Our study aimed to perform Hungarian cross-cultural adaptation and assess the reliability and validity of the Pain Self-Efficacy Questionnaire (PSEQ) in women diagnosed with endometriosis and chronic pelvic pain.

Methods

The current study was conducted in Hungary among women aged 18-50 (34.39 ± 6.68 years). We examined the reliability of the Hungarian version of PSEQ (PSEQ-HU) by applying internal consistency and test-retest evaluations. Confirmatory factor analysis was used to determine the construct validity of the PSEQ-HU, while Spearman's rank correlation coefficient established the convergent validity using the 36-Item Short-Form Health Survey, numeric rating scale (NRS), Pain Catastrophizing Scale, and Perceived Stress Scale. To determine discriminant validity, two groups were created based on NRS (0-4 no or mild pain, 5-10 moderate or strong pain). The results were analyzed using IBM SPSS version 28.0 software with a significance level of p ≤0.05.

Results

A total of 262 women participated in this study. The Cronbach's α was 0.97, and the intraclass correlation coefficient (ICC) values showed adequate reliability (ICC = 0.94. 95% confidence interval 0.88-0.97) for the PSEQ-HU. Based on the Spearman's correlation coefficients the convergent validity showed significant results (r = 0.22-0.63; p ≤0.001).

Conclusion

We concluded that the PSEQ is a reliable and valid measurement among Hungarian women with endometriosis-related pelvic pain.

A framework for the continuous monitoring of person-centred hospital care: validation of a checklist for participatory service improvement

BACKGROUND

In 2018, a nationwide survey carried out in 387 acute care hospitals from 16 out of 21 Italian regions, allowed defining an extended checklist for the participatory evaluation of person-centredness in hospital care. We aimed to validate a reduced set of core items for continuous use across the country.

METHODS

Factor analysis was used to validate the construct of the checklist. Varimax rotation with eigenvalues > 1 was used to optimize factor structure. Items with an item-total correlation > 0.30 and factor loadings > 0.4 were attributed to individual factors. Items with inter-item correlation coefficient > 0.70 were submitted to expert opinion for final decision. Overall internal consistency was assessed through Cronbach's alpha.

RESULTS

A total of 183 out of 243 items in the original checklist were submitted to factor analysis. A subgroup of 67 items was retained in 4 main areas, allocated as follows: 16 items in 4 sub-areas of "Person-oriented organizational and care processes", 16 items in 4 sub-areas of "Physical accessibility, liveability and comfort of the facilities", 15 items in 3 sub-areas of "Access to information, streamlining and transparency", and 20 items in 4 sub-areas of "Taking care of the relationship with patients and citizens". Overall values of Cronbach's alpha ranged between 0.77 and 0.90, showing high consistency.

CONCLUSIONS

This study validated a "core" checklist that can be routinely used to monitor the implementation of person-centred care in Italian hospitals. The tool can be applied more widely by multiple stakeholders as a measurement instrument for the participatory evaluation of person-centredness.

Psychometric evaluation of patient-reported experience measures for peri-anesthesia care: A systematic review based on COSMIN guidelines

BACKGROUND

Patient Reported Experience Measures (PREM) have become a critical component in assessing healthcare quality from the patient's perspective. Accurate and reproducible assessment tools are essential for generating robust and reliable results for evaluating peri-anesthesia patient experiences, identifying associated factors, and assessing the impact of healthcare interventions. However, there is currently no systematic review that consolidates all existing peri-anesthesia PREMs and evaluates their psychometric properties.

OBJECTIVE

To identify and assess the psychometric properties of PREMs for peri-anesthesia patients.

DESIGN

Systematic review of measurement properties following the COSMIN guidelines.

METHODS

Systematic searches were conducted in China National Knowledge Infrastructure, Wanfang, PubMed, Embase, Web of Science, CINAHL, and PsycINFO databases from January 1, 1993, to April 15, 2024. Studies reporting on the development and/or validation of any PREMs for use in the peri-anesthesia period were considered eligible. The measurement properties extracted included data on the item development process, content validity, structural validity, internal consistency, cross-cultural validity, reliability, hypothesis testing and responsiveness. For the same PREM across different studies, reliability coefficients were analyzed using a meta-analysis. The quality assessment, rating of measurement properties, synthesis, and modified grading of the evidence were carried out following the COSMIN methodology for systematic reviews.

RESULTS

A total of 26 studies encompassing 16 PREMs were included. Among them, the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq), Perception of Quality in Anesthesia (PQA), Sindhvananda General Anesthesia Satisfaction questionnaire, and Daycare Anesthesia Satisfaction (DAS) demonstrated moderate to high-quality evidence of adequate content validity and internal consistency, resulting in strong recommendations. Five PREMs exhibited high-quality evidence of inadequate structural validity and internal consistency, receiving a "not recommended" status. The remaining PREMs were weakly recommended.

CONCLUSIONS

This systematic review identified PSPACq and PQA as effective tools for assessing peri-anesthesia experiences in surgical patients, suitable for both research and clinical use. Future studies should focus on thoroughly evaluating the measurement properties of these two PREMs, as many aspects remain underexplored. A high risk of bias was noted in other PREMs, particularly in content validity, structural validity, and reliability, which increases uncertainty in the evidence base.

REGISTRATION

This study's protocol has been registered at PROSPERO under the registration number CRD42024537900.

The Eczema Area and Severity Index: An update of progress and challenges in its measurement of atopic dermatitis after 20 years of use

The Eczema Area and Severity Index is an investigator-assessed instrument reporting clinical signs of atopic dermatitis. The instrument is extensively validated in both adult and paediatric populations and recommended as a core outcome measure to assess clinical signs by the Harmonising Outcome Measures for Eczema initiative in clinical trials and was recently recommended as an option to measure signs in clinical practice. Here, we review the validation of the instrument using standard assessment criteria, explore controversies and challenges to its universal applicability and highlight future electronic adaptations. We find that the instrument demonstrates adequate performance in the measurement properties recommended by the COnsensus-based Standards for the selection of health Measurement INstruments initiative for instruments reporting clinical signs, is clinically interpretable, and is suitable for all atopic dermatitis severities. Some validation gaps remain. Information reporting on its performance in diverse populations, with emphasis on deeply pigmented skin, is promising though limited. Technological adaptations are demonstrating promising initial validation results and may facilitate remote and/or automated assessments assisting clinical care and decentralized clinical trials in the future. We find no strong evidence limiting its use in trials or clinical practice although questions pertaining to the effect of investigator training remain. We recommend that the Eczema Area and Severity Index be used in all interventional atopic dermatitis trials and be considered alongside other recommended clinical practice severity instruments.

Development of ICF-based patient-reported outcome and experience measures to study social participation among people with chronic diseases: a mixed-methods protocol

INTRODUCTION

Living with a chronic disease impacts many aspects of life, including the ability to participate in activities that enable interactions with others in society, that is, social participation (SP). Despite efforts to monitor the quality of care and life of chronically ill people in Belgium, no disease-specific patient-reported measures (PRMs) have been used. These tools are essential to understand SP and to develop evidence-based recommendations to support its improvement. This protocol presents the phases for the disease-specific development of patient-reported outcome and experience measures to assess SP and its potential determinants among people living in Belgium with cancer, cystic fibrosis, diabetes, HIV or a neuromuscular disease.

METHODS AND ANALYSIS

This protocol applies the PROMIS Instrument Development and Validation Scientific Standards and COnsensus-based Standards for the selection of health Measurement INstruments to develop PRMs in a disease-specific manner to quantify the components of the International Classification of Functioning, Disability and Health (ICF). A mixed-method approach is used to create broad initial item pools based on patient (focus groups) and literature perspectives which are compared within ICF-standardised language by applying the refined ICF linking rules. An item set is first created based on this cross-matching exercise and then validated by multidisciplinary expert panels. Cognitive assessment and pilot testing are followed by the dissemination of the survey to a representative sample in Belgium. Advanced psychometric testing (classical test theory and item response theory) is applied to inform an item reduction strategy for the final measures and to develop scales for the ICF components.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethics Committee of the Ghent University Hospital on 20 February 2023 to organise the patient focus groups (ONZ-2022-0470). Ethical approval for dissemination of the PRMs and psychometric testing will be sought at the Ghent University Hospital Ethics Committee at the start of Phase 6. Results will be disseminated through peer-reviewed journals and professional conferences.

Evaluation of the Psychometric Properties of the Musculoskeletal Health Questionnaire (MSK-HQ) in a Population of Kitesurfers: A Cross-Sectional Study

Background and Objectives: Musculoskeletal disorders affect a large portion of the population worldwide. The Musculoskeletal Health Questionnaire (MSK-HQ) is a helpful tool for assessing the health state of patients with these disorders. The primary goal of this study is to evaluate the psychometric properties of the MSK-HQ-IT in a population of kitesurfers. Materials and Methods: The study was conducted from September 2023 to July 2024. The questionnaire was completed using an online or paper form. Data were collected by submitting both the Italian and English versions of the MSK-HQ to a global sample of kitesurfers from various countries. Results: A total of 102 participants were recruited, consisting of 40 professionals and 62 non-professional kitesurfers. Cervical spine discomfort was significantly more prevalent among professionals (42.5%) compared to non-professionals (24%), as well as right shoulder pain (37.5% vs. 22.5%) and right wrist pain (12.5% vs. 3.2%). Non-professionals exhibited a significantly higher prevalence of functional limitations in the lumbar spine (25.8% vs. 5%) and reported more thoracic pain (21% vs. 17.5%). These findings indicate differing biomechanical stress patterns between the two groups, with professionals showing higher upper limb strain and non-professionals experiencing more lower back issues due to harness reliance. Conclusions: The MSK-HQ proved to be a reliable and valid tool for assessing musculoskeletal health in kitesurfers. The study highlights distinct injury patterns between professionals and non-professionals, with professionals being more prone to upper limb injuries and non-professionals showing a higher prevalence of lumbar and thoracic spine issues. These findings emphasize the need for targeted injury prevention strategies. Further research should focus on expanding the sample size and investigating long-term impacts of repetitive high-impact landings on musculoskeletal health in kitesurfers.

Psychometrics of Wearable Devices Measuring Physical Activity in Ambulant Children With Gait Abnormalities: A Systematic Review and Meta-analysis

Objective

To evaluate psychometrics of wearable devices measuring physical activity (PA) in ambulant children with gait abnormalities due to neuromuscular conditions.

Data Sources

We searched PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus in March 2023.

Study Selection

We included studies if (1) participants were ambulatory children (2-19y) with gait abnormalities, (2) reliability and validity were analyzed, and (3) peer-reviewed studies in the English language and full-text were available. We excluded studies of children with primarily visual conditions, behavioral diagnoses, or primarily cognitive disability. We performed independent screening and inclusion, data extraction, assessment of the data, and grading of results with 2 researchers.

Data Extraction

Our report follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed methodological quality with Consensus-based Standards for the selection of health measurement instruments. We extracted data on reported reliability, measurement error, and validity. We performed meta-analyses for reliability and validity coefficient values.

Data Synthesis

Of 6911 studies, we included 26 with 1064 participants for meta-analysis. Results showed that wearables measuring PA in children with abnormal gait have high to very high reliability (intraclass correlation coefficient [ICC]+, test-retest reliability=0.81; 95% confidence interval [CI], 0.74-0.89; I 2=88.57%; ICC+, interdevice reliability=0.99; 95% CI, 0.98-0.99; I 2=71.01%) and moderate to high validity in a standardized setting (r +, construct validity=0.63; 95% CI, 0.36-0.89; I 2=99.97%; r +, criterion validity=0.68; 95% CI, 0.57-0.79; I 2=98.70%; r +, criterion validity cutoff point based=0.69; 95% CI, 0.58-0.80; I 2=87.02%). The methodological quality of all studies included in the meta-analysis was moderate.

Conclusions

There was high to very high reliability and moderate to high validity for wearables measuring PA in children with abnormal gait, primarily due to neurological conditions. Clinicians should be aware that several moderating factors can influence an assessment.

Measurement properties of the German version of the Cambridge examination for mental disorders of older people with Down syndrome and others with intellectual disabilities (CAMDEX-DS)

BACKGROUND

The CAMDEX-DS is an instrument to diagnose Alzheimer's disease (AD) in Down syndrome consisting of an informant interview and a cognitive test battery (CAMCOG-DS). Measurement properties of the German CAMDEX-DS were investigated.

METHOD

Fifty-five adults with Down syndrome (19-58 years) participated in this observational study. "Dementia" and "Alzheimer's dementia" (Alzheimer's disease) were diagnosed clinically and operationalised CAMDEX-ICD-10 criteria were applied to evaluate criterion validity. Validity and reliability of the CAMCOG-DS were analysed.

RESULTS

Specificity of the interview was 69-93%; sensitivity 0-80% for "dementia"; and 0-20% for Alzheimer's disease. A complete CAMCOG-DS score was obtained in 85% (item difficulty 0.11-0.96). Construct validity and retest-reliability were low to moderate (τ = .04-.79), inter-rater reliability excellent (τ = .70-.89), internal consistency and selectivity acceptable to excellent.

CONCLUSIONS

Currently, the CAMDEX-DS including the CAMCOG-DS are the outcome assessments for assessing dementia in Down syndrome with the best psychometric properties; however, revision is recommended.

Measurement of Psychological Resilience to Support Therapy Interventions for Clients in the Clinical Mental Healthcare Setting: A Scoping Review

Waves of psychological research over 50 years have resulted in the development of scales to measure psychological resilience. Multiple psychological resilience definitions and factors have emerged during this time, making its measurement complex. The overall aim of the review was to identify and describe developments in the measurement of psychological resilience in the clinical mental healthcare setting. Specific objectives included (1) consideration of the validity and reliability of psychological resilience scales, (2) the effectiveness of the scales in clinical mental healthcare settings and (3) to identify the scope that resilience factors are addressed in the included scales. It provides a timely update regarding psychological resilience measurement tools and considers further developments that may be required. Between 2011 and 2024, databases were searched, and English-language, peer-reviewed papers with full text were extracted. Eligible studies were those reporting validated existing resilience measures or the outcomes of new measures for use in clinical mental healthcare settings. Seventeen studies met the inclusion criteria. The review demonstrated that psychological resilience measures require further development, particularly focusing on the utility of measurement tools in clinical mental healthcare settings. In this review, we highlight an existing gap in resilience measurement and underscore the need for a new measure of psychological resilience that can effectively assess individuals' subjective experience of their psychological resilience in clinical mental healthcare settings. The currently available psychological resilience measures included in this review do not directly reflect all the factors that might impact a client's depression or anxiety and warrant further research.

Psychometric properties and clinical utility of spinal health outcome measures in school-based interventions among children and adolescents: a systematic review protocol

INTRODUCTION

Spinal health in children and adolescents has global implications, impacting school attendance, academic performance and physical activity. Effective school-based interventions are essential for promoting spinal health literacy, positive behaviours and academic success.

OBJECTIVES

This review aims to collect data on school-based interventions for spinal health in children and adolescents over the past two decades. It will examine interventions such as education, exercise and appropriate furniture, focusing on outcomes including musculoskeletal pain, posture, sedentary behaviour and academic performance. Additionally, the review will describe the psychometric properties and clinical utility of the outcome measures used in these studies.

METHODS AND ANALYSIS

The systematic review will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, employing the PICO framework to define criteria for participants, interventions, comparisons, outcomes and study designs. Only English studies published between 2004 and 2024 will be included. Relevant databases will be searched using specific keywords derived from the PICO framework. The Critical Appraisal Tool and the COSMIN Risk of Bias tool will be used to evaluate the methodological quality and risk of bias in the selected studies. Review authors will independently assess articles, resolving discrepancies through consensus. Statistical analyses will be performed using CADIMA V.2.2.4.2 April 2023.

RESULTS

Data will be collected based on various outcome measures, evaluated with an approved checklist and presented through descriptive narratives and tables. Findings will be disseminated via conference presentations, Faculty Research Day and publication in reputable journals.

ETHICS AND DISSEMINATION

The study will adhere to the ethical principles outlined in the Declaration of Helsinki, ensuring a rigorous approach to minimise bias and guarantee valid results. Studies will be selected based on predetermined criteria following a consistent protocol. The findings will be disseminated through presentations and publication in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

The systematic review protocol is registered on PROSPERO (registration number CRD42024543258), with a planned date of commencement from August 2024 to November 2024.