Body Dysmorphic Disorder Questionnaire: Arabic Adaptation and Validation in Dermatology Population

BackgroundThe BRAF-MDQ1,2 and RAID3 are patient-reported outcome measures derived from the patient perspective. The 20 item BRAF-MDQ has 4 factors (physical, cognitive, emotional fatigue, living with fatigue) and the 7...

BackgroundThe 20-item BRAF-MDQ was developed in the UK to measure RA fatigue, with a total score and 4 distinct subscales reflecting different fatigue concepts; there are 35 translations. If the...

The Knee Injury Osteoarthritis Outcome Score (KOOS) is a widely used joint-specific measure employed to evaluate pain, symptoms, activities of daily living, recreational activities, and quality of life in patients with knee osteoarthritis (OA). Although the original KOOS has been translated into many languages, a Saudi Arabic version is not available. This study aimed to culturally adapt and evaluate the psychometric properties of the Saudi Arabic version of the KOOS in patients with knee OA. The original KOOS was translated and adapted into Saudi Arabic version over six stages according to the guidelines suggested by Beaton and recommended by the American Association of Orthopedic Surgeons Outcome Committee. Patients diagnosed with knee OA (n = 136) were recruited to examine the psychometric properties, such as internal consistency that was tested using Cronbach's alpha, test-retest reliability that was analyzed using the intra-class correlation coefficient (ICC2,1), and construct validity that examined by testing the correlations between the new version subscales, Form 36 Health Survey subscales, and the Visual Analog Scale, Spearman's correlation coefficient (rs) was used to measure the correlations. A total of 122 (89.7%) of the 136 participants with knee OA completed the second re-test of new Saudi Arabic version. Excellent internal consistency (Cronbach's alpha = 0.87-0.92) was detected in the subscales of the adapted version, as well as excellent test-retest reliability (ICC2,1 = 0.92-0.94). The pattern of correlation between the subscales of the Saudi Arabic version of the KOOS, SF-36 domains and the Visual Analog Scale for pain supported the construct validity of the adapted version. The Saudi Arabic version of the KOOS was well accepted and exhibited excellent reliability, internal consistency, and construct validity in Saudi patients with knee OA.

Body Dysmorphic Disorder (BDD) is a psychiatric condition characterized by an excessive preoccupation with perceived flaws in physical appearance, often resulting in significant emotional distress and impaired functioning. Although social influences are believed to contribute to the development of BDD, their specific impact remains underexplored, especially among males in the Middle East. This study aims to investigate the relationship between BDD symptoms and social factors, with a particular emphasis on the role of social media among adult males in the United Arab Emirates (UAE). A cross-sectional survey was conducted among men using a self-administered 30-item questionnaire. The instrument covered demographics, the Body Dysmorphic Disorder Questionnaire (BDDQ), body image and cosmetic surgery attitudes, social media use, and exercise behaviors. The questionnaire was translated using a forward-backward translation technique and reviewed for clarity and cultural appropriateness in accordance with WHO guidelines. Bivariate analyses were conducted to explore associations between variables. Chi-square and Fisher's exact tests were used for categorical variables, and t-tests for continuous variables, with statistical significance set at p < 0.05. Of the 403 participants, 53 (13.2%) met the BDDQ cutoff criteria, and 15 (3.7%) screened positive for BDD (excluding weight-related concerns). A significant association was found between BDD screening positivity and perceived negative impact of social media (χ²(2) = 19.92, p <.001). Similarly, perceived cultural pressure to attain an ideal appearance was significantly associated with higher BDDQ positivity. Participants who screened positive for BDD were significantly more likely to report physical discomfort (OR = 4.9, 95% CI: [1.5, 15.8], p = 0.005), concern about others' perceptions of their bodies (OR = 3.9, 95% CI: [1.2, 12.3], p = 0.017), and interest in cosmetic surgery (OR = 5.8, 95% CI: [2.0, 16.4], p = 0.002). Multivariate analysis showed that perceived negative social media impact, specific cosmetic concerns, and lower BMI were independent predictors of BDD. This study highlights the significant role of social media, cultural appearance pressures, and attitudes toward cosmetic surgery in the manifestation of BDD symptoms among males in the UAE. Culturally sensitive public health initiatives should focus on promoting healthy body image and increasing awareness of BDD.

ObjectivesTo examine the validity and reliability of the Dutch language short Anterior Cruciate Ligament—Return to Sport after Injury scale (short ACL-RSI-NL) in recreational athletes undergoing rehabilitation after ACL injury or ACL reconstruction (ACLR). MethodsThe original 12-item version of the ACL-RSI had been translated into Dutch. Short ACL-RSI-NL items were derived from this 12-item Dutch version. Content validity was evaluated by a team consisting of eight ACL experts and eight athletes. A cohort of 115 athletes with ACL injury or after ACLR completed the short ACL-RSI-NL and related questionnaires at various time points during their rehabilitation. Construct validity (hypothesis testing using Spearman correlations), internal consistency (Cronbach's alpha), floor and ceiling effects (percentage of athletes having the lowest or highest score possible), and structural validity (exploratory factor analysis) were evaluated in the entire ACL athlete group. Test-retest reliability (using intra-class correlation, ICC; standard error of measurement, SEM; smallest detectable change, SDC, at both group and individual levels) was investigated in a subgroup of athletes with a stable outcome on psychological readiness within a two-week interval (n ​= ​27). ResultsThe short ACL-RSI-NL demonstrated good construct validity (83% of hypotheses confirmed). Internal consistency was excellent (Cronbach's alpha 0.84), and there were no floor and ceiling effects (≤13.9% lowest or highest score). Test-retest reliability was good (ICC 0.89 with 95% CI 0.77–0.95, SEM 6.93, SDC individual level 19.2, SDC group level 3.7). Exploratory factor analysis confirmed the presence of a single underlying factor (accounting for 56.4% of the total variance of the score). ConclusionThe short ACL-RSI-NL exhibited good to excellent construct validity, internal consistency, and test-retest reliability. An averaged score ranging from 0 to 100 can be used to measure psychological readiness to return to sport. The short ACL-RSI-NL has potential for use in day-to-day practice to assess the psychological readiness of recreational athletes to return to sport after ACL injury or ACLR during their rehabilitation process. Level of evidenceLevel II.

The aim of this review is to critically appraise and summarize the quality of the measurement properties of all versions of the Stroke Specific Quality of Life Scale (SS-QOL) version 2.0. The Stroke Specific Quality of Life Scale version 2.0 was developed as a comprehensive measure in assessing the quality of life of stroke survivors. The shortened version and cross-culturally translated versions are further developed in different countries. A systematic review will clarify the levels of reliability and validity of all versions. The population of interest for this review will include adult stroke survivors of either sex diagnosed with a stroke (ischemic or hemorrhagic) who have no other comorbidities affecting their quality of life. The SS-QOL version 2.0 will be the specific instrument of interest, and the quality of life of stroke survivors will be the construct of interest in this review. The measures of reliability, validity, and responsiveness will be assessed as outcomes. Only the studies evaluating the reliability, validity, and responsiveness of all versions of the SS-QOL 2.0 will be included in the review. A literature search will be conducted for published studies in MEDLINE and Embase, and unpublished data in Google Scholar and ProQuest Dissertations and Theses. After a three-step search strategy, study selection will be done by two reviewers independently. Then, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology will be applied for assessment of methodological quality, data extraction, and synthesis. PROSPERO CRD42020211727.

BackgroundTo assess the 10-item Spine Functional Index (SFI-10) clinimetric properties in a general musculoskeletal disorder (MSD) spine population. Ascertain the psychometric characteristics’ consistency with the developmental study findings for structural and criterion validity, internal consistency, and floor/ceiling effect; establish the longitudinal characteristics for test–retest reliability, responsiveness, construct validity, and error scores; and clarify practical characteristics of readability, missing responses, and time/errors for completion/scoring related to administrative burden.MethodsA longitudinal study of deidentified spine MSD patients (n = 1317, 53.4% female, age = 18-91yrs, av = 49.5 ± 16.4yrs; neck = 36.5%, mid-back = 8.4%, low back = 56.0%, multi-site = 0.3%) who completed the SFI-10, the Patient Specific Functional Scale (PSFS), and Numerical Rating Scales for Global-function (G-NRS) and Pain (P-NRS). Structural validity used factor analysis, exploratory (EFA) and confirmatory (CFA), plus Rasch analysis. Criterion validity used Spearman's correlation coefficient (r) between the SFI-10 and criteria (PSFS, G-NRS and P-PRS) scores, and construct validity (n = 91, known-groups independent t-test). Internal consistency used Cronbach's alpha (α) and floor/ceiling effects were determined. Subgroups determined reliability (n = 104, intraclass correlation coefficient, ICC2.1); error (n = 171) through the standard error of measurement (SEM) and minimum detectable change (MDC90). Responsiveness (n = 171) was calculated using effect-size (ES), standard response mean (SRM), and area under the curve (AUC); and interpretability through the minimal clinically important difference (MCID). Practicality (n = 16) clarified missing responses, readability, and time/errors for completion/scoring.ResultsThe SFI-10’s structural validity was unequivocally one-dimensional from EFA and verified by CFA with acceptable fit-indices (chi-square/df = 2.88, CFI = 0.981, TLI = 0.975, RMSEA = 0.061), and supported by Rasch analysis (PSR = 0.79, Infit = 0.678–1.216, Outfit = 0.604–1.279, Item-difficulties = -1,215–2.488). Criterion validity varied from high (G-NRS, r = 0.60) and moderate (PSFS, r = 0.43) to low-inverse (P-NRS, r = -0.24). Internal consistency was strong (α = 0.84) and no floor/ceiling effects were present. Reliability was excellent (ICC2.1 = 0.97), responsiveness substantial (ES = 1.54; SRM = 1.64; AUC = 0.89), and measurement error robust (SEM = 3.84; MDC90 = 8.98%, MDIC = 10.4%), with construct validity confirmed (p < 0.001). Practicality showed no missing responses, completion/scoring errors < 1%, excellent readability (Grade = 5.1, Ease = 74.1%), short completion (39.2 ± 10.3 s) and scoring times (8.5 ± 1.8 s).ConclusionsThe SFI-10 demonstrates sound measurement properties in a general physiotherapy outpatient MSD spine population for both psychometric and practical characteristics. Further investigation in culturally diverse settings that include both inpatients and community settings with whole-spine and regional-spine criteria is required.

Introduction: Body Dysmorphic Disorder (BDD) is a psychiatric condition, with the primary symptom being an impairing preoccupation with a non-existent or slight defect in appearance, leading to seeking multiple cosmetic procedures. It is often difficult to diagnose, causing a lot of suffering, and is more prevalent in dermatology patients. There are few reports on the prevalence of BDD in the Indian population. Objectives: To determine the prevalence of BDD among patients seeking cosmetic dermatologic procedures, to analyse the relationship between dermatological and sociodemographic variables and possible cases of BDD, and to provide data on the phenomenology of compulsive behaviours associated with BDD. Materials and Methods: A total of 150 patients seeking cosmetic procedures in Shimoga Institute of Medical Sciences, Shivamogga were included in the study. Body Dysmorphic Disorder Questionnaire- Dermatology Version was used to screen the possible cases of BDD. Results: In our sample, we obtained a prevalence for BDD of 11.3% (95% CI: 6.05% -16.61%). The median age in the BDD group was 28 (26,33) which was slightly lower compared to the non-BDD group. 70.6% of BDD patients were females. 76.5% of BDD patients had a history of previous treatments. This was high compared to non BDD group and is statistically significant. 47.1% of BDD patients had facial pigmentation as their primary concern. The most frequent compulsive behaviour in BDD patients was in comparison with others (47.1%). Conclusion: BDD is relatively common in a dermatologic setting, especially among patients seeking cosmetic treatments. Dermatologists should be aware of its clinical characteristic of BDD to avoid unnecessary procedures and refer these patients to mental health professionals.

Current patient-reported outcome measures of fatigue in rheumatoid arthritis (RA) have limitations, providing only a global perspective. This study constructed a questionnaire (the Bristol RA Fatigue Multi-Dimensional Questionnaire [BRAF-MDQ]) from 45 preliminary questions derived from analysis of patient interviews and surveys and explored its structure for fatigue dimensions. The BRAF-MDQ and short BRAF numerical rating scales (NRS) and visual analog scales (VAS) for severity, effect, and ability to cope with fatigue were evaluated for validity. Two hundred twenty-nine RA patients with fatigue (VAS score ≥5 of 10) completed preliminary BRAF and comparator fatigue scales. Iterative analyses informed item removal or retention in the BRAF-MDQ and identification of subscales (using Cronbach's alpha for internal consistency and factor analysis to identify dimensions). The BRAF-MDQ and short scales were tested in relation to potentially associated variables for criterion and construct validity (Spearman's correlation). The 20-item BRAF-MDQ had good internal consistency (Cronbach's α = 0.932), criterion validity (correlation with other fatigue scales: r = 0.643-0.813), and construct validity (correlations with disability, mood, helplessness, and pain: r = 0.340-0.627). Factor analysis showed 4 distinct dimensions (physical fatigue, living with fatigue, cognition fatigue, and emotional fatigue), which correlated well with the RA Multidimensional Assessment of Fatigue scale (r = 0.548-0.834). The BRAF VAS and NRS showed similar criterion and construct validity. The BRAF instruments include standardized NRS and VAS for fatigue severity, effect, and coping, are RA specific, and have evidence to support validity. The BRAF-MDQ uniquely measures 4 separate dimensions, which may facilitate development of individually-tailored fatigue management programs.

Evaluation of maladaptive beliefs in patients with migraine: measurement properties for three versions (TSK-11, TSK-13, and TSK-17) of the Tampa Scale for Kinesiophobia

Evaluation of the PROMIS Upper Extremity Against Validated Patient-Reported Outcomes in Patients With Early Carpometacarpal Osteoarthritis

To design and validate a disease-specific health status instrument-the Tonsil and Adenoid Health Status Instrument-for use in children with tonsil and adenoid disease. Prospective psychometric and clinimetric instrument validation in 3 stages. A tertiary academic pediatric specialty hospital and a tertiary academic hospital, in 2 different cities. PATIENTS/OTHER PARTICIPANTS: Children with tonsil and adenoid disease presenting for evaluation and treatment (n = 224). INTERVENTION/METHOD: Prospective instrument validation. Stage 1 consisted of initial item testing, reduction, and subscale construction; stage 2, reliability and validity testing, factor analysis, and final item reduction; and stage 3, responsiveness analysis. Test-retest and internal consistency reliability; content, construct, and criterion validity; orthogonal principal components factor analysis; and response sensitivity analysis. Factor analysis and item analysis confirmed 6 distinct subscales measuring different constructs (aspects) of disease-specific health status that are affected by tonsil and adenoid disease: eating and swallowing, airway and breathing, infections, health care utilization, cost of care, and behavior. For each subscale, the Tonsil and Adenoid Health Status Instrument demonstrated excellent test-retest reliability (r = 0.72-0.88) and internal consistency reliability (Cronbach alpha = .73-.87). Content validity was ensured during the design process. Construct validity was demonstrated by means of convergent and divergent validity with a global quality-of-life instrument (the Child Health Questionnaire, version PF28). Criterion validity was also satisfactory. Finally, the instrument was appropriately sensitive, with high standardized response means and effect sizes. The Tonsil and Adenoid Health Status Instrument is a valid, reliable, and sensitive instrument with 6 distinct subscales. This instrument has significant utility for outcomes research in children with tonsil and adenoid disease.

Systemic lupus erythematosus is a chronic, progressive, autoimmune disease that causes significant stress on patients. There is no specific instrument for assessing stress in Chinese systemic lupus erythematosus patients. The objective of this study was to test the reliability and validity of the 10-item Perceived Stress Scale in Chinese systemic lupus erythematosus patients. Validity evaluation included structural and construct validity (convergent and discriminant validity). Structural validity was assessed by exploratory factor analysis. Convergent validity was assessed by correlating the total score of the 10-item Perceived Stress Scale with the Patient Health Questionnaire-9, Self-Efficacy for Managing Chronic Disease 6-Item Scale, the Simplified Coping Style Questionnaire, and the Systemic Lupus Erythematosus Disease Activity Index. Discriminant validity was determined by the statistically significant differences in perceived stress scores among patients with different education levels and disease activity. Reliability was assessed by internal consistency and test-retest reliability. The test-retest reliability was measured at 1-week intervals. Exploratory factor analysis extracted two dimensions that explained 66.45% of the variation. Moderate-to-strong correlations were also found between the 10-item Perceived Stress Scale and the Patient Health Questionnaire-9, Self-Efficacy for Managing Chronic Disease 6-Item Scale, the Simplified Coping Style Questionnaire, and Systemic Lupus Erythematosus Disease Activity Index. Excellent test-retest reliability (intraclass correlation coefficient = 0.954) and internal consistency (Cronbach's alpha = 0.810) were demonstrated. In conclusion, the 10-item Perceived Stress Scale can be used to measure stress among Chinese systemic lupus erythematosus patients and serve as a basis for further research.

Purpose To perform cross cultural adaptation of Boston Carpal Tunnel Questionnaire in standard Arabic language and assess the reliability and construct validity of the new tool. Materials and methods Cross cultural adaptation was performed according to guidelines. One hundred and one Arabic patients with carpal tunnel syndrome agreed to participate in the study and filled the questionnaire. Cronbach’s alpha was calculated to assess internal consistency. Test–retest reliability was assessed after two weeks by calculating Intraclass correlation coefficient. To assess construct validity; Spearman correlation coefficient with the Disabilities of the Arm, Shoulder and Hand Questionnaire was calculated. Results Arabic Boston Carpal Tunnel Questionnaire version had excellent internal consistency, Cronbach's Alpha was 0.877 for Symptoms Severity Scale and 0.895 for Functional Status Scale. Test–retest reliability was excellent (Interclass Correlation Coefficient was 0.899 for Symptoms Severity Scale and 0.944 for Functional Status Scale). Correlation with the Disabilities of the Arm, Shoulder and Hand Questionnaire was high which reflects excellent construct validity. All results were similar to the results of previous studies. Conclusions Arabic Boston Carpal Tunnel Questionnaire was produced. The tool demonstrated excellent internal consistency, test–retest reliability and construct validity. The questionnaire is suitable for use with carpal tunnel syndrome patients in the Middle East and North Africa region. Implications for rehabilitation Carpal tunnel syndrome is the most common peripheral neuropathy worldwide with many affected in Arabic speaking countries. Specific outcome measures like Boston Carpal Tunnel Questionnaire are important in evaluating the impact of different interventions on patients’ wellbeing. The Arabic Boston carpal tunnel questionnaire is a valid and reliable tool to use with Arabic speaking people with Carpal Tunnel Syndrome.

Diabetes distress syndrome (DDS) can lead to poor outcomes and should be assessed with adapted and validated tools. One of these tools is the Problem Areas in Diabetes (PAID) scale, which assesses diabetes distress in people suffering from diabetes (PsD). A short five-item form, PAID-5, is an easier and quicker alternative to be used in clinical and research practices, than the previous one with 20-items and has been validated by the original authors. This study intended to perform the cultural adaptation and validation of the PAID-5 scale in European Portuguese. To create the Portuguese version of PAID-5, translation-back translation, a clinical review, and a cognitive debriefing panel were performed. A convenience sample of 90 PsD was studied in three primary healthcare units for reliability and validity tests. Reliability was studied by the internal consistency (Cronbach's alpha) and the interval coefficient correlation (ICC) under a test-retest design. Structural validity was studied by principal component analysis. The construct validity was tested by the sensitivity of the PAID-5 total score with age, most recent HbA1c test, and socioeconomic class by the Socio-Economic Deprivation Index (SEDI). Criterion validity was tested by correlating the PAID-5 total score with the psychological distress questions of the Diabetes Health Profile 18 Questions (DHP-PDQ). A Cronbach's alpha coefficient value of 0.905 and an ICC of 0.905 were computed. In a sample of n = 90 PsD, 55.6% were males, 63.3% aged 65 years or more, SEDI was 5.2 ± 0.8 [3 to 6], 44.4% studied for less than 4 years, and 18.9% were living alone. The Spearman correlation between PAID-5 and DHP-PDQ total scores was ρ = 0.382, p < 0.001, between PAID-5 total score and age was ρ = -0.207, p = 0.050 and between PAID-5 total score and most recent HbA1c knowledge was ρ = 0.275, p = 0.040. There was no significant relationship between PAID-5 total score and SEDI ρ = 0.080, p = 0.452. DDS can now be assessed in the Portuguese context, accounting for better intervention by primary care teams. PAID-5 has good psychometric properties and is a reliable scale to identify diabetes-specific distress in the Portuguese diabetic population.