This study aimed to adapt the Social Participation Restrictions Questionnaire (SPaRQ) into Turkish (SPaRQ-T) and assess its validity and reliability for evaluating participation restrictions in adults with hearing loss. A cross-sectional, multicenter study was conducted with 278 individuals with hearing loss who had used hearing aids for at least one year. The adaptation process followed international guidelines, including back-translation and expert evaluation. Rasch analysis, test-retest reliability, and concurrent validity assessments were performed.The SPaRQ-T demonstrated strong internal consistency (Cronbach's α = 0.926 for Social Behaviors and 0.871 for Social Perceptions) and test-retest reliability (ICC = 0.928 and 0.773, respectively). Rasch analysis confirmed the unidimensionality of both subscales and supported good model fit. The SPaRQ-T is a reliable and valid instrument for assessing social participation restrictions in Turkish-speaking adults with hearing loss. It provides a comprehensive evaluation of the social and emotional dimensions of participation and can be used in clinical and research settings.

This study aimed to assess: 1) the concurrent validity between critical power (CP) and the corrected power output at the respiratory compensation point (PORCP) and between W' and the quantity of energy depleted above PORCP (W'mod-SRS) in a modified Step-Ramp-Step (mod-SRS) protocol; 2) the test-retest reliability of endurance variables derived from a mod-SRS protocol. Twelve trained male triathletes (31 ± 6 yr, 67.9 ± 7.1 mL.min-1.kg-1) performed i) a SRS protocol, ii) 4 to 5 severe-intensity Constant-Work Rate (CWR) trials, iii) two mod-SRS protocols (test/re-test) and iv) a heavy-intensity CWR trial. CP and W' were computed using a "best individual fit" approach. PORCP was corrected appropriately while W'mod-SRS was computed as the energy depleted above PORCP. Test-retest reliability was assessed with the intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the coefficient of variation (CV%). CP was higher than PORCP in both trials (bias = 19 ± 19 W and 17 ± 20 W, p = 0.019 and 0.045). W' and W'mod-SRS were similar between trials (bias = -2.8 ± 7.9 kJ and -5.4 ± 8.8 kJ, p = 0.735 and 0.173). Test-retest reliability was moderate for W'mod-SRS (ICC = 0.66, SEM = 3.0 kJ, CV = 11.6%) and high for V̇O2peak, GET, RCP and their associated PO values (ICCs = 0.85-0.95, SEMs = 68-184 mL.min-1 and 7-8W, CVs = 2.1-3.7%). The mod-SRS protocol reliably measures V̇O2peak, GET and RCP. Corrected PORCP systematically underestimated CP, which consequently impacts computation of W' using a mod-SRS protocol. The design of the protocol may allow a more complete depletion of energy available above RCP while still eliciting V̇O2peak.

Validity and Reliability Analysis. Evaluate the structural validity, reliability and criterion validity of the Wheelchair Mobility Activity Log (WC-MAL) using Rasch analysis. Sixty individuals with SCI and using a manual wheelchair participated in the study. The WC-MAL was employed remotely. Rasch analysis evaluated the structural validity of the instrument. The intra-rater reliability of the WC-MAL score was analysed using the random model Intraclass Correlation Coefficient(ICC) and the Standard Error of Measurement was calculated to estimate the precision of individual scores. For concurrent criterion validity, the data from the tachometer were used as the "gold standard" to assess wheelchair mobility, with the WC-MAL serving as the comparator. Pearson's correlation coefficient was used to evaluate the relationship between the tachometer data and WC-MAL Frequency Scale scores. The Rasch analysis led to the exclusion of three items (1, 3, and 10) from the original instrument, improving model fit and refining WC-MAL 2.0. WC-MAL 2.0 demonstrated good discriminant ability with a Person Separation Reliability of 0.91-0.93 and explained variance between 59.3 and 61%. The WC-MAL 2.0 showed no local dependency, maintained unidimensionality across all scales, and exhibited no uniform Differential Item Functioning. The WC-MAL 2.0 demonstrated excellent inter-rater reliability (ICC0.84-0.91), strong internal consistency (Cronbach's alpha 0.84-0.91), and strong correlations between the Frequency Scale and tachometer data (r = 0.78, p < 0.001), supporting its criterion validity. The WC-MAL 2.0 is a suitable instrument with adequate validity and reliability for assessing wheelchair performance in individuals with SCI.

Clinical assessment of the scapula is challenging because of the complex biomechanics of the scapulothoracic joint. To analyze the concurrent validity, reliability, and precision of goniometry in measuring scapular protraction and retraction. Observational, descriptive design. Academic. Sample of 50 healthy adults. Two experienced raters (occupational therapists and certified hand therapists) measured the resting, protracted, and retracted positions of the scapulae using the superior angle, frontal plane, and acromion as anatomical landmarks. The Dartfish motion analysis system was then used by a blinded researcher for digital measurement of the same scapular positions. Descriptive (means and standard deviations) statistics and reliability analysis (intraclass correlation coefficient [ICC], standard error of measurement [SEM]) were used to analyze interrater reliability. Additional statistics, including Pearson's r and Bland-Altman plots, were used to assess concurrent validity. Measures obtained by both raters demonstrated excellent interrater reliability (ICCs = .89-.99; SEM = .63-1.9: For minimum detectable changes, range = 1.7°-5.3°, and for percentage of the minimum detectable change, range = 7-20%). The mean variance between goniometric measurements and Dartfish values was less than 1°, with very strong correlation (r = .84-.92). The reliability and validity meet or exceed similar psychometric properties of goniometric techniques for other joints of the human body. Goniometric measurement of scapular protraction and retraction is a reliable and valid technique that can be efficiently implemented by rehabilitation practitioners. Plain-Language Summary: Protraction and retraction of the scapula are important, foundational movements of upper extremity function but have proven uniquely challenging to measure. The present findings support the use of goniometry as a valid, reliable, and efficient method for the assessment of scapular protraction and retraction by occupational therapists and other rehabilitation practitioners.

Development and Validation of a Culturally Adapted Interactive Game-Based Digital Tool for Screening Mild Cognitive Impairment in Older Adults.

Psychosocial functioning in older adults with bipolar disorder: Spanish validation of the Functioning Assessment Short Test for Older adults (FAST-O).

To evaluate the feasibility and validity of the tablet-based application CogniTOT for remote assessment of cognitive function. An ongoing follow-up study with children born < 32 weeks of gestational age uses Ages and Stages Questionnaire (ASQ). Parents were further invited to remote CogniTOT assessment and to fill in the Non-Verbal Cognitive Scale (NVC) of the parental questionnaire Parent Report of Children's Abilities Revised (PARCA-R) at 2 years of age. Factors influencing successful CogniTOT completion were examined. Construct validity was explored by comparing the preterm-born group with term-born controls. To ensure concurrent validity, CogniTOT scores were compared to NVC PARCA-R. Thirty-two out of 77 invited preterm children completed CogniTOT along with 12 term-born children. Median scores did not differ between groups (p = 0.51). Difficulties in completion were frequent and both technical and interpersonal. There was no correlation between NVC PARCA-R and CogniTOT scores (correlation coefficient 0.079, p = 0.65). The correlation between NVC PARCA-R and ASQ was moderate (correlation coefficient 0.535, p < 0.001). Remote assessment using a tablet-based task is challenging and did not correlate with parental report. Technical advances may make this feasible for large-scale assessment.

To evaluate the psychometric properties of the 10-item Clinical Outcomes in Routine Evaluation (CORE-10) in terms of change sensitivity and to develop clinical resources to support its use in routine practice for the Argentine adult population. Specifically, it explored the differentiation between clinical and non-clinical groups using traditional and data-driven approaches to determine clinical cut-off scores. Two independent samples were included: a cross-sectional sample (n = 637) composed of individuals from the general population and patients initiating therapy, and a longitudinal clinical sample (n = 148) assessed session-by-session. Psychometric analyses included factor structure, internal consistency, and convergent and divergent validity. Sensitivity to change was assessed through standardized effect sizes and mixed-effects modeling. Clinical cut-off scores were estimated using therapy status and data-driven clustering methods. The CORE-10 showed good internal consistency and a unidimensional factor structure with excellent fit. Strong concurrent and acceptable divergent validity were found. Moderate internal responsiveness was observed, and longitudinal analyses confirmed a significant reduction in CORE-10 scores over time. Clustering methods outperformed traditional therapy-status classifications, yielding more consistent and interpretable groupings. The optimal cut-off score derived from K-Means clustering was 1.39 (SD = 0.36; 95% CI [1.36, 1.42]). The reliable change index values were comparable to previous studies. The CORE-10 is a reliable and valid tool for monitoring psychological distress and change in Argentine psychotherapy settings. Beyond supporting its psychometric robustness, this study contributes practical, data-informed resources to improve clinical decision-making and routine outcome monitoring.

The primary objectives of the present cross-sectional study were to translate and culturally adapt the YouTube Addiction Scale (YAS) into Malay and to evaluate its reliability, factorial validity, concurrent validity, and measurement invariance across gender and ethnicity among Malaysian university students. A total of 690 students participated (mean age = 21.29 years [SD ± 2.42]; 74% female). Confirmatory factor analysis supported a unidimensional YAS structure with good fit (CFI = 0.98, TLI = 0.97, SRMR = 0.06, RMSEA = 0.07). The scale exhibited strong reliability (α = 0.83, ω = 0.84) and measurement invariance across gender and ethnicity. YAS scores showed correlation with Smartphone Application-Based Addiction Scale score (r = 0.17, p < 0.001) and Bergen Social Media Addiction Scale score (r = 0.23, p < 0.001), a weak correlation with time spent on social media (r = 0.09, p = 0.02), and no significant relationship with time spent on online gaming (r = 0.03, p = 0.47). The Malay YAS is a reliable and valid instrument for assessing YouTube addiction among Malaysian university students. Its unidimensional structure, strong reliability, robust measurement invariance across gender and ethnicity, and satisfactory concurrent validity support its application in research, screening, and intervention programs.

Objective: 3-Meter Backward Walk Test (3MBWT) is a physical performance-based test that assesses balance, proprioception, and fall risk. The present study aimed to reveal the reliability of the test-retest and the concurrent validity of 3MBWT in persons with knee osteoarthritis, which has not been studied yet. Patients and Methods: A total of 37 female patients were involved in the present study. 3MBWT was administered twice (one-week interval between sessions) in two different sessions, and the average score was recorded. The Timed Up and Go Test (TUG), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Modified Falls Efficacy Scale (MFES) were applied in the initial assessment to investigate correlations with 3MBWT. Results: The 3MBWT presented high intra-reliability (ICC=0.872). While, a strong correlation was observed between the 3MBWT and TUG (r=0.791), a moderate correlation was revealed between MFES and 3MBWT (r=-0.671). Significant correlations with the 3MBWT and KOOS subscales (ranging from – 0.726 to – 0.364) were also observed. The standard error of measurement (SEM) and the minimal detectable change (MDC95) were calculated as 2.36 and 6.55 seconds, respectively. Conclusion: 3MBWT is both a valid and reliable measurement tool in persons with knee osteoarthritis. It could be used to monitor the progression of the disease and the functional status of persons with knee osteoarthritis.

Background: Wrist-worn consumer activity trackers are widely used to promote physical activity (PA) and reduce sedentary behavior (SB). However, evidence regarding their validity for measuring PA and SB in free-living school-aged children remains limited. This study evaluated the concurrent validity and wear compliance of a wrist-worn consumer activity tracker in school-aged children under free-living conditions with protocol-defined wear requirements. Methods: A total of 102 children (mean age: 10.2 years; 44.1% girls) wore a wrist-worn device (Fitbit Ace) and a waist-worn accelerometer (Omron Active Style Pro HJA-750c, ASP-750c). Of the 1122 person-days collected over 11 days, 135 person-days meeting inclusion criteria for both devices were included (≥10 h/day wear time and an inter-device wear time difference of ≤60 min). Step count and time in SB, light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous PA (MVPA) were assessed. Correlations, mean absolute percentage error (MAPE), agreement, and wear compliance between the two devices were examined. Results: Correlations were strong for step count (r = 0.86), SB (r = 0.72), and LPA (r = 0.71); however, agreement was poor, with systematic overestimation of step count, SB, VPA, and MVPA and underestimation of LPA and MPA by the Fitbit Ace, and MAPE exceeding 20% for all PA variables. Wear compliance (≥10 h/day on ≥4 days) was higher for the Fitbit Ace (97.0%) than for the ASP-750c (62.2%). Conclusions: Although the Fitbit Ace may be useful for characterizing general patterns of LPA and SB in school-aged children, caution is warranted for accurate individual-level PA assessment.

Abstract The 21-item Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) is the most widely used instrument for the assessment of food and alcohol disturbance. In the present study, we examined the psychometric properties of a novel Romanian translation of the CEBRACS in two studies. In Study 1 with 1,022 Romanian university students, exploratory factor analysis and parallel analysis indicated that our data reduced to three latent factors reflecting Alcohol Effects, Bulimia, and Diet and Exercise motives. In Study 2 with 614 Romanian university students, we found that a 3-factor model based on exploratory structural equation modelling (ESEM) had better fit to the data than a model based on confirmatory factor analysis. In both studies, we found evidence of complete measurement invariance across gender identity and a lack of differential item functioning based on participant age and body mass index. The results of Study 2 also supported the convergent and concurrent validity of the Romanian CEBRACS, insofar as the three factors were significantly associated with symptoms of disordered eating, problematic alcohol use, body image, and life satisfaction. These results suggest that a 3-factor, ESEM-based model of the Romanian CEBRACS has adequate psychometric properties.

Background: Core beliefs, per Beck's cognitive theory, are fundamental views of self and others that shape emotion. Although the Negative Core Beliefs Inventory (NCBI) is validated in adults, evidence in adolescents-a key period for belief formation-remains limited. Objective: Validate the NCBI for adolescents by testing factorial structure, reliability, and validity. Methods: 146 students (12-17) in Salvador, Brazil, completed the NCBI plus anxiety, depression, and life satisfaction measures. Analyses included expert content review, EFA/CFA, graded response and generalized partial credit IRT models, and EBICglasso network modeling. Results: CFA supported the two-factor solution with acceptable fit (CFI = .89; RMSEA = .056). Internal consistency was good (most ω > .70); nCB-O ω = .87 and overall nCB-S ω = .93, but helplessness/vulnerability was lower (ω = .64). IRT indicated adequate discrimination for most items and greater information at higher trait levels; nCB-S9 performed poorly. Networks showed expected associations with anxiety, depression, and life satisfaction, supporting concurrent validity. Conclusions: The NCBI appears suitable for assessing negative core beliefs in adolescents and may aid early identification and intervention. Targeted refinement-particularly of nCB-S9 and the helplessness/vulnerability subscale-could strengthen psychometrics for this population. Broader samples and longitudinal designs are warranted to confirm stability and predictive validity.

Health Literacy (HL) has become popular in research for its potential in reducing health inequalities. HL is shaped by personal and situational factors, both having particular implications for migrant populations. This study adapted and validated the HLS19-Q12 in migrant and general populations of Finland using two large-scale population studies. We investigated methodological choices to ensure quality of HL measurement and monitoring across population groups. Finally, we examined the association between HL and socioeconomic, health- and migration-related factors in the general and migrant populations of Finland. We implemented the Nominal Categories Model (NCM) to empirically evaluate modeling assumptions, studied response functioning and measurement equivalence according to nativity in several language groups, including Finnish and English native (n=3673, n=379) and non-native (n=2077, n=1402) speakers, Russian native speakers (n=926). Methodological effects of opt-out and response format were investigated in the three language versions. Finally, we examined concurrent validity according to socioeconomic (i.e. sex, age, educational attainment, economic activity, economic deprivation, migrant-origin), health- (i.e. self-rated health, chronic disease, health-care use, smoking, obesity, cardiovascular disease risk score) and migration-related factors (i.e. length of residence, language proficiency, language barrier in healthcare) in the general and migrant populations under examination. Cronbach's alpha ranged from .93 to .96 and the u index indicated unidimensionality. Test information functions indicated the scale was most informative at low and medium levels of the trait continuum. The NCM showed acceptable fit and revealed expected ordering of Likert response categories, while the opt-out category showed inconsistencies. We found evidence of unbiased functioning of HLS19-Q12 respecting English and Finnish language nativity, and no evidence of acquiescence effects. Associations between HL and criterion factors were in line with expectations. This study introduced the Finnish version of HLS19-Q12 and approached valid and reliable HL monitoring as a key element within the field of social determinants of health. This study provided novel insights on HL while replicating findings reported in the literature. We provide specific recommendations for valid monitoring of HL and ponder over culturally and linguistically responsive policy making, in accordance with the Health in All Polices approach.

Teacher self-efficacy is a central construct influencing instructional practices, classroom management, and student outcomes. Despite its importance, no validated instrument exists in Azerbaijan to assess teachers’ self-efficacy. This study aimed to adapt the Teacher Sense of Efficacy Scale (TSES) into Azerbaijani and examine its psychometric properties. Data were collected from 293 Azerbaijani teachers via an online survey. Confirmatory factor analysis (CFA) supported the original three-factor structure, with acceptable fit indices (χ²/df = 3.283, CFI = .939, TLI = .922, RMSEA = .088). Reliability was evaluated through multiple indices, demonstrating high internal consistency (Cronbach’s α = .925), strong item homogeneity (McDonald’s ω = .926), and robust test-score reliability (Guttman’s λ6 = .930). Item Response Theory (IRT) analyses indicated strong discrimination parameters for all items (α = 1.78–2.91), confirming the scale’s capacity to differentiate teachers with varying efficacy levels. Concurrent validity was supported through positive correlations with work engagement and job satisfaction, and negative correlations with anxiety. Overall, the findings suggest that the Azerbaijani TSES is a psychometrically sound instrument, suitable for research, professional development, and policy applications. This adaptation provides a valuable tool for assessing teacher self-efficacy in Azerbaijani educational contexts, contributing to cross-cultural research and enhancing evidence-based strategies to improve teacher effectiveness and well-being

Specific diagnostic criteria for purging disorder (PD) are not currently provided in the DSM-5. The current study aims to compare point prevalence estimates and evidence of predictive validity for four alternative criteria sets for PD for men and women. Survey data collected in college (N = 3291) and at 10-year follow-up (n = 2223) were used in analyses. Point prevalence was assessed at both time points and compared in men versus women as well as in college versus at 10-year follow-up. Predictive validity was assessed using multiple linear regressions to determine prospective associations for each PD definition versus no eating disorder across external validators. Point prevalence was greater in women than in men in college across all definitions of PD, and no sex differences were found at follow-up. Point prevalence was greater in college than at follow-up in all but the narrowest definition of PD which required purging, on average, twice per week. Predictive validity was supported for PD defined by self-induced vomiting, laxative or diuretic misuse, with evidence of lower satisfaction with work and career at follow-up. Together, findings support defining PD through self-induced vomiting, laxative use, or diuretic use to influence body shape or weight, on average, at least once per week. Specifying diagnostic criteria for PD that demonstrate evidence of concurrent and predictive validity will contribute to improved diagnostic reliability, screening, assessment, and support future research efforts to improve treatment.

Patient satisfaction is a key indicator of the quality of care after urogynecological surgery. The aim of this study was to adapt and validate the Polish version of the International Consultation on Incontinence Questionnaire-Satisfaction (ICIQ-S) among women after urinary incontinence (UI) and/or pelvic organ prolapse (POP) surgery. This was a multicenter, cross-sectional study including 283 women 6-12 months after surgery. Translation was performed according to ICIQ guidelines. Participants completed the ICIQ-S twice via telephone interviews to assess test-retest reliability. Construct validity was analyzed using confirmatory factor analysis (CFA) and group comparisons. Concurrent validity was assessed through correlations with ICIQ lower urinary tract symptoms (LUTS), ICIQ female lower urinary tract symptoms (FLUTS), and the Pelvic Floor Distress Inventory (PFDI-20). Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients (ICC). The six-item ICIQ-S core showed strong internal consistency (Cronbach's α = 0.913) and excellent test-retest reliability (ICC = 0.958). CFA confirmed good construct validity (Comparative Fit Index = 0.985, Tucker-Lewis Index = 0.967, Standardized Root Mean Squared Residual = 0.021). The ICIQ-S total score demonstrated a very strong negative correlation with PFDI-20 total score (r = -0.764) and moderate negative correlations with ICIQ-LUTS and ICIQ-FLUTS. Group comparisons showed significant differences in satisfaction between UI, POP, and POP + UI groups. The Polish version of the ICIQ-S is a valid and reliable tool for assessing patient satisfaction after surgical treatment of UI and POP. It can be recommended for clinical practice and research to evaluate patient-centered outcomes in urogynecology.

Background The present study aimed to investigate the psychometric properties of an Arabic version of the Affective Lability Scale in its short form (ALS-18) within an Arabic-speaking sample. Particularly, the concurrent validity, sex invariance and factorial structure were examined. Methods The total sample of this cross-sectional study consisted of 748 adults, with a mean age of 34.48 ± 13.25 years, 66.5% females. After completing the forward-backward translation for cultural and linguistic adaptation, concurrent validity was assessed through correlations with related constructs, Confirmatory Factor Analysis was conducted to examine the factorial structure, and internal reliability as well as measurement invariance across sex were tested, the latter being through multigroup analyses. Results The fit of the scale’s original three-factor model was suggested through confirmatory factor analyses. Full measurement invariance at the configural, metric, and scalar levels was attained. The scale also yielded concurrent validity, with results indicating associations with increased levels of depression, anxiety and stress, and lower levels of self-esteem. The study’s findings further denoted good internal consistency of the Arabic ALS-18 with values of McDonald’s ω and Cronbach’s α greater than 0.70. Conclusion Results revealed that the Arabic ALS-18 is a reliable and valid self-report measure that could be utilized among an Arabic-speaking population to assess affective lability. The availability of the Arabic version of the ALS-18 is deemed to increase its use for research and provide a foundation for future clinical validation studies, globally benefiting Arabic-speaking individuals.

Background: Tinnitus, the perception of sound without an external source, can significantly affect an individual’s psychological well-being. However, tools for assessing tinnitus-related distress in the Hindi-speaking adults remain limited. This study aimed to translate, culturally adapt, and validate the mini tinnitus questionnaire (Mini-TQ) into Hindi (MiniTQ-H). Methods: The Hindi translation of the original Mini-TQ was conducted following standardized guidelines. The study included 60 individuals, comprising of two groups: normal hearing sensitivity with tinnitus (NWT) (n=30) and hearing impairment with tinnitus (HWT) (n=30). Psychometric evaluation of the Hindi MiniTQ was performed, including assessments of internal consistency, test-retest reliability, criterion validity, and concurrent validity. Sensitivity and specificity of the MiniTQ Hindi version were determined using receiver operating characteristic (ROC) curve analysis. Results: The MiniTQ-H demonstrated excellent psychometric properties. Content validity was confirmed by expert panel consensus, criterion validity demonstrated very strong agreement and Cronbach’s alpha for internal consistency was 0.822, indicating good reliability. Test-retest reliability was high, with all items maintaining significant correlations over time. MiniTQ-H showed a strong concurrent validity with THI-H. ROC analysis yielded a cut-off score of 14.5 with high score of 24, demonstrating high diagnostic accuracy in identifying individuals with tinnitus-related distress. Conclusions: The MiniTQ-H is a culturally and linguistically appropriate tool for assessing tinnitus-related distress in Hindi-speaking individuals aged 18 to 60 years. It provides a reliable and valid measure for clinical and research use in India.

The Moreno Social Atom Projective Test (MSAPT) is an adaptation of an egocentric social network measure first developed by Jacob Moreno in 1936. A theory- driven clinical instrument, Moreno's Social Atom Test has not achieved wider acceptance as a diagnostic test, in part because of a lack of empirical data to support its clinical utility. The author conducted this study in order to address the issues of standardization, reliability, validity, and clinical utility of the MSAPT. One hundred nonclinical adult participants were evaluated with a battery of three instruments: the MSAPT, the Multidimensional Scale of Perceived Social Support (MSPSS), and theSymptom Checklist-90-R (SCL-90-R). Multiple regression analyses demonstrated the MSAPT's ability to predict symptomology, using the Global Severity Index, F(6, 93) = 3.58, p&lt;.01, and each of the nine subscores of the SCL-90-R. The MSAPT conflict score was the major predictor for all SCL-90-R scores; reciprocity and gender scores also achieved significant levels. The MSAPT demonstrated good concurrent validity. The findings of this study indicate that the MSAPT is a valid and reliable clinical instrument. Suggestions for future research are presented; they include applying the MSAPT to clinical populations, establishing the instrument's test-retest reliability, and continuing the development and refinement of the individual variables.