Total Score Correlations Research Articles

Reliability of a new scale for essential tremor

The objective of this study was to determine the reliability of a new scale for the clinical assessment of essential tremor. The Essential Tremor Rating Assessment Scale contains 9 performance items that rate action tremor in the head, face, voice, limbs, and trunk from 0 to 4 in half-point intervals. Head and limb tremor ratings are defined by specific amplitude ranges in centimeters. Videos of 44 patients and 6 controls were rated by 10 specialists on 2 occasions 1-2 months apart. Inter- and intrarater reliability was assessed with a 2-way random-effects intraclass correlation, using an absolute agreement definition. Inter- and intrarater intraclass correlations for head and upper-limb tremor ranged from 0.86 to 0.96, and intraclass correlations for total score were 0.94 and 0.96. The intraclass correlations for voice, face, trunk, and leg were less robust. This scale is an exceptionally reliable tool for the clinical assessment of essential tremor.

뇌졸중 환자에서 Figure-of-8 walk test의 신뢰도와 타당도

Purpose : The purpose of this study was to establish intra-rater, inter-rater, test-retest reliability, and concurrent validity of figure-of-8 walk test in people with stroke. Methods : The subjects of this study were 17 patients who were diagnosed with a stroke. Subjects were tested twice by the same raters, with 1 day between tests. Subjects were assessed by two physical therapists. Test-retest reliability was calculated using intraclass correlation coefficients (ICC). The concurrent validity was demonstrated by spearman correlation of F8WT with 10m walking test (10MWT), timed up and go test (TUG), Berg balance scale (BBS), dynamic gait index (DGI) and four square step test (FSST). Results : Intra-rater, inter-rater, test- retest of F8WT time, showed high reliability. Intra-rater, inter-rater, test-retest of F8WT steps demonstrated high reliability. Intra-rater, inter-rater, test-retest of F8WT total smoothness score showed below moderate reliability. There was a significant positive correlation of F8WT time with 10MWT, TUG, FSST. There was a significant negative correlation of F8WT time with DGI, BBS. There was a significant positive correlation of F8WT steps with 10MWT, TUG, FSST. There was a significant negative correlation of F8WT steps with DGI. There was a significant positive correlation of F8WT test total smoothness score with BBS. Conclusion : The time, and number of steps in F8WT show high inter, intra-rater, test-retest reliability. The F8WT smoothness shows below moderate reliability. The F8WT shows high concurrent validity with other comparable balance, and walking tests. The F8WT is a valid and reliable measure for assessing walking function in patients with a stroke.

The validity and reliability of the Turkish version of short‐form McGill Pain Questionnaire in patients with leukemia

To assess reliability and validity of the Turkish version of the Short-form McGill Pain Questionnaire. Pain is one of the most frequent and significant problems encountered by nurses practice across the world. The Short-form McGill Pain Questionnaire was widely translated and used to assess the pain experience of several types of patients because it combines the properties of the standard McGill Pain Questionnaire but takes substantially less time to administer. The study used psychometric testing to establish reliability and validity of the Turkish version of Short-form McGill Pain Questionnaire. A convenience sample of 160 patients with leukaemia in Turkey was used to collect data regarding pain evaluation. The original version of the Short-form McGill Pain Questionnaire, adapted into Turkish, was tested for internal consistency, content validity, construct validity and concurrent validity. Internal consistency was found adequate at both assessments with Cronbach's α 0.88 for test and 0.91 for retest. For reliability of the total, sensory, affective and evaluative total pain intensity, high intraclass correlations were demonstrated (0.85, 0.84, 0.82 and 0.70, respectively). Correlation of total, sensory and affective score with the numerical rating scale was tested for construct validity demonstrating r = 0.61 (p < 0.01) for test and r = 0.68 (p < 0.01) for retest. Correlation with blood pressure values for concurrent validity was found to be r = 0.78 (p < 0.001) for test and r = 0.73 (p < 0.001) for retest. Turkish version of the Short-form McGill Pain Questionnaire has shown statistically acceptable levels of reliability and validity for pain evaluation in patients with leukaemia. This study provided evidence that the Turkish version of the Short-form McGill Pain Questionnaire is a reliable and valid instrument for assessing pain. This scale can be used to assess nursing interventions aimed at decreasing pain and efficacy of the treatment.

Development of an Objective Test of Upper-Limb Function in Tetraplegia

This study aimed to describe the development, internal consistency, and validity of the Capabilities of Upper Extremity Test (CUE-T) for persons with tetraplegia. This study used a cross-sectional sample of adults with spinal cord injury. CUE-T items and procedures were developed based on the CUE Questionnaire. Thirty adults with complete and incomplete spinal cord injury, neurologic levels C4-T6, were tested on one occasion. Each received upper limb manual muscle testing and the CUE Questionnaire followed by the CUE-T. Raw item scores were converted to a 0-4 scale. Internal consistency was evaluated using Cronbach alpha. Item score distributions were evaluated for ceiling and floor effects. Spearman correlations of total, right, and left CUE-T scores with upper-limb motor scores and international hand classification were performed. There were 23 men and 7 women, with an average age of 44.8 yrs. Twenty subjects had motor complete injuries; 13 had motor levels C4-C6, 13 had between C7 and C8, and 4 were T1 or below. The Cronbach alpha for the CUE-T was 0.96. Item score distributions found ceiling effects for the push/pull items, suggesting that these items were too easy. Correlations of right- and left-sided scores with upper-limb motor scores and international hand classification were strong, with all values greater than or equal to 0.89. The CUE-T displays good internal consistency and excellent construct validity on preliminary testing. Push/pull tests should be revised to increase difficulty. Reliability and responsiveness should be determined.

Superoxide dismutase activity and malondialdehyde levels in patients with travel-induced psychosis.

BackgroundOxidative stress is a neurotoxic factor that may precipitate acute psychoses.AimAssess the relationship of travel-induced psychosis and oxidative stress.MethodsTwenty-one inpatients with travel-induced psychosis related to prolonged train travel were evaluated using the Brief Psychiatric Rating Scale (BPRS) at the time of admission and their plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA) concentrations were assessed on the morning following admission. These assessments were repeated after the psychotic symptoms resolved, which typically occurred after 2-6 days of low-dose antipsychotic treatment. The SOD and MDA results in the patients were compared to those of 21 normal age and gender matched control subjects.ResultsAt admission the patient group had significantly higher SOD activity and MDA concentrations than the control group. After resolution of the psychotic symptoms the BPRS scores, SOD activity, and MDA concentrations all showed significant declines but the SOD activity and MDA concentrations remained higher than in the matched control group. At admission there was a non-significant positive correlation of the BPRS total score with SOD activity (r=0.32, p=0.164) and with MDA concentration (r=0.34, p=0.126). The before versus after drop in the BPRS total score was weakly correlated with the drop in the SOD activity (r=0.28, p=0.217) and with the drop in the MDA concentration (r=0.29, p=0.211).ConclusionThese findings suggest that the neurotoxic effects of oxidative stress are directly related to the development of travel-induced psychosis. This may be relevant to the understanding of other acute psychotic states such as schizophrenia.

Comparison of 2 Dementia Screeners, the Test Your Memory Test and the Mini-Mental State Examination, in a Primary Care Setting

Dementia is an important cause of morbidity but is often neglected in primary care settings. This relates, in part, to perceived difficulties with diagnosis and the need to focus on more pressing physical complaints. Screening provides a potential first-step solution. Existing screening measures are regarded as either too time consuming or insufficiently sensitive and specific. The Test Your Memory (TYM) questionnaire was recently developed in response to this problem. Its utility as a cognitive screener has not been assessed in primary care settings. In this study, we measured and compared the performance of an adapted English as well as Afrikaans translation of the self-administered TYM to the Mini-Mental State Examination, the current accepted standard screening instrument for dementia, in 100 older primary care patients in South Africa. We found a strong positive correlation of total scores between the measures, with a higher internal consistency for the TYM. The TYM was also easily self-administered. Our results, in conjunction with previous validation findings and diagnostic accuracy for the TYM, suggest that it has clinical utility and potential as a cognitive screener in this context.

Abstract 3600: Comparison of estrogen receptor expression in breast cancer cells by immunohistochemistry using the monoclonal antibodies SP1 and 1D5

Abstract Background: Accurate pathological analysis of biopsies is crucial for conclusive and precise disease diagnosis, prognosis and therapeutic guidelines. Evaluation of estrogen receptor (ER) expression in breast cancer (BC) is imperative in determining the disease prognosis, and patients' eligibility for hormonotherapy. Herein, ERα status was evaluated in 61 BC cases using two different anti-ERα monoclonal antibodies, Sp1 (rabbit) and 1D5 (mouse). Methods: Primary BC cases registered in two reference hospitals, with correspondent written informed consent, were used to generate in house tissue microarray platforms. ERα expression was accessed by immunohistochemistry using the monoclonal antibodies anti-ERα, SP1 and 1D5. Staining scoring followed the Allred method (PS, proportion score or percentage of stained cells; IS, intensity score). Concordance and correlation parameters were calculated using Kappa factor; Pearson, Spearman's, or intraclass correlation coefficient (CF). Staining patterns were compared by paired T-Test and Wilcoxon test. Findings: SP1 and 1D5 provided equivalent results (Concordance rate, 96.7%; Kappa factor, 0.921), whereas SP1 was more prone for positive results than 1D5 (2 samples diverged). Total concordance of PS was obtained (Pearson and intraclass CF, 0.7351 and 0.6193, respectively); however, concordance between the antibodies seems more accurate in higher PS values. Excellent SI correlation between antibodies was observed throughout the population (Spearman's CF, α=0.9150). Following the Allred score, 17 out of 42 positive BC samples diverged; always pointing 1D5 to weaker staining than SP1. When calculating Spearman's CF of Total Score (TS) within the population, excellent correlation between both the antibodies (α=0.9238) was noted; nonetheless, results were less concordant result among the BC positive cases (α=0.7743). Indeed, 20 samples were differentially classified using the antibodies (only 3 had higher TS with 1D5). Considering the mean TS of all samples, or of invasive ductal carcinoma, SP1 provided higher scores than 1D5 (p&amp;lt;0.05). Interpretation: Despite the equivalence between the anti-ERα monoclonal antibodies, SP1 and 1D5, the former has proven superior to the latter with respect to the IS and TS. Therefore, we suggest the clinical use of SP1 while diagnosing BC, due to its higher accuracy in examining ER status; thus, enabling more accurate therapeutic decisions to treat the disease. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3600. doi:1538-7445.AM2012-3600

A comparison of two scoring methods for an automated speech scoring system

This paper compares two alternative scoring methods – multiple regression and classification trees – for an automated speech scoring system used in a practice environment. The two methods were evaluated on two criteria: construct representation and empirical performance in predicting human scores. The empirical performance of the two scoring models is reported in Zechner, Higgins, Xi, &amp; Williamson (2009), which discusses the development of the entire automated speech scoring system; the current paper shifts the focus to the comparison of the two scoring methods, elaborating both technical and substantive considerations and providing a reasoned argument for the trade-off between them. We concluded that a multiple regression model with expert weights was superior to the classification tree model. In addition to comparing the relative performance of the two models, we also evaluated the adequacy of the regression model for the intended use. In particular, the construct representation of the model was sufficiently broad to justify its use in a low-stakes application. The correlation of the model-predicted total test scores with human scores ( r = 0.7) was also deemed acceptable for practice purposes.

Comparative Study of TCM Syndrome Scale for Liver Disease and Chronic Liver Disease Questionnaire Based on Assessment of Posthepatitic Cirrhosis

Objective. To compare and analyze the relevance and applied value of chronic liver disease questionnaire (CLDQ) and Traditional Chinese Medicine liver disease questionnaire (TCMLDQ) in patients with posthepatitic cirrhosis. Methods. The data of 146 patients' scales of CLDQ and TCMLDQ which based on the characteristics of chinese medical symptoms were collected. We made comparative analysis of the relationship between these two scales by the linear regression model and canonical correlation method and evaluated the advantages and disadvantages of two scales about its items setting and dimension definition. Result. There is a negative correlation in total scores between the two scales and the linear regression equation: CLDQ = 239.38 − 1.232TCMLDQ. The further canonical correlation analysis was used to analyze the two extracted canonical correlative variables with significances (P < 0.05), and the results showed that the overall negative correlation between the two scales mainly came from contributions of both the four dimensions of TCMLDQ (CS, GSYX, GYPX, and OS) and the five dimensions of CLDQ (AS, FA, SS, AC, and EF). Conclusion. These two scales have good consistency in the evaluation of severity and life quality of liver cirrhosis patients, so we suggested that TCMLDQ can be used to evaluate the severity and life quality of patients with posthepatitic cirrhosis.

Adaptation, validity and reliability of the Leahy Emotional Schema Scale Turkish version based on Turkish university students and workers / Üniversite öğrencileri ve çalışanları örnekleminde Leahy Duygusal Şema Ölçeği’nin Türkçe uyarlaması, geçerlilik ve güvenilirliği

Objective: Emotional schema concept is developed for determining beliefs and attributions about emotions. The aim of this study was to examine validity and reliability of the Turkish version of “Leahy Emotional Schema Scale” (LESS). Method: The sample consisted of 436 participants including students, workers and their relatives from various faculties of two Turkish universities. Translation, back-translation and pilot assessment of LESS Turkish version completed. Socio-demographic data form, LESS Turkish version and short form of the Metacognition Questionnaire (MCQ-30) were administered to participants. For reliability of LESS test-retest correlation, split-half technique, Cronbach’s alpha coefficient and item-dimension total score correlations were used. Principal component analysis and varimax rotation used for factor analysis and Pearson correlation analysis was used for convergent and divergent validity. Results: The mean age of participants was 22.5±4.84 years (age range: 18-53 years) and 51.1% (n=223) were female. Statistically significant results supported LESS Turkish version’s reliability. Item-dimension total score correlation analyses revealed statistically significant correlation coefficients that show high internal consistency (Cronbach alpha = 0.86). Factor analysis revealed that LESS Turkish version, as the original version, had 14 dimensions, and these explained 56.8% of the total variance. In five dimensions, factor analysis showed inconsistency with original version of LESS. For convergent and divergent validity, we compared related subscales of LESS and MCQ-30 and revealed significant relations. Conclusion: The results of this study show that the Turkish version of LESS is a reliable and valid scale for the assessment of beliefs and attributions about emotions on non-clinical population.

Development of Spanish Version of the Littlears Parental Questionnaire for Use in the United States and Latin America.

The LittlEARS Auditory Questionnaire is a parent questionnaire created to assess development of age-dependent auditory behaviors of children in the pre-verbal stage. The original questionnaire was developed in Austria (in German), and is now being introduced in the United States in English. This study was designed to obtain normative data on a Spanish translation. Fifty parents or caregivers participated. Responses were obtained at their child’s visit to a hospital clinic or an external ambulatory site. Children ranged in age from .5 to 21.4 months (mean = 9.5 months). Parents were either Spanish monolingual or bilingual representing 5 national origins. Analyses included correlation of age with total score, and with individual questions, index of difficulty, discrimination and selectivity indices, scale analysis, split-half reliability and internal consistency. Specifically, correlation between age and number of observed behaviors was 0.927. A measure of internal consistency was high, 0.95.Results indicated that the translated LittlEARS for use with Spanish speakers is a potentially useful tool for clinicians assessing pre-verbal auditory behavior. High correlations of total score with age suggested that the questionnaire reflects a progression of auditory skills in the 0 to 24 months age group.

Performance of Health Literacy Tests Among Older Adults with Diabetes

Knowing a patient's health literacy can help clinicians and researchers anticipate a patient's ability to understand complex health regimens and deliver better patient-centered instructions and information. Poor health literacy has been linked with lower ability to function adequately in health care systems. We evaluated and compared three measures of health literacy and performance among older patients with diabetes. Cross-sectional study utilizing in-person interviews conducted in participants' homes. A tri-ethnic sample (n = 563) of African American, American Indian, and white older adults with diabetes from eight counties in south-central North Carolina. Participants completed interviews and health literacy assessments using the Short-Form Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimates of Adult Literacy in Medicine Short-Form (REALM-SF), or the Newest Vital Signs (NVS). Scores for reading comprehension and numeracy were calculated. Over 90% completed the S-TOFHLA numeracy and approximately 85% completed the S-TOFHLA reading and REALM-SF. Only 73% completed the NVS. The correlation of S-TOFHLA total scores with REALM-SF and NVS were 0.48 and 0.54, respectively. Age, gender, ethnic, educational and income differences in health literacy emerged for several instruments, but the pattern of results across the instruments was highly variable. A large segment of older adults is unable to complete short-form assessments of health literacy. Among those who were able to complete assessments, the REALM-SF and NVS performed comparably, but their relatively low convergence with the S-TOFHLA raises questions about instrument selection when studying health literacy of older adults.

Cross‐cultural adaptation and psychometric properties of the Brazilian–Portuguese version of the Duke Anticoagulation Satisfaction Scale

The aim of this study was to evaluate the internal reliability and validity of the Brazilian-Portuguese version of Duke Anticoagulation Satisfaction Scale (DASS) among cardiovascular patients. Oral anticoagulation is widely used to prevent and treat thromboembolic events in several conditions, especially in cardiovascular diseases; however, this therapy can induce dissatisfaction and reduce the quality of life. Methodological and cross-sectional research design. The cultural adaptation of the DASS included the translation and back-translation, discussions with healthcare professionals and patients to ensure conceptual equivalence, semantic evaluation and instrument pretest. The Brazilian-Portuguese version of the DASS was tested among subjects followed in a university hospital anticoagulation outpatient clinic. The psychometric properties were assessed by construct validity (convergent, known groups and dimensionality) and internal consistency/reliability (Cronbach's alpha). A total of 180 subjects under oral anticoagulation formed the baseline validation population. DASS total score and SF-36 domain correlations were moderate for General health (r=-0.47, p<0.01), Vitality (r=-0.44, p<0.01) and Mental health (r=-0.42, p<0.01) (convergent). Age and length on oral anticoagulation therapy (in years) were weakly correlated with total DASS score and most of the subscales, except Limitation (r=-0.375, p<0.01) (Known groups). The Cronbach's alpha coefficient was 0.79 for the total scale, and it ranged from 0.76 (hassles and burdens)-0.46 (psychological impact) among the domains, confirming the internal consistency reliability. The Brazilian-Portuguese version of the DASS has shown levels of reliability and validity comparable with the original English version. Healthcare practitioners and researchers need internationally validated measurement tools to compare outcomes of interventions in clinical management and research tools in oral anticoagulation therapy.

Measuring Pain in Systemic Sclerosis: Comparison of the Short-form McGill Pain Questionnaire Versus a Single-item Measure of Pain

Studies of pain in systemic sclerosis (SSc) have used a variety of measures, including single-item measures and the 15-item short-form McGill Pain Questionnaire (MPQ-SF). The objective of our study was to compare the performance of the MPQ-SF to a single-item pain numerical rating scale (NRS) and determine whether the MPQ-SF effectively differentiates between sensory and affective components of pain in SSc. A cross-sectional, multicenter study of 1091 patients from the Canadian Scleroderma Research Group Registry who completed the MPQ-SF and pain NRS. Correlations of MPQ-SF total scores and pain NRS scores with relevant outcome measures (disability, quality of life, depressive symptoms) were compared. To assess whether the MPQ-SF differentiated between sensory and affective factors, confirmatory factor analysis modeling was used, and correlations of sensory and affective factor scores with other outcome measures were compared. MPQ-SF total score and the pain NRS correlated similarly with other outcome measures, as did the sensory and affective scores. MPQ-SF sensory and affective factors were highly correlated (0.92), and a single-factor model fit as well as a 2-factor (sensory and affective) model. The substantial overlap between sensory and affective subscales of the MPQ-SF and the similarity of the MPQ-SF and NRS pain measures compared to other patient-reported outcomes suggest that the 15-item MPQ-SF does not provide tangible advantages compared to the single-item pain NRS. These findings support recommendations to use a single-item NRS pain measure in SSc as it is less burdensome to patients than the MPQ-SF.

PLASMA HOMOCYSTEINE LEVEL AND APATHY IN ALZHEIMER'S DISEASE

PLASMA HOMOCYSTEINE LEVEL AND APATHY IN ALZHEIMER'S DISEASE

Cultural and linguistic validation of acne‐QoL in French

Acne-Quality of Life (acne-QoL) is a facial acne-specific quality-of-life instrument developed in English. Our objective was to translate and validate acne-QoL in French and to establish the reliability and responsivity of this measure. Acne-QoL was translated into French (acne-QoLfr) in accordance with international methodological recommendations. The validated French version of the Cardiff Acne Disability Index (CADIfr) was used as a comparator. Acne patients in Quebec (n = 20) and France (n = 14) completed the acne-QoLfr and CADIfr on three occasions over 3 months (day 0, day 2-3, day 60-90). A total of 34 patients were recruited. Pearson's correlation for total acne-QoLfr scores at day 0 and day 2-3 was 0.77. Of the four domains comprising the acne-QoLfr, correlations were highest for symptoms (0.85) and lowest for the role-emotional domain (0.66). At day 60-90, total acne-QoLfr scores increased by a mean of 19.7 points, reflecting improved quality-of-life with acne therapy and demonstrating responsivity of the instrument. Acne-QoLfr is a linguistically and culturally validated tool for facial acne that is both reliable and responsive.

Prevalence of depression and its relationship with other clinical characteristics in a sample of patients with stable schizophrenia

Aim To evaluate the prevalence of depression using the Calgary Depression Scale for Schizophrenia (CDSS) in a sample of Spanish patients with stable schizophrenia and without a diagnosis of depression. Methods We included stable outpatients of 18 to 50 years of age, with a diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder who had not been diagnosed with depression. In this cross-sectional study, we administered the CDSS, the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale to Assess Unawareness of Mental Disorder (SUMD), the Simpson Angus Scale (SAS), and the Barnes Akathisia Rating Scale (BARS). Results A total of 95 patients were recruited, 90 of them were included in the statistical analysis. Twenty-eight patients had a total score of 5 or more points on the CDSS, making the prevalence of depression 31% (95% confidence interval, 22-41). The CDSS had a high correlation with the depressive factor of the PANSS and a moderate correlation with the general psychopathology subscale of the PANSS. The correlation of the CDSS total score with negative symptoms was moderate using the SANS and low with the PANSS-negative. There was no correlation between depressive symptoms and positive symptoms, insight, and extrapyramidal symptoms; and the correlation with akathisia was low. Conclusion Our results suggest that patients with stable schizophrenia who have not been diagnosed with depression frequently have clinically relevant symptoms of depression, and that these symptoms, with the possible exception of a contribution from negative symptoms, are not secondary to other symptoms of their disorder or to extrapyramidal adverse effects of medications.

Development and Preliminary Evaluation of a Practice-Based Learning and Improvement Tool for Assessing Resident Competence and Guiding Curriculum Development

Although practice-based learning and improvement (PBLI) is now recognized as a fundamental and necessary skill set, we are still in need of tools that yield specific information about gaps in knowledge and application to help nurture the development of quality improvement (QI) skills in physicians in a proficient and proactive manner. We developed a questionnaire and coding system as an assessment tool to evaluate and provide feedback regarding PBLI self-efficacy, knowledge, and application skills for residency programs and related professional requirements. Five nationally recognized QI experts/leaders reviewed and completed our questionnaire. Through an iterative process, a coding system based on identifying key variables needed for ideal responses was developed to score project proposals. The coding system comprised 14 variables related to the QI projects, and an additional 30 variables related to the core knowledge concepts related to PBLI. A total of 86 residents completed the questionnaire, and 2 raters coded their open-ended responses. Interrater reliability was assessed by percentage agreement and Cohen κ for individual variables and Lin concordance correlation for total scores for knowledge and application. Discriminative validity (t test to compare known groups) and coefficient of reproducibility as an indicator of construct validity (item difficulty hierarchy) were also assessed. Interrater reliability estimates were good (percentage of agreements, above 90%; κ, above 0.4 for most variables; concordances for total scores were R = .88 for knowledge and R = .98 for application). Despite the residents' limited range of experiences in the group with prior PBLI exposure, our tool met our goal of differentiating between the 2 groups in our preliminary analyses. Correcting for chance agreement identified some variables that are potentially problematic. Although additional evaluation is needed, our tool may prove helpful and provide detailed information about trainees' progress and the curriculum.

Clinical Investigation of Pain-related Fear and Pain Catastrophizing for Patients With Low Back Pain

to investigate select psychometric properties of fear-avoidance model measures commonly used to assess pain-related fear and catastrophizing in clinical studies of low back pain. a convenience sample was recruited from patients (n=80) seeking outpatient physical therapy for low back pain. All patients completed self-report questionnaires for pain-related fear [Fear-avoidance Beliefs Questionnaire-physical activity (FABQ-PA), FABQ-work scale (W), and Tampa Scale for Kinesiophobia -11] and pain catastrophizing (PCS) at initial evaluation session. Patients also completed clinical measures for pain intensity (numerical rating scale) and self-report of disability (Oswestry Disability Index) at the initial evaluation session. Construct redundancy of the fear-avoidance questionnaires was assessed by factor analysis for individual items and Pearson correlation for total questionnaire scores. Concurrent validity was investigated with multiple regression models for pain intensity and disability. item analysis indicated all PCS and FABQ-W items loaded on 2 separate factors. The FABQ-PA and Tampa Scale for Kinesiophobia-11 loaded together on a third factor. As expected, all of the fear-avoidance questionnaires were significantly correlated with each other to varying degrees (rs ranged from 0.28 to 0.55, P<0.05 for all). In the multiple regression models only the FABQ-PA and PCS contributed unique variance to pain intensity and disability measures. Further analysis indicated the PCS mediated the relationship of the FABQ-PA by weakening its association with pain intensity and disability. these analyses suggest clinical assessment of the Fear-Avoidance Model of Musculoskeletal Pain likely captures 3 factors including PCS, beliefs about work, and beliefs about physical activity. The FABQ-PA and PCS can be recommended for clinical use because of their unique associations with pain intensity and disability. The FABQ-W may only be appropriate for those interested in assessing work specific beliefs.

Objective Structured Clinical Examination–Based Assessment of Regional Anesthesia Skills

Simulation techniques are increasingly being used in anesthesia training programs and to a lesser extent in evaluation of residents. We describe 7 years of experience with Objective Structured Clinical Examination-based regional anesthesia assessment in the Israeli National Board Examinations in Anesthesiology. We believe this is the first use of such mock scenarios for the assessment of regional anesthesia for the important purpose of national accreditation. During the study period, 308 candidates were examined in 1 of 8 different blocks. The total pass rate was 83%(257 of 308), ranging from 73% to 91%. The interrater correlation for total, critical, and global scores were 0.84, 0.88, and 0.75, respectively. Technological and cost constraints preclude actual assessment of regional anesthesia. However, testing formats that more closely reflect clinical practice are potentially valuable adjuncts to traditional examinations.