Floor Effects Research Articles

Cross-cultural adaptation, reliability, and validity of the Turkish version of the Exercise Therapy Burden Questionnaire for individuals with chronic diseases.

Chronic diseases, which caused 36 million deaths in 2008, are the most common cause of death worldwide. Exercise is one of the non-pharmacological treatment methods. Although exercise benefits are well known, more than half of the population does not exercise due to the burden of exercise. The objectives of the current study were to evaluate the Turkish version of the Exercise Therapy Burden Questionnaire (ETBQ-T) and to investigate its reliability and validity. A total of 100 participants (female: 69, male: 31) who were diagnosed with at least one chronic disease participated in the translation validity and reliability analysis of the study. Cross-cultural adaptation of the ETBQ-T was performed according to Beaton's guidelines. The ETBQ-T, the European Quality of Life 5 Dimensions (EQ-5D), pain, satisfaction, and self-efficacy were applied for convergent validity. The ETBQ-T was retested to examine its reliability after 7 days. The internal consistency and reliability were excellent (intraclass correlation coefficient=0.959; Cronbach's α=0.919). The standard error of measurement was reported as 5.35. The minimum detectable difference was also demonstrated at 1.35. The ETBQ-T had a good correlation with pain (r=0.545, p<0.001), satisfaction (r=-501, p<0.001), and self-efficacy (r=-0.579, p<0.001). However, the correlation of the ETBQ-T with EQ-5D (r=0.340, p=0.001) was weak. A factor was extracted, accounting for 58.289% of the total variation. There were no floor or ceiling effects. The ETBQ-T is a reliable and valid tool to evaluate the exercise burden in the Turkish population with chronic disease.

Validation and application of the Dermatology Life Quality Index score, a modification of the DLQI score, in psoriasis patients

BackgroundAll the scoring methods for the DLQI miss the moderate impact of the disease on patients, which may underestimate the impact of psoriasis on patients’ quality of life. To improve the accuracy of the assessment of the Dermatology Life Quality Index score (DLQI) for patients with psoriasis, this study proposed and validated a new scoring method, the DLQI-NS, which includes the moderate impact option in the self-assessment of each item in psoriasis patients.MethodsA cross-sectional study was conducted in which patients with psoriasis were enrolled. A total of 425 participants completed the DLQI, DLQI-NS and Skindex-16 questionnaires. Reliability, validity, ceiling and floor effects were evaluated of both DLQI and DLQI-NS questionnaires.ResultsAbout 14.4-32.5% of the patients reported a moderate impact on quality of life. The DLQI-NS allowed 17 more patients (4.0%) to achieve severe disease. The Cronbach’s alpha coefficient of the DLQI-NS was 0.90, and that of the DLQI was 0.89. The KMO test results for the DLQI-NS and DLQI were 0.927 and 0.916, respectively. One factor was identified for each questionnaire. The items of the DLQI-NS showed an item-total correlation from 0.52 to 0.82, and the DLQI questionnaire’s item-total correlation ranged from 0.47 to 0.83. The DLQI-NS, DLQI total score and Skindex-16 had Spearman’s rank correlation coefficients of 0.89 and 0.84, respectively. Both the DLQI-NS and DLQI showed significant moderate correlations with the BSA (0.51 vs. 0.50) and PASI (0.47 vs. 0.46). No ceiling effects were observed for any of the items of both questionnaires.ConclusionThe validity and reliability of the DLQI-NS and DLQI were good, but the DLQI-NS was superior to the DLQI. The DLQI-NS is an effective self-assessment tool for assessing quality of life in psoriasis patients.

The Bed Bridge Test: a new functional test for hospital inpatients – a feasibility and measurement study

Purpose To develop and assess the Bed Bridge Test’s (BBT) feasibility, safety, and clinimetric properties and evaluate functional capacity in hospitalised patients. Materials and methods This feasibility and measurement study examined four BBT versions, including the timed-limited at 30 and 60 s and repetition-limited at 5 and 10 times, in hospitalised patients in a university hospital in Brazil. Ninety-two functionally stable patients with respiratory, gastrointestinal, or post-surgical conditions participated. Participants completed the BBT versions in a random order. BBT concurrent criterion validity was evaluated using the Short Physical Performance Battery (SPPB), Sit-to-Stand (STS) test, and Functional Status Score (FSS). Results The participants were 51 ± 17 years old, 60% female, and 66% with clinical conditions. All participants completed the BBT versions without adverse events. Test–retest reliability was good–excellent (intraclass correlation coefficient >0.87) for all BBT versions, with acceptable agreement parameters and minimal detectable changes. The time-limited versions of the BBT might be affected by a ceiling effect. Floor effects were minimal for all BBT versions. BBT showed moderate associations with SPPB and STS and weak associations with FSS. Conclusions The BBT is feasible and has promising measurement properties.

Experimental and numerical research on seismic behavior of end-plate connection beam-column joints considering concrete floor effect

With the aims to study the seismic performance of the end-plate connection (EPC) joint with concrete floor, four full-scale specimens with different configuration (two specimens in major direction, and the other in minor direction) of the pseudo-static cyclic loading tests were conducted. Based on the failure criteria, the mechanical behaviors and failure modes of the specimens were investigated, including major and minor connection directions. The hysteresis response, bearing capacity, stiffness evaluation, and energy dissipation of the specimens were evaluated, and with a average ductility coefficient value of all specimens is about γ = 4.0. Meanwhile, to analyze and verify the accuracy of experimental results, the nonlinear models of the specimens were performed in ABAQUS software. In addition, a series of parametric analysis were performed to study the influence of axial compression ratios, thickness ratios (the ratio(η1) of end-plate thickness to column flange thickness, and the ratio(η2), of end-plate thickness to column web thickness), and concrete compressive strength on the joint seismic performance. This parametric analysis result indicates that increasing the thickness ratio and concrete compressive strength reasonably can effectively improve the seismic behavior of the overall joint with the concrete floor, especially in minor direction joints.

Measurement properties of the Iranian version of the breast cancer perception scale (BCPS) according to the COSMIN checklist

BackgroundBreast cancer is a prevalent cancer characterized by its aggressive nature and potential to cause mortality among women. The rising mortality rates and women’s inadequate perception of the disease’s severity in developing countries highlight the importance of screening using conventional methods and reliable scales. Since the validity and reliability of the breast cancer perception scale (BCPS) have not been established in the Iranian context. Therefore, this study aimed to determine the measurement properties of the BCPS in women residing in Tabriz, Iran.MethodsThe present study comprised a cross-sectional design, encompassing a sample of 372 Iranian women. The participants were selected through a multi-stage cluster random sampling technique conducted over a period spanning from November 2022 to February 2023. The measurement properties of the Iranian version of BCPS were assessed following the guidelines outlined in the COSMIN checklist. This involved conducting various steps, including the translation process, reliability testing (internal consistency, test-retest reliability, and measurement error), and methodological tests for validity (content validity, face validity, construct validity, and hypothesis testing). The study also investigated the factors of responsiveness and interpretability. The presence of floor and ceiling effects was assessed.ResultsThe internal consistency of the scale was assessed using Cronbach’s alpha, yielding a satisfactory value of 0.68. Additionally, McDonald’s omega (95% CI) was computed, resulting in a value of 0.70 (0.66 to 0.74). Furthermore, the test-retest reliability was evaluated, revealing a high intraclass correlation coefficient (ICC) of 0.97 (95% CI: 0.94 to 0.99). The CVI, CVR, and impact scores of the BCPS were determined to be 0.98, 0.95, and 3.70, respectively, indicating favorable levels of content and face validity. To assess construct validity, an examination of the Exploratory Factor Analysis (EFA) was conducted on a set of 24 items. This analysis revealed the presence of six distinct factors, which collectively accounted for 52% of the cumulative variance. The fit indices of the validity model (CFI = 0.91, NFI = 0.96, RFI = 0.94, TLI = 0.90, χ2/df = 2.03, RMSEA = 0.055 and SRMR = 0.055) were confirmed during the confirmatory factor analysis (CFA). The overall score of BCPS exhibited a ceiling effect of 0.3%. The floor effect observed in the overall score (BCPS) was found to be 0.5%. Concerning the validation of the hypothesis, Spearman’s correlation coefficient of 0.55 was obtained between the BCPS and the QLICP-BR V2.0. This correlation value signifies a statistically significant association. Furthermore, it is worth noting that the minimum important change (MIC) of 3.92 exhibited a higher value compared to the smallest detectable change (SDC) of 3.70, thus suggesting a satisfactory level of response.ConclusionsThe obtained findings suggest that the Iranian version of the BCPS demonstrates satisfactory psychometric properties for assessing the perception of breast cancer among Iranian women. Furthermore, it exhibits favorable responsiveness to clinical variations. Consequently, it can serve as a screening instrument for healthcare professionals to comprehend breast cancer and as a reliable tool in research endeavors.

Validation of the psychoactive substance refusal Self-Efficacy Questionnaire (PSRSEQ) in adolescent case-clients of social workers in Hong Kong

BackgroundSelf-efficacy is a key concept in various behavioral theories. Refusal self-efficacy is important in understanding issues related to psychoactive substance use. To facilitate related research, this study translated and validated the Chinese version of the 14-item Psychoactive Substance Refusal Self-efficacy Questionnaire (PSRSEQ) among adolescents. There is a debate about whether such a refusal self-efficacy scale should be unidimensional or multidimensional. MethodsA survey was conducted among 601 adolescent case-clients of social workers in Hong Kong from July 2021 to June 2022. Various psychometric properties were examined. ResultsThe confirmatory factor analysis (CFA) supported the original 3-factor structure of the PSRSEQ (emotional relief, opportunistic, and social facilitation refusal self-efficacy), which showed satisfactory psychometric properties (internal consistency, convergent validity in terms of significant negative correlations with the intention of psychoactive substance use in the next year and psychoactive substance use behavior in the past six months, and the absence of floor effect) but ceiling effect was obvious. Notably, unacceptable discriminant validity of one subscale and strong correlations among the three subscales were observed. In another set of analyses using two split-half subsamples, the exploratory factor analysis identified a 1-factor 14-item structure, which was confirmed by CFA and showed satisfactory psychometric properties. ConclusionsThe 1-factor PSRSEQ, instead of the one having a 3-factor structure, was preferred and recommended to assess psychoactive substance refusal self-efficacy among Chinese adolescents. It is warranted to validate the scale in other adolescent and age groups in future studies.

Psychometric Validation of the Modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA) in Patients With Spinocerebellar Ataxia

This study aimed to generate evidence to support psychometric validity of the modified functional Scale for the Assessment and Rating of Ataxia (f-SARA) among patients with spinocerebellar ataxia (SCA). Psychometric measurement properties and minimal change thresholds of the f-SARA were evaluated using data from a cohort of SCA subjects (recruited at Massachusetts General Hospital [MGH]; n = 33) and data from a phase 3 trial of troriluzole in adults with SCA (NCT03701399 [Study 206]; n = 217), including a subset of patients with the SCA3 genotype (n = 89). f-SARA item ceiling effects were absent within the MGH cohort, while floor effects were present. Excellent internal consistency reliability was demonstrated (αtotal = 0.90; αitems-removed = 0.86–0.90), and item-to-total correlations were strong (r = 0.82–0.91, per item). High test–retest reliability was demonstrated with intraclass correlation coefficients of 0.91 (total) and 0.73–0.92 (items). Convergent and divergent validity was supported, with strong correlations observed between the f-SARA and similarly constructed scales (FARS-FUNC, BARS, PROM-ADL, and FARS-ADL; all p < 0.001) and weaker correlations observed among measures of differing constructs. Mean item and total scores increased with disease severity (by FARS-FUNC quartile; p < 0.001). A 1-point threshold for meaningful changes was supported as 0.5 × SD = 0.89, SEM = 1.12, and mean changes from baseline for patients classified as “improved,” “no change,” or “deteriorated” were −0.68, 0.02, and 0.58, respectively. Similar trends were observed in Study 206 all-SCA and SCA3 cohorts. The measurement properties of the f-SARA provide evidence of its psychometric validity, responsiveness, and suitability as a clinical outcome measure in patients with SCA, including those with SCA3.

Transcultural adaptation and validation of the DASH questionnaire in Mexican healthy volunteers and patients with neurogenic disorders of the upper extremity

The Disability of the Arm, Shoulder and Hand (DASH) questionnaire assesses the impact of upper extremity disorders on quality of life. However, its use in the Mexican population has not been formally validated. To conduct a cultural adaptation and validation of the DASH questionnaire to evaluate the perspective of patients with neurogenic disorders of the upper extremity regarding the impact on their quality of life. We performed an adaptation of the Spanish version of the DASH questionnaire to the Mexican vocabulary and applied it to 478 volunteers. Ceiling effect, floor effect, item-total correlation, descriptive statistics of items and total score, internal consistency, precision, cross-sectional and longitudinal validity were estimated by comparing healthy controls and affected individuals with different disability levels. Our DASH questionnaire version was equivalent to those previously approved and showed homogeneity of the items with respect to the total value of the questionnaire (Cronbach's alpha > 0.96). In addition, it showed an accuracy of 7.25 points and the crosssectional and longitudinal validity was documented with significant differences between groups and subgroups with distinct disability levels. The DASH questionnaire can be used with a high level of confidence in the Mexican population.

Cross-cultural adaptation of the Thoracic Outlet Syndrome Index for Turkish-speaking patients with thoracic outlet syndrome.

Considering that there is no specifically designed scale to measure quality of life (QoL) and level of functioning among Turkish-speaking patients with thoracic outlet syndrome (TOS), the aim of this study was to adapt the Thoracic Outlet Syndrome Index (TOSI) to the Turkish language (TOSI-TR) and analyze its psychometric properties in patients with TOS. Thirty-nine patients with symptomatic TOS were included in the study. The participants were assessed using the following measures: the QuickDASH, the Western Ontario Rotator Cuff Index (WORC), and a visual analog scale (VAS). The psychometric properties of the TOSI-TR were examined in terms of test-retest reliability, construct validity, convergent validity, and feasibility. The ICC2,1 of the TOSI-TR was 0.949 (95% CI: 0.903-0.973). The Kaiser-Meyer-Olkin value was found to be 0.716 with a significant result for Bartlett's sphericity test (p < 0.001). The TOSI-TR had a one-factor solution explaining 74.05% of the total variance. There was a significant correlation between TOSI-TR scores and QuickDASH (r = 0.762, p < 0.001), WORC (r =0.794, p < 0.001), and VAS (r = 0.663, p < 0.001) scores. The WORC and VAS scores were significant determinants of the TOSI-TR score, explaining 65.3% of the variance. There were no floor or ceiling effects. The TOSI-TR is a reliable, valid, and feasible questionnaire for the QoL and functional status in Turkish-speaking patients with TOS. We recommend this 15-item scale for optimal assessment in patients with TOS.

Comparing the EQ-5D-5L and stroke impact scale 2.0 in stroke patients: an analysis of measurement properties

BackgroundStroke has evolved to become a chronic disease and a major public health challenge. To adequately capture the full disease burden of stroke patients, the assessment of health-related quality of life (HRQoL) and thus the performance of respective measures is increasingly relevant. The aim of this analysis was to compare the measurement properties of two self-report instruments, the EQ-5D-5L and the Stroke Impact Scale 2.0.MethodsThe data used for the analysis was derived from a quasi-experimental case management study for mildly to moderately affected incident stroke and transient ischemic attack (TIA) patients aged ≥ 18 in Germany. Data was collected patient-individually at 3, 6 and 12 months after initial stroke. The EQ-5D-5L and SIS 2.0 were compared in terms of feasibility, ceiling and floor effects, responsiveness and known-groups validity (Kruskal-Wallis H and Wilcoxon rank-sum test).ResultsA response for all three follow-ups is available for n = 855 patients. The feasibility of the EQ-5D-5L is determined as good (completion rate: 96.4–96.6%, ≥ one item missing: 3.2 − 3.3%), whereas the SIS 2.0 is moderately feasible (overall completion rate: 44.9–46.1%, ≥ one item missing in domains: 4.7 − 28.7%). The SIS 2.0 shows substantial ceiling effects in comparable domains (physical function: 10.4 − 13%, others: 3.5–31.3%) which are mainly larger than ceiling effects in the EQ-5D-5L index (17.1–21.5%). In terms of responsiveness, the EQ-5D-5L shows small to moderate change while the SIS 2.0 presents with moderate to large responsiveness. The EQ-5D-5L index, mobility, usual activities and Visual Analogue Scale show known-groups validity (p < 0.05). Content-related domains of the SIS 2.0 show known-groups validity as well (p < 0.05). However, it is compromised in the emotion domain in both measures (p > 0.05).ConclusionsThe EQ-5D-5L seems to be slightly more suitable for this cohort. Nonetheless, the results of both measures indicate limited suitability for TIA patients. Large-scale studies concerning responsiveness and known-groups validity are encouraged.Trial registrationThe study was registered in the German Clinical Trials Register, retrospective registration on 21.09.2022. Registration ID: DRKS00030297.

Does sleep benefit source memory? Investigating 12-h retention intervals with a multinomial modeling approach.

For retention intervals of up to 12h, the active systems consolidation hypothesis predicts that sleep compared to wakefulness strengthens the context binding of memories previously established during encoding. Sleep should thus improve source memory. By comparing retention intervals filled with natural night sleep versus daytime wakefulness, we tested this prediction in two online source-monitoring experiments using intentionally learned pictures as items and incidentally learned screen positions and frame colors as source dimensions. In Experiment 1, we examined source memory by varying the spatial position of pictures on the computer screen. Multinomial modeling analyses revealed a significant sleep benefit in source memory. In Experiment 2, we manipulated both the spatial position and the frame color of pictures orthogonally to investigate source memory for two different source dimensions at the same time, also allowing exploration of bound memory for both source dimensions. The sleep benefit on spatial source memory replicated. In contrast, no source memory sleep benefit was observed for either frame color or bound memory of both source dimensions, probably as a consequence of a floor effect in incidental encoding of color associations. In sum, the results of both experiments show that sleep within a 12-h retention interval improves source memory for spatial positions, supporting the prediction of the active systems consolidation hypothesis. However, additional research is required to clarify the impact of sleep on source memory for other context features and bound memories of multiple source dimensions.

Clinimetric Properties of the Chinese Short Form of the Sarcopenia Quality of Life Questionnaire in Patients With Cancer.

Sarcopenia, prevalent in patients with cancer, negatively affects quality of life. However, generic tools are unable to capture the minor effects of sarcopenia on quality of life. The short-form version of the Sarcopenia Quality of Life (SF-SarQoL) questionnaire was developed as an efficient tool to assess the impact of sarcopenia on quality of life in older adults. However, its clinimetric properties in patients with cancer remain unknown. This study was designed to examine the clinimetric properties of the Chinese SF-SarQoL in patients with colorectal cancer, particularly with regard to its ability to detect changes in quality of life. A longitudinal survey was conducted using the SF-SarQoL and other questionnaires on 408 patients with colorectal cancer planning to undergo surgery. Follow-up was subsequently conducted on 341 of these patients 1 month after surgery. The clinimetric properties of the SF-SarQoL were examined, including reliability (internal consistency), validity (construct validity, concurrent validity), sensitivity (ability to detect changes, discriminative ability), and floor and ceiling effects. The internal consistency of the SF-SarQoL was found to be acceptable (Cronbach's alpha = .94 and McDonald's omega = .94). Strong scalability of the total score and each item was confirmed using Mokken analysis. Concurrent validity analyses indicate the SF-SarQoL is significantly correlated with muscle-related and health-related questionnaire scores. The SF-SarQoL showed adequate sensitivity due to its good ability to detect changes in quality of life with a moderate effect size (Cohen's d = 0.56) and discriminate between sarcopenic and nonsarcopenic patients (area under the curve = 0.73, 95% CI [0.66, 0.79]) using receiver operating characteristic curve analyses. No floor or ceiling effects were observed. The Chinese SF-SarQoL exhibits good clinimetric properties in preoperative patients with colorectal cancer and is sufficiently sensitive to capture changes in quality of life after surgery.

Dissecting the digital divide: A household fixed effects approach to estimating gender gaps in digital skills of youth in low- and middle-income economies

This study investigates gender gaps in digital skills among youth (15–24 years old) in 32 low- and middle-income economies using data from UNICEF-supported and internationally comparable Multiple Indicator Cluster Surveys (MICS). Utilizing a household fixed effects approach, we aim to isolate gender-based disparities from household-level variations. The intra-household analysis reveals significant inequalities, with biases against young women in possessing digital skills, including the very basic ones. Supplementary analysis using a mixed-effects model, which accounts separately for within- and between-household variation, highlights that wealthier households exhibit larger gender gaps in digital skills, disadvantaging young women primarily due to a floor effect in the poorest households. The paper concludes with policy implications aimed at reducing gender gaps in digital skills.

Reliability and validity of a Japanese version of life-space assessment in institutionalized settings

PurposeA reduction in life space (LS) is associated with a negative impact on medical and functional status during hospitalization, with potential consequences after discharge. A validated version of an evaluation tool for assessing LS in Japanese individuals in an institutionalized setting is lacking. This study developed and validated a Japanese version of the Life-Space Assessment in Institutionalized Settings (LSA-IS-J). Material and methodsThe LSA-IS-J was developed using a specified process. This study included 30 inpatients admitted to the rehabilitation ward. The Timed Up and Go Test, Berg Balance Scale scores, 10-meter walking time, Functional Independence Measure, and Falls Efficacy Scale-International were used to assess construct validity. For test-retest reliability, the same assessor evaluated the LSA-IS-J within two days. Correlation coefficients were calculated to determine the construct validity. ResultsThe mean LSA-IS-J total score mean was 37.7 (standard deviation: 7.4), with skewness of -0.17 and kurtosis of -1.39. No ceiling or floor effects are observed. The test-retest reliability was excellent for the total and subtests, with intraclass correlations ranging from 0.78 to 0.99. The LSA-IS-J showed significant correlations with almost all variables related to motor status and concerns about falling, indicating high construct validity. In contrast, more generic variables were not significantly associated. ConclusionsThe LSA-IS-J demonstrated broad feasibility for assessing LS without ceiling or floor effects among patients undergoing ward-based rehabilitation. The LSA-IS-J also demonstrated excellent test-retest reliability and adequate construct validity for constructs with a high impact on LS.

Development and validation of a 13-item short version of the inflammatory bowel disease self-efficacy scale

BackgroundThe inflammatory bowel disease self-efficacy scale (IBD-SES) is an instrument used across many countries to measure important health outcomes of patients with inflammatory bowel disease (IBD). We aimed to develop and validate a substantially shorter version of this scale to reduce patients’ response burden.MethodsA total of 919 patients with IBD, 482 recruited from an IBD clinic and 437 recruited online, completed the Japanese version of the original, 29-item IBD-SES. These data were then used to develop a shorter version of the scale. The original 29 items of the IBD-SES were reduced with three analytic steps: assessing ceiling and floor effect, testing correlation between items, and assessing test-retest reliability. The resulting 13-item IBD-SES was evaluated for construct validity by confirmatory factor analysis, criterion validity by Pearson correlation coefficients with original version, and internal consistency by item-total correlations and the Cronbach’s α coefficient.ResultsThe short version consisted of the same four subscales “managing stress and emotions,” “managing medical care,” “managing symptoms and disease,” and “maintaining remission” as the original scale. The fit indices of the final model were as follows: normed chi-square, 7.18 (p < 0.001); comparative fit index, 0.94; goodness-of-fit index, 0.93; adjusted goodness-of-fit index, 0.89; parsimony goodness-of-fit index, 0.60; and root mean square error of approximation, 0.084. Correlation of each subscale with the original scale was high (0.97–0.98). Cronbach’s α for each subscale ranged from 0.68 to 0.86.ConclusionsA short version of the IBD-SES was developed. The results confirmed the improved validity, reliability, and psychometric properties of the IBD-SES.Trial registrationNot applicable.

The Need to Practice What We Teach: Revisiting the Sticky Floor Effect in Five Southern U.S. States’ Public Universities

Administrative appointments throughout higher education are sought after, highly coveted positions that exhibit power and authority for many as they become leaders. Historically, males have held a majority of these positions. Johnson, Long, and Faught (2014) found “a clear discrepancy exists” (p. 29). This study revisits the research of Johnson, Long, and Faught in examining the gender composition of public university administrators, following the chain of command from the colleges of business upwards, in five southern U.S. states. As in the original research, this study investigates the presence and prevalence of the sticky floor effect and the perceived fair employment practices of universities in applying diversity concepts within their institutions 11 years after the initial study.

The Posterior Shoulder Instability Questionnaire: internal consistency, content and criterion validity, responsiveness, and reliability of a new tool for the assessment of posterior shoulder instability

Posterior shoulder instability (PSI) is an increasingly recognized cause of shoulder dysfunction particularly in young active patients and certain athlete populations. When evaluating the efficacy of treatment for PSI, specific outcome measures for this population are essential. The aim of the current research was to describe the development and evaluation of a patient reported outcome measure (PROM) specific for PSI. A retrospective cohort study design of patients with PSI was used to develop and evaluate the "Posterior Shoulder Instability Questionnaire (PSI-Q)". Items for PSI-Q were generated through an expert focus group and existing questionnaires. Preliminary data analysis identified redundancy of items and resulted in the PSI-Q being refined. The final PSI-Q was evaluated on 128 patients with PSI with a structural lesion requiring surgical intervention. Participants were excluded in the absence of a posterior glenohumeral joint lesion. Internal consistency (Cronbach α and corrected item-total correlation), content validity, criterion validity, responsiveness, and test-retest reliability (intraclass correlation coefficient; ICC) were examined. Content validity, criterion validity and responsiveness were compared with the Melbourne Instability Shoulder Score (MISS) and the Western Ontario Shoulder Index (WOSI). The minimum detectable change score (MDC) was calculated. The Cronbach α for the total scale pre and post-intervention was high (α = 0.97). All five domains (Pain, Instability/Weakness/Stiffness, Function, Occupation and Sport, and Quality of Life and Satisfaction) demonstrated acceptable internal consistency for each subsection and the overall score of the scale (α > 0.70). The corrected-item total correlation for each domain were within an acceptable range. The responsiveness of the PSI-Q questionnaire was excellent (effect size, 2.06; standard response mean, 1.34) and was higher than the MISS and WOSI. There were no relevant floor effects and one ceiling effect. Reliability was excellent (ICC (1,1) = 0.93) and the calculated MDC was 10.9 points. This study designed and validated a questionnaire specific for measuring symptoms and function in people with structural PSI requiring surgery. The PSI-Q demonstrates good measurement properties and provides an MDC that is useful for researchers and clinicians. In structural PSI, the PSI-Q has a higher responsiveness and more accurately reflects a patient's overall perceived shoulder status compared to current patient reported outcomes for shoulder instability. The psychometric properties of the PSI-Q are still to be determined in a non-surgical population.

Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest

Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. Despite these symptoms indicating potential balance deficits, systematic investigations and validated assessments are lacking. Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. Balance was assessed post-ICU discharge (V1) and at discharge from inpatient neurorehabilitation (V2) in patients with ≥ 5 days of invasive ventilation. Mini-BESTest measurement characteristics were evaluated in an ambulatory subgroup. A multiple linear regression was conducted. The prospective cohort study comprised 250 patients (34% female, 62 ± 14 years, median ICU stay 55 days). Median Mini-BESTest scores improved significantly from V1 (5 (IQR 0–15)) to V2 (18.5 (10–23)) with a large effect size. Excellent inter-rater and test–retest reliabilities of the Mini-BESTest were observed (ICC = 0.981/0.950). Validity was demonstrated by a very high correlation with the Berg Balance Scale (ρ = 0.90). No floor or ceiling effects were detected. Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. Due to its excellent psychometric properties, the Mini-BESTest is suitable for use in critical illness survivors.Registration: The study was registered at the German Clinical Trials Register (DRKS00021753, date of registration: 2020-09-03).

P.151 A critical appraisal of the application of frailty and sarcopenia in the spinal oncology population

Background: Frailty and sarcopenia predict worse surgical outcomes among spinal degenerative and deformity-related populations; this association is less clear in the context of spinal oncology. Here, we identified frailty and sarcopenia tools applied in spinal oncology and appraised their clinimetric properties. Methods: A systematic review was conducted from January 1st, 2000, until June 2022. Study characteristics, frailty tools, measures of sarcopenia, component domains, individual items, cut-off values, and measurement techniques were collected. Clinimetric assessment was performed according to Consensus-based Standards for Health Measurement Instruments. Results: Twenty-two studies were included (42,514 patients). The three most employed frailty tools were the Metastatic Spine tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. The three most common sarcopenia measures were the L3-Total Psoas Area (TPA)/Vertebral Body Area (VBA), L3-TPA/Height2, and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height2). Frailty and sarcopenia measures lacked content and construct validity. Positive predictive validity was observed in select studies employing the HFRS, mFI-5, MSTFI, and L3-TPA/VBA. All frailty tools had floor or ceiling effects. Conclusions: Existing tools for evaluating frailty and sarcopenia in surgical spine oncology have poor clinimetric properties. Here, we provide a pragmatic approach to utilizing existing frailty and sarcopenia tools, until more clinimetrically robust instruments are developed.

Psychometric testing of the Chinese version of the International Classification of Functioning, Disability, and Health Measure of Participation and Activities Screener in people with stroke.

Clinicians need a validated measure to assess the activity and participation of Chinese people with stroke. To culturally adapt and psychometrically test the Chinese (Cantonese) version of the International Classification of Functioning, Disability and Health Measure of Participation and Activities (C-IMPACT-S) in community-dwelling people with stroke. We followed the standard translation procedures to culturally adapt the C-IMPACT-S. Then we administered the C-IMPACT-S to 100 people with stroke and 50 healthy counterparts for psychometric testing, including the ceiling and floor effects, internal consistency, test - retest, measurement error, minimal detectable change, correlations with other outcome measures, known-group validity and optimal cutoff scores. The C-IMPACT-S has no floor effects but ceiling effects in item 5. It has poor to excellent (Cronbach's α = 0.56-95) internal consistency and fair to excellent (Intraclass correlation coefficients = 0.58-1.00) test-retest reliability. The overall C-IMPACT-S mean score and activity and participation component mean scores had statistically significant no to weak correlations with the Fugl-Meyer Assessment, the Chinese versions of Geriatric Depression Scale, Fatigue Assessment Scale, Lawton Instrumental Activities of Daily Living Scale and Community Integration Measure. The stroke participants had lower C-IMPACT-S scores then their health counterparts. The optimal cutoff scores of the overall C-IMPACT-S and activity and participation domains were 88.02% (sensitivity 72%, specificity 80%), 80.56% (sensitivity 86%, specificity 68%) and 91.67% (sensitivity 68%, specificity 80%), respectively. C-IMPACT-S is a reliable and valid measure for assessing the levels of activity and participation of people with chronic stroke.