Measurement Properties Of Instruments Research Articles

J28 Clinimetric Properties Of Instruments To Assess Postural Stability In Patients With Huntington's Disease: A Systematic Review

Introduction Postural instability is a major characteristic of Huntington’s disease (HD) causing considerable disability in many patients. Valid and reliable instruments measuring balance in HD patients are crucial in order to perform high quality research and clinical care regarding HD-related postural instability. However, little is known about the measurement properties of instruments that assess this phenomenon in HD patients. Aims To critically appraise and compare the measurement properties of assessment tools that measure postural stability in patients with HD. Methods A systematic review of the literature in PubMed, Embase, Web of Science and CINAHL was performed. The COSMIN-checklist was applied to evaluate the methodological quality of studies found after this literature search. Only full text, original articles, published in English, French, German or Dutch until January 2014 were included. These articles had to discuss the development or evaluation of measurement properties of clinimetric, posturographic or neurophysiological instruments that assess postural balance in manifest HD patients. The presentation of the outcome of analyses was mandatory. Results Criteria were met by 11 studies evaluating 23 assessment tools. The number of evaluated measurement properties varied from one to three per article. The methodological quality was rated as either poor or fair. After combining different studies most evaluated measurement properties were found for the Berg Balance Scale, including reliability, measurement error, content validity, structural validity and responsiveness. Four of them were rated as poor. Conclusions Instruments that assess postural stability in HD patients are currently not sufficiently validated. Future studies are needed to provide better evidence for reliability, validity and responsiveness of these instruments.

Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity.

Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials. To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions. Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases. Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework. Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness. Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs. The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes. The National Institute for Health Research Health Technology Assessment programme.

FRI0582-HPR A Critical Review on Measurement Properties of Instruments Used to Evaluate Body Function in People with Knee Osteoarthritis

BackgroundWith the increasing prevalence of knee osteoarthritis (KOA) today1, it is imperative to use valid and reliable instruments to evaluate the effectiveness of interventions and to understand the pathology's impact...

Quality appraisal of generic self-reported instruments measuring health-related productivity changes: a systematic review

BackgroundHealth impairments can result in disability and changed work productivity imposing considerable costs for the employee, employer and society as a whole. A large number of instruments exist to measure health-related productivity changes; however their methodological quality remains unclear. This systematic review critically appraised the measurement properties in generic self-reported instruments that measure health-related productivity changes to recommend appropriate instruments for use in occupational and economic health practice.MethodsPubMed, PsycINFO, Econlit and Embase were systematically searched for studies whereof: (i) instruments measured health-related productivity changes; (ii) the aim was to evaluate instrument measurement properties; (iii) instruments were generic; (iv) ratings were self-reported; (v) full-texts were available. Next, methodological quality appraisal was based on COSMIN elements: (i) internal consistency; (ii) reliability; (iii) measurement error; (iv) content validity; (v) structural validity; (vi) hypotheses testing; (vii) cross-cultural validity; (viii) criterion validity; and (ix) responsiveness. Recommendations are based on evidence syntheses.ResultsThis review included 25 articles assessing the reliability, validity and responsiveness of 15 different generic self-reported instruments measuring health-related productivity changes. Most studies evaluated criterion validity, none evaluated cross-cultural validity and information on measurement error is lacking. The Work Limitation Questionnaire (WLQ) was most frequently evaluated with moderate respectively strong positive evidence for content and structural validity and negative evidence for reliability, hypothesis testing and responsiveness. Less frequently evaluated, the Stanford Presenteeism Scale (SPS) showed strong positive evidence for internal consistency and structural validity, and moderate positive evidence for hypotheses testing and criterion validity. The Productivity and Disease Questionnaire (PRODISQ) yielded strong positive evidence for content validity, evidence for other properties is lacking. The other instruments resulted in mostly fair-to-poor quality ratings with limited evidence.ConclusionsDecisions based on the content of the instrument, usage purpose, target country and population, and available evidence are recommended. Until high-quality studies are in place to accurately assess the measurement properties of the currently available instruments, the WLQ and, in a Dutch context, the PRODISQ are cautiously preferred based on its strong positive evidence for content validity. Based on its strong positive evidence for internal consistency and structural validity, the SPS is cautiously recommended.

Measurement properties of instruments assessing self-efficacy in patients with rheumatic diseases

The measurement properties of instruments assessing self-efficacy (SE) in patients with rheumatic diseases were reviewed. The consensus-based standards for the selection of health measurement instruments (COSMIN) checklist was applied following systematic searches of seven electronic databases from 1989 to December 2011. Fifteen articles met the inclusion criteria that included the arthritis SE scales (ASES), generalized SE scale (GSES), joint protection SE scale (JP-SES), Marcus & Resnick SE exercise behaviour (SEEB) instruments, and RA SE scale (RASE). The ASES and RASE have undergone more than one evaluation. There was little formal evaluation of content validity for the instruments. Evidence for the RASE suggests that it is not unidimensional. The JP-SES and SEEB were evaluated using modern psychometric methods. The instruments require further evaluation before application. The quality of the evidence for the ASES and RASE is generally poor. The generic focus of the GSES limits its relevance. The JP-SES and SEEB have only undergone one evaluation and that relating to the latter was narrow in scope. Future studies should address these methodological weaknesses.

Instruments measuring externalizing mental health problems in immigrant ethnic minority youths: a systematic review of measurement properties.

BackgroundLittle is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths.AimsTo provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results.MethodsA systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the ‘COSMIN-checklist’. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given.ResultsTwenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity.ConclusionIt seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths.

Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties

BackgroundThe measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed.MethodObjectives: To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. Data Sources: A systematic review of articles using electronic databases MEDLINE (1950–2012), CINAHL (1982–2012), EMBASE (1980–2012), Cochrane Library (2012), Expanded Academic ASAP (1994–2012), Health Collection Informit (1995–2012) and PEDRO (1999–2012). Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter- or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist.ResultsThirteen outcome measures were identified. Thirty-one studies evaluating measurement properties of the outcome measures in participants with NSCLC were included. Functional capacity was assessed using the six- and twelve-minute walk tests; incremental- and endurance-shuttle walk tests; and the stair-climbing test. Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness. Physical activity was measured using accelerometers and pedometers. Only the construct validity for accelerometers and pedometers was reported. Muscle strength was measured using hand-held dynamometry, hand-grip dynamometry, manual muscle test, one-repetition maximum and the chair-stand test, however only two studies reported reliability and measurement error and one study reported construct validity.ConclusionCurrently there is a gap in the literature regarding the measurement properties of commonly used outcome measures in NSCLC participants, particularly reliability, measurement error and responsiveness. Further research needs to be conducted to determine the most suitable outcome measures for use in trials involving NSCLC participants.

Performance-based physical function in older community-dwelling persons: a systematic review of instruments

Identification of older persons at risk for the loss of independence, onset of (co)-morbidity or functional limitations through screening/assessment is of interest for the public health-care system. To date several different measurement instruments for overall physical function are frequently used in practice, but little information about their psychometric properties is available. Objectives and Our aim was to assess instruments with an overall score related to functional status and/or physical performance on content and psychometric properties. Electronic databases (Medline, EMBASE, AMED, Cochrane Library and CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if their primary or secondary purpose was to evaluate the measurement properties of measurement instruments for overall physical function in community-dwelling older persons aged 60 years and older. Reliability, validity, responsiveness and practicability were evaluated, adhering to a specified protocol. In total 78 articles describing 12 different functional assessment instruments were included and data extracted. Seven instruments, including their modified versions, were evaluated for reliability. Nine instruments, including their modified versions, were evaluated with regard to validity. In conclusion, the Short Physical Performance Battery can be recommended most highly in terms of validity, reliability and responsiveness, followed by the Physical Performance Test and Continuous Scale Physical Functional Performance.

Measurement properties of questionnaires measuring continuity of care: a systematic review.

BackgroundContinuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties.MethodsWe did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including ‘continuity of care’, ‘coordination of care’, ‘integration of care’, ‘patient centered care’, ‘case management’ and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist.ResultsWe included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties.ConclusionsMost included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire.

Development of a patient-reported outcome measure for the foot affected by rheumatoid arthritis

ObjectiveTo develop an idiographic and nomothetic patient-reported outcome measure (PROM) for the assessment and evaluation of patients with feet affected by rheumatoid arthritis (RA). Study Design and SettingThe development of the Salford Rheumatoid Arthritis Foot Evaluation (SAFE) Instrument PROM was divided into four stages: establishment of the PROM’s conceptual basis and content generation, following a descriptive phenomenological study; clinimetric instrument development; instrument pretesting, involving expert reviews and cognitive interviews; and demonstration of instrument measurement properties, including convergent validity and test–retest reliability of the nomothetic scale. ResultsA total of 123 items were initially generated for the SAFE, with 25 of them clinimetrically selected for nomothetic scale (SAFE-Part A) and 80 items initially included in the idiographic scale (SAFE-Part B). The pretesting strategy proved effective for improving and refining the SAFE, with the final draft consisting of 19 items in Part A and 42 items in Part B. The SAFE-Part A has strong evidence for convergent validity and test–retest reliability. ConclusionThe SAFE features a nomothetic and idiographic assessment strategy that, with further development, will prove to be a valuable tool for clinicians involved in managing the foot health problems associated with RA.

Validation of the Reflux Symptom Questionnaire Electronic Diary in Partial Responders to Proton Pump Inhibitor Therapy

OBJECTIVES:We aimed to develop and validate the Reflux Symptom Questionnaire electronic Diary (RESQ-eD) for use in clinical trials in patients with a partial response to proton pump inhibitor (PPI) therapy, using methods that meet US Food & Drug Administration (FDA) regulatory standards.METHODS:Patient interviews were performed to elicit new items and evaluate existing items from the Reflux Disease Questionnaire. The instrument's measurement properties were evaluated, based on data from two clinical trials of patients with gastroesophageal reflux disease (GERD) with a partial response to PPIs who received lesogaberan or placebo as an add-on to PPI therapy.RESULTS:The content validity phase resulted in 13 RESQ-eD items. Principal component analysis supported a four-domain structure. All domains had a high inter-item correlation (Cronbach's alpha lower 95% confidence limit: 0.87–0.95). Test-retest reliability was good to excellent (intraclass correlation coefficient: 0.65–0.85). Convergent and discriminant validity was confirmed by correlation assessments referencing the Gastrointestinal Symptom Rating Scale. The RESQ-eD demonstrated a good ability to capture change in mean intensity and proportion of symptom-free days. Confirmatory psychometric evaluation verified internal consistency reliability, test-retest reliability, and ability to capture change.CONCLUSIONS:The RESQ-eD demonstrated good content validity and psychometric properties in the clinical trial setting in patients with GERD who have a partial response to PPI therapy. To our knowledge, the RESQ-eD is the first electronic symptom diary for use in partial responders to PPI that has been developed in line with the FDA guidance on patient-reported outcomes.

Reliability and Construct Validity of Self-Report Questionnaires for Patients With Pelvic Girdle Pain

There is little evidence for the measurement properties of instruments commonly used for women with pelvic girdle pain. The aim of this study was to examine the internal consistency, test-retest reliability, and construct validity of instruments used for women with pelvic girdle pain. This was a cross-sectional methodology study, including test-retest reliability assessment. Women with pelvic girdle pain in pregnancy and after delivery participated in a postal survey that included the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODI), Disability Rating Index (DRI), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and 8-item version of the Medical Study 36-Item Short-Form Health Survey questionnaire (SF-36). Test-retest reliability was assessed with a random subsample 1 week later. Internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity based on hypotheses was assessed by correlation analysis. Discriminant validity was assessed with the area under the receiver operating characteristic curve. All participants responded to the main (N=87) and test-retest (n=42) surveys. Cronbach alpha values ranged from .88 to .94, and ICCs ranged from .78 to .94. The MDC at the individual level constituted about 7% to 14% of total scores for the 8-item version of the SF-36, ODI, and PGQ activity subscale; about 18% to 22% for the DRI, PGQ symptom subscale, and PCS; and about 25% for the FABQ. Hypotheses were mostly confirmed by correlations between the instruments. The PGQ was the only instrument that significantly discriminated participants who were pregnant from participants who were not pregnant as well as pain locations. A comparison of responsiveness to change of the various instruments used in this study was not undertaken, but will be carried out in a future study. Self-report instruments for assessing health showed good internal consistency, test-retest reliability, and construct validity for women with pelvic girdle pain. The PGQ was the only instrument with satisfactory discriminant validity, thus, it is recommended for evaluating symptoms and disability in patients with pelvic girdle pain.

What makes a measurement instrument valid and reliable?

High quality instruments are useful tools for clinical and research purposes. To determine whether an instrument has high quality, measurement properties such as reliability and validity need to be assessed, using standardised criteria. This paper discusses these quality domains and measurement properties using the standardised criteria that were recently published by the COSMIN group. Examples are given of studies evaluating the measurement properties of instruments frequently used in trauma. This paper presents a helpful tool for readers who want to evaluate or assess the quality of a measurement instrument on reliability and validity.

Ordinal Logistic Regression to Detect Differential Item Functioning for Gender in the Institutional Integration Scale

Many factors can influence a student's decision to withdraw from college. Intervention programs aimed at retention can benefit from understanding the factors related to such decisions, especially in underrepresented groups. The Institutional Integration Scale (IIS) has been suggested as a predictor of student persistence. Accurate prediction of persistence, especially across subgroups, in part, depends on the instrument's measurement properties being invariant or similar across those groups. Examination of item level invariance is one component of validity assessment to assist in ensuring scores on the IIS have similar meaning across groups. Ordinal logistic regression was used to examine differential item functioning by gender in a revised version of the IIS. Results suggest that the items do function similarly across men and women.

Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments

ObjectivesFor the measurement of patient-reported outcomes, such as (health-related) quality of life, often many measurement instruments exist that intend to measure the same construct. To facilitate instrument selection, our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstracts to be screened, but at a higher risk of missing relevant studies.MethodsA random sample of 10,000 PubMed records (01-01-1990 to 31-12-2006) was used as a gold standard. Studies on measurement properties were identified using an exclusion filter and hand searching. Search terms were selected from the relevant records in the gold standard as well as from 100 systematic reviews of measurement properties and combined based on sensitivity and precision. The performance of the filters was tested in the gold standard as well as in two validation sets, by calculating sensitivity, precision, specificity, and number needed to read.ResultsWe identified 116 studies on measurement properties in the gold standard. The sensitive search filter was able to retrieve 113 of these 116 studies (sensitivity 97.4%, precision 4.4%). The precise search filter had a sensitivity of 93.1% and a precision of 9.4%. Both filters performed very well in the validation sets.ConclusionThe use of these search filters will contribute to evidence-based selection of measurement instruments in all medical fields.

Measurement Instruments in Behavioral Medicine

Measurements is the cornerstone of science. Measurement instruments (e.g., questionnaires, observational methods, and assessment of physiological parameters) are used to gather data: these data are used to test hypotheses (deductive approach) or to generate new hypotheses (inductive approach). In both approaches, a high-quality measurement instrument is an essential requirement for good science. This applies to behavioral medicine as well. It is therefore highly appropriate for the International Journal of Behavioral Medicine to publish the special series on ‘measurement instruments in behavioral medicine’. One of the challenges facing behavioral medicine is the bewildering variety of measurement instruments. Several years ago, 31 questionnaires and 26 performance-based tests were identified to measure pain and activity limitations in osteoarthritis [1, 2]. And this is osteoarthritis only: in other areas an equally wide range of instruments is available for measuring functioning and quality of life. This wide range of measurement instruments constitutes a huge impediment to scientific communication. Results of studies using different instruments cannot be fully compared. Are questionnaire X and questionnaire Y really measuring the same construct or do they measure different concepts? How does a 15-point improvement on questionnaire X compare to a nine-point improvement on questionnaire Y? In a way, the situation in measuring health resembles the pre-Napoleonic era, when cities and even villages had their own measures of length, volume, and weight: this created confusion and impediments to science and trade [3]. It is high time for the field of behavioral medicine to reach consensus on preferred measurement instruments. In the natural sciences, consensus on the International System of Units was reached a little bit more than 150 years ago. Behavioral medicine should aim for a similar consensus. At least one step into the direction of reaching consensus on preferred measurement instruments is the translation of existing questionnaires into other languages, instead of developing fully new questionnaires. Six papers in the present special series concern translation of an existing questionnaire. Ng et al. [4] evaluated a Chinese translation of the Daily Spiritual Experience Scale. Spindler et al. [5] and Pedersen et al. [6] translated the questionnaire for assessing Type D personality into the Danish and Ukrainian language, respectively. Canavarro et al. [7] translated the World Health Organization Quality of Life scale into the Portuguese language, while Maiano et al. [8] translated the Body Image Avoidance Questionnaire into the French language. In all cases, the psychometric properties of the translated questionnaires were satisfactory: translating existing instruments is an excellent alternative to developing new instruments. However, translation might introduce subtle differences in various language versions of the same questionnaire. Even if the measurement properties of the various versions of the questionnaire are good, there is no guarantee for full measurement equivalence across cultures. In a carefully designed study, Choi et al. [9] demonstrated differences in item scores of the Job Content Questionnaire between European cultures. To reduce cross-language differences in the future, the authors argue in favor of a stricter translation process and studies using only items which have been shown not to suffer from cross-cultural differences. Three other papers in the special series concern the further validation of measurement instruments. Lee et al. [10] validated the Life Control Scale in a new population. Guo et al. [11] and Weck et al. [12] evaluated the factor structure of the Decisional Balance Scale and the Illness Attitude Scales, respectively. Cross-validation and evaluation of the factor structure of existing instruments are highly relevant objectives: in the context of reaching consensus on measurement instruments thorough information on measurement properties of measurement instruments is highly desirable. The present special series is intended to contribute to information on properties of measurement instruments, in the context of reaching consensus on preferred measurements in behavioral medicine.

Using Rasch analysis to establish the construct validity of rehabilitation assessment tools

Background Rasch analysis is a statistical model that can be used in the development of new assessment tools and the evaluation of already existing ones. Rasch analysis can also be used to provide various forms of construct validity evidence. In the revised conceptualization of validity, validity is operationalized as a unitary concept with five types of evidence. This article aims to inform rehabilitation practitioners of the different forms of validity evidence that can be demonstrated using Rasch analysis. Content The history and the more recently accepted conceptualization of validity is briefly outlined. Examples of studies in the field of rehabilitation and health care are given to illustrate the varying forms of Rasch-generated validity evidence. Conclusions An understanding of Rasch analysis application in the validation of assessment tools will equip rehabilitation practitioners with better skills in interpreting the measurement properties of instruments developed using Rasch analysis. Rehabilitation practitioners are also encouraged to use Rasch analysis to evaluate existing instruments, with the aim of generating equivalent measures of underlying constructs.

Evaluation of the methodological quality of systematic reviews of health status measurement instruments

A systematic review of measurement properties of health-status instruments is a tool for evaluating the quality of instruments. Our aim was to appraise the quality of the review process, to describe how authors assess the methodological quality of primary studies of measurement properties, and to describe how authors evaluate results of the studies. Literature searches were performed in three databases. One hundred and forty-eight reviews were included. The purpose of included reviews was to identify health status instruments used in an evaluative application and to report on the measurement properties of these instruments. Two independent reviewers selected the articles and extracted the data. Reviews were often of low quality: 22% of the reviews used one database, the search strategy was often poorly described, and in many cases it was not reported whether article selection (75%) and data extraction (71%) was done by two independent reviewers. In 11 reviews the methodological quality of the primary studies was evaluated for all measurement properties, and of these 11 reviews only 7 evaluated the results. Methods to evaluate the quality of the primary studies and the results differed widely. The poor quality of reviews hampers evidence-based selection of instruments. Guidelines for conducting and reporting systematic reviews of measurement properties should be developed.

Assessment of the behavior of children in painful situations: literature review

To analyze the scientific production published between 2001 and 2006 describing studies assessing children in painful situations, with a focus on preschool children. Searches were run for empirical articles indexed in electronic databases using the keywords pain assessment and behavior and their equivalents in Portuguese. A total of 33 articles were identified, 18 of which were studies of the psychometric properties of instruments for the measurement of pain, while 11 dealt with the application of such instruments and four were studies of intervention procedures for the relief of pain. The results indicate that more recent literature on the assessment of preschool children's behavior in painful situations is focused on testing the psychometric properties of measurement instruments. Acute pain, especially during surgical procedures, was most often assessed using one-dimensional instruments. Pain in children was most often assessed using facial activity as indicator and intensity as dimension. With relation to assessment of pain in special populations, advances were observed related to assessment of pain in preverbal children or preschool children with special needs.

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

OBJECTIVE: To analyze the scientific production published between 2001 and 2006 describing studies assessing children in painful situations, with a focus on preschool children. SOURCES: Searches were run for empirical articles indexed in electronic databases using the keywords pain assessment and behavior and their equivalents in Portuguese. SUMMARY OF THE FINDINGS: A total of 33 articles were identified, 18 of which were studies of the psychometric properties of instruments for the measurement of pain, while 11 dealt with the application of such instruments and four were studies of intervention procedures for the relief of pain. CONCLUSIONS: The results indicate that more recent literature on the assessment of preschool children's behavior in painful situations is focused on testing the psychometric properties of measurement instruments. Acute pain, especially during surgical procedures, was most often assessed using one-dimensional instruments. Pain in children was most often assessed using facial activity as indicator and intensity as dimension. With relation to assessment of pain in special populations, advances were observed related to assessment of pain in preverbal children or preschool children with special needs.