Performance Of Screening Instruments Research Articles

Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport

Background: Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. Methods: The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords “psychosocial screening”, “low back pain”, “sciatica” and “prognosis”, “athletes”. We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months. Results: We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). Conclusion: Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.

Evidence ‘Insufficient’ for Cognitive-Impairment Screening

Citing an ongoing lack of data about the benefits and harms of screening, the U.S. Preventive Services Task Force has left unchanged the recommendations of its 2003 guidelines on cognitive-impairment screening in older adults, according to an update published recently. “Evidence on the effect of screening and early detection of mild to moderate dementia on decision making, planning, or other important patient outcomes is a critical gap in the evidence,” Virginia A. Moyer, MD, said in a report on behalf of the USPSTF. Other research needs include further study of the harms of screening, new interventions that address the changing needs of patients and families, and interventions that affect the long-term clinical direction of mild-to-moderate dementia. In its review, the USPSTF evaluated 55 studies on instruments that screen for cognitive impairment, of which 46 provided evidence on the sensitivity of dementia screening and 27 provided evidence on mild cognitive impairment. Screening tests included a variety of tasks to assess at least one cognitive function, such as memory, attention, language, and visuospatial/executive functioning. The USPSTF looked at studies that used the Mini-Mental State Examination (MMSE), Clock Drawing Test, verbal fluency tests, Informant Questionnaire on Cognitive Decline in the Elderly, Memory Impairment Screen, Mini-Cog Test, Abbreviated Mental Test, and Short Portable Mental Status Questionnaire. The MMSE was the most-evaluated screening tool, with 25 published studies in people 69-95 years old. Mean prevalence of dementia ranged from 1.2% to 38%. The pooled sensitivity from 14 studies for the most commonly reported cut points was 88.3% (95% confidence interval, 81.3%-92.9%), and specificity was 86.2% (CI, 81.8%-89.7%). Other screening tools “were studied in far fewer studies (four to seven studies each), had limited reproducibility in primary care relevant populations, and had unknown optimum cut points,” Dr. Moyer wrote. In addition, no trial compared clinical and decision-making outcomes in screened and unscreened patients, the report said. And no study probed the consequences of false-positive or false-negative screening results, such as psychological harms, unnecessary diagnostic testing, or stigmatization. Types of dementia in older adults include Alzheimer's disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease with dementia, and mixed-cause dementia. The USPSTF distinguishes between dementia and mild cognitive impairment, which is defined as less severe and not considerably interfering with day-to-day activities. The prevalence of dementia is estimated to be 5% in adults aged 71-79 years of age, 24% in those aged 80-89 years, and 37% in those aged 90 years and older. The prevalence of mild cognitive impairment is more uncertain, and estimates range from 3% to 42% in adults aged 65 years and older. This report differs from the 2003 recommendations because it considers screening and treatment for mild cognitive impairment, as well as dementia, and it includes additional information about the performance of screening instruments. “The overall evidence is insufficient to make a recommendation on screening,” Dr. Moyer said. Editor's NoteWhether the harms of screening for cognitive impairment outweigh the benefits in the general population, everybody gets tested in our nursing homes. The Brief Inventory of Mental Status is performed on every resident no less frequently than quarterly. So we have a screening test and a surveillance test right there in the chart. The BIMS certainly can be helpful to us as clinicians in several ways, so don't forget that it's in there, along with the PHQ-9 depression inventory.—Karl Steinberg, MD, CMD Editor in Chief Whether the harms of screening for cognitive impairment outweigh the benefits in the general population, everybody gets tested in our nursing homes. The Brief Inventory of Mental Status is performed on every resident no less frequently than quarterly. So we have a screening test and a surveillance test right there in the chart. The BIMS certainly can be helpful to us as clinicians in several ways, so don't forget that it's in there, along with the PHQ-9 depression inventory. —Karl Steinberg, MD, CMD Editor in Chief

Diagnostic accuracy of the trauma screening questionnaire after the 2005 London bombings

The diagnostic accuracy of screening instruments in the immediate aftermath of disaster is unknown. Following the 2005 London bombings a 2-year outreach program identified and screened affected persons. In 331 persons the accuracy of the Trauma Screening Questionnaire (TSQ) was compared to a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder. The sensitivity of the TSQ was comparable with previous studies, but specificity was substantially lower. Specificity was lowest immediately after the bombings and rose steadily over the next 18 months. Specificity was also lower in non-White individuals, who had elevated scores on the TSQ. The data are consistent with previous research showing elevated distress in ethnic minorities following trauma, and suggest limitations on the performance of screening instruments.

Screening for postnatal depression in primary care: cost effectiveness analysis

Objective To evaluate the cost effectiveness of routine screening for postnatal depression in primary care.Design Cost effectiveness analysis with a decision model of alternative methods of screening for depression, including...

Performance of Screening Instruments for Alcohol Use Disorders in Emergency Department Patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.

Screening for alcohol problems in two emergency service samples in Poland: Comparison of the RAPS4, CAGE and AUDIT

Prior research on alcohol-related problems among emergency service patients in Poland found substantial alcohol involvement on the part of injured males, suggesting emergency services may be a productive venue for identifying patients who could benefit from a brief intervention or referral for treatment. Performance of the RAPS4, CAGE and AUDIT against ICD-10 and DSM-IV criteria for alcohol dependence and for alcohol abuse/harmful drinking was compared in probability samples of emergency service patients from two regions of Poland. Sensitivity of the RAPS4 and AUDIT was significantly better than the CAGE for alcohol dependence among males in Warsaw, but specificity was poorer. Among females, although numbers were small, sensitivity for alcohol abuse/harmful drinking and for alcohol dependence or abuse/harmful drinking was significantly better for the RAPS4-QF than for the CAGE or AUDIT at a cut point of 8 across both sites. Performance of the AUDIT at a cut point of 3 was similar to the RAPS4-QF for females. Among males, sensitivity was higher but specificity considerably lower for the RAPS4-QF compared to the CAGE at a cut point of 1 or for the AUDIT at a cut point of 8. Alternate cut points for the AUDIT optimized performance. Findings suggest some regional and gender differences in performance of screening instruments in these Polish samples, but no instrument or cut point is optimal in identifying those with alcohol use disorders. Additional cross-cultural research is needed to evaluate the performance of instruments, especially among females with alcohol use disorders.

Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force

Family and intimate partner violence is common in the United States and is often associated with acute and chronic health problems. Although the clinician's role in identification and intervention is considered a professional, ethical, and sometimes legal responsibility, the effectiveness of screening is uncertain. To examine evidence on the benefits and harms of screening women and elderly adults in health care settings for family and intimate partner violence. MEDLINE, PsycINFO, CINAHL, Health & Psychosocial Instruments, AARP Ageline, Cochrane Controlled Trials Register, reference lists, and experts. The authors selected English-language studies that included original data focusing on the performance of screening instruments (14 studies for women, 3 for elderly persons) and the effectiveness of interventions based in health care settings (2 studies for women, none for elderly persons). Study design, patient samples and settings, methods of assessment or intervention, and outcome measures were extracted, and a set of criteria was applied to evaluate study quality. No trials of the effectiveness of screening in a health care setting for reducing harm have been published. Several screening instruments have been developed; some have demonstrated fair to good internal consistency and some have been validated with longer instruments, but none have been evaluated against measurable violence or health outcomes. Few intervention studies have been conducted. Existing intervention studies focused on pregnant women, and study limitations restrict their interpretation. Although the literature on family and intimate partner violence is extensive, few studies provide data on detection and management to guide clinicians.

Screening children for family violence: a review of the evidence for the US Preventive Services Task Force.

We wanted to evaluate the benefits and harms of screening children in primary health care settings for abuse and neglect resulting from family violence by examining the evidence on the performance of screening instruments and the effectiveness of interventions. We searched for relevant studies in MEDLINE, PsycINFO, CINAHL, ERIC, Cochrane Controlled Trials Register, and reference lists. English language abstracts with original data about family violence against children focusing on screening and interventions initiated or based in health care settings were included. We extracted selected information about study design, patient populations and settings, methods of assessment or intervention, and outcome measures, and applied a set of criteria to evaluate study quality. All instruments designed to screen for child abuse and neglect were directed to parents, particularly pregnant women. These instruments had fairly high sensitivity but low specificity when administered in high-risk study populations and have not been widely tested in other populations. Randomized controlled trials of frequent nurse home visitation programs beginning during pregnancy that address behavioral and psychological factors indicated improved abuse measures and outcomes. No studies were identified about interventions in older children or harms associated with screening and intervention. No trials of the effectiveness of screening in a health care setting have been published. Clinician referrals to nurse home visitation during pregnancy and in early childhood may reduce abuse in selected populations. There are no studies about harms of screening and interventions.

Screening for mental disorders in cardiac and orthopaedic rehabilitation

The detection of patients with comorbid mental disorders is of high clinical importance in cardiac and orthopaedic rehabilitation. To simplify detection of cases, screening instruments are recommended. This study investigated the discriminant validity of the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS-D) to identify patients with comorbid mental disorders and specifically affective or anxiety disorders. 213 patients with cardiovascular diseases and 206 patients with musculoskeletal diseases participated in a two-stage survey. Patients were assessed with the GHQ-12 and the HADS-D; and they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Validity of the two screenings regarding the detection of mental disorders was compared using ROC-analysis. In both patient groups the HADS-D performed better in nearly all analyses compared to the GHQ-12, especially in the detection of affective disorders (AUC in cardiac patients 0.78, in orthopaedic patients 0.79). Both screening instruments can be used for the detection of comorbid affective and anxiety disorders in patients with cardiovascular and musculoskeletal diseases. Limitations in performance of screening instruments are due to the different methodological approaches of tests as well as to difficulties in diagnosing mental disorders in patients with physical illness.

Screening for Alcohol Problems: A Comparison of Instrument Performance Between the Er and the General Population Among Mexican Americans in the U.S. And Mexicans in Mexico

Relatively little is known about the performance of screening instruments for alcohol use disorders in the general population compared to clinical populations, or among Mexicans or Mexican Americans. The sensitivity and specificity of three screening measures: CAGE, TWEAK, and holding five or more drinks (HOLD), for alcohol dependence, are compared between ER and general population samples in the U.S. (Santa Clara, County, California) and in Mexico (Pachuca). In Pachuca sensitivity of the TWEAK and HOLD was significantly better in the general population compared to the ER, while in Santa Clara sensitivity of the CAGE was significantly better in the ER compared to the general population. HOLD appeared to perform better in the general population than in the ER in Santa Clara. The data suggest differential performance of screening instruments among Hispanics in the general population compared to the ER in both the U.S. and Mexico, and HOLD may be the measure of choice for identifying alcohol use disorders in the Hispanic general population.

Screening for anxiety, depressive and somatoform disorders in rehabilitation󒀔validity of HADS and GHQ-12 in patients with musculoskeletal disease

Purpose: The detection of patients with comorbid mental illness is of high clinical importance in orthopaedic rehabilitation. To simplify detection of cases, screening instruments are recommended. The study investigated the discriminant validity of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12) to identify patients with comorbid mental disorders, specifically anxiety, depressive and somatoform disorders. Method: Two hundred and six patients with musculoskeletal disease from four orthopaedic rehabilitation clinics participated in a two-stage survey: (1) patients were assessed with the GHQ-12 and HADS; and (2) they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Validity of the two instruments regarding the detection of mental disorders was compared using ROC-analysis and CIDI-diagnoses as criteria. Results: The HADS sumscale performed better in all analyses compared to the GHQ-12, specifically in detecting depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.79, a sensitivity of 78% and a specificity of 71% (cutoff point = 16). The positive predictive value (PPV) is best for the detection of any mental disorder with a cut-off point of 16 (46%). Conclusions: The HADS can be used as a screening instrument for the detection of comorbid depressive and anxiety disorders in patients with musculoskeletal disorders. Limitations in performance of screening instruments are due to: (1) different methodological approaches of tests (dimensional approach) and criterion (categorical approach); and (2) difficulties in diagnosing mental disorders in patients with prominent physical illness.

Screening for alcohol problems: a comparison of instrument performance among black emergency department and primary care patients

While alcohol problems are over-represented in primary care settings and in emergency departments (EDs), screening for alcohol use disorders has not been a routine part of care in the United States, and little is known of the performance of screening instruments for problem drinking, particularly among women and ethnic minorities. The sensitivity and specificity of the CAGE, BMAST, AUDIT, TWEAK, and RAPS are compared against DSM-IV and ICD-10 criteria for alcohol dependence in probability samples of black patients interviewed in the ED (n= 1091) and primary care clinics (n = 711) in Jackson, Mississippi. Instruments appeared to perform better in the ED than in primary care. The CAGE and RAPS appeared to perform best in the primary care sample, and the AUDIT and RAPS in the ED sample. While the prevalence of alcohol dependence in the primary care clinics was lower than in the ED, findings suggest that both sites are important for screening and identification of patients with alcohol use disorders. Further research is needed for determining those screening instruments which perform optimally in identifying problem drinking patients across clinical sites.

Performance of Screening Instruments for Alcohol Problems in the ER: A Comparison of Mexican- Americans and Mexicans in Mexico*

The performance of standard screening instruments and alternate measures against ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) patients from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER patients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. All instruments performed better for alcohol dependence than for abuse/harmful drinking. Arrests for drinking and driving performed better in Santa Clara than in Pachuca, while a positive Breathalyzer reading and reporting drinking prior to the event performed better in Pachuca; both were significantly more sensitive among the injured compared to the noninjured in Pachuca. The data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instruments appear to work reasonably well in both samples for alcohol dependence, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the “best” instrument.

Performance of Screening Instruments for Alcohol Problems in a Black Primary Care Population

While alcohol use disorders have been found to be overrepresented in some primary care settings, the majority of patients with these disorders go undetected by primary health care providers, and little is known of the performance of screening instruments for identifying problem drinking, particularly among females or ethnic minorities. The performance of several screening instruments—CAGE, Brief Michigan Alcoholism Screening Test (BMAST), Alcohol Use Disorders Identification Test (AUDIT), TWEAK, Rapid Alcohol Problems Screen (RAPS)—and holding five or more drinks (HOLD), against International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence/harmful drinking/alcohol abuse, was compared by gender in a probability sample of black primary care clinic patients (n = 711). Sensitivity of all measures except BMAST and HOLD was significantly better for males than for females. The RAPS performed best...

Performance of Screening Instruments for Identifying Alcohol Dependence in the General Population, Compared with Clinical Populations

Performance of Screening Instruments for Identifying Alcohol Dependence in the General Population, Compared with Clinical Populations

Detection of depressive symptoms in the elderly: The impact of cognitive decline upon the performance of screening instruments

Detection of depressive symptoms in the elderly: The impact of cognitive decline upon the performance of screening instruments