Measurement Properties Research Articles

Translation, content validity and internal structure of the Brazilian version of the Adolescent Resilience Questionnaire (B-ARQ).

Resilience refers to one's ability to face life's challenges and achieve positive outcomes, and has drawn increasing interest from researchers and policymakers. The Adolescent Resilience Questionnaire (ARQ) is a measure that assesses resilience in adolescents according to a multidimensional perspective, encompassing its several different domains. This cross-sectional study aimed to translate and evaluate the measurement properties of the Brazilian version of the ARQ (B-ARQ) for use with Brazilian adolescents. Two native speakers in Brazilian Portuguese language who were also fluent in English language translated the ARQ from English into Portuguese. A committee of experts in validation studies compared the translated versions. A summarized version was produced and back-translated by a translator native of the English language and fluent in Portuguese. The B-ARQ was pre-tested in a sample of 21 adolescents. An expert committee considered the suggestions and defined the final version of the instrument, which was tested in a sample of 210 adolescent students from public and private schools in the city of Dom Pedrito, Brazil. All students filled out the 88-item instrument as well as a socio-demographic questionnaire. Statistical analysis included descriptive statistics of all variables (frequency distribution, floor, ceiling effects), internal consistency, and confirmatory factor analysis of the version with 88 items and the shortened version with 49 items. The short version with 49 items was validated in a cross-sectional study in an adolescent population of high school students using exploratory factor analysis in the Unites States. The 88-item ARQ had poor structural validity with unsatisfactory model fit indices. Therefore, the investigation focused on the short 49-item version of the ARQ (B-ARQ-SV). The final model presented satisfactory RMSEA = 0.042 (p = 0.994, 90% CI: 0.037-0.047) and SRMR of 0.076, despite the low CFI (0.878). The internal consistency was estimated with McDonald's Omega for each factor: Confidence (ω = 0.480), Negative Cognition (ω = 0.588), Empathy/tolerance (ω = 0.295), Emotional insight (ω = 0.425), Social Skill (ω = 0.235), Family Domain Connectedness (ω = 0.785), Family Domain Availability (ω = 0.847), Peers Domain Connectedness (ω = 0.719), Peers Domain Availability (ω = 0.402), School Domain Supportive environment (ω = 0.677), School Domain Connectedness (ω = 0.013), Community Domain Connectedness (ω = 0.791). One scale showed a ceiling effect (frequency higher than 15.0%), but we identified no critical floor effect. The B-ARQ-SV is a valid (in terms of content and structural validity) and reliable (in terms of internal consistency) measurement instrument to assess resilience in Brazilian adolescents.

The Internet Gaming Disorder Scale 9-Short Form: longitudinal measurement invariance across a three-year interval

ABSTRACT Objective Internet gaming disorder (IGD) refers to persistent, recurrent, and excessive involvement with computer or video games that cannot be controlled, despite associated problems. Given that it has been relatively stable for several years, questionnaires measuring IGD need to demonstrate measurement invariance (i.e. consistency in its measurement properties when administrated repeatedly over time), to ensure accurate measurement over time. This longitudinal study examined invariance of the Internet Gaming Disorder Scale 9-Short Form (IGDS9-SF5), which measures Internet gaming disorder (IGD) symptoms, based on the Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Method Participants were recruited from English speaking countries (e.g. Australia, USA, UK and Canada). A total of 276 adults (mean age = 31.86 years; SD = 9.94; males = 71%) provided responses to an online survey (including demographic questions and the IGDS9-SF) at three time points one year apart (2020/21/22). Results When the chi-square difference (∆χ2) test was applied, the results supported configural invariance, full metric invariance, error variances, and invariance for all structural components (latent variances and covariances). However, scalar invariance was not observed for three item intercepts (tolerance, preoccupation, and giving up other activities). For all three items, the scores were higher at time 1 than time 2 and time 3. Conclusion The findings indicate that IGDS9-SF observed scores across yearly intervals are generally free from scaling and measurement biases, making them reliable for monitoring the progression of IGD symptoms and evaluating clinical treatment effects over time.

Outcome measurement instruments for adult brachial plexus injury: a systematic review of development and measurement properties

Purpose To review candidate outcome measurement instruments (OMIs) for the core outcome set (COS) for brachial plexus injury (BPI) and identify those with the strongest measurement properties. Methods We conducted a PRISMA-compliant systematic review to identify studies on the measurement properties of domain-specific OMIs for adult BPI. OMIs with adequate content validity were further evaluated. Two independent reviewers assessed the methodological quality of each study using the COSMIN Risk of Bias checklist and assessed overall quality using a modified GRADE approach. Results Nineteen development/validation studies concerning nine OMIs were identified. The Brachial Assessment Tool (BrAT) and the Impact of Brachial Plexus Injury Questionnaire (IMBPIQ) (both measuring carrying out daily routine) had sufficient content validity to proceed to full evaluation. The BrAT had moderate quality evidence to support its psychometric properties. The IMBPIQ needs further research to evidence structural validity and internal consistency. The Brief Pain Inventory has strong psychometric properties in other populations and is recommended for the core measurement set (CMS) for chronic pain. Conclusions The BrAT and the Brief Pain Inventory are recommended for inclusion in the BPI CMS. Further consensus work is needed to identify the most appropriate OMI for voluntary movement. Systematic Review Registration: PROSPERO (CRD42022307564).

Assessing alexithymia in chronic pain: psychometric properties of the Toronto Alexithymia Scale-20 and Perth Alexithymia Questionnaire.

Alexithymia is elevated in chronic pain and relates to poor pain-related outcomes. However, despite concerns from other clinical populations, the psychometric properties of alexithymia measures have not been rigorously established in chronic pain. This study examined the psychometric properties of the Toronto Alexithymia Scale-20 Item (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) in adults with chronic pain. An online sample of adults with chronic pain across the United States (N = 1453) completed the TAS-20, PAQ, and related questionnaires at baseline, 3-month follow-up, and 12-month follow-up. Both measures showed good temporal stability, convergent validity (with emotion regulation scores), divergent validity (with depression and anxiety scores), and criterion validity. Some concerns were raised about the TAS-20: the original 3-factor structure showed a poor model fit; the Externally Oriented Thinking subscale of the TAS-20 had poor factor loadings and unacceptable internal consistency; and, we identified several TAS-20 items that may slightly inflate the predictive validity of the TAS-20 on pain-related outcomes. The original 5-factor structure of the PAQ showed a good fit; each PAQ subscale had good factor loadings and excellent internal consistency. Both the TAS-20 and PAQ had psychometric strengths. Our data raised some concern for the use of TAS-20 subscales; the PAQ may be a psychometrically stronger option, particularly for investigators interested in alexithymia subscale analysis in people with chronic pain.

Communicative health literacy with physicians in healthcare services– results of a Hungarian nationwide survey

BackgroundIn an efficient and effective healthcare delivery, good communication plays an essential role. The communicative health literacy (COMM-HL) of the patients is an important attribute, but the number of validated COMM-HL assessment tools is low, and they do not cover all aspects of COMM-HL. That’s why a new scale has been developed within an international collaboration. Our aims are to check the measurement properties of the Hungarian version of this COMM-HL questionnaire, to describe the COMM-HL of the Hungarian adult population and to investigate its determinants.MethodsA total of 1205 adults completed the telephone interview in 2020 as part of the European Health Literacy Population Survey 2019–2021. The questionnaire included items on sociodemographic data, self-perceived health, social support and COMM-HL. The questionnaire’s measurement properties were assessed using Cronbach’s alpha, Spearman-Brown, and item-total correlation coefficients, while the construct validity was investigated with principal component (PCA) and confirmatory factor analysis. The determinants of the COMM-HL were investigated by linear regression.ResultsBoth the value of Cronbach’s alpha and the Spearman-Brown correlation were 0.87. The items belonged to one factor and 62.2% of the total variation was explained by this factor based on the PCA. The fit indices indicated that the one-factor structure of the six-item questionnaire exhibited a good fit for the data. The mean score on the COMM-HL scale was 86.8. The easiest task was explaining health concerns while getting enough time in the consultation was rated as the most difficult one. COMM-HL was lower among females, while it was higher among people aged 66–75 years (compared with 18–25 years), those with greater social support and those without financial deprivation.ConclusionsThe questionnaire can be characterized with good internal consistency and the structure of the COMM-HL questionnaire was best explained as a one factor model. In consultations with patients, the effectiveness of communication should be improved, so that patients do not feel that there is not enough time for consultation. At-risk groups with low COMM-HL need special attention during the interactions and the role of social support has to be clarified, too.

Brazilian Portuguese Version of the Diagnostic Criteria for Temporomandibular Disorders Axis II: Translation, Cross-Cultural Adaptation and Measurement Properties.

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial tool for TMD assessment. To implement a translated version in the Brazilian context, standardised adaptation and validation are necessary. To translate, adapt and verify the measurement properties of the DC/TMD Axis II instruments Pain Drawing (PD), Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS) and Oral Behaviours Checklist (OBC). The translation and cross-cultural adaptation processes of orofacial-related Axis II instruments followed the Guidelines for Establishing Cultural Equivalency. The validation research was carried out with 117 Brazilians with TMD, in two assessment days. Structural validity, internal consistency, test-retest reliability, measurement error, construct validity-hypothesis testing, and ceiling and floor effects were tested. PD showed substantial reliability (Kappa 0.63), and GCPS, JFLS and OBC showed excellent reliability over time (intraclass correlation coefficient > 0.85). The internal consistency was adequate for all instruments (Cronbach's alpha > 0.77) except for the functional activities domain of OBC (Cronbach's alpha = 0.48). Construct validity was good for all instruments (75% hypotheses confirmed), except for the OBC total score. Regarding parameters of structural validity, GCPS showed Goodness of Fit Index = 0.98 for the solution with two domains. JFLS and OBC presented Goodness of Fit Index < 0.90 for the solutions with three and two domains, respectively. The Brazilian Portuguese version of DC/TMD Axis II can be used in Brazil, but more studies are necessary to find an adequate structure for JFLS and OBC in a Brazilian sample.

Item-level measurement properties of the pediatric awareness and sensory motor assessment in children with medical complexity

IntroductionChildren with medical complexity (CMC) are medically fragile with severe brain damage and chronic conditions, necessitating daily care. Their neurological impairments often limit participation in childhood activities, affecting quality of life. Current assessment tools fail to detect subtle abilities in CMC, hindering development of effective rehabilitation goals and interventions. The Pediatric Awareness and Sensory Motor Assessment (PASMA) was created to fill this gap, providing sensitive measurement of sensory awareness and motor response across five domains (i.e., olfactory, visual, auditory, gustatory, and tactile).MethodsIn this retrospective study, a Rasch analysis was conducted on PASMA data for CMC. The PASMA was administered five times over ten weekdays to each child, reflecting its intended clinical use to gain a reliable sense of each child's awareness.ResultsAnalysis of data from 36 CMC revealed that the PASMA is sufficiently unidimensional, effectively measuring sensory awareness and motor response as a single construct. Its rating scale structure was validated without modifications, and the item hierarchy matched clinical expectations. High item reliability (0.97) was observed, with one item (V2 blink in response to light) slightly misfitting, but without affecting overall measures. Adequate person reliability was observed (0.81), with 15% person misfit. Person misfit did not degrade item measures or model statistics. Differential item functioning (DIF) was noted for the three easiest items on specific days. The PASMA successfully stratified participants into three distinct awareness levels (low, medium, and high awareness), without floor or ceiling effects.DiscussionThe PASMA is a valid unidimensional measure of sensory awareness and motor response in CMC. Rating scale characteristics, item hierarchy, and person separation measures all support the PASMA's measurement properties within this heterogeneous sample of CMC. DIF findings support a potential reduction in the recommended number of PASMA administrations per individual. Future research will focus on establishing rater reliability and external validity. Additional efforts will support health professionals to utilize the PASMA for baseline assessments, guiding personalized interventions, and tracking progress.ConclusionClinical use of the PASMA could provide new opportunities to detect subtle abilities, preferences, and changes in CMC, to promote meaningful participation and improve quality of life.

Construct validity and responsiveness of clinical upper limb measures and sensor-based arm use within the first year after stroke: a longitudinal cohort study

BackgroundConstruct validity and responsiveness of upper limb outcome measures are essential to interpret motor recovery poststroke. Evaluating the associations between clinical upper limb measures and sensor-based arm use (AU) fosters a coherent understanding of motor recovery. Defining sensor-based AU metrics for intentional upper limb movements could be crucial in mitigating bias from walking-related activities. Here, we investigate the measurement properties of a comprehensive set of clinical measures and sensor-based AU metrics when gait and non-functional upper limb movements are excluded.MethodsIn this prospective, longitudinal cohort study, individuals with motor impairment were measured at days 3 ± 2 (D3), 10 ± 2 (D10), 28 ± 4 (D28), 90 ± 7 (D90), and 365 ± 14 (D365) after their first stroke. Using clinical measures, upper limb motor function (Fugl-Meyer Assessment), capacity (Action Research Arm Test, Box & Block Test), and perceived performance (14-item Motor Activity Log) were assessed. Additionally, individuals wore five movement sensors (trunk, wrists, and ankles) for three days. Thirteen AU metrics were computed based on functional movements during non-walking periods. Construct validity across clinical measures and AU metrics was determined by Spearman’s rank correlations for each time point. Criterion responsiveness was examined by correlating patient-reported Global Rating of Perceived Change (GRPC) scores and observed change in upper limb measures and AU metrics. Optimal cut-off values for minimal important change (MIC) were estimated by ROC curve analysis.ResultsNinety-three individuals participated. At D3 and D10, correlations between clinical measures and AU metrics showed variability (range rs: 0.44–0.90). All following time points showed moderate-to-high positive correlations between clinical measures and affected AU metrics (range rs: 0.57–0.88). Unilateral nonaffected AU duration was negatively correlated with clinical measures (range rs: -0.48 to -0.77). Responsiveness across outcomes was highest between D10-D28 within moderate to strong relations between GRPC and clinical measures (rs: range 0.60–0.73), whereas relations were weaker for AU metrics (range rs: 0.28–0.43) Eight MIC values were estimated for clinical measures and nine for AU metrics, showing moderate to good accuracy (66–87%).ConclusionsWe present reference data on the construct validity and responsiveness of clinical upper limb measures and specified sensor-based AU metrics within the first year after stroke. The MIC values can be used as a benchmark for clinical stroke rehabilitation.Trial registrationThis trial was registered on clinicaltrials.gov; registration number NCT03522519.

The 9-item Tampa Scale for Kinesiophobia (TSK-9) has adequate measurement properties in patients with chronic low back pain.

To assess the test-retest reliability, internal consistency, and construct validity of the 9-item Tampa Scale for Kinesiophobia in patients with chronic low back pain. Questionnaire validation study. Study was conducted in an online environment. We included people aged 18 to 50 years with self-reported low back pain lasting > three months and assessed the Pain-Related Catastrophizing Thoughts Scale and the 9-item Tampa Scale for Kinesiophobia. We used intraclass correlation coefficient, standard error of measurement, minimum detectable change, and Cronbach's alpha to assess the reliability and internal consistency of the 9-item Tampa Scale for Kinesiophobia. We tested correlations between the domains of the 9-item Tampa Scale for Kinesiophobia and the other variables to assess construct validity. A total of 174 participants with chronic low back pain were included in the analysis. No ceiling or floor effect was found. In terms of construct validity, there was a positive correlation between the domains of the 9-item Tampa Scale for Kinesiophobia and the other variables. In the reliability analysis, there was adequate test-retest reliability of the two domains of the 9-item Tampa Scale for Kinesiophobia: intraclass correlation coefficient = 0.99, standard error of measurement = 3.4%, and minimum detectable change = 9.6% for the activity avoidance domain; and intraclass correlation coefficient = 0.99, standard error of measurement = 3.5%, and minimum detectable change = 9.9% for the somatic focus domain. There was acceptable internal consistency (Cronbach's alpha ≥ 0.68) for both domains. The 9-item Tampa Scale for Kinesiophobia has adequate measurement properties in patients with chronic low back pain.

The Depression, Anxiety, Stress Scales-21: Principal component analysis and evaluation of abbreviated versions in young adults with temporomandibular disorders.

The Depression, Anxiety, Stress Scales-21 (DASS-21) contain three subscales measuring depression, anxiety, and stress. Several abbreviated DASS-21 versions have been developed, demonstrating better clinical utility and measurement properties than the original instrument. This study explored the factor structure of various abbreviated DASS-21 versions and identified/validated the optimal one for assessing young adults with temporomandibular disorders (TMDs). A total of 974 university-attending young adults were recruited in two waves (wave 1: 519; wave 2: 455). Demographic information, the DASS-21, and quintessence five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs were collected. Principal component analysis (PCA) was employed to condense the DASS-21 (wave 1 data), while confirmatory factor analysis (CFA) was used to determine maximum likelihood estimates and compare different abbreviated DASS-21 versions (wave 2 data). Known-group, concurrent (criterion) validity and reliability were subsequently evaluated. The mean age of the study participants was 21 (SD = 0.1) years and 80.4% were women. Twelve DASS-21 items were identified from the PCA. However, the Korean DASS-12 provided the best-fit model (χ2/df = 2.07, CFI = 0.975, TLI = 0.960, RMSEA = 0.049, SRMR = 0.033) among the seven abbreviated versions in the CFA. The Korean DASS-12 showed good known-group and concurrent (rs = 0.959) validity and reliability when contrasted to the DASS-21. The Korean DASS-12 possessed a good fit, known-group, as well as concurrent (criterion) validity and reliability, and was the best abbreviated DASS-21 version for screening young adults with TMD symptoms for psychological distress.

Measuring spiritual, religious, and existential constructs in children: A systematic review of instruments and measurement properties

Sparse knowledge exists about measuring spiritual, religious, and existential (SRE) constructs in children. Well-validated questionnaires measuring such concepts are necessary when researchers want to quantitatively investigate the spiritual lives of children. We aimed to identify questionnaires measuring SRE constructs in children and assess their psychometric properties. We conducted literature searches in four electronic databases. Studies were included if they described the use of a questionnaire measuring SRE constructs in children under 12 years. Systematic data extraction and assessment of the studies using standardized COSMIN guidelines were performed. A total of 17,681 records were screened. Twenty-seven articles assessing 18 different questionnaires met the inclusion criteria. In total, 16 structural validity, 20 internal consistency, 4 measurement invariance, and 16 construct validity studies were found. We identified no high-quality content validity studies. The Meaning in Life in Children Questionnaire by Shoshani and Russo-Netzer showed promising measurement properties. However, all included instruments need further content validity testing before being recommended for use.

Assessment of Measurement Properties of Clinical Tests for Foot Posture in Children and Adolescents: A Systematic Review

ABSTRACT The study aimed to analyze, synthesize, and investigate the measurement properties of clinical tests that assess foot posture in children and adolescents. The study included research published in scientific journals that analyzed the measurement properties of clinical tests, focusing on the validity, reliability, responsiveness, or specificity of tests for assessing foot posture in children and adolescents (ages 4 to 18 years). Studies involving children with lower limb surgery, neurological issues, or deformities, reviews, case studies, and abstracts were excluded. The search followed PRISMA guidelines on MEDLINE, EMBASE, PUBMED, CINAHL, SPORTDIscus. The methodological quality was assessed using the COSMIN and Brink and Louw tool, while the certainty of the evidence was evaluated using GRADE. Twelve studies were included in this systematic review, evaluating the following clinical tests: foot posture index-6, normalized truncated navicular height, Staheli index, plantar arch index, arch height index, navicular drop, resting and neutral calcaneal stance position, pediatric flat foot proforma, subjective perception of the height of the feet arch and Clarke angle. Current clinical tests predominantly prioritize the examination of intra- and inter-rater reliability. Conversely, validity has only been found in restricted studies, and responsiveness has not been assessed. No evidence supports high-quality measurement properties for clinical tests evaluating foot posture in children and adolescents.

Convergent construct validity and test-retest reliability of both German versions of the original and the revised Niigata PPPD Questionnaire: NPQ and NPQ-R

BackgroundPersistent Postural-Perceptual Dizziness (PPPD) is a frequent chronic functional disorder that manifests with dizziness, unsteadiness, or non-spinning vertigo present for at least 3 months. Characteristic provocation factors are moving or complex visual stimuli and exclusion of organic diseases. To assess the severity and impact of PPPD, Japanese researchers developed the Niigata PPPD Questionnaire (NPQ). The study's aim was to evaluate the concurrent construct validity and reliability [including test-retest reliability, internal consistency, standard error of measurement (SEM), and minimal detectable change (MDC)] of the German version of the NPQ (12 items) and its revised version, NPQ-R, which contains 19 items addressing additional symptoms and symptom behavior.MethodsThe Swiss Reha Rheinfelden and the German Center for Vertigo and Balance Disorders included 265 PPPD patients (mean age 50.2 ± 16.8 years, disease duration 46.3 ± 76.6 months). Patients completed the NPQ and the NPQ-R (twice), the DHI and potentially related constructs: anxiety (ABC-Scale, VSS), depression (HADS), and general health (SF-36) once. To assess the questionnaires' reliability and validity, several statistical measures were calculated, including Spearman's rank correlation coefficients, Intraclass Correlation Coefficients (ICC2, 1), Cronbach's alpha, SEM, and MDC.ResultsOn average, patients scored 29.9 ± 13.2 for NPQ and 52.3 ± 19.6 for NPQ-R. Correlations between NPQ/NPQ-R and (1) disease-specific questionnaires were rs= 0.712 and rs= 0.752 (DHI), rs=0.426 and rs= 0.0.462 (VSS-V), rs= -0.500 and rs= -0.545 (ABC-Scale), (2) anxiety-specific subscales rs = 0.394 and rs = 0.430 (VSS-A) and rs= 0.354 and rs= 0.430 (HADS-A), (3) depression-related subscales rs=0.438 and rs= 0.487 (HADS-D), and (4) general health rs ranged between rs= -0.216 and −0.578 (all SF-36 subscales). Internal consistency, test-retest reliability, SEM and MDC calculated for NPQ/NPQ-R were α = 0.88/α = 0.91, ICC=0.83 (CI 0.77 to 0.0.87), SEM 5.55/8.37, and MDC 15/23 points.ConclusionThe German versions of NPQ and NPQ-R are valid and reliable patient-reported outcome measures for assessing PPPD, demonstrating satisfactory psychometric measurement properties including convergent construct validity and reliability parameters: internal consistency, test-retest reliability, SEM, and MDC as an evaluative measure. The NPQ-R, with its additional subscales addressing associated symptoms and symptom behavior, represents both the patient and clinician perspective on PPPD-specific problems. Therefore, we recommend utilizing the NPQ-R for a comprehensive assessment of PPPD.

Psychometric Properties of a Questionnaire for Assessing the Extent and Severity of the Concerns of People With an Implanted Cardioverter-Defibrillator.

Background and Purpose: Considering the numerous concerns patients express about having implantable cardioverter-defibrillators (ICDs) and the potential clinical implications of these concerns, it is essential to develop a valid and reliable measure of ICD-related concerns. The implantable cardioverter-defibrillator concerns (ICDC) questionnaire was initially designed for ICD recipients in England to assess and address these concerns. However, it remains uncertain whether this questionnaire possesses similar measurement properties and is suitable for ICD recipients in the United States. The purpose of this study was to provide evidence of the reliability and validity of the ICDC among ICD recipients in the United States with the aim to evaluate the internal consistency reliability of the ICDC, provide evidence of construct validity using Exploratory Factor Analysis (EFA), and test the hypothesis that higher scores on the ICDC would predict higher anxiety levels as measured by the Brief Symptoms Inventory-Anxiety (BSI-6). Methods: Data from a cross-sectional observational study of 240 adult ICD recipients were used to test their knowledge, attitudes, and perceptions of ICDs. Cronbach's coefficient α (alpha) was calculated to assess reliability. EFA using principal components analysis was conducted to evaluate validity. Results: Cronbach's coefficient α (alpha) was .94, indicating high reliability. The results of the EFA suggested that a one-component solution was optimal. The correlation between the BSI-6 measure of anxiety and the ICDC total score was positive and statistically significant. Conclusions: The findings from this study support the reliability and validity of the ICDC questionnaire among ICD recipients in the United States.

Caregiver Contribution to Self-Care of Chronic Illness Inventory: Evaluation of Measurement Properties in a Middle-Income Country

Background/Objectives: Caregivers engage in essential tasks that support patients’ well-being and survival, including administering medications, promoting healthy lifestyle choices, and monitoring and managing symptoms. To date, no valid and reliable instrument is available to assess Caregiver Contribution (CC) to self-care in chronic conditions in middle-income countries such as Albania. Aim: To evaluate the measurement properties (structural and construct validity, internal consistency reliability, stability, and measurement error) of the instrument CC to Self-Care of the Chronic Illness Inventory (CC-SC-CII) in Albanian caregivers caring for elderly people affected by multiple chronic conditions. Methods: A cross-sectional study. We enrolled caregivers of patients with multiple chronic conditions, from August 2020 to April 2021, if they were (a) 18 years of age or older and (b) were identified by the patient as the main unpaid caregiver. Results: Confirmatory factor analysis confirmed the two-factor structure of the CC to Self-Care Maintenance and Management scales and the one-factor structure of the CC to Self-Care Monitoring scale. Reliability estimates were adequate for all (coefficients ranging between 0.827 and 0.961). The construct’s validity was supported. The measurement error was adequate. Conclusions: The Albanian version of the CC to Self-Care of the Chronic Illness Inventory features sound measurement properties and is a valid and reliable instrument for assessing caregiver contribution to patient self-care behaviors in the Albanian population.

Estimating a firm-year measure of conditional conservatism for non-U.S. firms: evidence from Japan

ABSTRACT C_Score, a firm-year-level conditional conservatism measure, is widely used in international accounting research because of its parsimony, that is, the use of firm size, market-to-book ratio, and leverage as the main variables. However, it is developed for the U.S. and may not be valid in other countries because their institutional features differ from the U.S. We replicate the property tests of Khan and Watts (2009, ‘Estimation and empirical properties of a firm-year measure of conditional conservatism,’ Journal of Accounting and Economics 48: 132–150) and further investigate its validity using data from Japanese listed firms. Our findings are summarized as follows: first, market-to-book ratio and leverage are not statistically significant for many years. Second, C_Score does not predict future asymmetric timeliness of earnings. Third, the three variables’ contributions to C_Score’s variance fluctuate over time. Fourth, our result shows that firm size solely determines the measure for many years. Fifth, cash flow asymmetry, not accrual asymmetry, affects the asymmetric timeliness of earnings across the deciles based on C_Score. Finally, we find no relationship between C_Score and asset write-downs including non-current asset impairments. Overall, our findings suggest that C_Score is not valid for Japanese listed firms.

Generalizations and Properties of Normalized Similarity Measures for Boolean Models

In this paper, we provide a closer look at some of the most popular normalized similarity/distance measures for Boolean models. This work includes the generalization of three classes of measures described as generalized Kulczynski, generalized Jaccard, and generalized Consonni and Todeschini measures, theoretical ordering of the similarity measures inside each class, as well as between classes, and positive and negative results regarding the metric properties of measures related to satisfying or not satisfying the triangle inequality axiom.

Development of the PRECIOUS Short-Form (PRECIOUS-SF) quality of care measure for children with serious illnesses

BackgroundRising number of children with complex medical conditions necessitate regular healthcare quality evaluation to achieve optimal outcomes. To address the need for a periodic and quick assessment of quality of care in serious childhood illnesses, we developed a short version of previously validated 45-item PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS) measure.MethodologyPRECIOUS was administered by parents of children living with serious illnesses at two time-points (baseline and two weeks) in an online survey. PRECIOUS Short-Form (PRECIOUS-SF) items were derived from the full PRECIOUS measure, which comprises five scales, using an exploratory factor analysis and best subset regression. The measurement properties of PRECIOUS-SF scales were assessed using the concurrent validity using Pearson correlation (r) with the PRECIOUS scales, internal consistency (Cronbach’s α) within each scale, convergent validity with overall QoC rating, and test-retest reliability (intraclass correlation coefficient, ICC) between baseline and two-week responses.ResultsPRECIOUS-SF included 10 items across four scales – (1) access to financial and medical resources (2), collaborative and goal-concordant care (3), caregiver support and respectful care and (4) reduction of caregiving stressors. A fifth and optional scale was suggested for hospitalization-specific processes. PRECIOUS-SF scales correlated strongly with corresponding PRECIOUS scales (r = 0.91 to 0.98) and demonstrated satisfactory internal consistency (α = 0.77 to 0.91) and test-retest reliability (ICCs > 0.70).ConclusionsPRECIOUS-SF demonstrated internal consistency, convergent validity, test-retest reliability, and concurrent validity with PRECIOUS. PRECIOUS-SF offers a practical tool for routine quality of care assessment in pediatric serious illnesses for promoting timely service evaluation and quality improvement.

Measurement properties of the Trunk Impairment Scale-modified Norwegian version among people with mild to moderate multiple sclerosis

Purpose The Trunk Impairment Scale–modified Norwegian version (TIS-modNV) measures trunk control for clinical and research purposes. This study examined the validity and reliability of the TIS-modNV in people with multiple sclerosis (pwMS). Materials and methods Sixty-eight pwMS (mild to moderate) participated. The TIS-modNV and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scores were compared for construct validity using Spearman’s rho (rs ). TIS-modNV performance was videotaped and rated by four physiotherapists on two occasions. The inter- and intrarater reliability was analyzed via intraclass correlation coefficients (ICC), standard errors of measurement (SEM), Bland–Altman plots, and kappa statistics (k). Results Validity was demonstrated (rs = 0.55–0.61). Interrater reliability for the total score was moderate to good (ICC(A,1) =0.67; ICC(C,1) = 0.78), and the SEM was 2 points (12.8%). Interrater reliability varied across the rater pairs (ICC(A,1) = 0.54-0.81) as displayed in the Bland–Altman plots. Item-level interrater agreement varied from poor to good (k = 0.10–0.79). Intrarater reliability of the total scores was moderate to good (ICC(A,1) = 0.67–0.82). Conclusion This study supports the construct validity and overall reliability of the TIS-modNV in pwMS with mild to moderate disability. However, variations in rater reliability need to be addressed.

Mobile Toolbox sequences task: development and validation of a remote, smartphone-based working memory test

ObjectiveThe ability to assess cognitive skills remotely is increasing with the widespread use and availability of smartphones. The Mobile Toolbox (MTB) is a measurement system that includes Sequences, a new measure of working memory designed specifically for smartphones. This study describes the development of Sequences and presents the studies conducted to evaluate its psychometric properties.MethodsWe developed a new measure of working memory that can be self-administered remotely using an iOS or Android smartphone. In Sequences, a series of numbers and letters are shown on the screen one at a time, and the participant must first tap the letters they see in alphabetical order, followed by tapping the numbers in ascending numerical order. The Sequences measure was evaluated for usability and feasibility across two pilot studies and then assessed in this validation study (which included a total sample size of N = 1,246). Psychometric properties of the new measure were evaluated in three studies involving participants aged 18–90 years. In Study 1 (N = 92), participants completed MTB measures in a laboratory setting. They were also administered both an equivalent NIH Toolbox (NIHTB) measure along with external measures of similar constructs. In Study 2 (N = 1,007), participants were administered NIHTB measures in the laboratory and then completed MTB measures remotely on their own devices. In Study 3 (N = 147), participants completed MTB measures twice, remotely on their own devices, with a 2–week interval between sessions.ResultsSequences exhibited moderately high correlations with a comparable NIHTB test and external measures of a similar construct, while exhibiting a lower correlation with an unrelated test, as hypothesized. Internal consistency was high, but test-retest reliability was moderate. When controlling for age, phone operating system (iOS vs. Android) and sex assigned at birth did not significantly impact performance; however, there was a significant difference between individuals who completed college and those with a high school education or lower.ConclusionThe results support the validity of Sequences as a measure of working memory for remote self-administered use. The internal consistency was strong, with moderate test-retest reliability that is likely a function of the test's unproctored self-administration method. The findings suggest that Sequences is appropriate for use with adults aged 18–90 years in remote self-administered designs that focus on group results.