Test-retest Intraclass Correlation Research Articles

Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery

BackgroundWhilst validated quality-of-recovery (QoR) tools exist for general surgery, there is no specific obstetric equivalent. We aimed to develop and evaluate a modified QoR score after elective Caesarean delivery. MethodsTwenty-two obstetric specific items were selected following review and modification of the QoR-40 survey by 16 experts and interviews with 50 stakeholders. Item selection was based on relevance to Caesarean delivery and endorsement by >66% of stakeholders. Items were tested on women pre-delivery, at 24 h, and 25 h post-delivery. An 11-item obstetric-specific QoR score (ObsQoR-11) was created based on correlation with a numerical rating scale (NRS) of global health status (r>0.20) at all time points. Reliability, responsiveness, acceptability, and feasibility were tested. ResultsOne hundred and fifty-two women responded to the 22-item questionnaire pre-delivery (complete in 146), 100 at 24 h, and 10 at 25 h. The ObsQoR-11 correlated with the global health status NRS (r=0.53; 95% confidence interval: 0.43–0.62; P<0.0001) and discriminated good vs poor recovery (NRS score ≥70 vs <70 mm) at 24 h. There was a negative correlation between the ObsQoR-11 score at 24 h and hospital length of stay (r=–0.39; P=0.003). ObsQoR-11 was reliable (internal consistency: 0.85; split-half 0.76; test–retest intra-class correlation coefficient ri>0.6 in 82% of items) and responsive (Cohen effect size: 1.36; standardised response mean: 0.85). A longer 22-item ObsQoR had high (97%) completion rates and short (median: 2 min) completion times. ConclusionsThe ObsQoR-11 provides a valid, reliable, and responsive global assessment of recovery after elective Caesarean delivery.

Social support for healthy eating: development and validation of a questionnaire for the French-Canadian population.

The present study aimed to develop and validate a questionnaire assessing social support for healthy eating in a French-Canadian population. A twenty-one-item questionnaire was developed. For each item, participants were asked to rate the frequency, in the past month, with which the actions described had been done by family and friends in two different environments: (i) at home and (ii) outside of home. The content was evaluated by an expert panel. A validation study sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on items to assess the number of subscales. Internal consistency reliability was assessed using Cronbach's ɑ. Test-retest reliability was evaluated with intraclass correlations between scores of the two completions. Online survey. Men and women from the Québec City area (n 150). The content validity assessment led to a few changes, resulting in a twenty-two-item questionnaire. Exploratory factor analysis revealed a two-factor structure for both environments, resulting in four subscales: supportive actions at home; non-supportive actions at home; supportive actions outside of home; and non-supportive actions outside of home. Two items were removed from the questionnaire due to low loadings. The four subscales were found to be reliable (Cronbach's ɑ=0·82-0·94; test-retest intraclass correlation=0·51-0·70). The Social Support for Healthy Eating Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. This questionnaire will be useful to explore the role of social support and its interactions with other factors in predicting eating behaviours.

Reliability and validity of the Japanese translation of the DN4 Diagnostic Questionnaire in patients with neuropathic pain.

The Douleur Neuropathique 4 questionnaire (DN4) is a simple and objective tool developed by the French Neuropathic Pain Group to screen for neuropathic pain. This prospective observational study was undertaken in three hospitals to assess the validity of a Japanese translation of the DN4. We first translated the DN4 into Japanese using a forward-backward method. Pain specialists then examined patients independently and diagnosed them with neuropathic or non-neuropathic pain, according to the International Association for the Study of Pain definitions. The Japanese version of the DN4 questionnaire was then given to each patient. Of 187 patients that met our inclusion criteria, 100 and 87 were diagnosed with neuropathic and non-neuropathic pain, respectively. The test-retest intra-class correlation coefficient (95% confidence interval) was 0.827 (0.769-0.870). Among patients with identical diagnoses of neuropathic or non-neuropathic pain, receiver-operating characteristic curve analysis revealed an area under the curve of 0.89. A cut-off point of equal or greater than 4 resulted in a sensitivity of 71% and specificity of 92%. The Japanese version of the DN4 was found to be a helpful tool for discriminating between neuropathic and non-neuropathic pain.

Reliability of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT).

The delivery of evidence-based health care requires the routine adoption of outcome measures that are valid and reliable. The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) was developed in Australia to capture a global snapshot of status for any client, and has preliminary psychometric evidence to support use. Building on the psychometric evidence of the AusTOMs-OT will provide therapists and researchers with further information as to how best to apply the AusTOMs-OT in their field. This study reports on the reliability of the 12 AusTOMs-OT scales, which are each scored on the four domains of Impairment, Activity Limitation, Participation Restriction and Distress/Wellbeing. A total of 31 occupational therapists rated 12 written case studies on two occasions, separated by two weeks. Test-retest reliability, inter-rater reliability, intra-rater reliability (using intra-class correlation coefficients (ICCs)) and measurement error were calculated, in line with the COnsensus-based guidelines for the Selection of health Measurement Instruments (COSMIN). The ICCs for inter-rater reliability for all domains for all scales ranged from 0.531 to 0.922 suggesting moderate to very high reliability. Therapist intra-rater reliability ranged from ICC 0.675 to 1.000, suggesting moderate to high consistency. The stability of the scales was demonstrated with test-retest ICCs coefficients ranging from 0.616 to 0.960. The measurement error was found to be below 0.5 point for all scales and domains except for Scale 1, Impairment (just over at 0.604) and similarly the error range for each scale was also all below 1 point except Scale 1, Impairment. The AusTOMs-OT scales possess moderate to very high reliability across the 12 scales. Occupational therapists can continue to use AusTOMs-OT with confidence with all clients to establish global outcomes and to build evidence to underpin practice.

Cross-Cultural adaption, validity and reliability of a Hindi version of the Corah's Dental Anxiety Scale.

Background: An appropriate scale to assess the dental anxiety of Hindi speaking population is lacking. This study, therefore, aims to evaluate the psychometric properties of Hindi version of one of the oldest dental anxiety scale, Corah’s Dental Anxiety Scale (CDAS) in Hindi speaking Indian adults.Methods: A total of 348 subjects from the outpatient department of a dental hospital in India participated in this cross-sectional study. The scale was cross-culturally adapted by forward and backward translation, committee review and pretesting method. The construct validity of the translated scale was explored with exploratory factor analysis. The correlation of the Hindi version of CDAS with visual analogue scale (VAS) was used to measure the convergent validity. Reliability was assessed through calculations of Cronbach’s alpha and intra class correlation 48 forms were completed for test-retest.Results: Prevalence of dental anxiety in the sample within the age range of 18-80 years was 85.63% [95% CI: 0.815-0.891]. The response rate was 100 %. Kaiser-Meyer-Olkin (KMO) test value was 0.776. After factor analysis, a single factor (dental anxiety) was obtained with 4 items.The single factor model explained 61% variance. Pearson correlation coefficient between CDASand VAS was 0.494. Test-retest showed the Cronbach’s alpha value of 0.814. The test-retest intraclass correlation coefficient of the total CDAS score was 0.881 [95% CI: 0.318-0.554].Conclusion: Hindi version of CDAS is a valid and reliable scale to assess dental anxiety in Hindi speaking population. Convergent validity is well recognized but discriminant validity is limited and requires further study.

Reproducible automated breast density measure with no ionizing radiation using fat-water decomposition MRI.

Increased breast density is a significant independent risk factor for breast cancer, and recent studies show that this risk is modifiable. Hence, breast density measures sensitive to small changes are desired. Utilizing fat-water decomposition MRI, we propose an automated, reproducible breast density measurement, which is nonionizing and directly comparable to mammographic density (MD). Retrospective study. The study included two sample sets of breast cancer patients enrolled in a clinical trial, for concordance analysis with MD (40 patients) and reproducibility analysis (10 patients). The majority of MRI scans (59 scans) were performed with a 1.5T GE Signa scanner using radial IDEAL-GRASE sequence, while the remaining (seven scans) were performed with a 3T Siemens Skyra using 3D Cartesian 6-echo GRE sequence with a similar fat-water separation technique. After automated breast segmentation, breast density was calculated using FraGW, a new measure developed to reliably reflect the amount of fibroglandular tissue and total water content in the entire breast. Based on its concordance with MD, FraGW was calibrated to MR-based breast density (MRD) to be comparable to MD. A previous breast density measurement, Fra80-the ratio of breast voxels with <80% fat fraction-was also calculated for comparison with FraGW. Pearson correlation was performed between MD (reference standard) and FraGW (and Fra80). Test-retest reproducibility of MRD was evaluated using the difference between test-retest measures (Δ1-2 ) and intraclass correlation coefficient (ICC). Both FraGW and Fra80 were strongly correlated with MD (Pearson ρ: 0.96 vs. 0.90, both P < 0.0001). MRD converted from FraGW showed higher test-retest reproducibility (Δ1-2 variation: 1.1% ± 1.2%; ICC: 0.99) compared to MD itself (literature intrareader ICC ≤0.96) and Fra80. The proposed MRD is directly comparable with MD and highly reproducible, which enables the early detection of small breast density changes and treatment response. 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:971-981.

Translation, and interobserver and test–retest reliability of the Brazilian Portuguese version of Children's Hospital Oakland Hip Evaluation Scale for patients with sickle cell disease

BackgroundThe Children's Hospital Oakland Hip Evaluation Scale is a disease-specific tool for the clinical and functional assessment of the hip in sickle cell disease. ObjectivesTo translate the tool into Brazilian Portuguese and evaluate the interobserver and test–retest reliability. MethodsEighteen patients diagnosed with sickle cell disease and a mean age of 49±11.9 years participated in the study. The scale was applied by two evaluators who did not speak to each other regarding their understanding of the tool and who had no prior training. Interobserver and test–retest reliability of individual items and of the total score were evaluated using the intraclass correlation coefficient and the Bland–Altman method. ResultsWhen the overall score for each hip was considered, the test–retest intraclass correlation coefficient score for the right hip was 0.95 (0.89–0.98) and for the left hip it was 0.96 (0.91–0.98). Considering all assignments (total score), the score was 0.96 (0.90–0.98). The test–retest intraclass correlation coefficient varied from 0.76 to 1 for 18 of the 27 items (excellent) and from 0.53 to 0.75 for nine items (moderate). When the overall score for each hip was considered, the interobserver intraclass correlation coefficient for both hips was 0.94 (0.86–0.98). Considering all assignments, the total score was 0.94 (0.86–0.98). The interobserver intraclass correlation coefficient varied from 0.48 to 0.75 for 18 out of 27 items (moderate) and varied from 0.77 to 1 for the remaining nine items (excellent). ConclusionThe results demonstrate that the Brazilian version of the Children's Hospital Oakland Hip Evaluation Scale presented adequate interobserver and test–retest reliability and that the version can be used to evaluate clinical function in sickle cell disease patients, producing consistent, standardized and reproducible results.

Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease specific patient-reported outcome measure

To better understand our urethroplasty outcome, we translated the English version of a urethral stricture surgery patient-reported outcome measure (USS-PROM) into Japanese and used it to evaluate the effect of urethroplasty for anterior urethral strictures. The PROM quantifies lower urinary tract symptoms (LUTS) and health-related quality of life (EQ-5D), and it evaluates overall satisfaction by asking patients to choose “very satisfied”, “satisfied”, “unsatisfied”, or “very unsatisfied”. 93 Japanese-speaking male patients with anterior urethral stricture who underwent urethroplasty completed it before (baseline) and 6 months after urethroplasty. The psychometric criteria evaluated in the present study were the PROM’s internal consistency, test–retest reliability, criterion validity, and responsiveness. Qmax was negatively correlated with the LUTS-total scores (r = − 0.61). Cronbach’s alpha was 0.80 and the test–retest intraclass correlation coefficient for the LUTS-total score was 0.82. 83 patients (89.2%) achieved stricture-free, which was defined as no re-stricture on cystoscopy and no need for additional treatment. The mean total LUTS-score improved from 12.4 at baseline to 3.7 postoperatively (p < 0.0001). The mean EQ-5D visual analogue scores and EQ-5D index improved from 61.2 and 0.76, respectively, at baseline to 77.9 and 0.89 postoperatively (p < 0.0001, p < 0.0001). 55 patients (59.1%) were “very satisfied” with the outcome of their urethroplasty and 33 (35.5%) were “satisfied”. The Japanese version of the USS-PROM has adequate psychometric properties. Urethroplasty improved not only objective data but also voiding symptoms and health-related QOL, and it resulted in a high rate of patient satisfaction.

Statistical evaluation of test-retest studies in PET brain imaging.

Positron emission tomography (PET) is a molecular imaging technology that enables in vivo quantification of metabolic activity or receptor density, among other applications. Examples of applications of PET imaging in neuroscience include studies of neuroreceptor/neurotransmitter levels in neuropsychiatric diseases (e.g., measuring receptor expression in schizophrenia) and of misfolded protein levels in neurodegenerative diseases (e.g., beta amyloid and tau deposits in Alzheimer’s disease). Assessment of a PET tracer’s test-retest properties is an important component of tracer validation, and it is usually carried out using data from a small number of subjects. Here, we investigate advantages and limitations of test-retest metrics that are commonly used for PET brain imaging, including percent test-retest difference and intraclass correlation coefficient (ICC). In addition, we show how random effects analysis of variance, which forms the basis for ICC, can be used to derive additional test-retest metrics, which are generally not reported in the PET brain imaging test-retest literature, such as within-subject coefficient of variation and repeatability coefficient. We reevaluate data from five published clinical PET imaging test-retest studies to illustrate the relative merits and utility of the various test-retest metrics. We provide recommendations on evaluation of test-retest in brain PET imaging and show how the random effects ANOVA based metrics can be used to supplement the commonly used metrics such as percent test-retest. Random effects ANOVA is a useful model for PET brain imaging test-retest studies. The metrics that ensue from this model are recommended to be reported along with the percent test-retest metric as they capture various sources of variability in the PET test-retest experiments in a succinct way.

Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behavior questionnaire in persons with spinal cord injury.

Cross-sectional psychometric study. To evaluate the reliability and validity of a spinal cord injury lifestyle scale (SCILS) and Health Behavior Questionnaire (HBQ) in the Persian language for persons with spinal cord injury (SCI). Participants were selected among those referred to health centers and the Brain and Spinal Cord Injury Research Center. In accordance with standard procedure for translation, two questionnaires, the SCILS and HBQ, were translated using a forward and backward translation approach by professional translators. Face validity of the questionnaires was assessed by ten persons with SCI and content validity was agreed upon by 12 professors from health care teaching universities. To test the final versions of both questionnaires, 97 persons with SCI were included using a consecutive sampling method. Other questionnaires were used to assess concurrent validity (secondary impairment checklist, as well as SCILS and HBQ) and convergent validity (impact of event scale revised, brief symptom inventory, beck depression inventory, and functional independence measure). Internal consistency of SCILS and HBQ, assessed by Cronbach's alpha, was 0.75 for SCILS and 0.85 for HBQ. Test-retest reliability intraclass correlations were 0.86 and 0.92 for SCILS and HBQ, respectively. The number of current secondary impairments had a significant and negative correlation with SCILS (r = -0.22, P < 0.001), but it was not correlated with HBQ. SCILS had a significant and strong correlation with HBQ (r = 0.65, P < 0.001). SCILS and HBQ can be used for measuring the health behavior of persons with SCI in Iran.

Translation and Cross-cultural Adaptation of the Hip Disability and Osteoarthritis Score into Persian Language: Reassessment of Validity and Reliability.

Background:This study aimed Persian translation and validation of the hip disability and osteoarthritis outcome score (HOOS) questionnaire.Methods:The study was carried out in two phases. First, we translated the HOOS according to acceptable guidelines. We assessed HOOS content convergent validity on 203 hip osteoarthritis patients using SF-36. Internal consistency was tested using Cronbach's alpha coefficient if each item removed and intraclass correlation coefficient (ICC) for the assessment of test-retest reproducibility.Results:Patients had mean (standard deviation) age of 39 (17). Test-retest ICC in whole was 0.95 (P = 0.014) showing excellent reliability. ICC was 0.92 for the “pain” subscale (P = 0.02), 0.81 for the “symptom” subscale (P = 0.002), 0.81 for the “function of daily living (FDL)” (P = 0.022), 0.88 for the “function of sports and recreational activities” (P = 0.006), but it was 0.62 (P = 0.1) for the “quality of life (QOL).” Cronbach's alpha was 0.92, 0.73, 0.97, 0.86, 0.80, and 0.80 for the pain, symptom, FDL, function of sports, QOL, and stiffness, respectively, showing good to excellent internal consistancy. Having SF-36 for the assessment of convergent validity, there was a strong correlation between total HOOS score and the physical component summary domain of SF-36 (r = 0.64, P = 0.0001), whereas the t correlation with the mental component summary domain was weak (r = 0.16, P = 0.04).Conclusions:The Persian version of the HOOS questionnaire is a valid (regarding physical not mental aspects) and reliable assessment tool in patients with hip osteoarthritis.

Validity and reliability of the Ocular Motor Nerve Palsy Scale.

Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index (CVI) and factor analysis were used to analyze the scale's construct validity. The intraclass correlation coefficient and Cronbach's alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results (I-CVI = 1.0, S-CVI = 0.9, P = 0.016, K* = 1) indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965 (P < 0.01), a test-retest reliability intraclass correlation coefficient of 0.976 (P < 0.01), and Cronbach's alpha values of 0.63-0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry (registration number: ChiCTR-OOC-17010702).

Cross-Cultural and Psychometric Properties Assessment of the Exercise Self-Efficacy Scale in Individuals with Spinal Cord Injury.

The Exercise Self-Efficacy scale (ESES) is a reliable measure, in the English language, of exercise self-efficacy inindividuals with spinal cord injury. The aim of this study was to culturally adjust and validate the Exercise Self-Efficacy scale in thePortuguese language. The Exercise Self-Efficacy scale was applied to 76 subjects, with three-month intervals (three applications intotal). The reliability was appraised using the intra-class correlation coefficient and Bland-Altman methods, and the internal consistencywas evaluated using Cronbach´s alpha. The Exercise Self-Efficacy scale was correlated with the domains of the Quality of lifeQuestionnaire SF-36 and Functional Independence Measure and tested using the Spearman rho coefficient. The Exercise Self-Efficacy scale-Brazil presented good internal consistency (alpha 1 = 0.856; alpha 2 = 0.855; alpha 3 =0.822) and high reliability in the test-retest (intra-class correlation coefficient = 0.97). There was a strong correlation between theExercise Self-Efficacy scale-Brazil and the SF-36 only in the functional capacity domain (rho = 0.708). There were no changes inExercise Self-Efficacy scale-Brazil scores between the three applications (p = 0.796). The validation of the Exercise Self-Efficacy scale questionnaire permits the assessor to use it reliably in Portuguesespeaking countries, since it is the first instrument measuring self-efficacy specifically during exercises in individuals with spinal cordinjury. Furthermore, the questionnaire can be used as an instrument to verify the effectiveness of interventions that use exercise as anoutcome. The results of the Brazilian version of the Exercise Self-Efficacy scale support its use as a reliable and valid measurementof exercise self-efficacy for this population.

Ultrasound measurements of Achilles tendon length using skin markings are more reliable than extended-field-of-view imaging.

Elongation of the Achilles tendon has been associated with poorer function in patients treated for ruptures. This has led to the development of various ultrasound-based measurements, and the purpose of the present study was to compare the reliability of three ultrasound-based measuring procedures. Twenty healthy individuals (40 tendons) were assessed by two testers at two occasions, 12 weeks apart. The tendon length was measured from the calcaneal insertion to the mid-sagittal muscle tendon junction (MTJ) using skin markings or extended-field-of-view (EFOV) imaging, or from the calcaneal insertion to the distal medial MTJ using skin markings. Test-retest and inter-tester reliability as well as side-to-side length differences were assessed for all three procedures. Test-retest intraclass correlation coefficients (ICCs) for measurements from the mid-sagittal MTJ using EFOV imaging and skin markings, and from the distal medial MTJ using skin markings were 0.83, 0.90 and 0.96 for tester 1 and 0.87, 0.91 and 0.96 for tester 2, respectively. The corresponding inter-tester ICCs were 0.85, 0.91 and 0.96. Side-to-side lengths were significantly different for measurements from the mid-sagittal MTJ and the distal medial MTJ using skin markings, with mean differences of 0.3 and 0.4cm, respectively. Test-retest and inter-tester ICCs were excellent for all three measuring procedures, however, the use of skin markings provided consistently better agreement and reliability compared to EFOV images. The best agreement and highest ICCs were achieved for measurements from the distal medial MTJ, but side-to-side length differences warrant caution when contralateral measurements are used to evaluate tendon elongation. III.

International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction.

The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction. The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4-8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1-5 years after reconstruction, and repeated this 2-8 weeks later (test-retest reliability). All participants completed debriefing questionnaires. A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test-retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test-retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire. The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.

Measuring oral mucositis of pediatric patients with cancer: A psychometric evaluation of chinese version of the oral mucositis daily questionnaire

Objective:Oral mucositis is a frequent clinical condition that has been shown to affect pediatric cancer patients. Oral Mucositis Daily Questionnaire (OMDQ) is one of the few available patient-reported outcome measures to assess the extent and impact of oral mucositis. The objectives of the study were to translate the Mouth and Throat Soreness-Related Questions of the OMDQ into Chinese (OMDQ MTS-Ch) for children and adolescents aged 6–18 years receiving chemotherapy and to evaluate its psychometric properties.Methods:This was part of a multicenter, prospective cohort study involving two phases. Phase I involved forward-backward translation to fit the cognitive and linguistic age level of the children and adolescents, followed by face and content validation, together with pretesting. In Phase II, which evaluated the internal consistency, test-retest reliability, and discriminant validity, a total of 140 patients completed the OMDQ MTS-Ch for 14 days.Results:The OMDQ MTS-Ch had satisfactory face and content validities. The Cronbach's alpha coefficient of the OMDQ MTS-Ch was 0.984. All of the corrected item-total correlations were higher than 0.90. The test-retest intraclass correlation coefficient between consecutive days for the OMDQ MTS-Ch items ranged from 0.576 to 0.983; the only value that was not over 0.70 was that for the paired study days 7 and 8 for the item of talking. The mean area-under-the-curve OMDQ MTS-Ch item scores were significantly different among patients with different degrees of mucositis severity (P < 0.001), supporting the discriminant validity.Conclusions:It has been shown that the OMDQ MTS-Ch has a good level of reliability and discriminant validity and can be completed by children aged ≥6 years and adolescents on a daily basis to measure mucositis and its related functional limitations.

Validación del Timed up and go test como predictor de riesgo de caídas en sujetos con artritis reumatoide. Parte I: confiabilidad y aplicabilidad clínica

IntroductionPersons with rheumatoid arthritis (RA) have a high risk of falls. There is a need for tools that identify at-risk patients. The Timed Up and Go test (TUG) is used to predict the risk of falls but it is essential to study its psychometric properties. The aim of this study was to establish intra- and interobserver reliability, test-retest reliability and the clinical applicability of the TUG test in persons with a diagnosis of RA. Material and methodObservational, prospective, longitudinal study. intra- and interobserver reliability and the test-retest reliability of the TUG were established with intraclass correlation coefficients (ICC). Bland-Altman plots were constructed for intra- and interobserver reliability. ResultsThe intraobserver reliability ICC for the two assessors was 0.98 (95% CI 0.96-0.99) and 0.99 (95% CI 0.98-0.99), and was 0.97 (95% CI 0.95-0.98) at normal speed and 0.99 (95% CI 0.99-0.99) at maximal speed. The interobserver reliability ICC at normal speed was 0.99 (95% CI 0.98-0.99) and 0.99 (95% CI 0.99-0.99) at maximal speed. The test-retest reliability ICC was 0.77 (95% CI 0.61-0.87) at normal speed and 0.91 (95% CI 0.83-0.95) at maximal speed. A total of 23% of the participants reported minimal difficulty in understanding the test. The average administration time was 90seconds. ConclusionThis study identifies the intra- and interobserver reliability, test-retest reliability and the clinical applicability of the TUG test at normal and maximal speed in RA patients.

Psychometric Properties of a Clinical Strength Assessment Protocol in People with Multiple Sclerosis.

Strength training in people with multiple sclerosis (MS) is an important component of rehabilitation, but it can be challenging for clinicians to quantify strength accurately and reliably. This study investigated the psychometric properties of a clinical strength assessment protocol using handheld dynamometry and other objective, quantifiable tests for the lower extremities and trunk in people with MS. This study determined discriminant validity between 25 participants with MS and 25 controls and between participants with MS who had higher versus lower disability; test-retest reliability across 7 to 10 days; and response stability. The protocol included handheld dynamometry measurements of ankle dorsiflexion, knee flexion and extension; hip flexion, extension, abduction, and adduction; and trunk lateral flexion. Muscular endurance tests were used to measure trunk extension, trunk flexion, and ankle plantarflexion. The protocol discriminated between participants with MS and controls for all muscles tested (P < .001-.003). The protocol also discriminated between low- and moderate-disability groups (P = .001-.046) for 80% of the muscles tested. Test-retest reliability intraclass correlation coefficients were high (0.81-0.97). Minimal detectable change as a percentage of the mean was 13% to 36% for 85% of muscles tested. This study provides evidence for the discriminant validity, test-retest reliability, and response stability of a strength assessment protocol in people with MS. This protocol may be useful for tracking outcomes in people with MS for clinical investigations and practice.

The Spanish version of the Patient-Rated Wrist Evaluation outcome measure: cross-cultural adaptation process, reliability, measurement error and construct validity

BackgroundThe Patient-Rated Wrist Evaluation (PRWE) is a widely used measure of patient-reported disability and pain related to wrist disorders. We performed cross-cultural adaptation of the PRWE into Spanish (Spain) and assessed reliability and construct validity in patients with distal radius fracture.MethodsAdaptation of the English version to Spanish (Spain) was performed using translation/back translation methodology. The measurement properties of the PRWE-Spanish were assessed in a sample of 40 consecutive patients (31 women), mean age 58 (SD 19) years, with extra-articular distal radius fractures treated with closed reduction and cast. The patients completed the PRWE-Spanish and the standard Spanish versions of the 11-item Disabilities of the Arm, Shoulder and Hand (QuickDASH) and EQ-5D questionnaires at baseline (health status before fracture) and at 8, 9, 12, and 13 weeks after treatment. Internal-consistency reliability was assessed with the Cronbach alpha coefficient and test-retest reliability with the intraclass correlation coefficient (ICC) comparing responses at 8 and 9 weeks and responses at 12 and 13 weeks. Cross-sectional precision was analyzed with the Standard Error of the Measurement (SEM). Longitudinal precision for test-retest reliability coefficient was analyzed with the Standard Error of the Measurement difference (SEMdiff) and the Minimal Detectable Change at 90% (MDC90) and 95% (MDC95) confidence levels. For assessing construct validity we hypothesized that the PRWE-Spanish (lower score indicates less disability and pain) would have strong positive correlation with the QuickDASH (lower score indicates less disability) and moderate negative correlation with the EQ-5D Index (higher score indicates better health); Spearman correlation coefficient (r) was used.ResultsFor the PRWE total score, Cronbach alpha was 0.98 (SEM = 2.67) at baseline and 0.96 (SEM = 4.37) at 8 weeks. For test-retest reliability ICC was 0.94 (8 and 9 weeks) and 0.96 (12 and 13 weeks) with SEMdiff 7.61 and 6.18 and MDC95 13.74 and 12.11, respectively. The PRWE-Spanish scores had strong positive correlation with the QuickDASH scores at baseline (r = 0.71) and at 8 weeks (r = 0.79) and moderate negative correlation with the EQ-5D Index (r = −0.44 and r = −0.40, respectively).ConclusionsThe PRWE-Spanish showed high internal-consistency and test-retest reliability and good construct validity in patients with distal radius fracture.

Validation and reliability of the Chichewa translation of the EQ-5D quality of life questionnaire in adults with orthopaedic injuries in Malawi.

The EQ-5D is a standardised instrument that measures health-related quality-of-life and explores cost-effectiveness of treatments. Malawi is a low-resource country that would benefit from assessment of quality-of-life among individuals living with chronic conditions. Chichewa is the official native language of Malawi. The Chichewa version of the EQ-5D-3L developed by EuroQoL group has not been validated with Chichewa speakers. The purpose of this study was to evaluate the clinimetric properties of the Chichewa EQ-5D-3L. Patients with orthopaedic conditions were recruited in the outpatient orthopaedic clinics and wards at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifty-three patients with various musculoskeletal problems were administered the Chichewa EQ-5D-3L and World Health Organization quality of life (WHO-QOL) questionnaires. To assess repeatability, a separate test-retest population of 20 patients were also selected from orthopaedic clinics and wards to fill out the questionnaire twice. Convergence validity was determined, with each of the WHO-QOL domains and the EQ-5D descriptive index and visual analogue scale (VAS) having good to moderate correlation (r = 0.3-0.7). Internal consistency was measured for the descriptive index, and the Cronbach's alpha was 0.7. The ceiling effect for the descriptive index and the VAS were 9.4% and 0%, respectively. No respondents reached floor effect for the descriptive index or the VAS. The test-retest intraclass correlation coefficient reliability at 14 days was 0.984 for the VAS and 1 for the descriptive index, with all 20 respondents providing the same responses. The EuroQoL translated version of the Chichewa EQ-5D-3L was found to demonstrate adequate validity, internal consistency, floor/ceiling effects, and reliability.