The validity of the modified patient generated index – a quantitative and qualitative approach

The purpose of this study was to determine the validity of the recently modified patient generated index (PGI) when used as a self-completed postal questionnaire by older people with arthritis. Two postal surveys were used, followed by interviews with a theoretically chosen sub-sample of respondents to both. Data from the self-completed modified PGI and the arthritis impact measurement scales (AIMS) and the interviews were assessed against 10 pre-defined validity criteria. A total number of 1027 people over 65 years old and with arthritis were surveyed and 53 were selected for interview. The response rates to the two-part survey were 78 and 83%. Complete data for the validity analysis were available from 47% of the respondents. The modified PGI met four and failed to meet six validity criteria. Pre-defined correlations were found with the AIMS and differentiation was possible between respondents with mild, moderate and severe arthritis and between those who had recently sought medical attention and those who had not. The areas that had been chosen for inclusion in the modified PGI were affected by arthritis but may not have been the ‘most important’ areas. The measurement method could not detect changes in health nor differentiate between respondents taking and not taking analgesics. There were several problems in the respondents' interpretation of the instructions, which were only revealed during the interviews. These data should help inform further modification of the PGI. This revised version was published online in June 2006 with corrections to the Cover Date.     

Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) was very high

BACKGROUND AND OBJECTIVE: There is increasing international interest in using patient-based outcome measures to evaluate interventions. We compared responses to postal administration of Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) with the gold standard of supervised self-completion. STUDY DESIGN AND SETTING: Validation study involving 96 adults, recruited from U.K. general practice, sent the postal questionnaires with an instruction sheet 1 week before supervised self-completion. Responses for those whose quality of life (n=56) or asthma control (n=61) had 'not changed' between postal and supervised completions were compared using paired-sample t-tests, Pearson's correlation coefficient (r), and intraclass correlation coefficient (ICC). RESULTS: For the MiniAQLQ, overall mean scores were similar in both groups: Postal=5.14 (SD=1.42) vs. Supervised=5.17 (SD=1.39), with mean difference of -0.03 (95% CI=-0.14, 0.08; P=.59), with a high degree of correlation (r=.96, P<.001) and concordance (ICC=0.96; 95% CI=0.93, 0.98; P<.001). For the ACQ, overall mean scores (with SD) were also similar in both groups: Postal=1.24 (SD=1.09) vs. Supervised=1.26 (SD=1.10), with mean difference of -0.02 (95% CI=-0.12, 0.08; P=.74), with good correlation (r=.94, P<.01) and concordance (ICC=0.94; 95% CI=0.90, 0.96; P<.01). CONCLUSIONS: Correlation and concordance between supervised and postal administration of the MiniAQLQ and ACQ are very high. Users may confidently choose the mode of administration most appropriate to their needs.     

Patient satisfaction with large-scale out-of-hours primary health care in The Netherlands: development of a postal questionnaire

BACKGROUND: Since the turn of the millennium, out-of-hours primary health care in The Netherlands has faced a substantial change from small locum groups towards large GP cooperatives. Improving the quality of care requires evaluation of patient satisfaction. OBJECTIVE: To develop a reliable postal questionnaire for wide-scale use by patients contacting their out-of-hours GP cooperative and to present the results of a national survey. METHODS: Literature review and interviews with both patients and health carers were carried out to identify issues of potential relevance, followed by two postal pilot studies and additional interviews to remove or rephrase items. Finally, postal questionnaires were sent to 14,400 people who contacted one of 24 GP cooperatives in The Netherlands. RESULTS: Overall response was 52.2% for all types of contact. Three scales were identified prior to the field phase and confirmed by principal components analysis: telephone nurse, doctor and organization. Reliability was high, with Cronbach's alphas and intraclass correlation coefficients exceeding 0.70 for all scales. Only items in the organization scale showed clear differences among the participating cooperatives. Respondents receiving telephone advice showed lower levels of satisfaction than respondents with other types of contact (P < 0.001); centre consultation scored lower than home visit (P < 0.030 or less for all differences). CONCLUSION: A reliable measure of patient satisfaction has been developed that can also be used for the comparison of GP cooperatives on an organizational level. Overall satisfaction was high, showing highest levels for home visit and lowest levels for telephone advice.     

Comparison of three instruments assessing the quality of economic evaluations: a practical exercise on economic evaluations of the surgical treatment of obesity

OBJECTIVES: The increasing use of full economic evaluations has led to the development of various instruments to assess their quality. The purpose of this study was to compare the frequently used British Medical Journal (BMJ) check-list and two new instruments: the Consensus Health Economic Criteria (CHEC) list and the Quality of Health Economic Studies (QHES) instrument. The analysis was based on a practical exercise on economic evaluations of the surgical treatment of obesity. METHODS: The quality of nine selected studies was assessed independently by two health economists. To compare instruments, the Spearman rank correlation coefficient was calculated for each assessor. Moreover, the test-retest reliability for each instrument was assessed with the intraclass correlation coefficient (ICC) (3,1). Finally, the inter-rater agreement for each instrument was estimated at two levels: comparison of the total score of each article by the ICC(2,1) and comparison of results per item by kappa values. RESULTS: The Spearman's rank correlation coefficient between instruments was usually high (rho > 0.70). Furthermore, test-retest reliability was good for every instruments, that is, 0.98 (95 percent CI, 0.86-0.99) for the BMJ check-list, 0.97 (95 percent CI, 0.73-0.98) for the CHEC list, and 0.95 (95 percent CI, 0.75-0.99) for the QHES instrument. However, inter-rater agreement was poor (kappa < 0.40 for most items and ICC(2,1) < or = 0.5). CONCLUSIONS: The study shows that the results of the quality assessment of economic evaluations are not so much influenced by the instrument used but more by the assessor. Therefore, quality assessments should be performed by at least two independent experts and final scoring based on consensus.     

Design and validation of a questionnaire for the detection of major depression in elderly patients

BACKGROUND AND OBJECTIVE: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). METHODS: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). RESULTS: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). CONCLUSIONS: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.     

Interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia

OBJECTIVES: To determine the interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia. DESIGN: A cross-sectional reliability study. SETTING: Nursing homes and an acute care hospital. PARTICIPANTS: Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections. MEASUREMENTS: Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model. RESULTS: On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI -0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76). CONCLUSION: In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be "fair." Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone.     

The problem of measuring change in individual health-related quality of life by postal questionnaire: use of the patient-generated index in a disabled population

The Patient-generated Index (PGI) is a health-related quality of life (HRQoL) measure which asks respondents to nominate the areas of their lives which are most affected by their health condition, so that they can then rate the severity of the effects and weight their relative importance. It is unusual amongst such measures in that it is designed for postal administration. This study assessed the ability of the revised PGI to measure change in HRQoL in a population of 161 people who had previously been identified as having limiting long-term illness. A questionnaire, including a revised version of the PGI and the developmental version of the SF-36, was mailed at two time points (T1 and T2), 4.5 months apart. The PGI was subsequently assessed in terms of practicality, validity, reliability and responsiveness. At T1, 62% of those who felt that they still had a health problem affecting their life completed the PGI correctly. These people were significantly younger and had spent longer in education than the remaining 38%. Only 19 respondents completed the PGI correctly on both occasions, rendering reliability and responsiveness testing inconclusive. The value of the PGI is significantly diminished by the fact that many people cannot complete it correctly. Future development of the instrument is appraised in the context of related measurement methods.     

A portable x-ray fluorescence instrument for analyzing dust wipe samples for lead: evaluation with field samples

Dust wipe samples collected in the field were tested by nondestructive X-ray fluorescence (XRF) followed by laboratory analysis with flame atomic absorption spectrophotometry (FAAS). Data were analyzed for precision and accuracy of measurement. Replicate samples with the XRF show high precision with an intraclass correlation coefficient (ICC) of 0.97 (P<0.0001) and an overall coefficient of variation of 11.6%. Paired comparison indicates no statistical difference (P=0.272) between XRF and FAAS analysis. Paired samples are highly correlated with an R(2) ranging between 0.89 for samples that contain paint chips and 0.93 for samples that do not contain paint chips. The ICC for absolute agreement between XRF and laboratory results was 0.95 (P<0.0001). The relative error over the concentration range of 25 to 14,200 microgram Pb is -12% (95% CI, -18 to -5). The XRF appears to be an excellent method for rapid on-site evaluation of dust wipes for clearance and risk assessment purposes, although there are indications of some confounding when paint chips are present.     

Electronic mail was not better than postal mail for surveying residents and faculty

OBJECTIVE: To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. STUDY DESIGN AND SETTING: A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. RESULTS: For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. CONCLUSION: E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.     

JCQ scale reliability and responsiveness to changes in manufacturing process.

BACKGROUND: The job content questionnaire (JCQ) was administered to automobile manufacturing workers in two interviews, 5 years apart. Between the two interviews, the company introduced substantial changes in production technology in some production areas. The aims were: (1) to describe the impact of these changes on self-reported psychosocial exposures, and (2) to examine test-retest reliability of the JCQ scales, taking into account changes in job assignment and, for a subset of workers, physical ergonomic exposures as assessed through field observations. METHODS: The study population included 790 subjects at the first and 519 at the second interview, of whom 387 were present in both. Differences in demand and control scores between interviews were analyzed by Wilcoxon matched-pairs signed-rank test. Test-retest reliability of these scales was evaluated by the intraclass correlation coefficient (ICC) and the Spearman's rho coefficient. RESULTS: The introduction of more automated technology produced an overall increase in job control but did not decrease psychological demand. The reliability of the control scale was low overall but increased to an acceptable level among workers who had not changed job. The demand scale had high reliability only among workers whose physical ergonomic exposures were similar on both survey occasions. CONCLUSIONS: These results show that 5-year test-retest reliability of self-reported psychosocial exposures is adequate among workers whose job assignment and ergonomic exposures have remained stable over time.     

Race/ethnicity and self-reported diabetes among adults in the National Health Interview Survey: 2000-2003

OBJECTIVE: We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors. METHODS: Using the National Health Interview Survey 2000-2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents). RESULTS: The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03). CONCLUSIONS: This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.     

Response patterns to a postal survey using a cervical screening register as the sampling frame

This study compared different types of respondent to a postal survey. A random sample of women aged 20-64 years (n = 4057) was selected from a population-based cervical screening register to examine their information experience during the screening programme. The initial response rate was 57%, and this increased to 81% after one reminder. Respondents were older (P < 0.0001) than non-respondents, but both groups were comparable with regard to attendance history for cervical screening (respondents 89.3%; non-respondents 89.1%) and normal smear test results (respondents 84.0%; non-respondents 81.4%). Early and late respondents were similar in age. Compared with late respondents, early respondents were more likely to live in highly affluent (P < 0.0001) and rural areas (P = 0.026). They were also more likely to be non-attenders (P < 0.0001), but they were less likely to have had inadequate smear results (P = 0.030) than late respondents. These results suggest that consideration should be given to factors other than sociodemographic differences when examining response patterns to postal surveys.     

Understanding high school students' risk behaviors to help reduce the HIV/AIDS epidemic in KwaZulu-Natal,South Africa

Of 901 rural learners (X age 16.1, SD = 2.4) at 10 randomly selected high schools in KwaZulu-Natal, South Africa, those living with a parent were less likely to drink alcohol (P < 0.0001) or use drugs (P = 0.006). Thirty percent (95% CI 26.9, 33.1) were sexually active, and 53.1% used a condom in the past 30 days. The odds of males being sexually active was 7.27 the likelihood of females (95% CI 5.2, 10.1). Only one-third of male respondents always used condoms. Of sexually active respondents, 46.5% had experienced coercive sex. More males (14.1%) than females (3.6%) smoked cigarettes (P < 0.0001). The odds of males drinking alcohol was 4.5 times that of females (P < 0.0001). Smoking, (OR 2.42, 95% CI 1.32, 4.44) and drinking, (OR 2.67, 95% CI 1.71, 4.19) among learners increased the likelihood of sexual activity. With youth at increasing risk of HIV/AIDS in KwaZulu-Natal, South Africa, interventions to reduce learners' risk behaviors are required.     

Test-retest reliability of adult surveillance measures for physical activity and inactivity

BACKGROUND: Several physical activity measures used in U.S. surveillance systems lack estimates of reliability in this country. This information is needed among diverse populations of women and men, to aid in interpretation and use of the measures. The objective of this study was to document the test-retest reliability of several measures of physical activity and inactivity used in surveillance in a diverse adult population. METHODS: Test and retest surveys were conducted over the telephone with 106 African-American and white women and men living in Forsyth County, North Carolina or Jackson, Mississippi in 2003. Physical activity and inactivity were self-reported using surveillance measures, such as from the Behavioral Risk Factor Surveillance System. Reliability was determined using kappa and intraclass correlation coefficients (ICCs) overall and separately by gender and race. RESULTS: Thirteen percent of the participants met recommendations for physical activity, 44% were insufficiently active, and 43% were inactive. Reliability of the measures to categorize participants into these categories was 0.44 (95% confidence interval [CI]=0.27-0.58). The reliability of several categoric definitions of leisure activity ranged from 0.46 to 0.68. Occupational activity had substantial reliability (0.82, 95% CI=0.72-0.89), while any transportation activity (0.27, 95% CI=0.09-0.44) and walking (0.40, 95% CI=0.23-0.55) were lower. Indicators of inactivity categorized at >7 hours/week included time per week on the computer (0.83, 95% CI=0.57-0.78) and time per week watching television (0.40, 95% CI=0.22-0.54). Some gender and racial differences were noted in the reliability estimates. CONCLUSIONS: In conclusion, this study provides estimates of test-retest reliability for several physical activity and inactivity measures used for surveillance purposes. Validity data, coupled with the reliability estimates reported here and elsewhere, can aid in interpretation and use of these measures in surveillance, as well as in epidemiologic studies.     

Measurement of young women's attitudes about communication with providers regarding Papanicolaou smears.

PURPOSE: To describe the psychometric properties of a scale created to measure communication with the provider regarding Papanicolaou (Pap) smears. METHODS: A scale based on expectancy-value theory was developed and administered to 490 young women aged 12 to 24 years in an urban adolescent clinic. Psychometric properties were assessed using factor analysis to evaluate latent variables, intraclass correlation coefficient to evaluate test-retest reliability, and Cronbach coefficient alpha to evaluate internal consistency reliability. Content validity was assessed by qualitative interviews, feedback on a pilot survey, and expert review. Construct validity was evaluated by examining whether relevant health care characteristics, knowledge, and attitudes were significantly associated with perceived communication. RESULTS: Mean respondent age was 18.2 +/- 2.1 years; 50% were black and 22% Hispanic. The scale items loaded on one factor. The intraclass correlation coefficient was 0.83 and Cronbach alpha 0.95. Report of a consistent provider, report that a provider recommended a Pap smear, knowledge of Pap smears and Human Papillomavirus (HPV), intention to return for follow-up Pap smears, and positive attitudes about Pap follow-up were significantly associated with good communication. CONCLUSIONS: The scale appears to be reliable and valid as a measure of young women's communication with providers regarding Pap smears. Future research should focus on whether this newly developed scale is useful in the design and evaluation of cervical cancer prevention programs for young women.     

Occupational determinants for rheumatoid arthritis

OBJECTIVES: The aim of the present study was to evaluate possible occupational determinants for rheumatoid arthritis according to lifetime occupational history. METHODS: The cases were identified retrospectively from 1980 to 1995 at the University Hospital in Link?ping, Sweden. The study comprised 422 cases and 859 randomly selected referents. Exposure data were collected through a postal questionnaire. RESULTS: For men, occupations with increased, although nonsignificant, odds ratios (OR) were farmers or farm workers [OR 1.8, 95% confidence interval (95% CI) 1.0-3.5], textile workers (OR 2.0, 95% CI 0.3-16.2), asphalters (OR 14.0, 95% CI 1.2-799.0 without latency requirement), and employees at service stations (OR 2.2, 95% CI 0.5-9.5). Among the women, hairdressers and beauticians (OR 2.7, 95% CI 0.8-8.6) had an increased risk for rheumatoid arthritis, as well as those exposed to hairdressing chemicals (OR 3.0, 95% CI 1.0-9.4) and meat products (OR 2.0, 95% CI 1.0-4.0). CONCLUSIONS: Several of the findings in this study are in accordance with those of previous studies. The increased risks of rheumatoid arthritis for asphalters and employees at service stations are however new associations previously not described in the literature.     

Development and validation of an instrument measuring individual empowerment in relation to personal health care: the Health Care Empowerment Questionnaire (HCEQ)

PURPOSE: The purpose of this study was to develop and validate a questionnaire that measures the degree of individual empowerment in relation to personal health care and services. DESIGN: The questionnaire was developed by identifying individual empowerment indicators from the literature, generating corresponding items, and pretesting the tool with older persons. SETTING: The Health Care Empowerment Questionnaire (HCEQ) was developed and validated with subjects participating in the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in the Sherbrooke and Quebec City area. SUBJECTS: Eight hundred seventy-three subjects agreed to participate, for a response rate of 56.28%. The mean ages of men and women were 81.1 and 82.4 years, respectively. Analysis. Factor analysis (exploratory and confirmatory) determined the validity of the questionnaire, and the reliability was assessed using measures of internal consistency and temporal stability (test-retest). RESULTS: The multidimensional nature of the concept of individual empowerment was confirmed by three factors that explain more than 68% of the total variance. The Cronhbach's alpha coefficient of internal consistency was .83 and the intraclass correlation coefficients (test-retest) was .70 (95% CI: .48-.83). CONCLUSION: In light of these findings, the characteristics and multidimensional perspective of the HCEQ appear to be useful in advancing knowledge about individual empowerment in relation to personal health care and services.     

Validity and reliability in reporting sexual partners and condom use in a Swiss population survey

Objectives: To examine the validity and reliability of indicators of sexual behaviour and condom use in annual telephone surveys (n=2800) of the general population aged 17 to 45 for the evaluation of AIDS prevention in Switzerland. Methods: A test-retest study with additional focused interviews was conducted on a subsample (n=138) of the respondents aged 17 to 22 years. Results: The subsample included more French speaking respondents (OR: 1.7, CI: 1.1–2.5) and more people in a stable relationship (OR: 2.2, CI: 1.5–3–3) than the initial sample but did not differ in any other way, although no data is available on their attitudes towards sex. The reliability of the indicators considered was high: number of lifetime, casual sex partners in the last 6 months and condom use with them, acquisition of a new steady partner during the year and condom use with this partner, condom use at last intercourse. However, the focused interviews raised questions about the validity of some of these indicators, presumably due to imprecise wording of the questionnaire items. Among sexually active respondents, 12.5% (95% CI: 4.7–25.5) of the men included non-penetrative sex in the definition of sexual intercourse, but only 1.9% (95% CI: 0.1–10.3) of the women. The propensity for men of counting acts or partners with whom no penetration had taken place in the total reported sex acts or partners was not significantly associated with any socio-demographic variables. In addition, among the 15 respondents who had reported consistent condom use with casual sex partners at interview, 40% (95% CI: 16.3–67.7) admitted at reinterview that sometimes they also had unprotected sex. Conclusions: The reliability of reports on sexual behaviour and condom use in this Swiss evaluation survey is good. The indicators derived from the annual surveys are robust measures and the monitoring of trends seems to be based on reliable measurement. However, more research is required on the validity of the data.     

The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease

Parkinson's disease is a common degenerative neurological condition. A number of general health status measures exist but these may not address areas salient to specific diseases. We report here the development and validation of a short 39 item health status questionnaire for use in Parkinson's disease. Questionnaire items, generated from indepth interviews with people with Parkinson's disease, were developed into a 65 item questionnaire. Data from a postal survey using the 65 item questionnaire were statistically analysed to produce a shorter questionnaire with 39 items and eight scales addressing different dimensions of Parkinson's disease. A second postal survey was conducted in order to assess the reliability and validity of the new 39 item questionnaire. The final questionnaire, referred to here as the 39 item Parkinson's Disease Questionnaire (PDQ-39), proved to have satisfactory internal and test-retest reliability, and construct validity in relation to other measures, reported by respondents with Parkinson's disease.     

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36)

OBJECTIVE: The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). METHODS: A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbach's alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. RESULTS: Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbach's alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. CONCLUSIONS: The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode.