Neck Disability Index,short form-36 physical component summary,and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion

Background ContextThe Neck Disability Index (NDI), the short form-36 (SF-36) physical component summary (PCS), and pain scales for arm and neck pain are increasingly used to evaluate treatment effectiveness after cervical spine surgery. The minimum clinically important difference (MCID) is a threshold of improvement that is clinically relevant to the patient. However, the true goal is to provide the patient with a substantial clinical benefit (SCB).PurposeThis study determines the MCID and SCB using common anchor-based methods for NDI, PCS, and pain scales for arm and neck pain in patients undergoing cervical spine fusion for degenerative disorders.Study Design/SettingThe study setting is a longitudinal cohort in a multisurgeon spine specialty clinic.Patient sampleThe sample comprises 505 patients who underwent a cervical fusion for degenerative spine conditions and who have prospectively collected outcome scores with a minimum 1-year follow-up.Outcome MeasuresThe outcome measures of the study were NDI, SF-36, and numeric rating scales for arm and neck pain.MethodsThe MCID and SCB values for NDI, PCS, and pain scales for arm and neck pain were determined using receiver operating characteristic (ROC) curve analysis with the Health Transition Item of the SF-36 as an anchor. The Health Transition Item asks a patient “Compared to one year ago, how would you rate your health in general now?” with answers ranging from “Much Better,” “Somewhat Better,” “About the Same,” “Somewhat Worse,” to “Much Worse.” An ROC curve was constructed for each measure. The ROC curve–derived MCID was the change score with equal sensitivity and specificity to distinguish the “Somewhat Better” from the “About the Same” patients. The ROC curve–derived SCB was the change score with equal sensitivity and specificity to distinguish the “Much Better” from the “Somewhat Better” patients. Distribution-based methods including the standard error of the mean and the minimum detectable change were also used to calculate MCID.ResultsThe calculated MCID is 7.5 for the NDI, 4.1 for SF-36 PCS, and 2.5 for arm and neck pain. The calculated SCB is 9.5 for the NDI, 6.5 for SF-36 PCS, and 3.5 for arm and neck pain.ConclusionsPatients with an eight-point decrease in NDI, a 4.1-point increase in PCS, and a three-point decrease in arm or neck pain can detect a minimally clinically important change. Patients with a 10-point decrease in NDI, a 6.5-point increase in PCS, and a four-point decrease in arm or neck pain can detect an SCB after cervical spine fusion.     

Is “fear of passive movement” a distinctive component of the Fear-Avoidance Model in whiplash?

Objectives:Modify the Tampa Scale for Kinesiophobia (TSK) for ‘fear of passive motion’ beliefs.Methods:With permission, a 14-item modification, the TSK-PM (passive movement), was created. Test-retest reliability was tested first. Construct validity was tested in chronic whiplash patients by comparing the TSK-PM with the TSK, the Neck Disability Index (NDI) and cervical ranges of motion.Results:The TSK-PM showed high test-retest reliability (r = 0.83) and high correlation with the original TSK (r = 0.84). Low, non-significant correlations were found with other variables. NDI scores were strongly correlated with ranges of motion.Conclusions:While having high test-retest reliability and a single factor structure, the TSK-PM failed to demonstrate distinctive construct validity vs the original TSK. The original TSK is likely to be sufficient to assess fear of being moved in neck pain patients in a clinical setting. Modifications to the current version of the TSK-PM might improve its construct validity in future studies.     

The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire

Prospective single cohort study. To evaluate the NDI by comparison with the SF36 health Survey Questionnaire. The NDI is a simple ten-item questionnaire used to assess patients with neck pain. The SF36 measures functional ability, well being and the overall health of patients. It is used as a gold standard in health economics to assess the health utility, gain and economic impact of medical interventions. One hundred and sixty patients with neck pain attending the spinal clinic completed self-assessment questionnaires. A second questionnaire was completed in 34 patients after a period of 1-2 weeks. The internal consistency of the NDI and SF36 was calculated using Cronbach's alpha. The test-retest reliability was assessed using the Bland and Altman method. The concurrent validity of the NDI with respect to the SF-36 was assessed using Pearson correlations. Both questionnaires showed robust internal consistency: Cronbach's alpha for the NDI scale was acceptable (0.864, 95% confidence limits 0.825-0.894) though slightly smaller than that of the SF36. The correlations between each item of the NDI scores and the total NDI score ranged from 0.447 to 0.659, (all with P < 0.001). The test-retest reliability of the NDI was high (intra-class correlation 0.93, 95% confidence limits 0.86-0.97) and comparable with the best values found for SF36. The correlations between NDI and SF36 domains ranged from -0.45 to -0.74 (all with P < 0.001). We have shown that the NDI has good reliability and validity and that it compares well with the SF36 in the spinal surgery out patient setting.     

Reliability and Validity of Cross Culturally Adapted Punjabi Version of NDI (NDI-P) in Patients with Neck Pain: A Psychometric Analysis

BackgroundNeck disability index (NDI) is one of the commonest patient-reported outcome measures used to evaluate disability related to neck pain. Its application to non-English-speaking Punjabi population is limited as a validated and cross-culturally adapted Punjabi version of NDI is not available. The purpose of the study was to analyze the psychometric properties of Punjabi version of neck disability index (NDI-P) in patients with neck pain.Materials and MethodsThe translation and cross-cultural adaptation of Punjabi version of NDI was done according to well-recommended guidelines. The pre-final version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 100 patients with neck pain of more than 2 weeks duration. Psychometric properties comprising internal consistency, test–re-test reliability, construct validity and factorial structure of the questionnaire were determined.ResultsThe developed NDI-P showed excellent internal consistency (Chronbach alpha of NDI-P is 0.87), test–re-test reliability (ICC 0.840) and construct validity (Spearman correlation coefficient with VAS 0.547). Factor analysis proved the questionnaire to be having a 2-factor structure with a total variance of 56.58%.ConclusionNDI (P) is a reliable and valid instrument for measurement of disability related to neck pain in Punjabi population. It can be used both in research and clinical care settings in future.Electronic supplementary materialThe online version of this article (10.1007/s43465-020-00280-7) contains supplementary material, which is available to authorized users.     

Predictors of failure to achieve minimal clinical important difference for pain and disability after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain: a retrospective analysis of 4998 patients

Purpose

To determine predictors of failure to achieve minimal clinical important difference (MCID) for pain and disability at discharge after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain (NP).

Methods

Pre- and post-treatment numerical pain rating scale (NPRS) and neck disability index (NDI) in patients with mechanical NP were analysed in this retrospective study. Multivariate analysis was performed to investigate the effect of covariates such as age, gender, lifestyle, body mass index, presentation, diabetes, osteoporosis, response to repeated movement testing, treatment sessions, compliance rate, and pre-treatment NPRS and NDI scores on failure to achieve MCID of ≥ 30% for NPRS and NDI scores post-treatment.

Results

In the 4998 patients analysed for this study, 7% and 14.5% of patients failed to achieve MCID for NPRS and NDI scores, respectively, at the end of treatment. Age > 70 years, diabetes, osteoporosis, partial or non-response to repeated movements, lesser treatment sessions, and lower compliance rate were associated with increased risk for failure to achieve MCID for NPRS and NDI scores. A higher pre-treatment NDI score was associated with failure to achieve MCID for NPRS score, whereas lower pre-treatment NPRS and NDI scores were associated with failure to achieve MCID for NDI score.

Conclusion

Although MDT-based multimodal rehabilitation helped to achieve significant reduction in pain and disability in mechanical NP, several baseline risk factors were associated with failure to achieve MCID for pain and disability after treatment. Identifying and modifying these factors as part of rehabilitation treatment may help to achieve better outcomes in mechanical NP.

     

Validation of the LOCOMO-25 and its minimum clinically important differences in domain scores for Chinese patients with low back pain and neck pain

BackgroundThe 25-question Geriatric Locomotive Function Scale (LOCOMO-25) was developed to assess any decline in mobility functions. This study aims to validate the LOCOMO-25 in Chinese patients with chronic low back pain and/or neck pain.MethodsAdult patients with chronic low back pain and/or neck pain completed the LOCOMO-25, SF-36, EQ-5D-5L, ODI, VAS and/or NDI. Internal consistency was assessed by Cronbach's alpha coefficient (α). Test-retest reliability was assessed by intra-class correlation coefficients. Construct validity was assessed by Spearman correlation tests against other outcome measures. Sensitivity to detect differences between groups was assessed by Mann–Whitney U or Kruskal–Wallis H test, where appropriate. Intergroup comparison was performed further in terms of domain scores and their changes at test-retest.ResultsA total of 111 patients were consecutively recruited. LOCOMO-25 demonstrated excellent internal consistency (α = 0.915) and test-retest reliability (Intraclass correlation: 0.705 to 0.826). LOCOMO-25 was significantly correlated with all domains of SF-36, EQ-5D, ODI, NDI, and VAS (p < 0.01). It was found to be sensitive in differentiating between patients with neural compression (32.8 ± 16.9) and without (21.2 ± 12.7), with history of fall(s) within the previous one year (30.8 ± 16.0) and without (24.2 ± 15.1), requires assistive devices for ambulation (40.6 ± 21.6) or independent (23.6 ± 13.1) and various pain levels (mild: 17.2 ± 10.6; moderate: 23.5 ± 11.7; severe: 38.5 ± 16.5). Patients with neural compression scored significantly higher in the domain of pain and patients requiring assistive devices for ambulation scored significantly higher in the domains of ADL and social functions. The minimum detectable differences for various domains of the LOCOMO-25 score included pain (2.76), activities of daily living (6.07), social function (1.59), and mental health status (2.06).ConclusionsLOCOMO-25 has been validated in Chinese patients with chronic low back and neck pain with satisfactory psychometric properties, and with individual domain minimum clinically important differences. There is adequate internal consistency, test-retest reliability, construct validity and sensitivity to detect differences between patients with/without neural compression, different ambulatory statuses and pain severity.     

The Penn shoulder score: reliability and validity

STUDY DESIGN: Psychometric evaluation of a cross-sectional survey. OBJECTIVES: The purpose of this study was to examine the psychometric properties of reliability and validity of the Penn Shoulder Score (PSS). BACKGROUND: Shoulder outcome measures are used to assess patient self-report levels of pain, satisfaction, and function. The PSS is a 100-point shoulder-specific self-report questionnaire consisting of 3 subscales of pain, satisfaction, and function. This scale has been utilized in the literature. However, the measurement properties of reliability and validity, including responsiveness, of the PSS subscales and overall scale need to be established. METHODS AND MEASURES: Patients (n = 40) with shoulder disorders undergoing a course of outpatient physical therapy completed the PSS at initial visit and again within 72 hours to assess test-retest reliability. The Constant Shoulder Score (CSS) and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were also completed at the initial visit and compared to the PSS to assess convergent construct validity. A separate cohort of patients (n = 109) completed the PSS at initial visit and 4 weeks later. These scores were used to assess internal consistency and responsiveness. RESULTS: Reliability analysis revealed a test-retest ICC2,1 of 0.94 (95% CI, 0.89-0.97). Internal consistency analysis revealed a Cronbach alpha of 0.93. The standard error of measurement (SEM) was +/- 8.5 scale points (based on a 90% CI) and the minimal detectable change (MDC) was +/- 12.1 scale points (based on a 90% CI). The minimal clinically important difference (MCID) for improvement was 11.4 points. Pearson product moment correlation coefficients between the PSS and the CSS and ASES were 0.85 and 0.87, respectively. Responsiveness analysis revealed an effect size of 1.01 and a standardized response mean of 1.27. CONCLUSIONS: This study has demonstrated that the PSS is a reliable and valid measure for reporting outcome of patients with various shoulder disorders.     

Outcomes of cervical disc replacement in patients with neck pain greater than arm pain

BACKGROUND CONTEXTAlthough anterior cervical discectomy and fusion is believed to positively impact a patient's radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement (CDR) with regards to neck pain specifically have not been established.PURPOSEPrimary: to assess clinical improvement following CDR in patients with neck pain greater than arm pain. Secondary: to compare the clinical outcomes between patients undergoing CDR for predominant neck pain (pNP), predominant arm pain (pAP), and equal neck and arm pain (ENAP).STUDY DESIGNRetrospective review of prospectively collected data.PATIENT SAMPLEPatients who had undergone one- or two-level CDR for the treatment of degenerative cervical pathology and had a minimum of 6-month follow-up were included and stratified into three cohorts based on their predominant location of pain: pNP, pAP, and ENAP.OUTCOME MEASURESPatient-reported outcomes: Neck Disability Index (NDI), Visual Analog Scale (VAS) neck and arm, Short Form 12-Item Physical Health Score (SF12-PHS), Short Form 12-Item Mental Health Score (SF12-MHS), minimal clinically important difference (MCID).METHODSChanges in Patient-reported outcomes from preoperative values to early (<6 months) and late (≥6 months) postoperative timepoints were analyzed within each of the three groups. The percentage of patients achieving MCID was also evaluated.RESULTSOne hundred twenty-five patients (52 pNP, 30 pAP, 43 ENAP) were included. The pNP cohort demonstrated significant improvements in early and late NDI and VAS-Neck, early SF-12 MCS, and late SF-12 PCS. The pAP and ENAP cohorts demonstrated significant improvements in all PROMs, including NDI, VAS-Neck, VAS-Arm, SF-12 PCS, and SF-12 MCS, at both the early and late timepoints. No statistically significant differences were found in the MCID achievement rates for NDI, VAS-Neck, SF-12 PCS, and SF-12 MCS at the late timepoint amongst the three groups.CONCLUSIONSCDR leads to comparable improvement in neck pain and disability in patients presenting with neck pain greater than arm pain and meeting specific clinical and radiographic criteria.     

Test-retest Reliability and Construct Validity of the Satisfaction with Treatment Result Questionnaire in Patients with Hand and Wrist Conditions: A Prospective Study

BackgroundA patient’s satisfaction with a treatment result is an important outcome domain as clinicians increasingly focus on patient-centered, value-based healthcare. However, to our knowledge, there are no validated satisfaction metrics focusing on treatment results for hand and wrist conditions.Questions/purposesAmong patients who were treated for hand and wrist conditions, we asked: (1) What is the test-retest reliability of the Satisfaction with Treatment Result Questionnaire? (2) What is the construct validity of that outcomes tool?MethodsThis was a prospective study using two samples: a test-retest reliability sample and a construct validity sample. For the test-retest sample, data collection took place between February 2020 and May 2020, and we included 174 patients at the end of their treatment with complete baseline data that included both the primary test and the retest. Test-retest reliability was evaluated with a mean time difference of 7.2 ± 1.6 days. For the construct validity sample, data collection took place between January 2012 and May 2020. We included 3742 patients who completed the Satisfaction with Treatment Result Questionnaire, VAS, and the Net Promotor Score (NPS) at 3 months. Construct validity was evaluated using hypothesis testing in which we correlated the patients’ level of satisfaction to the willingness to undergo the treatment again, VAS scores, and the NPS. We performed additional hypothesis testing on 2306 patients who also completed the Michigan Hand Outcomes Questionnaire (MHQ). Satisfaction with the treatment result was measured as the patients’ level of satisfaction on a 5-point Likert scale and their willingness to undergo the treatment again under similar circumstances.ResultsWe found high reliability for level of satisfaction measured on Likert scale (intraclass correlation coefficient 0.86 [95% CI 0.81 to 0.89]) and almost-perfect agreement for both level of satisfaction measured on the Likert scale (weighted kappa 0.86 [95% CI 0.80 to 0.91]) and willingness to undergo the treatment again (kappa 0.81 [95% CI 0.70 to 0.92]) of the Satisfaction with Treatment Result Questionnaire. Construct validity was good to excellent as seven of the eight hypotheses were confirmed. In the confirmed hypotheses, there was a moderate-to-strong correlation with VAS pain, VAS function, NPS, MHQ pain, and MHQ general hand function (Spearman rho ranged from 0.43 to 0.67; all p < 0.001) and a strong to very strong correlation with VAS satisfaction and MHQ satisfaction (Spearman rho 0.73 and 0.71; both p < 0.001). The rejected hypothesis indicated only a moderate correlation between the level of satisfaction on a 5-point Likert scale and the willingness to undergo the treatment again under similar circumstances (Spearman rho 0.44; p < 0.001).ConclusionThe Satisfaction with Treatment Result Questionnaire has good-to-excellent construct validity and very high test-retest reliability in patients with hand and wrist conditions.Clinical RelevanceThis questionnaire can be used to reliably and validly measure satisfaction with treatment result in striving for patient-centered care and value-based healthcare. Future research should investigate predictors of variation in satisfaction with treatment results.     

The Modified Back Beliefs Questionnaire as a tool to screen for incorrect beliefs regarding back pain: Cross-cultural adaptation and measurement properties

BackgroundThe Modified Back Beliefs Questionnaire (MBBQ) evaluates and screens for incorrect beliefs about low back pain (LBP). Although the MBBQ has been used to assess, its measurement properties remain unknown therefore, a rigorous cross-cultural validation is necessary.ObjectiveTo translate and cross-culturally adapt the MBBQ into Brazilian Portuguese and investigate its measurement properties.MethodsThe MBBQ was translated and cross-culturally adapted into Brazilian Portuguese. In the final stage of the cross-cultural adaptation process, the translated version was tested with 30 physical therapists to check the understanding of each item. Then, we evaluated the measurement properties in a sample of 100 physical therapists. We calculated test-retest reliability, internal consistency, standard error of the measurement (SEM) and minimal detectable change (MDC). The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT) was used in the construct validity analysis.ResultsThe reliability analysis showed high internal consistency, good to excellent test-retest reproducibility. Cronbach alpha coefficient for the MBBQ inevitability score was 0.80 and for the composite score 0.89. Intraclass correlation coefficient (ICC) for the Inevitability score was 0.67 (95%CI: 0.55 to 0.77) and 0.79 (95%CI: 0.70 to 0.86) for the composite score. The MBBQ inevitability and composite scores showed SEM of 1.9 and 2.4 points and minimal detectable change (MDC) of 5.1 and 6.7 points, respectively. Construct validity analyses showed moderate to excellent correlation of the MBBQ scores and the biomedical subscale of the PABS.PT.ConclusionsMBBQ showed acceptable measurement properties and may be considered a reliable and valid tool to assess physical therapists' beliefs about low back pain.     

Using Carpal Tunnel Questionnaire in clinical practice: A systematic review of its measurement properties

IntroductionCarpal Tunnel Questionnaire (CTQ) is widely used for assessing condition-specific impairments in individuals with carpal tunnel syndrome (CTS) or for assessing outcomes after carpal tunnel surgery (carpal tunnel release [CTR]). A systematic review of its measurement properties can greatly facilitate its evidence-based use in clinical practice. The purpose of this study was to systematically locate, appraise, and synthesize the evidence concerning the reliability, responsiveness, validity, minimal detectable change (MDC), and minimal clinically important difference (MCID) for the CTQ and its scales.Study DesignThis is a systematic review of measurement properties.MethodsUsing predefined keywords, PubMed, CINAHL, PsychInfo, and ProQuest were searched to locate primary studies that assessed measurement properties of the CTQ. The methodological quality of the included studies was assessed using a standardized tool. Data concerning the measurement properties were extracted and synthesized. The pooled estimates for the indices of test-retest reliability, standard error of measurement, responsiveness, MDC, and MCID were calculated from the included studies.ResultsA total of 34 articles were deemed eligible and included in this review. The methodological quality of these 34 studies was generally good. Most studies suggested that the CTQ and its scales had good test-retest reliability and internal consistency. However, few studies found that the Symptom Severity Scale had more than one factor. The responsiveness of the CTQ and its scales was excellent across the studies. The pooled estimates for the MDC₉₀ and MCID for Symptom Severity Scale/Functional Status Scale were 0.72/0.79 and 1.05/1.13, respectively.DiscussionThe results of this review support the use of CTQ and its scales in assessing conditions-specific impairments in individuals with CTS or after CTR. However, an effort should be made to review and modify the content of the symptom severity scale due to multiple reports challenging its unidimensional structure.ConclusionsThe totality of evidence emerging from this systematic review suggests that the CTQ and its scales provide reliable and valid estimate of impairments resulting from CTS or after CTR.     

Test-retest reliability,minimal detectable change and minimal clinically important differences in modified shuttle walk test in children and adolescents with cystic fibrosis

BackgroundIn youths with cystic fibrosis (CF) the modified shuttle walk test (MSWT) has been shown to be useful for assessing exercise tolerance; however, no studies to date have evaluated the reliability of MSWT, the minimal detectable change (MDC) and the minimal clinically important differences (MCID) for the MSWT distance for children and adolescents with CF.MethodsTest-retest reliability: 35 CF patients and 34 healthy controls performed two MSWTs (separated by 2–4 days). MCID: 33 patients were invited to participate in a 6-week home-based exercise program consisting of 30–60-min sessions, 5 days a week.ResultsThe test-retest reliability of the MSWT distance for children and adolescents with CF was excellent, obtaining a MDC₉₀ and MDC₉₅ of 97.08 m and 115.32 m, respectively. The test-retest reliability also was excellent in healthy controls, founding a MDC₉₀ and MDC₉₅ of 69.12 m and 82.11 m, respectively. The ROC curve analysis established (with a sensitivity of 82% and specificity of 76%) that a change of 60 m represented MCID.ConclusionsThe MSWT is a reliable tool to measure of exercise tolerance in children/adolescents with CF and those without CF. We propose a change in the score of at least 97.08 m (MDC₉₀) as the most appropriate value for assessing the exercise response of children and adolescents with CF, given that this value exceeds the MCID based on the children's perception.     

Validity, reliability and responsiveness of the Japanese version of the Neck Disability Index

Background

The Neck Disability Index (NDI) is one of the most widely used questionnaires for neck pain. The purpose of this study was to validate the Japanese NDI.

Methods

We performed two surveys with an 8-week interval in 130 patients with neck pain, radiculopathy and myelopathy. We asked patients to answer two versions of the Japanese NDI: the original NDI, which had been completed by a forward–backward translation procedure, and the modified NDI, which has the phrase “because of neck pain” to the phase “because of neck pain or numbness in the arm.” The other parameters examined were the strength of pain and numbness, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, the Hospital Anxiety and Depression Scale, and Short Form 36. Attending surgeons judged the symptom severity. Patients were asked to report the patient global impression of change (PGIC) at the second survey. The internal consistency, criterion-related and discriminative validity, and reliability were evaluated.

Results

The original NDI and the modified NDI were 26.9 ± 17.1 and 29.9 ± 15.5, respectively. The Cronbach α values of the original NDI and the modified NDI were 0.92 and 0.89, respectively. Both versions of the NDI had good to excellent correlative coefficients with the related domains. The modified NDI had a higher validity for numbness and mental health-related QOL. The symptom severity was significantly correlated with the modified NDI. The intraclass correlation coefficients of the two surveys of the modified and original NDI were comparable. The effect sizes of the modified and the original NDI were 0.64 and 0.55, respectively. Spearman’s ρ between the change of the NDI and the PGIC was 0.47 in the original NDI and 0.59 in the modified NDI.

Conclusions

We demonstrated the validity, reliability and responsiveness of the Japanese NDI. The modified NDI was more strongly correlated with numbness and mental health-related QOL.     

Validation of the French version of the Bournemouth Questionnaire

Self questionnaires are an important aspect of the management of neck pain patients. The Bournemouth Questionnaire (BQ), based on the biopsychosocial model, is designed to evaluate patients with neck pain. The validated English version of this questionnaire (BQc-English) has psychometric properties that range from moderate to excellent. The goal of this study is to translate and validate a French version of the Bournemouth Questionnaire for neck pain patients (BQc-f). Its translation and adaptation are performed using the translation back-translation method, generating a consensus among the translators. This validation study was performed on 68 subjects (mean age 41 years old) who participated in a randomized controlled trial regarding the efficiency of manual therapy for neck pain patients. This experimental protocol was designed to generate data in order to evaluate the construct validity, longitudinal validity, test-retest reliability and responsiveness. The BQc-f psychometric properties of construct validity (r = 0.67, 0.61, 0.42) for pre treatment, post treatment and longitudinal validity, respectively), test-retest reliability (r = 0.97) and responsiveness (effect size = 0.56 and mean standardized response = 0.61) are sufficient to suggest it could be used in the management of patients with neck pain.     

The Patient-Rated Tennis Elbow Evaluation Questionnaire was successfully translated to Persian

IntroductionThe Patient-Rated Tennis Elbow Evaluation (PRTEE) is designed to evaluate pain and disability in subjects with lateral elbow tendinopathy. This questionnaire is available in Swedish, Italian, and some other languages. A Persian language version of the questionnaire is needed for both research and clinical purposes.Purpose of the StudyThe purpose of this study was to translate and cross-culturally adapt the PRTEE questionnaire into the Persian language and to determine its validity and reliability.MethodsThe PRTEE was translated and culturally adapted from English into Persian (PRTEE-P) according to the established guidelines. The PRTEE-P was completed by 68 Iranian subjects (44 women, 24 men) diagnosed with chronic lateral elbow tendinopathy. To assess test-retest reliability, all subjects filled out the PRTEE-P on a second admission within one week. The intraclass correlation coefficient (ICC) and Cronbach's alpha were measured to report reliability. The validity was determined by correlating the PRTEE-P questionnaire with the Persian version of the Disabilities of the Arm, Shoulder, and Hand questionnaire.ResultsThe Persian version of the PRTEE showed a high internal consistency with a Cronbach's alpha of 0.99, demonstrating good test-retest reliability (ICC = 0.99). It was well correlated with Disabilities of the Arm, Shoulder, and Hand (r = 0.80).ConclusionThe PRTEE-P is a reliable and valid tool designed for measuring pain and disability in subjects with lateral elbow tendinopathy.     

维多利亚运动评估研究院髌腱肌腱病量表中文版的研制及其信效度研究

目的 将维多利亚运动评估研究院髌腱肌腱病量表（VISA-P）翻译成中文版量表（VISA-P-Ch）,并对其信度和效度进行研究。方法 将英文版的VISA-P按规定翻译成中文版的VISA-P-Ch,用该评分表对30名髌腱肌腱病病人及30名健康受试者进行测试,1周内进行重测,用组内相关系数（intraclass correlation coefficients,ICCs）评价重测信度。用主成分及因子分析结构效度;通过VISA-P-Ch与Blazina分级之间的相关性来分析量表的效标效度;对髌腱肌腱病组和对照组进行区分效度评价。结果 VISA-P-Ch评分量表重测的ICC=0.972。主成分及因子分析共选出3个公因子,解释总变量的78.6%。髌腱肌腱病组和对照组的VISA-P-Ch评分分别为（71.0±10.5）分、（98.9±1.2）分,两组间总分和量表内各问题得分比较,差异均有统计学意义（P均＜0.05）。结论 VISA-P-Ch评分表具有良好的信度、效度和可实施性,能用于中文区髌腱肌腱病病人的评价和随访。     

Subjective health measure used on Chinese patients with neck pain in Hong Kong

STUDY DESIGN: A prospective observational study was conducted on the use of the Chinese version of the Northwick Park Neck Pain Questionnaire. OBJECTIVE: To examine the reliability, validity, and responsiveness of the Chinese version of the Northwick Park Neck Pain Questionnaire in Chinese patients with neck pain in Hong Kong. SUMMARY OF BACKGROUND DATA: There is increasing recognition that patient perspectives are essential both in making medical decisions and in judging the treatment outcomes. A valid Chinese version of a neck disability index questionnaire is urgently needed for effective and reliable evaluation of the treatment outcomes for patients with neck pain. METHODS: Two samples with 532 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong who completed the Northwick Park Neck Pain Questionnaire were observed and measured at different intervals: at the beginning of physiotherapy, at 7 days, at 3 weeks, and 6 weeks after physiotherapy. RESULTS: The questionnaire had good content validity, very good test-retest reliability, and internal consistency (intraclass correlation coefficient, 0.95; Cronbach's alpha, 0.87). It also had good validity (Spearman correlation coefficient of 0.59 when the score was correlated with that of a generic 42-item Chinese health questionnaire) and good responsiveness (effect size of 1.11 at week 6 after treatment began). CONCLUSIONS: The Chinese version of the Northwick Park Neck Pain Questionnaire has been shown to demonstrate very good content validity, a high degree of test-retest reliability, and internal consistency. It also exhibited good construct validity and high sensitivity to changes in severity over time.     

Reliability and responsiveness of the Dutch version of the Neck Disability Index in patients with acute neck pain in general practice

A prospective cohort study with a 1 week follow-up. To examine the reliability and responsiveness of the Dutch version of the Neck Disability Index (NDI) in patients with acute neck pain in general practice. An increasing number of studies on treatment options is published in which the NDI is used. Reports of the ability of the NDI to detect change over time, often called responsiveness, however have not yet been published. At baseline 187 patients (119 women, 68 men) were included. They completed a questionnaire on demographic variables, self-reported cause of their complaints and the NDI. After 1 week, 86 patients were sent the NDI again together with the perceived recovery scale which was used as our external criterion. The scale ranged from 1 (complete recovery) to 7 (complaints are worse than ever). Response rate was 93%. Test–retest scores on reliability were good (ICC = 0.90). A Bland and Altman plot and a graph of total sum score differences showed no visible tendency towards unequal spreading of the data. For patients that reported on the perceived recovery scale that they were “stable” we found a responsiveness ratio of 1.82. The standard error of measurement (SEM) was 0.60 what resulted in a minimal detectable change (MDC) of 1.66. The NDI has shown to be a reliable and responsive instrument in patients with acute neck pain in general practice.     

Workers compensation patients experiencing depression report meaningful improvement in mental health scores after anterior cervical discectomy and fusion

BackgroundMental health has been demonstrated to affect postoperative outcomes. No prior literature has reported the relationship between preoperative mental health on outcomes following anterior cervical discectomy and fusion (ACDF) in the Workers Compensation (WC) population.MethodsWC claimants who underwent primary ACDF were identified from a single-surgeon retrospective database. Patients were separated by SF-12 MCS score into Depressed (<45.6) or Not Depressed (ND) (≥45.6) cohorts. Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (SF-12 PCS), SF-12 MCS, visual analog scale (VAS) neck/arm pain, and Neck Disability Index (NDI) were collected and compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups.ResultsDepressed patients had greater length of stay (p = 0.007) and postoperative narcotic consumption (p = 0.026). Depressed patients improved at 12-week to 2-year PROMIS PF, 6-month SF-12 PCS, 6-week to 6-month SF-12 MCS, 6-week to 6-month and 2-year VAS neck, all VAS arm, and 6-month NDI (p ≤ 0.045, all). ND patients improved at 12-week to 1-year PROMIS PF, 6-month to 2-year SF-12 PCS, 12-week to 1-year VAS neck, 6-week to 1-year VAS arm, and 12-week to 1-year NDI (p ≤ 0.044, all). Between groups, ND patients reported superior PROMIS PF, SF-12 MCS, VAS neck, VAS arm, and NDI scores at two or more periods (p ≤ 0.045, all). MCID achievement rate regarding SF-12 MCS was greater in the Depressed cohort at all postoperative points up to 1 year (p ≤ 0.020, all).ConclusionDepressed patients tended to have a greater length of stay and postoperative narcotic consumption immediately after surgery. Not depressed patients reported more favorable physical and mental function, pain, and disability scores preoperatively and postoperatively. Depressed patients reported greater MCID achievement in mental function following surgery. Depressed patients with WC have a greater likelihood of reporting tangible improvement in mental health scores following ACDF.     

Construct validity and reliability of the Concussion Knowledge Assessment Tool (CKAT)

ObjectiveTo evaluate the test-retest reliability and construct validity of the concussion knowledge assessment tool (CKAT) as a measure of knowledge of concussion and its management among chiropractic subgroups and to compare these properties for two scoring strategies for the CKAT.MethodsThree chiropractic subgroups (first year students, interns and sports chiropractors) completed the CKAT via SurveyMonkey with as second administration two to six weeks later for a subset of respondents. Scatter plots and Intraclass Correlation Coefficients (ICC) were used for test-retest reliability. A priori hypotheses regarding the relationship of CKAT scores across known subgroups, and with concussion knowledge self-rankings were established prior to data collection. Distributions of CKAT scores were compared across the subgroups using boxplots and ANOVA for known groups validity, and correlation of CKAT scores with concussion knowledge self-ranking was examined.ResultsTest-retest ICC for the revised scoring was 0.68 (95%CI 0.51–0.80). First year students had a mean revised CKAT (out of 49) of 36.9 (SD= 4.7), interns 39.9 (SD=3.0) and sports chiropractors 41.8 (SD=3.2) which are significantly different (F_2,125=17.54; p<0.0001).ConclusionsThe CKAT distinguished between chiropractic subgroups expected to have different levels of knowledge, supporting construct validity, however, it did not achieve adequate test-retest reliability.