Strengthening the research to policy and practice interface: exploring strategies used by research organisations working on sexual and reproductive health and HIV/AIDS

Background

Although measures of knowledge translation and exchange (KTE) effectiveness based on the theory of planned behavior (TPB) have been used among patients and providers, no measure has been developed for use among health system policymakers and stakeholders. A tool that measures the intention to use research evidence in policymaking could assist researchers in evaluating the effectiveness of KTE strategies that aim to support evidence-informed health system decision-making. Therefore, we developed a 15-item tool to measure four TPB constructs (intention, attitude, subjective norm and perceived control) and assessed its face validity through key informant interviews.

Methods

We carried out a reliability study to assess the tool's internal consistency and test-retest reliability. Our study sample consisted of 62 policymakers and stakeholders that participated in deliberative dialogues. We assessed internal consistency using Cronbach's alpha and generalizability (G) coefficients, and we assessed test-retest reliability by calculating Pearson correlation coefficients (r) and G coefficients for each construct and the tool overall.

Results

The internal consistency of items within each construct was good with alpha ranging from 0.68 to alpha = 0.89. G-coefficients were lower for a single administration (G = 0.34 to G = 0.73) than for the average of two administrations (G = 0.79 to G = 0.89). Test-retest reliability coefficients for the constructs ranged from r = 0.26 to r = 0.77 and from G = 0.31 to G = 0.62 for a single administration, and from G = 0.47 to G = 0.86 for the average of two administrations. Test-retest reliability of the tool using G theory was moderate (G = 0.5) when we generalized across a single observation, but became strong (G = 0.9) when we averaged across both administrations.

Conclusion

This study provides preliminary evidence for the reliability of a tool that can be used to measure TPB constructs in relation to research use in policymaking. Our findings suggest that the tool should be administered on more than one occasion when the intervention promotes an initial 'spike' in enthusiasm for using research evidence (as it seemed to do in this case with deliberative dialogues). The findings from this study will be used to modify the tool and inform further psychometric testing following different KTE interventions.     

International Development of the Patient-Reported Outcome Indices for Multiple Sclerosis (PRIMUS)

BackgroundThe Patient-Reported Indices for Multiple Sclerosis (PRIMUS) comprises a suite of three scales for assessing symptoms, activity limitations, and quality of life in multiple sclerosis (MS). It was developed in the UK and has been shown to have excellent psychometric properties. This study describes the adaptation of eight language versions for Canadian English, Canadian French, French, German, Italian, Spanish, Swedish, and US English.MethodsThe PRIMUS was translated using the dual-panel process. Cognitive debriefing interviews conducted with MS patients assessed face and content validity. Psychometric and scaling properties were assessed via a two-administration postal survey conducted in each country involving the PRIMUS, the Nottingham Health Profile (NHP), the Unidimensional Fatigue Impact Scale (U-FIS), and demographic questions.ResultsCognitive debriefing interviews demonstrated the acceptability of the new language versions. Analysis of survey data showed that the new language versions of the three PRIMUS scales were unidimensional (as indicated by fit to the Rasch model) and that they had good internal consistency and reproducibility. PRIMUS scale scores correlated as expected with those on the NHP and the U-FIS. The scales in all countries were able to discriminate between groups of patients on the basis of their self-reported MS severity, general health, and employment status.ConclusionsThe PRIMUS was successfully adapted into eight new languages. Most of the tests showed the PRIMUS to have good unidimensionality and to have good internal consistency, reproducibility, and construct validity. The measure is now available for use in clinical studies and trials involving these countries and the UK. Further work is required to assess the measure's responsiveness.     

A health-related quality of life measure for multiple sclerosis

The need for measures of health-related quality of life (HRQOL) for clinical effectiveness research and for quality of care research, particularly for chronic diseases, is increasingly recognized. We assessed a measure of HRQOL for people with multiple sclerosis, a chronic neurological condition. We used the RAND 36-Item Health Survey 1.0 (aka SF-36) as a generic core measure, to enable comparisons of HRQOL of patients with multiple sclerosis to those of other patient populations and to the general population. To enhance comparisons within groups of multiple sclerosis patients, these items were supplemented with 18 additional items in the areas of health distress (four items), sexual function (four items), satisfaction with sexual function (one item), overall quality of life (two items), cognitive function (four items), energy (one item), pain (one item), and social function (one item). The final measure, the Multiple Sclerosis Quality of Life (MSQOL)-54 instrument, contains 52 items distributed into 12 scales, and two single items. Internal consistency reliability estimates for the 12 multi-item scales ranged from 0.75 to 0.96 in a sample of 179 patients with multiple sclerosis. Test-retest intraclass correlation coefficients ranged from 0.66 to 0.96. Exploratory factor analysis confirmed two underlying dimensions of physical health and mental health. Construct validity was supported by significant associates between MSQOL-54 scales and degree of multiple sclerosis symptom severity in the prior year, level of ambulation, employment limitations due to health, admission to hospital in the previous year, and depressive symptoms.This research was supported by a grant from the Health Services Research Grant Program of the National Multiple Sclerosis Society. The National Institutes of Neurological Disorders and Stroke provided support for Dr Vickrey through a Clinical Investigator Development Award (K08 NS01669-02). Opinions are those of the authors and do not necessarily reflect the views of the sponsoring institutions, RAND, or the University of California, Los Angeles.     

An interrater reliability study of the revised elderly persons' disability scale

The aim of this study was to investigate the interrater reliability of the Revised Elderly Persons' Disability Scale (REPDS). In a correlational design four raters assessed 15 subjects all over the age of 65, and diagnosed as having dementia of varying stages of severity. All subjects attended day hospital facilities and were assessed by the raters. The raters comprised two staff nurses, one occupational therapist and one occupational therapy helper. Kendall's coefficient of concordance (W) was used to determine the overall interrater reliability of the REPDS as well as the seven subsections which make up this assessment tool. It was found that all of the subsections and the overall scale obtained significant values of W at the p < 0.05 level. The Spearman rank order correlation coefficient (r_s) was used to compare the raters' scores individually, which suggested that the qualified members of the staff achieved slightly higher levels of interrater reliability in comparison to an unqualified staff member.     

Development of a teaching style inventory for tutor evaluation in problem-based learning

OBJECTIVE: To develop and validate a self-rating instrument to assess teaching styles among tutors in problem-based learning (PBL). METHODS: The development of the teaching style inventory (TSI) was based theoretically on four types of teaching behaviours: the assertive, suggestive, collaborative and facilitative styles, as proposed by Bibace et al. A 35-item questionnaire was generated and evaluated for content validity by a group of experienced tutors. The questionnaire was mailed to 196 tutors at the National Taiwan University College of Medicine. The results were submitted for item analysis, internal consistency testing and exploratory factor analysis. Longterm test-retest reliability was assessed by a sample of 50 tutors after a 6-month interval. RESULTS: Finally, 118 tutors returned the questionnaires. In the item reduction process, seven items were excluded due to low interscale correlation. Principle component factoring yielded a three-factor solution that accounted for 48.5% of the total variance. Internal consistency coefficients of the four hypothetical domains ranged from 0.73 to 0.83. All domains correlated to each other as expected. Assertive and facilitative styles, which are theoretically opposite teaching styles, showed a negative correlation with each other. Most of the items of each hypothetical domain correlated better with their own domain than with other domains. Longterm test-retest correlations of the four domains ranged from 0.54 to 0.81. CONCLUSION: The TSI demonstrated high internal consistency reliability, acceptable longterm test-retest reliability, and construct validity. Further psychometric testing should focus on applicability to other populations, predictive validity and short-term test-retest reliability. This instrument can be used by programme directors for the recruitment of tutors and can also be used to increase the self-awareness of tutors.     

Health and safety management system audit reliability pilot project

This pilot study assessed occupational health and safety (OHS) management system audit finding reliability using a modified test-retest method. Two industrial hygienists with similar training and education conducted four, 1-day management system audits in four dissimilar organizational environments. The researchers examined four auditable sections (employee participation, training, controls, and communications) contained in a publicly available OHS management system assessment instrument. At each site, 102 auditable clauses were evaluated using a progressive 6-point scale. The team examined both the consistency of and agreement between the scores of the two auditors. Consistency was evaluated by calculating the Pearson r correlations for the two auditors' scores at each site and for each section within each site. Pearson correlations comparing overall scores for each site were all very low, ranging from 0.206 to 0.543. Training and communication system assessments correlated the highest, whereas employee participation and control system scores correlated the least. To measure agreement, t-tests were first calculated to determine whether the differences were statistically significant. Aggregate mean scores for two of the four sites were significantly different. Of the 16 total sections evaluated (i.e., 4 sections per site), seven scores were significantly different. Finally, the agreement of the scores between the two auditors for the four sites was evaluated by calculating two types of intraclass correlation coefficients, all of which failed to meet the minimum requirement for agreement. These findings suggest that opportunities for improving the reliability of the instrument and the audit process exist. Future research should include governmental and commercial OHS program assessments and related environmental management systems and their attendant audit protocols.     

Rasch analysis of the Multiple Sclerosis Impact Scale (MSIS-29)

Background  

Multiple Sclerosis (MS) is a degenerative neurological disease that causes impairments, including spasticity, pain, fatigue, and bladder dysfunction, which negatively impact on quality of life. The Multiple Sclerosis Impact Scale (MSIS-29) is a disease-specific health-related quality of life (HRQoL) instrument, developed using the patient's perspective on disease impact. It consists of two subscales assessing the physical (MSIS-29-PHYS) and psychological (MSIS-29-PSYCH) impact of MS. Although previous studies have found support for the psychometric properties of the MSIS-29 using traditional methods of scale evaluation, the scale has not been subjected to a detailed Rasch analysis. Therefore, the objective of this study was to use Rasch analysis to assess the internal validity of the scale, and its response format, item fit, targeting, internal consistency and dimensionality.     

The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19)

The purpose of the present study was to develop a reliable and valid self-report questionnaire to assess the perceived influence of Multiple Sclerosis (MS) symptoms on sexual activity and satisfaction and the perceived influence of MS symptoms on the overall quality of intimate relationships. This instrument was called the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ). The initial item pool consisted of 72 items reflecting primary, secondary, and tertiary sexual dysfunction. The MSISQ was revised by eliminating items assessing the impact of MS symptoms on the overall quality of intimate relationships because they were redundant with items assessing the impact of MS symptoms on sexual activity and satisfaction. Factor analysis, reliability analysis, and item analysis demonstrated that the MSISQ could be further shortened without diminishing the statistical integrity of the instrument. Hence, it was shortened to a 19-item questionnaire (MSISQ-19), with primary, secondary, and tertiary sexual dysfunction subscales. Reliability analyses provided evidence for high internal consistency for the total MSISQ-19 ( = .91) and for the primary( = .82), secondary ( = .85) and tertiary ( = .87) subscales. The MSISQ-19 demonstrated concurrent validity with measures of: (1) marital satisfaction, specifically satisfaction with affective communication, problem solving communication, and sexual dissatisfaction, (2) neurological impairment and level of disability in MS, (3) psychological distress and well-being, and (4) global sexual dysfunction in MS. In addition, a comparison of the distribution of scores of the MSISQ-19 and the Sexual Function Scale (SFS) of the Minimal Record of Disability (MRD) in MS demonstrated that the MSISQ-19 was more sensitive to moderate and high levels of sexual difficulty. Study limitations, theoretical, clinical, and research implications, and directions for further research are discussed.     

Rasch analysis of the short form 8-item Parkinson’s Disease Questionnaire (PDQ-8)

Purpose To evaluate the Italian version of the 8-item Parkinson’s Disease Questionnaire (PDQ-8)—a subset of PDQ-39 (a 39-item health-related quality of life instrument for subjects with Parkinson’s Disease [PD])—through classical psychometric techniques and Rasch analysis. Methods Two convenience samples (100 PD subjects each) were observed consecutively from 2004 to 2006. One group completed the PDQ-8 nested within PDQ-39, the other, the stand-alone PDQ-8. Results Once verified that the two independent samples came from the same population and showed consistent item calibrations using differential item functioning analysis, the two groups were combined. Cronbach’s alpha was 0.72. According to Rasch analysis, the response scale of PDQ-8 could be simplified into a 3-category rating scale. After that, all the PDQ-8 items fitted the construct that the scale was intended to measure. Item separation reliability of PDQ-8 was 0.98 and person separation reliability was 0.70. Principal component analysis on the standardized residuals suggested a minor departure in the data from Rasch criteria (multidimensionality) and some marginal inter-item dependency. Conclusions The PDQ-8 embedded in the PDQ-39 presented psychometric properties similar to the stand-alone PDQ-8. Our results, while consistent with previous classical psychometric analyses, add information on the meaningfulness of PDQ-8 in people with PD. In particular, a simplification of its rating scale is recommended. Moreover, additional analyses should be performed in order to further check unidimensionality and local dependence, and try to improve item selection and scaling properties of the questionnaire. In order to use the PDQ-8 for clinical decision-making in reference to individuals, its reliability should first be increased.     

Child/parent-assessed population health outcome measures: a structured review

AIMS: To identify generic measures of health-related quality of life (HRQL) for children and adolescents developed for use within general populations. Instruments are evaluated on the basis of evidence relating to their reliability and validity. METHODS: Systematic literature searches were used to identify instruments, which were then assessed against predefined criteria. Information relating to instrument content, population, reliability and validity was extracted from published papers. RESULTS: Sixteen instruments were identified that had been evaluated among a general population of children or adolescents. Four instruments had reported data on both internal consistency and test-retest reliability. All except two instruments had undergone some degree of construct validation. CONCLUSIONS: The evidence suggests that the Child Health Questionnaire (CHQ) has been the most extensively evaluated for younger populations but is available as a parent-completed measure only. The new version of the Child Health and Illness Profile (CHIP-CE) is particularly promising and has parallel child- and parent-completed versions for young ages. The weight of evidence suggests that versions of these two instruments are suitable for older children. The Warwick Child Health and Morbidity Profile could be used where information on morbidity and health service contacts is required. Once basic psychometric criteria are fulfilled, instruments should be chosen by assessing their content and design in the light of the prospective application.     

Validation of the Italian version of the EUROPEP instrument for patient evaluation of general practice care

Objective: To describe the validity and reliability of the Italian version of the EUROPEP instrument for patient evaluation of general practice care. Methods: A survey was performed among patients who visited a general practice (n=983), using the 23-item EUROPEP questionnaire. The scores are aggregated in two dimensions: “clinical behaviour” and “organization of care”. The cultural adaptation of the questionnaire into Italian has been performed by using the formal translation procedures applied in other European countries. Data were analysed with respect to item response rate, item–scale correlation, internal consistency reliability and construct validity of the instrument. Results: The item response rate was good for 17 items, acceptable for four items and problematic for one item. The item–scale correlation largely exceeded a value of 0.40 for all items in both scales. The internal consistency of the aggregated scores was also very good, the reliability coefficients being 0.95 for “clinical behaviour” and 0.90 for “organization of care”. As expected, older age and better health status were associated with more positive evaluation of care.

Conclusion: Our study confirms that, even in its Italian version, the EUROPEP is a valid and easy-to-use instrument for gathering information on patients’ experience with and evaluation of general practice care.     

Introducing the Occupational Balance Questionnaire (OBQ)

Abstract

Objective: The concept of occupational balance is frequently used in occupational therapy but the fact that it has been defined and measured differently is a limitation. This article introduces the Occupational Balance Questionnaire (OBQ), which focuses on satisfaction with the amount and variation of occupations. It consists of 13 items measured on six-step ordinal scales. It has shown good content validity in a sample of 21 occupational therapists but other psychometric properties have not been investigated. The aim was to investigate the OBQ regarding internal consistency, test–retest reliability, and floor/ceiling effects. Methods: The OBQ was administered twice to a sample selected through convenience sampling. Internal consistency was investigated by Cronbach's alpha and test–retest reliability analysed with Spearman's Rho correlation for the total score and weighted kappa on each item. Potential floor/ceiling effects were explored by checking for the percentage of participants who scored lowest and highest. Results: The results demonstrated that the OBQ has good internal consistency (Cronbach's alpha 0.936) and sufficient test–retest reliability (Spearman's Rho for the total score was 0.926) and, thus, seems stable over time. No floor or ceiling effect was detected. Conclusions: The OBQ therefore showed promising reliability, although further instrument development studies to examine its construct validity are required.     

Questionnaire techniques in assessing acne handicap: Reliability and validity study

The purpose of this study was to examine and compare the reliability and validity of two acne-specific measures, the Cardiff Acne Disability Index (CADI), the Acne Disability Index (ADI) and a general health status instrument, the United Kingdom Sickness Impact Profile (UKSIP). The test-retest reliability was carried out for the UKSIP, ADI and CADI with an interval of 10 days in 70 patients with acne. The correlation coefficient for the overall UKSIP score was high (r=0.99, p<0.001) for the CADI was 0.96 (p<0.001) and for the ADI was 0.98 (p<0.001). Individual category score correlations in the UKSIP and ADI were greater than 0.83. Tests of internal consistency of the instruments scored highly. A further 100 patients with acne and 50 controls completed all three instruments. The overall UKSIP mean score of patients was 5.6 (sd=4.7) and of controls was 0.45. The ADI mean patient score was 40.3%, controls 17.6%. The CADI mean patient score was 42.1%, controls 13.2%. The CADI was the only instrument that correlated with the clinical acne severity score (p<0.05); the UKSIP score correlated with the CADI score (p<0.05) but not with the ADI score. This study has established aspects of the reliability and validity of the UKSIP, the ADI and the CADI.     

The General Practice Assessment Survey (GPAS): tests of data quality and measurement properties

OBJECTIVES: The aim of this study was to describe the psychometric properties of the General Practice Assessment Survey (GPAS) and its acceptability to patients in the UK. GPAS comprises seven multiple item scales and two single item scales addressing nine key areas of primary care activity (access, technical care, communication, inter-personal care, trust, knowledge of patient, nursing care, receptionists and continuity of care). A further four single items relate to patients' perceptions of the GP's role in referral and co-ordination of care, their willingness to recommend their GP and their overall satisfaction with care received. METHODS: Two hundred consecutive patients attending routine consulting sessions at 55 inner London practices were invited to complete the GPAS questionnaire. The acceptability, reliability and validity of GPAS was assessed using standard psychometric techniques. RESULTS: Out of 11 000 patients, 7247 (66%) completed a questionnaire in a GP surgery. Fifty-five out of a separate sample of 77 patients attending one practice completed a second questionnaire mailed to them 1 week following their attendance. GPAS was acceptable to patients as evidenced by low proportions of missing data for all items, and a full range of possible scores for all but one of the nine scales. Reliability of the instrument was good. Multiple item scales had excellent internal consistency, high item-total correlations, and test-retest reliability. Scaling assumptions were confirmed, with six of the seven scales achieving 100% scaling success (convergent and discriminant validity). Construct validity was evident, although this requires further evaluation against external measures. CONCLUSIONS: GPAS is a useful instrument for assessing several important dimensions of primary care. It is acceptable, reliable and valid, and has the potential for versatility in mode of administration. It will be a useful instrument for practices, primary care groups and primary care researchers evaluating key areas of primary care activity. Further work is required to evaluate its performance in non-inner-city settings and to evaluate further its validity against external criteria.     

Development of the final version of the occupational adaptation questionnaire for family caregivers

BackgroundGiven the growing role of family caregivers in meeting the increasing demand for ageing-related care in Japan, the occupational adaptation of family caregivers needs to be evaluated.MethodsThis study developed the Occupational Adaptation Questionnaire for Family Caregivers (OAQC) and evaluated its reliability, validity, and effectiveness. To develop the OAQC item pool, the construct ‘Occupation of nursing care engaged in by family caregivers’ was evaluated. Using the Delphi method, 8 experts evaluated 64 items and confirmed that 41 items adequately represented the domain. The scale was then completed by 216 family caregivers of users of outpatient service establishments affiliated with hospitals in the Chubu region. The validity of the scale items was tested, and statistical analysis was performed. The construct validity and internal consistency of the OAQC were examined using exploratory factor analysis and the ω coefficient, respectively.ResultsThe discrimination ability and difficulty level were calculated using the item response theory. The findings showed that the scale’s reliability and validity were satisfactory. Construct validity was acceptable for 16 items with 5 factors. The OAQC also had high internal consistency, reliability, and effectiveness. The item slope parameters and difficulty parameters revealed good item response, indicating that the scale could effectively measure family caregivers’ occupational adaptation.ConclusionThe scale was compatible with the data obtained from family caregivers. Given its overall effectiveness, data obtained using the OAQC can contribute towards implementing personal care support programs for caregivers and enriching their lives by offering support from an occupational adaptation perspective.     

Development of EMPRO: A Tool for the Standardized Assessment of Patient-Reported Outcome Measures

Objective:  This study was aimed to develop a tool for the standardized assessment of patient-reported outcomes (PROs) to assist the choice of instruments.
Methods:  An expert panel adapted the eight attributes proposed by the Medical Outcomes Trust as evaluation review criteria, created items to evaluate them, and included a response scale for each item. A pilot test was designed to test the new tool's feasibility and to obtain preliminary information concerning its psychometric properties. The Spanish versions of five measures were selected for assessment: the SF-36 Health Survey, the Nottingham Health Profile, the COOP-WONCA charts, the EuroQol-5D, and the Quality of Life Questionnaire EORTC-QLQ-C30. We assessed the new tool's reliability (Cronbach's alpha and intraclass correlation coefficient [ICC]) and construct validity.
Results:  The new EMPRO (Evaluating the Measurement of Patient-Reported Outcomes) tool has 39 items covering eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, burden, alternative modes of administration, and cross-cultural and linguistic adaptations. Internal consistency was high (α = 0.95) as was interrater concordance (ICC: 0.87–0.94). Positive associations consistent with a priori hypotheses were observed between EMPRO attribute scores and the number of articles identified for the measures, the years elapsed since the publication of the first article, and the number of citations.
Conclusion:  A new tool for the standardized assessment of PRO measures is available. It has shown good preliminary reliability and validity and should be a useful aid to investigators who need to choose between alternative measures. Further assessment of the tool is necessary.     

Reliability and validity of the Leisure Satisfaction Scale (LSS--short form) and the Adolescent Leisure Interest Profile (ALIP)

This study aimed to evaluate the reliability and validity of the Leisure Satisfaction Scale (LSS – short form) and the Adolescent Leisure Interest Profile (ALIP). The LSS and the ALIP are instruments that occupational therapists can use to evaluate the leisure activities that clients enjoy. Evaluation of leisure interest and participation will assist in creating goals for therapy to maximize a client's ability to participate in leisure activities. This study examined the test–retest reliability and concurrent validity of the LSS and the ALIP using a sample of 37 adolescents between the ages of 13 and 17 with no known impairments. The assessments were administered individually or in small groups 7 to 17 days apart. Cronbach's alpha was used to determine the internal consistency. Pearson product moment correlations were calculated to examine the test–retest reliability of the 60 subscales and the six question totals of the ALIP, as well as for the 6 subscales and total score of the LSS. Concurrent validity was evaluated between the ‘How often?’ question of the ALIP and the LSS (short form). Based on the study results, the ALIP and the LSS seem to have good test–retest reliability levels when used with adolescents with no known physical or mental impairments. The concurrent validity between the two instruments was not supported, with many of the scores indicating only weak or no association to each of the subscales, suggesting that the assessments differ in some fundamental way. However, the evidence of some relationships between subscales may indicate some areas where the ALIP and the LSS are similar. Copyright © 2002 Whurr Publishers Ltd.     

Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples

STUDY OBJECTIVES: This study assessed the feasibility, reliability, and validity of the 28 item short child health questionnaire parent form (CHQ-PF28) containing the same 13 scales, but only a subset of the items in the widely used 50 item CHQ-PF50. DESIGN: Questionnaires were sent to a random regional sample of 2040 parents of schoolchildren (4-13 years); in a random subgroup test-retest reliability was assessed (n = 234). Additionally, the study assessed CHQ-PF28 score distributions and internal consistencies in a nationwide general population sample of (parents of) children aged 4-11 (n = 2474) from Statistics Netherlands. MAIN RESULTS: Response was 70%. In the school and general population samples seven scales showed ceiling effects. Both CHQ summary measures and one multi-item scale showed adequate internal consistency in both samples (Cronbach's alpha>0.70). One summary measure and one scale showed excellent test-retest reliability (intraclass correlation coefficient >0.70); seven scales showed moderate test-retest reliability (intraclass correlation coefficient 0.50-0.70). The CHQ could discriminate between a subgroup with no parent reported chronic conditions (n = 954) and subgroups with asthma (n = 134), frequent headaches (n = 42), and with problems with hearing (n = 38) (Cohen's effect sizes 0.12-0.92; p<0.05 for 39 of 42 comparisons). CONCLUSIONS: This study showed that the CHQ-PF28 resulted in score distributions, and discriminative validity that are comparable to its longer counterpart, but that the internal consistency of most individual scales was low. In community health applications, the CHQ-PF28 may be an acceptable alternative for the longer CHQ-PF50 if the summary measures suffice and reliable estimates of each separate CHQ scale are not required.     

Measurement Properties of the Modified Spinal Function Sort (M-SFS): Is It Reliable and Valid in Workers with Chronic Musculoskeletal Pain?

Purpose To analyze the reliability and validity of a picture-based questionnaire, the Modified Spinal Function Sort (M-SFS). Methods Sixty-two injured workers with chronic musculoskeletal disorders (MSD) were recruited from two work rehabilitation centers. Internal consistency was assessed by Cronbach’s alpha. Construct validity was tested based on four a priori hypotheses. Structural validity was measured with principal component analysis (PCA). Test–retest reliability and agreement was evaluated using intraclass correlation coefficient (ICC) and measurement error with the limits of agreement (LoA). Results Total score of the M-SFS was 54.4 (SD 16.4) and 56.1 (16.4) for test and retest, respectively. Item distribution showed no ceiling effects. Cronbach’s alpha was 0.94 and 0.95 for test and retest, respectively. PCA showed the presence of four components explaining a total of 74% of the variance. Item communalities were >0.6 in 17 out of 20 items. ICC was 0.90, LoA was ±12.6/16.2 points. The correlations between the M-SFS were 0.89 with the original SFS, 0.49 with the Pain Disability Index, ?0.37 and ?0.33 with the Numeric Rating Scale for actual pain, ?0.52 for selfreported disability due to chronic low back pain, and 0.50, 0.56–0.59 with three distinct lifting tests. No a priori defined hypothesis for construct validity was rejected. Conclusions The M-SFS allows reliable and valid assessment of perceived self-efficacy for work-related tasks and can be recommended for use in patients with chronic MSD. Further research should investigate the proposed M-SFS score of <56 for its predictive validity for non-return to work.