Characteristics of each activity domain comprising ADL for partially dependent older adults

The purpose of this study was to examine the characteristics of each activity domain which make up activities of daily living (ADL). We used the ADL index with a unidimensional scale for partially dependent older adults, and examined the distribution of the ADL score and self-evaluation of health and physical fitness. There were 466 subjects from age 60 to 98 (132 male, 81.7 +/- 8.22 years; 334 female, 82.5 +/- 7.25 years). Seventeen items representing 7 domains (holding and changing the posture of the body, dressing, toilet usage, bathing, manual activity, walking, and locomotion and carrying) were selected as ADL items. Each item was measured on a dichotomous scale. A questionnaire consisting of 17 ADL items and two questions concerning self-evaluation of health and physical fitness were administered on subjects by institutional therapists (OT, PT, nurse, social worker). An examination of the cumulative relative frequency distribution curve of total score showed that ADL scores of all domains can be used to assess ADL achievement ability level with a wide range from low to high level. It is inferred that the total score will be low when the score is low for holding and changing body-posture, toilet usage and manual activity. On the other hand, it will be high when the score is high for dressing and walking. ADL abilities for all domains also tended to be higher in persons with higher perceptual levels of health and physical fitness.     

Development and initial validation of the Effort Sense Rating Scale (ESRS): a self-perceived index of physical fitness

BACKGROUND. The Effort Sense Rating Scale is a non invasive, easy to administer, self-assessment device for deriving an index of physical fitness comprising only aerobic and anaerobic power components. The scale originates from the notion that people who have experienced varying degrees of effort doing "everyday" tasks can accurately estimate the exertion required in fairly common, physically demanding "situations" when provided with an appropriate perceptual frame-of-reference. Estimations elicited in this way can be scaled and used to categorize fitness level. This article reports an initial validity study. Further development of this technique is in progress. SAMPLE. Forty volunteers from a university community, mainly students (17 women and 23 men), completed ESRS twice and then underwent submaximal aerobic (cycle ergometry: YMCA protocol) and anaerobic power (Wingate protocol) assessments. RESULTS. Nonparametric correlation coefficients between the Effort Sense Rating Scale and the aerobic power were r(s) = 0.47 (P < 0.05) and anaerobic power r(s) = 0.62 (P < 0.05). Interpreted at the category level there was 77.5% agreement between ESRS indices and category levels for measured fitness components. Readministration of the Effort Sense Rating Scale after 14 days prior to physical assessments showed 100% consistency in choice of rating items with some changes in assigned values (r(s) = 0.86, P < 0.01). CONCLUSIONS. Modifications to the equivalence and selection of fitness elements and wording of the effort-demanding "scenarios," the discriminative level of the fitness categories, and broadening the size and composition of the validation sample are required to further enhance the veracity of the scale. Appropriately tuned, this perception-based approach to self-assessment of physical fitness can provide a low-cost, meaningful device for baseline setting and progress monitoring by people either entering or continuing with an exercise program for health-related fitness purposes.     

ADL ability characteristics of partially dependent older people: Gender and age differences in ADL ability

Age and gender differences in ADL ability were investigated using 568 Japanese partially dependent older people (PD, Mean age=82.2±7.76 years) living in welfare institutions. The subjects were asked about 17 ADL items representing 7 ADL domains by the professional staff working at subjects' institutions. Each item was assessed by a dichotomous scale of “possible” or “impossible”. Item proportions of “possible” response were calculated for gender and age groups (60s, 70s, 80s and 90s). Two-way analysis of variance (ANOVA) using the arcsine transformation method indicated no gender differences. Significant decreases in ADL ability with aging were found in 13 of the 17 items. The dependency of ADL in the PD significantly increases with aging, and there is no significant difference in this trend between men and women. The dependency of more difficult activities using lower limb increase from the 70s, and independency of low-difficult activities such as manual activities, feeding and changing posture while lying is maintained until the 80s and over.     

The proposal of the activities of daily living (ADL) index for institutionalized older adults

The purpose of this study was to propose the ADL index constructed with a unidimensional scale based on item difficulty for institutionalized older adults. Six hundreds and three subjects (159 males and 444 females) were divided into the following four groups based on assisting devices for movement: G1 did not use assisting devices for movement; G2 used a stick or a walker; G3 used a wheelchair; G4 could not move. As the results of examinations from the points of the approximation of proportions, non-answer rates and agreement rates of each item according to 74 ADL items representing 9 ADL domains, the 27 ADL items were selected as utility items. The reliability and unidimensionality of the ADL index consisting of 27 items were considered to be high. As the results of examining the difficulty of items and ADL ability characteristics of each group, the ADL concerning movement and other lower limb activity in G1 and G2, and concerning changes of posture and manual activity in G3 and G4 were considered to reflect the individual differences of ADL ability, respectively. The numbers of ADL items which should first be assessed in each group were as follows: 20 items in G1; 21 items in G2; 21 items in G3; 11 items in G4.     

Development of a "self efficacy for health promotion scale" in community-dwelling elderly]

The purpose of this study is to develop a Japanese version of a self efficacy scale for health promotion activities by the elderly. In September to October 1997, we asked all of 1758 persons aged 65 and over who were living in a village in Nagano Prefecture to answer a questionnaire. The questionnaire included 15 self efficacy items for health promotion, Activities of Daily Living (ADL), general self efficacy, health behavior, and community activities. The present study examined reliability and validity of the scale by investigating the correlation to other factors. 1173 of the subjects completed the answer sheet by themselves. The mean age of the subjects was 72.9 +/- 6.1, and 54.7% were female, the education level of 52.2% was middle school, 54.0% worked as a laborers, and 41 persons (3.5%) needed help in instrumental ADL. Almost half of the subjects participated in various community activities. When applied to the 1173 subjects, the first principal component accounted for 53.9% of variance. We considered a self efficacy scale for health promotion by using the sum of 15 items. Alpha coefficient of the scale was 0.93 and test-retest reliability was 0.68, showing the reliability of the scale. Criterion-related validity was demonstrated by the significant relationship between the self efficacy scale and general self efficacy (r = 0.42). The score of the 15-item version did not correlate with age and sex but ADL and health behavior (r = 0.29, 0.21, p < 0.001). High self efficacy was found among those who had high self rated health, and participated in health counseling, health screening, golden-age community center activity, and volunteer activities. This scale can be used to measure personal belief for health promotion as well as the effects of interventions to alter health behaviors. To standardize the scale, further study of urban dwelling elderly and the disabled elderly is necessary.     

The Sunnaas Index of Activities of Daily Living: Responsiveness and Concurrent Validity in Stroke

The aim of this study was to evaluate the responsiveness and concurrent validity of the Sunnaas Index of activities of daily living (ADL) as an instrument for measuring primary and instrumental ADL functions after stroke. Fifty-five consecutive stroke patients were scored using the Sunnaas ADL Index and the Barthel ADL Index on admission and at discharge after median 21 days inpatient rehabilitation. The results of the two indices were compared, and the Barthel Index was used as a gold standard for validity tests. The neurological impairments and motor functions of the patients were scored using the Scandinavian Stroke Scale and the Modified Motor Assessment Scale. The total score of the Sunnaas ADL Index and the subscores reflecting primary and instrumental ADL functions increased significantly (p < 0.0001) during rehabilitation. The Sunnaas score correlated significantly with the scores of the Barthel Index (Spearman correlation coefficient r = 0.83 on admission and 0.88 at discharge), the Scandinavian Stroke Scale (r = 0.81 on admission) and the Modified Motor Assessment Scale (r = 0.79 on admission and 0.76 at discharge). The Sunnaas ADL Index seems able to detect clinically important improvements of primary and instrumental ADL functions after stroke, i.e. its responsiveness is good. These results provide further evidence for the concurrent validity of the Sunnaas Index for measuring functional recovery after stroke.     

Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women

Malnutrition, a risk factor for osteoporotic fractures, is frequent in elderly people and, is underdiagnosed and undertreated. There are only few studies on the nutritional status of elderly people in Europe. The Mini Nutritional Assessment (MNA) is a non invasive and validated questionnaire to evaluate nutritional status in elderly people, classified in three groups: 1 degree score < 17: malnourished, 2 degrees score >17 and < 24: at risk of malnutrition, 3 degrees score >24: well-nourished, with a maximum of 30 points. Quantitative ultrasound of bone (QUS) is a method for assessing quality of bone which can be easily performed in nursing homes. Therefore, these two tests allowed to study the relationships between nutritional status and ultrasonic parameters of bone in 78 institutionalized women aged 86 +/- 6 years, living in 11 nursing homes around Lausanne (Switzerland). All were assessed by the MNA, had a measurement of the tricipital skin fold and of the grip strength. Functional status was evaluated by the scale "Activity of Daily Living" (ADL), and serum albumin level was measured when permitted. All had QUS of the calcaneus (with an Achilles, GE Lunar). The measured parameters are the Broadband Ultrasound Attenuation (BUA), attenuation of a band of ultrasonic frequencies through the medium, expressed in dB/MHz, and the Speed of Sound (SOS), speed of the ultrasounds through the medium, expressed in m/s. A third parameter, the stiffness index (SI), expressed as a percentage of the values obtained by the manufacturer in a young population and derived from BUA and SOS, was calculated automatically : SI = (0.67xBUA) + (0.28xSOS) - 420, expressed in percent compared to a young adult population (%YA). Fifteen percent of the women were undernourished and 58% were at risk of malnutrition. As expected, compared with the well-nourished minority, undernourished subjects had significant lower body mass index (BMI), tricipital skin fold (TSF), ADL score and albumin level (p < 0,01). The subjects "at risk of malnutrition" had significant lower BMI, ADL score (p < 0.01), tricipital skin fold and serum albumin (p < 0.05). Ultrasound parameters were low independently of the nutritional status. MNA score correlated significantly with tricipital skin fold (r = 0.508, p < 0.01), ADL (r = 0.538, p < 0.01) and albumin serum level (r = 0.409, p = 0.01). There was a trend for a correlation between the MNA and the ultrasound parameter BUA (r = 0.207, p = 0.07), whereas no correlation was found with SOS and SI. A multivariate analysis showed that tricipital skin fold and ADL explained 61% of the variance of the MNA. In conclusion, using simple and non invasive methods, this study showed that malnutrition and osteoporosis are frequent in institutionalized elderly persons in our country, and the ultrasound parameters are influenced by many others factors in addition to nutrition, especially at this age and in elderly residents of nursing homes.     

Relationship of normal levels of activity of daily living and daily habits among elderly women at home

PURPOSE: The relationship of activities of daily living (ADL) with daily habits and age was investigated with a focus on the results of measurements of the normal speed (ordinary level: OL) and maximum speed (maximum capacity: MC) in performing items on a functional fitness test. The significance of the measurement of the ordinary level was also discussed. METHODS: The subjects were 69 women, aged 60-90 years old, who participated in a health workshop for the elderly sponsored by a local municipality and who performed at least 4 items on a functional fitness test. Public health nurses asked subjects about habitual life style, subjective health status and degree of satisfaction in daily life. The ADL level was measured using the tests of functional fitness developed by Oida et al and partially revised by ourselves and physical fitness tests (grip strength, sit and reach, and balancing on one leg with opened eyes). OL was measured as the time needed to perform functional fitness items at normal speed, and MC as the time needed when performing these tasks as quickly as possible. RESULTS: All functional fitness items were accomplished significantly faster with MC than OL. Correlation coefficient values between OL and MC were high significant. Age was found to be significantly related to the hand working test (Hand-T) to evaluate dexterity and the rope working test (Rope-T) to evaluate self-care, except with the MC. An analysis of covariance with age as the covariant revealed that, with OL, there were relationships between Hand-T and Rope-T and the item "active at home," and between the zigzag walking (Zigzag-T) and Rope-T and "walking or riding a bicycle to go shopping." With MC, there were relationships between Hand-T and "active at home," and between Zigzag-T and "walking of riding a bicycle to go shopping." Regarding physical capacity, relationships were seen between both hands and "high level of physical fitness" and "walking fast" and grip strength (Left hand), respectively. CONCLUSION: The ADL items measured in the preset study were related to the daily activities of elderly people. As the OL and MC results demonstrated a high correlation and the ADL items related with OL were found to have almost the same link with MC, we conclude that OL is suitable for testing with the advantage of safety. However, we could not explain differences in relationships between measurements and daily activities, pointing to a need for further research. Elderly people must maintain their capacity for ADL to support a good quality of life, and we have demonstrated the utility of measurements that include normal levels of activity as indicators.     

Development of a Modified Version of the Spinal Function Sort (M-SFS): A Mixed Method Approach

Purpose To develop a modified version of the spinal function sort (M-SFS) by measuring work-related self-efficacy beliefs in patients with chronic low back pain. Methods A mixed method design consisting of three different methods (M1–3) was performed. In semi-structured interviews participants were asked how often they performed the activities of the 50 SFS items in 1 week, and which spinal postures and movements were associated with their back pain (M1). Quantitative analysis of previously obtained SFS data investigated internal consistency, unidimensionality, item response, and floor and ceiling effect (M2). Experts rated the SFS items based on their relevance (M3). The findings from these methods were used within a final scoring system for item reduction. Results From semi-structured interviews with 17 participants, eight new items emerged (M1). Quantitative analysis of 565 data sets (M2) revealed very high internal consistency of all items (Cronbach’s alpha = 0.98) indicating item redundancy; unidimensionality of the SFS was supported by principal component analysis; good item response was confirmed by Rasch analysis; and a floor effect of four items depicting very heavy material handling was found. Experts agreed on 8 out of the 50 SFS as relevant (M3). From the original SFS, 12 items met the predefined summary score of 9. Conclusions A modified version of the SFS with 20 items has been developed. Feasibility, reliability and validity of this modified version must be tested before it can be used in clinical practice.     

A 6-year cohort study on relationship between functional fitness and impairment of ADL in community-dwelling older persons

We measured functional fitness in older subjects and performed a follow-up survey for 6 years to clarify whether the level of functional fitness at a given point contributes to prediction of the subsequent occurrence of impairment of functions necessary for independent living. The longitudinal data were obtained for 391 persons aged 60 years or over, who were independently living in the community. Four items of functional fitness, i.e. the ability to perform standing/sitting movements, ability to perform traveling movements, ability to perform housekeeping movements, and ability to perform personal grooming activities, were assessed. The relationship between functional fitness and the risk of the occurrence of impairment of independence in daily living was evaluated using a binomial logistic regression model. In males, all the 4 items of functional fitness were significantly related to the risk of impairment of activities of daily living (ADL). In females, however, none of the items was significantly related to the risk of ADL impairment. In conclusion, functional fitness appears to be valid as a predictive parameter of future occurrence of ADL impairment in relatively healthy and independent elderly males. However, its validity in elderly females needs further evaluation.     

Development of a scale for subjective QOL common to patients with intractable diseases

OBJECTIVE: We have developed a scale for evaluating subjective quality of life (QOL) common to patients with intractable diseases. SUBJECTS: Two-hundred and forty-seven outpatients of housebound patients from 7 collaborating hospitals or institutions participated in preliminary surveys. The patients were diagnosed with one of 14 diseases targeted by the Ministry of Health and Welfare's Specific Disease Treatment Research Project. Two-hundred and fifty-seven outpatients or housebound patients of 8 collaborating hospitals or institutions participated in a second survey that targeted 15 diseases. METHODS: The concept of subjective QOL was examined, and a favorable subjective QOL score was defied as "a state in which patients accept their current condition and possess a high level of morale with no signs of anxiety, despite the presence of their disease". Sixty-six items were then identified and included in a preliminary survey. Three preliminary surveys and a second survey were then conducted. A final scale for the items was then decided, and the items were assessed for their reliability and validity. RESULTS: Nine items reflecting two factors, "acceptance" and "morale", were selected and assessed for their reliability and validity as follows: 1) The response of subjects who accepted their illness yet possessed a high level of morale showed a good fit with the proposed scale (Adjusted Goodness of Fit Index = 0.925). 2) The confidence coefficient of the re-test method for subjective QOL scale scores was r = 0.78 (95% con idence interval: 0.72-0.83; n = 226) nd the alpha coefficient was 0.822, indicating a high level of reliability. 3) A strong negative correlation (r = -0.76, 95% confidence interval: -0.82 to -0.69; n = 178) was found between the subjective QOL scale scores and self-rating depression scale (SDS) scores, and a moderately positive correlation (r = 0.35, 95% confidence interval: 0.23-0.46; n = 238) was found between the subjective QOL scale scores and activities of daily living (ADL) scores. 4) No statistically significant differences were observed in the distribution of subjective QOL scale scores when analyzed according to sex, age group, disease, or duration of illness. CONCLUSIONS: We have developed a scale consisting of 9 items for determining the subjective QOL of patients with intractable diseases. The scale was confirmed to properly reflect our concept of subjective QOL, which consists of two factors: "acceptance" and "morale" The scale was also confirmed to be stable and highly reliable.     

中文版格林围绝经期评估量表的信效度研究

摘要:目的　检验中文版格林围绝经期评估量表（GCS）的信度和效度。方法　采用经Brislin翻译和文化调试的中文版格林围绝经期期量表,对340名围绝经期妇女症状进行调查研究,并对量表的信、效度检验。结果　中文版GCS 量表保留21个条目,因子分析提取4个公因子,累计贡献率为59.426%,GCS 量表的总Cronbach'sα系数为0.926,折半信度为0.871。内容效度各条目的内容效度值（I-CVI）为0.90。各条目得分与总分Pearson相关系数（r）在0.474～0.771之间不等,说明具有良好的内部一致性。结论　中文版GSC量表具有良好的信效度,适宜作为围绝经期妇女的评估工具。     

Development and Validation of the Nursing Home Care-related Quality of Life Scale

ObjectivesWe developed an instrument to assess nursing home residents' quality of life (QOL), with a focus on QOL-related factors modifiable through nursing home care, within the South Korean context; then, we tested its validity and reliability.DesignThe scale was constructed through a literature review, qualitative interviews, expert panel review, and a focus group interview; then, it was validated through survey research.Setting and participantsResidents (N = 667) from 42 nursing homes in South Korea participated in scale validation.MethodsNinety-nine items across 5 dimensions were initially drafted through a literature review and qualitative interview data. The expert panel review and a focus group interview yielded a scale with 31 items across 3 dimensions. Next, using survey data from nursing home residents, we examined the construct and concurrent validity and reliability (using Kuder-Richardson 20) of the 31-item QOL scale.ResultsThrough a series of factor analyses, the 31 items were reduced to 17 items across 2 dimensions: Environment and Services (13 items) and Social Interaction (4 items). This 17-item scale was further examined for model fitness and reliability. The scale had acceptable to good fit (root mean square error of approximation = 0.07 and 0.07; comparative fit index = 0.83 and 0.98 for Environment and Services and Social Interaction, respectively), and good concurrent validity and internal consistency (Kuder-Richardson 20 = 0.72).Conclusions and implicationsThis 17-item scale is a valid and reliable tool to assess nursing home residents' QOL in South Korea, with a focus on factors modifiable through nursing home care. Through more research to test its usefulness, validity, and reliability, the scale can be used as an index of nursing home care quality and contribute to the development of strategies to improve nursing home residents' QOL.     

Evaluation of the Social Participation Questionnaire in adult patients with depressive symptoms using Rasch analysis

Purpose

The aim of this study was to explore the psychometric properties of the 22-item Social Participation Questionnaire (SPQ).

Methods

The SPQ was administered to 789 adult primary care patients with depressive symptoms. As the items were intended to be summed together to provide total score, Rasch analysis (partial credit model) was applied to assess the overall fit of the model, individual item fit, differential item functioning (DIF), targeting of persons, response dependency, unidimensionality and person separation.

Results

To improve the scale’s fit, it was necessary to re-score the response format. Two items demonstrated some DIF for gender and eight items showed DIF for age. To support the assumption of unidimensionality post hoc principal component analysis was performed. The analysis showed two subtests of the residuals with positive and negative loadings, but the person estimates derived from these two subtests were not statistically different to that derived from all items taken together. The response dependence between two items was identified; however, the magnitude of difficulty was very small. Although the questionnaire appeared to have insufficient items to assess the full spectrum of informal social contact, the SPQ was reasonably well targeted.

Conclusion

The SPQ is a promising questionnaire for the measurement of social participation although it could benefit from the inclusion of further items to measure informal social contact. This study found support for the internal validity, internal consistency reliability, and unidimensionality. A future study will investigate whether targeting can be improved when additional items are included.     

Reliability and Validity of Turkish Version of the Simplified Nutritional Appetite Questionnaire (SNAQ)

Objective

We aimed to investigate reliability and validity of the Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in geriatric outpatients.

Design/Setting

A cross-sectional study was designed through 2013–2016 years. At first, translation and back translation processes of the SNAQ from English to Turkish languages were done consecutively. Then construct validity was performed. Participants: They were recruited among the outpatients aged >=60 years that were consecutively admitted to the geriatric outpatient clinic of the Istanbul University hospital.

Measurements

Demographic data was recorded. SNAQ, Mini Nutritional Assessment (MNA), six-item Katz activities of daily living (ADL) and eight-item Lawton instrumental activities of daily living (IADL) scales were applied.

Results

442 participants consisted of 305 women and 137 men with a mean age of 77.1 ± 6.8 years. The SNAQ identified 21.5% (n=95) of the participants with poor appetite. Reliability analysis showed good inter-rater reliability (r=0.693, p<0.05) and test-retest stability (r=0.654, p<0.05). Cronbach’s alpha coefficient was 0.522. In terms of construct validity of SNAQ, Cohen’s kappa analysis showed fair to moderate agreement between SNAQ and MNA (κ=0,355, p<0.001). Female gender, being illiterate, functional dependency in IADL were significantly associated with poor appetite. The SNAQ score was weakly correlated with scores of MNA-SF and MNA-LF (r=0.392 and r=0.380, respectively, p<0.0001 for both). There was statistically significantbut negligible correlation between the SNAQ and Katz ADL index, Lawton IADL index, and age.

Conclusion

Turkish version of the SNAQ is a simple measurement with sufficient reliability and validity to screen poor appetite in community-dwelling older adults.

     

Dietitian services are associated with improved patient outcomes and the MEDFICTS dietary assessment questionnaire is a suitable outcome measure in cardiac rehabilitation

OBJECTIVE: The purposes of this study were to (a) examine the effectiveness of registered dietitian (RD) education and counseling on diet-related patient outcomes compared with general education provided by the cardiac rehabilitation (CR) staff, and (b) evaluate the effectiveness of the Meats, Eggs, Dairy, Fried foods, In baked goods, Convenience foods, Table fats, Snacks (MEDFICTS) score as an outcome measure in CR. METHODS: Observational study data examined from 426 CR patients discharged between January 1996 and February 2004. Groups were formed based on education source: (a) RD and (b) general education from CR staff. Baseline characteristics were compared between groups; pre/post diet-related outcomes (lipids, waist circumference, body mass index, MEDFICTS score) were compared within groups. Controlling for baseline measures and lipid-lowering medication, associations were examined between (a) RD education and diet-related outcomes and (b) ending MEDFICTS score and diet-related outcomes. RESULTS: Mean age was 62+/-11 years, 30% of patients were female, and 28% were nonwhite. At baseline, the RD group (n=359) had more dyslipidemia (88% vs 76%), more obesity (47% vs 27%), a larger waist (40+/-6 vs 37+/-5 inches), a higher body mass index (calculated as kg/m(2); 30+/-6 vs 27+/-5), a higher diet score (32+/-28 vs 19+/-19), and lower self-reported physical activity (7+/-12 vs 13+/-18 metabolic equivalent hours) (all P<.05) than the general education group (n=67). RD education was associated with improved low-density lipoprotein (r=0.13; P=.04), triglycerides (r=0.48; P=.01), and MEDFICTS score (r=0.18; P=.01). Improvements in MEDFICTS scores were correlated with improved total cholesterol, triglycerides, and waist measurements (all r=0.19; P=.04). CONCLUSIONS: Dietary education by an RD is associated with improved diet-related outcomes. The MEDFICTS score is a suitable outcome measure in CR.     

A physical performance battery assessing low/high extremity functional fitness in older Japanese women

The aim of this study was to establish a physical performance test battery to assess the wide variation of functional fitness in older Japanese women. The criteria for sampling low/high extremity functional fitness were the amount of physical activities that older women perform on a regular basis and the distance they could move by foot. Seventeen tests related to the activities parallel to daily living (APDL) were completed for 178 women, aged 60 to 91 years. Principal component analysis of the 17 performance tests in the reference group (n = 140) yielded 5 components accounting for 63.5% of the total variance. Fourteen test items were heavily loaded on the 1st principal component, so that 31.4% of the total variance was accounted for by this component. Considering these results as well as test-retest reliability, kurtosis, and skewness of each item, the following four items were selected as a combination of test battery: (X1) repetition of the bicipital flexion/extension, (X2) walking around two cones and sitting on a chair, (X3) moving beans with chopsticks, and (X4) functional reach. Principal component analysis was again applied to these four variables so as to obtain the first principal component score of each person. As a result, the following equation was drawn: the first principal component score = 0.063X1 - 0.055X2 + 0.098X3 + 0.042X4 - 2.65. The scores averaged 0.68 +/- 0.27 for the exercise group (n = 19) (those who played croquet or other similar sports activities consistently twice or more a week); and -0.76 +/- 0.55 for the sedentary group (n = 19) (those who did no exercise and confined their activities to the home). Biserial correlation coefficient as an index of criterion-related validity was 0.67 (P < 0.05) between the scores in the exercise and sedentary groups. These results indicate that a wide range of functional fitness among older Japanese women can be assessed by the four tests.     

脑卒中患者健康信念简表的信效度检验

目的 为了更简便地测量脑卒中患者的健康信念水平,将Champion健康信念量表 （the champion health belief model scale,CHBMS）中文版进行简化。方法 对88例患者的CHBMS健康信念量表的完整中文版问卷进行条目分析,并采用专家咨询法进行修订并简化为健康信念简表（short form fealth belief model scale,SF-HBMS）,并对235例脑卒中患者问卷调查,采用SPSS 17.0及Mplus 7.0软件检验简表的信度和效度。结果 简化后的量表的条目水平内容效度指数（item-level content validity index,I-CVI）平均为0.97,量表水平的全体一致内容效度指数（sale-content validity index/universal agreement,S-CVI/UA）和平均内容效度指数（sale-content validity index/ average,S-CVI/Ave）分别为0.85、0.97;总量表的同质性信度、分半信度、重测信度分别为0.835、0.779、0.811;验证性因子分析模型的常态化卡方值（χ2/df）为1.642,比较拟合指数（comparative fit index,CFI）为0.939,Tucker-Lewis 指数（tucker-lewis index,TLI）为0.926,标准化残差均方根（standardized root mean square residual,SRMR）为0.062,近似误差平方根（root mean square error of approximation,RMSEA）为0.052,P=0.361,说明模型精确拟合数据。简表与完整版量表的效标效度为0.956。SF-HBMS能区分不同文化程度患者的健康信念水平（t=-2.282,P=0.023）,区分效度较好。结论 SF-HBMS具有较好的信度和效度,可用于测量脑卒中患者的健康信念水平。     

Aggregated measures of functional disability in a nationally representative sample of disabled people: analysis of dimensionality according to gender and severity of disability

Objective To determine (i) the dimensional invariance of instrumental and basic activities of daily living (IADL/ADL) by gender subgroups, and (ii) the extent to which ADL dimensionality varies with the inclusion or exclusion of nondisabled people. Methods Data were taken from the 1999 Spanish Survey on Disability, Impairment and State of Health. The analysis focussed on 6,522 people aged over 65 years who received help to perform or were unable to perform IADL/ADL items. Unidimensional and multidimensional item response theory (IRT) models were applied to this sample. Results In the female sample, IADL/ADL items formed a scale with sufficient unidimensionality to fit a two-parameter logistic IRT model. In the male sample, the structure was bidimensional: self-care and mobility, and household activities. When the sample was composed of IADL/ADL disabled people, ADL items formed a unidimensional scale; when it was composed only of ADL disabled people, they formed a bidimensional structure: self-care and mobility. Conclusions IADL/ADL items can be combined in a single scale to measure severity of functional disability in females, but not in males. Separate aggregated scores must be considered for each subdomain, basic mobility and self-care, in order to measure the severity of ADL disability.     

Cross-diagnostic validity of the Nottingham health profile index of distress (NHPD)

Background

The Nottingham Health Profile index of Distress (NHPD) has been proposed as a generic undimensional 24-item measure of illness-related distress that is embedded in the Nottingham Health Profile (NHP). Data indicate that the NHPD may have psychometric advantages to the 6-dimensional NHP profile scores. Detailed psychometric evaluations are, however, lacking. Furthermore, to support the validity of the generic property of outcome measures evidence that scores can be interpreted in the same manner in different diagnostic groups are needed. It is currently unknown if NHPD scores have the same meaning across patient populations. This study evaluated the measurement properties and cross-diagnostic validity of the NHPD as a survey instrument among people with Parkinson's disease (PD) and peripheral arterial disease (PAD).

Methods

Data from 215 (PD) and 258 (PAD) people were Rasch analyzed regarding model fit, reliability, differential item functioning (DIF), unidimensionality and targeting. In cases of cross-diagnostic DIF this was adjusted for and the impact of DIF on the total score and person measures was assessed.

Results

The NHPD was found to have good overall and individual item fit in both disorders as well as in the pooled sample, but seven items displayed signs of cross-diagnostic DIF. Following adjustment for DIF some aspects of model fit were slightly compromised, whereas others improved somewhat. DIF did not impact total NHPD scores or resulting person measures, but the unadjusted scale displayed minor signs of multidimensionality. Reliability was > 0.8 in all within- and cross-diagnostic analyses. Items tended to represent more distress (mean, 0 logits) than that experienced by the sample (mean, -1.6 logits).

Conclusion

This study supports the within- and cross-diagnostic validity of the NHPD as a survey tool among people with PD and PAD. We encourage others to reassess available NHP data within the NHPD framework to further evaluate the strengths and weaknesses of this simple patient-reported index of illness-related distress.