The Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5): Development and Initial Psychometric Evaluation

The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM‐correspondent self‐report measure of PTSD symptoms. The PCL was recently revised to reflect DSM‐5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM‐5 (PCL‐5). Psychometric properties of the PCL‐5 were examined in 2 studies involving trauma‐exposed college students. In Study 1 (N = 278), PCL‐5 scores exhibited strong internal consistency (α = .94), test‐retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM‐5 4‐factor model, χ²(164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker‐Lewis index (TLI) = .84, and superior fit with recently proposed 6‐factor, χ² (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7‐factor, χ² (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL‐5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL‐5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL‐5 in a variety of assessment contexts are discussed.     

Psychometric Properties of the Stanford Acute Stress Reaction Questionnaire (SASRQ): A Valid and Reliable Measure of Acute Stress

A reliable and valid measure is needed for assessing the psychological symptoms experienced in the aftermath of a traumatic event. Previous research suggests that trauma victims typically experience dissociative, anxiety and other symptoms, during or shortly after a traumatic event. Although some of these symptoms may protect the trauma victim from pain, they may also lead to acute stress, posttraumatic stress, or other disorders. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was developed to evaluate anxiety and dissociation symptoms in the aftermath of traumatic events, following DSM-IV criteria for acute stress disorder. We present data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.     

The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative

OBJECTIVE: To derive a cross-culturally valid, short measure of physical function using function subscales (daily living and sports and recreation) of the Hip disability and Osteoarthritis Outcome Score (HOOS). METHODS: Rasch analysis was conducted on data from individuals from multiple countries who had hip osteoarthritis (OA). Fit of the data to the Rasch model was evaluated by model chi(2) and item fit statistics (chi(2), size of residual, and F-test). Differential item functioning was evaluated by gender, age and country. Unidimensionality was evaluated by factor analysis of residuals. Individual data sets were analyzed and data pooled and re-analyzed for fit to the model. Regression modeling was conducted to derive a nomogram converting raw summed scores to Rasch derived interval scores. RESULTS: Seven data sets were included (n=2991), ages 19-96 years, male/female ratio was 1:1.23. The final model included five HOOS items. From the easiest to most difficult, the items (logit) were as follows: sitting (1.832), descending stairs (0.729), getting in/out of bath or shower (0.255), twisting/pivoting on loaded leg (-0.221) and running (-2.595). The separation index was 0.80. CONCLUSION: The daily activity and sports and recreational items of the HOOS were reduced to five items achieving a feasible, short measure of physical function with interval level properties. This tool has potential for use as the function component of an OA severity scoring system. Further testing of this measure is warranted.     

The development and validation of a multi-dimensional measure of chronic foot pain: the ROwan Foot Pain Assessment Questionnaire (ROFPAQ)

The development and validation of the ROwan Foot Pain Assessment Questionnaire (ROFPAQ) is described. This is the first attempt to develop a multi-dimensional measure of chronic foot pain, and recognizes pain as having sensory, affective and cognitive dimensions. The ROFPAQ was developed from themes that emerged from running focus groups and semi-structured interviews with people with chronic foot pain. Following piloting and selection of appropriate items by both psychometric and semantic means, the scale was found to meet the accepted criteria for validity and reliability. The final scale demonstrates better than standard readability, has a short completion time and a simple scoring method. The scale allows clinicians to determine which dimension(s) of foot pain are the most relevant to the subject, thereby aiding decisions regarding appropriate treatment. Topics for further work on the ROFPAQ are highlighted.     

Brief Practical Screeners in English and Spanish for Acute Posttraumatic Stress Symptoms in Children

With millions of children experiencing acute traumatic events, validated screening tools are needed in both research and service contexts. We aimed to identify and evaluate short forms of the Acute Stress Checklist for Children in English (ASC‐Kids) and Spanish (Cuestionario de Estrés Agudo‐Niños [CEA‐N]), using data from 4 samples (Ns of 254, 225, 176, and 80) of children with recent acute trauma. Confirmatory factor analyses of the full checklist in the largest sample guided item selection for 6‐item and 3‐item short forms. Across samples, both short forms (ASC‐6/ASC‐3 in English; CEA‐6/CEA‐3 in Spanish) were correlated with acute stress disorder (ASD) symptom severity on the full checklist (r = .79 to .92), and on an interview measure (r = .52 to .62). Receiver operating curve analyses for each short form detecting current ASD status showed high areas under the curve (.76 to .95). Cutoff scores identified based on Sample 1 provided acceptable sensitivity (.59 to 1.00) and specificity (.57 to .86) across samples. Children scoring above the cutoff on each screener reported greater concurrent impairment from ASD symptoms and more severe posttraumatic stress 3 months later. These very brief measures could expand clinicians’ and researchers’ ability to screen for acute posttraumatic stress in children.     

Acute presentation of hydromyelia in a child

Summary The authors document a rapid development, within 3 weeks, of hydromyelia in a 12 year-old boy. The boy was admitted to a local hospital because of drowsiness and persistent severe neck pain. Neurological examination disclosed a lethargic boy with no neurological deficit other than Parinaud’s sign. During his transfer to our department, he presented a cardio-respiratory arrest with coma and bilateral mydriasis. External ventricular drain and craniocervical decompression achieved excellent clinical and neuroradiological outcomes. The development of hydromyelia in this case is caused by obstruction to the natural cerebrospinal fluid pathway at the craniocervical junction and the cardio-respiratory arrest is provoked by a brain stem compression against the clivus and odontoid process. This report illustrates that hydromyelia may complicate acute obstructive hydrocephalus due to acquired Chiari malformation.     

The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS) - an OARSI/OMERACT initiative

OBJECTIVE: To develop a short measure of physical function for knee osteoarthritis (OA) using multi-national data from individuals with varying degrees of severity of knee OA. METHODS: Rasch analysis, based on the partial credit model, was conducted on Knee injury and Osteoarthritis Outcome Score and Western Ontario McMaster Universities' Osteoarthritis Index data from individuals with knee OA, ranging from community to pre-total knee replacement samples from five countries. Fit of the data to the Rasch model was evaluated by overall model fit and item-level fit statistics (chi(2), size of residual, F-test). Invariance across age, gender and country was evaluated. Unidimensionality was evaluated by factor analysis of residuals. The derived short measure was further tested for fit through re-analyses in individual sub-samples. A nomogram converting raw summed scores to Rasch-derived interval scores was developed. RESULTS: Thirteen data sets were included (n=2145), with an age range of 26-95 years, and a male/female ratio of 1:1.4. The final model included seven of the original 22 items. From easiest to most difficult, the items (logit) were as follows: rising from bed (1.366), putting on socks/stockings (1.109), rising from sitting (0.537), bending to the floor (0.433), twisting/pivoting on injured knee (-0.861), kneeling (-1.292) and squatting (-1.292). Sub-sample analyses confirmed findings. CONCLUSION: Based on the use of accepted Rasch-based measurement methods and the compliment of countries, languages and OA severity represented in this study, our seven item short measure of physical function for knee OA is likely generalizable and widely applicable. This measure has potential for use as the function component in an OA severity scoring system.     

The brain injury rehabilitation scale (BIRS): a measure of change during post-acute rehabilitation

This article describes the development of the Brain Injury Rehabilitation Scale (BIRS), a 20-item scale rating attention, memory, cognition, goal-directed behaviour, social interaction, and adjustment to injury. The BIRS was designed to provide ratings of clinical progress during post-acute rehabilitation from the perspective of the patient, the family and the treating staff. The BIRS was administered to two groups. Group one included five patients in a post-acute rehabilitation programme who were administered the BIRS each week for the 24 weeks of the programme. Group two was a control group composed of 21 college students. The BIRS was administered to each control subject for three consecutive weeks. The BIRS was found to be a sensitive and reliable measure of rehabilitation progress. Inter-rater reliability was high. Further evaluation of the BIRS is warranted.     

Enhancing self-report assessment of PTSD: development of an item bank

The authors report results of work to enhance self-report posttraumatic stress disorder (PTSD) assessment by developing an item bank for use in a computer-adapted test. Computer-adapted tests have great potential to decrease the burden of PTSD assessment and outcomes monitoring. The authors conducted a systematic literature review of PTSD instruments, created a database of items, performed qualitative review and readability analysis, and conducted cognitive interviews with veterans diagnosed with PTSD. The systematic review yielded 480 studies in which 41 PTSD instruments comprising 993 items met inclusion criteria. The final PTSD item bank includes 104 items representing each of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association [APA], 1994), PTSD symptom clusters (reexperiencing, avoidance, and hyperarousal), and 3 additional subdomains (depersonalization, guilt, and sexual problems) that expanded the assessment item pool.     

The Rapunzel syndrome (trichobezoar) causing atypical intussusception in a child: a case report

The Rapunzel syndrome (trichobezoar) occurs when gastrointestinal obstruction is produced by a rare manifestation of a trichobezoar with a long tail that extends to or beyond the ileocecal valve. A case history of a 7-year-old girl is described. This is the eleventh patient with Rapunzel syndrome reported in the literature. The epidemiology, clinical features, diagnosis, complications, treatment, and literature are reviewed briefly.     

Acute laparoscopic intervention for diverticular disease (AIDD): a feasible approach

Introduction  

Early laparoscopic rectosigmoid resection for acute complicated diverticulitis may avoid secondary hospital stay and stoma-related complications. Benefits of elective surgical therapies could advance the early laparoscopic approach for acute sigmoid diverticulitis.     

Acute urinary retention in a child withappendiceal abscess: Diagnostic dilemma

Rarely do children with appendiceal abscess present with acute urinary retention as the only sign or symptom. This presentation may delay diagnosis and definitive therapy, thereby causing additional morbidity and possible mortality. We report the eighth case of acute urinary retention in a child associated with an appendiceal abscess.     

小儿膀胱过度活动症106例治疗报告

目的探讨小儿膀胱过度活动症的临床特点及治疗方法。方法回顾分析近5年门诊收治的106例小儿膀胱过度活动症的临床表现、个性化治疗方法及疗效。结果38例学龄前患儿经心理疏导、改变生活习惯等方法治疗,30例治愈,治愈率78．9％。其余76例患儿予口服654．2片,其中58例治愈,治愈率76．3％;另18例加服硝苯吡啶联合治疗,16例治愈,2例好转。总治愈率98．1％。结论小儿膀胱过度活动症治疗应根据个人特点采取个性化治疗方案,治愈后复发率低。     

The development of a treatment pathway for dermal regenerative matrix (DRM)

The process of standardising burn care and creating protocols within burn centres has, at its core, evidence-based practice principles combined with the clinical experiences of burn care specialists. Although protocols and pathways have been created for certain topics of burn care, they tend to be tailored to the local individual needs of each burn centre, which is a limiting factor for consideration of larger/nationwide approaches. In order to continue to improve the short and long term outcomes after burn injuries, such as increasing the survival rate, reduction in the incidence of sepsis and organ failure, and improving wound healing and scarring, more generalised care pathways combining the recommendations of a nationwide working group of burn care specialists should be created around the topics of interest to ultimately improve patients’ outcomes. We describe the steps put in place in Canada to design and adopt a nationwide protocol from a single burn centre on the topic of wound healing and dermal substitutes as the initial exemplary process. This report summarizes the Canadian experience for this type of initiative, which can be used as framework for developing additional guidelines/protocols in other relevant burn care related topics in Canada or other countries.