A validity study of a new rating scale for psychiatric patients

A criterion validation of a new scale, REHAB (Rehabilitation Evaluation Hall And Baker) (1) is described. Forty-three long-stay psychiatric patients from two wards were observed by a psychologist over a 2-week period using a time sampling procedure. The observed behaviour was coded into predetermined categories based on Blunden & Kushlick's (2) concept of engagement. Also during this period the ward nurses rated the 43 patients using the REHAB assessment. The time sampled observations were correlated with REHAB factors and items. Five hypotheses about the relationship between the two measures were tested. Four of the five hypotheses were supported by the data. Overall, despite certain limitations of the study, it is concluded that evidence is provided for the criterion validity of REHAB.     

Ataxia clinical rating scale in Friedreich disease

The Ataxia Clinical Rating Scale was used on 22 patients with Friedreich disease. We found a positive correlation (r=0.64, p<0.005) between total score and duration of symptoms. For this reason the scale may be useful in the follow-up of patients affected by Friedreich disease.

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Sommario La Ataxia Clinical Rating Scale è stata applicata a 22 pazienti affetti da malattia di Friedreich. Abbiamo riscontrato una correlazione positiva (r=0.64, p<0.005) tra il punteggio totale e la durata della sintomatologia. Per questo motivo la scala è utile nel follow-up dei pazienti affetti da malattia di Friedreich.

     

Conners教师评定量表的临床效度研究

目的　检验Conners教师用评定量表的临床效度。方法　将Conners教师用评定量表(TRS)应用于符合DSM Ⅳ注意缺陷多动障碍 (ADHD)标准的 5 7例ADHD儿童及同年龄、同性别的全国常模样本上海组儿童。结果　 (1)内容效度 :ADHD组的因子分及总分均高于对照组 (t=11 2 4 0～16 6 5 2 ,P <0 0 0 1) ;(2 )效标效度 :TRS对ADHD儿童的诊断灵敏度是 86 0 % ,特异度 94 7% ,诊断符合率 90 3% ;(3)结构效度 :各因子与总分的相关 (γ =0 892～ 0 974 )超过各因子之间的相关 (γ =0 6 93～ 0 96 3) ;经最大方差旋转后得出了 5个因子 ,有 3个因子与美国TRS的因子相似 ,即多动、注意力不集中、冲动 ,并产生了 2个不同于美国儿童的因子 :社交问题、被动。结论　Conners教师用评定量表适合于我国儿童注意缺陷多动障碍儿童的评估。     

A standardized psychiatric assessment scale for rating chronic psychotic patients

Simple 5-point scales are described together with the method used to study their reliability, the results of which are shown. The scales are short, easy to administer and sensitive to change, therefore particularly applicable where there is the need for screening chronic psychotic populations. Some uses for the scales are suggested.     

Measuring observed mental state in acute psychiatric inpatients

Background  Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined. Aim  Data from a multi-centre service evaluation (11 units, 5,546 admissions) were used to examine mental state patterns and associations with clinical characteristics, events and adverse incidents. Method  During the 12-month evaluation period, nursing staff completed shift-level ratings using a new rating scale, the observed mental state (OMS) scale, which assessed active psychopathology (emotional distress, disinhibition, psychosis, cognitive impairment) and withdrawal (45,885 sets of day/afternoon shift ratings). Results  The OMS scale performed satisfactorily and is worth considering elsewhere (e.g., active psychopathology: internal consistency, α = 0.72; short-term stability, r = 0.72; sensitivity to change, adjusted standardised difference, ASD = 0.71). Levels of active psychopathology were much higher on shifts in which reportable (ASD = 1.47) and less serious aggression occurred (ASD = 1.44), compared with other shifts in which pro re nata medications were also administered (ASD = 0.76), suggesting that medication usage often followed these events, and possibly that agitation and distress levels either rose rapidly or went initially unnoticed on these shifts. Although mental state improved steadily across the admission, one-fifth of the patients with schizophrenia received OMS psychosis ratings in the moderate to severe range during the days prior to discharge. Conclusions  Observed mental state ratings were strongly linked with diagnosis and reflected key events and incidents. Routine recording using the OMS scale may assist clinical decision-making and evaluation in acute psychiatric units.     

Development and validation of a clinical scale for rating the severity of Blepharospasm

Existing scales for rating the severity of blepharospasm (BSP) are limited by a number of potential drawbacks. We therefore developed and validated a novel scale for rating the severity of BSP. The development of the scale started with careful examination of the clinical spectrum of the condition by a panel of experts who selected phenomenological aspects thought to be relevant to disease severity. Thereafter, selected items were first checked for reliability, then reliable items were combined to generate the scale, and clinimetric properties of the scale were evaluated. Finally, the confidence with which the scale could be used by people without high levels of movement disorders skill was assessed. The new scale, based on objective criteria, yielded moderate to almost perfect reliability, acceptable internal consistency, satisfactory scaling assumptions, lack of floor and ceiling effects, partial correlations with a prior severity scale and with a quality of life scale, and good sensitivity to change. Despite a few limitations, the foregoing features make the novel scale more suitable than existing scales to assess the severity of BSP in natural history and pathophysiologic studies as well as in clinical trials. © 2015 International Parkinson and Movement Disorder Society     

Rasch analysis in the development of a rating scale for assessment of mobility after stroke

The study describes the development of a rating scale for assessment of mobility after stroke. It was based on 74 first-stroke patients, 40 men and 34 women, each assessed three times during rehabilitation. Their median age was 69 years, and they represented all degrees of severity of paresis. Content, construct, criterion and convergent validity were examined, as well as the inter-rater reliability. The final rating scale has three special characteristics: 1) it reflects the regularity in the recovery of mobility after stroke; 2) the sum of item scores comprises the information contained in the 10-item subscores; 3) the score sum is independent of age, side of hemiparesis, and gender of the patient. Latent trait analysis (Rasch) was found to be an ideal model for statistical investigation of these properties.     

Validation of the hospital anxiety and depression rating scale (HADS) in an elderly psychiatric population

A study was undertaken to validate the Hospital Anxiety and Depression Rating Scale in an elderly psychiatric population. The depression subscale (HAD-D) was shown to relate well to global measures of depression and to be sensitive to changes in the severity of the depression. No conclusion could be drawn about the anxiety subscale of the HAD. The advantages of this observer-assisted self-rating scale in the elderly are discussed.     

卒中评分量表新进展

卒中评分量表是评估卒中患者情况的一项重要工具,贯穿卒中全过程,包括卒中风险预测评分、神经功能缺损评分、残疾评定、预后评分、卒中复发风险预测评分等,将患者进行分层管理,从而指导临床治疗.卒中评分量表大部分内容简便,易于临床操作,已经在国内外大量卒中人群研究中很好的证实了其信度、效度、灵敏度等.随着其在临床中的应用及研究的不断深入,其优缺点日益清晰.各种量表在原基础之上已进行了不断修改,而且又陆续有一些新的量表诞生.这些量表在卒中患者的诊断、治疗、评残和评估预后中发挥着重要作用.     

Derivation of a definition of remission on the Montgomery-Asberg depression rating scale corresponding to the definition of remission on the Hamilton rating scale for depression

During the past decade the Montgomery–Asberg Depression Rating Scale (MADRS) has been used with increasing frequency to measure outcome in antidepressant efficacy trials (AETs). In characterizing treatment outcome in AETs it is common to define treatment remission as a score below a predetermined cutoff score on the scale. Various cutoffs have been used to define remission on the MADRS. The goal of the present paper is to determine the cutoff on the MADRS that most closely corresponds to the cutoff most frequently used on the Hamilton Rating Scale for Depression to define remission. Three hundred and three psychiatric outpatients who were being treated for a DSM-IV major depressive episode were rated on the HRSD and the MADRS. A linear regression equation was computed to estimate MADRS scores from HRSD scores. After deriving the regression equation, we computed the MADRS score corresponding to an HRSD score of 7. We also examined the sensitivity, specificity and overall classification rate of the MADRS for identifying remission on the HRSD. Based on the equation from a linear regression analysis for the entire sample, a MADRS score of 11 would correspond to a score of 7 on the HRSD. We repeated the analysis after excluding the more severely depressed patients who currently met criteria for MDD, and based on the equation from this regression analysis a MADRS score of 10 would correspond to a score of 7 on the HRSD. In a complementary analysis, we examined the sensitivity, specificity and overall classification rate of the MADRS at different cutoff points for identifying remission, and found that a cutoff of 10 maximized the level of agreement with the HRSD definition of remission. In conclusion, the regression equation relating HRSD and MADRS scores is dependent, in part, on the range and severity of scores in the sample. To facilitate comparisons of studies using the HRSD and MADRS our results suggest that a cutoff of 10 on the MADRS is equivalent to the HRSD cutoff of 7.     

Validation of the besta neurological institute rating scale for myasthenia gravis

Introduction: We validated the scale for myasthenia gravis (MG) developed at the Neurological Institute Foundation of Milan (INCB‐MG scale). Methods: A total of 174 patients were evaluated with the INCB‐MG and compared with the MG Composite (MGC) as the gold standard. Dimensionality, reliability, and validity of the INCB‐MG scale were studied by principal component factor analysis, Cronbach alpha, and Pearson correlation coefficients; interobserver reliability was calculated by the weighted Cohen K coefficient. Results: Generalized and bulbar INCB‐MG subscales were unidimensional with excellent consistency; the INCB‐MG and MGC scales were strongly correlated. Fatigability assessment was correlated with the INCB‐MG generalized, bulbar, and respiratory subscales. Conclusions: The INCB‐MG scale is a reliable tool to assess MG and is strongly correlated with the MGC. The INCB‐MG scale is a valid tool for every day practice and should be further investigated for its application in clinical trials. Muscle Nerve 53 : 32–37, 2016     

Agreement in psychiatric assessment

In 103 schizophrenic patients we investigated the extent of practice needed in the use of the Brief Psychiatric Rating Scale (BPRS) to enable its reliability to be assessed. The agreement level of the 7 raters was analysed. Generally, the lowest mean agreement found was for the negative symptoms of the BPRS schizophrenia subscale. A high degree of agreement was attained both for the positive symptoms of the BPRS schizophrenia subscale and for the symptoms of the depression – and of the mania subscale. The degree of disagreement observed was due to both individual differences in assessment ability and the rating procedure. These results indicate that it is necessary to state the degree of agreement achieved in studies in which several raters are taking part.     

The case record rating scale: a method for rating symptom and social function data from case records

Case records provide a vast resource of information for clinical research, yet their value has been limited by several methodological problems. One of these has been the absence of standardized approaches for making diagnoses and other clinical judgements from case record data. This report describes the Case Record Rating Scale, an instrument designed to provide a standardized method for abstracting case record information. The reliability of the scale is demonstrated, and the advantages and problems encountered using case record data for research are described.     

Calibration of unified Parkinson's disease rating scale scores to Movement Disorder Society‐unified Parkinson's disease rating scale scores

The aim of this study was to develop formulas to convert the UPDRS to Movement Disorder Society (MDS)‐UPDRS scores. The MDS‐UPDRS is a revision of the UPDRS with sound clinimetric properties. Reliable formulas to recalculate UPDRS scores into MDS‐UPDRS equivalents are pivotal to the practical transition and definitive adoption of the MDS‐UPDRS. UPDRS and MDS‐UPDRS scores were collected on 875 PD patients. A developmental sample was used to regress UPDRS scores on corresponding MDS‐UPDRS scores based on three H & Y groupings (I/II, III, and IV/V). Regression weighting factors and intercept terms provided formulas for UPDRS conversions to be tested in a validation sample. Concordance between the true MDS‐UPDRS Part scores and those derived from the formulas was compared using Bland‐Altman's plots and Lin's concordance coefficient (LCC). Significant concordance between UPDRS‐estimated MDS‐UPDRS scores was achieved for Parts II (Motor Experiences of Daily Living) (LCC = 0.93) and III (Motor Examination) (LCC = 0.97). The formulas resulted in mean differences between the true MDS‐UPDRS and estimated MDS‐UPDRS scores of less than 1 point for both Parts II and III. Concordance was not achieved for Parts I and IV (Non‐motor Experiences of Daily Living and Complications of Therapy). Formulas allow archival UPDRS Parts II and III individual patient data to be accurately transferred to MDS‐UPDRS scores. Because Part I collects data on much more extensive information than the UPDRS, and because Part IV is structured differently in the two versions, old ratings for these parts cannot be converted. © 2012 Movement Disorder Society     

Sensory ataxia rating scale: Development and validation of a functional scale for patients with sensory neuronopathies

Sensory neuronopathies (SN) result from dorsal root ganglia damage and manifest with a combination of sensory deficits and proprioceptive ataxia. Characterization of the natural history and development of therapeutic trials are hampered by the lack of clinical scales that capture the whole spectrum of SN‐related manifestations. We propose and validate a rating instrument for SN. Three experienced neuromuscular specialists developed items to rate SN. The resultant instrument was later validated by the assessment of the intra‐class correlation coefficient, for inter‐rater validity in 48 SN patients, and later in a smaller subset of 16 patients to assess its intra‐rater validity. Standardized Crombach's alpha and Oblimin rotation analysis were performed to verify internal consistency and items' relationship, respectively. Evaluation of Sensory Ataxia Rating Scale (SEARS)'s external validity was performed by comparison to: scale for the assessment and rating of ataxia (SARA), Beck balance scale (BBS), and INCAT sensory sum score (ISS). A 10‐item scale with an intra‐class correlation coefficient >0.95 for intra‐ and inter‐rating measurements with a good internal consistency (standardized Cronbach's alpha of 0.83) were observed. There was a normal distribution of the scores without a floor or ceiling effect. A moderate to good correlation between SEARS and SARA, BBS, and ISS was observed. SEARS is a reliable, easy‐to‐perform and consistent instrument to rate SN. Larger cohorts and multicenter studies are needed to validate its usefulness towards possible treatment trials.     

Length of stay of acute psychiatric inpatients: an exponential model

We examined the length of stay of inpatients admitted to a psychiatric unit in central London. The commonest length of stay (mode) was less than 1 week. In general, subsequent weeks showed successively fewer discharges, so that the distribution curve of the number of patients by length of stay showed a smooth decline. Analyzing the first 13 weeks of stay, the distribution curve corresponded very closely to a theoretical exponential decay curve. This has implications for recording the average length of stay and thus for comparing one hospital unit with another. It may also have implications for planning for acute psychiatric services. A plea is made for using the median rather than the mean for recording the average length of admission for some purposes.