Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems

IntroductionFoot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients’ quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems.Method215 people aged 17–60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach’s alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively.ResultsA strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach’s alpha were 0.981 and 0.98 for SAFE-Q, respectively.ConclusionThe results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.     

Validity and reliability of Swedish WOMAC osteoarthritis index: a self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP)

We assessed whether a disease-specific, self-administered questionnaire could replace a generic instrument as an outcome tool after total hip replacement, and tested the validity and reliability of the Swedish WOMAC osteoarthritis index. 58 patients operated on with total hip arthroplasty 2-10 years ago were randomized to the study. All patients were asked to answer one disease-specific questionnaire (WOMAC osteoarthritis index) and two generic instruments (NUP and SF-36) in the same week. The procedure was repeated after 4 weeks. We tested content validity, construct validity, criterion validity, test-retest reliability and internal consistency reliability according to total score, domains and items. We found that both the generic instruments (NHP and SF-36) and the disease-specific test (WOMAC) had a high validity, i.e., measuring what they were supposed to measure (high validity). The questionnaires were also reproducible over time (high reliability). We suggest the Swedish WOMAC to be used after total hip arthroplasty in future studies.     

Validity and reliability of Swedish WOMAC osteoarthritis index: A self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP)

We assessed whether a disease-specific, self-administered questionnaire could replace a generic instrument as an outcome tool after total hip replacement, and tested the validity and reliability of the Swedish WOMAC osteoarthritis index. 58 patients operated on with total hip arthroplasty 2-10 years ago were randomized to the study. All patients were asked to answer one disease-specific questionnaire (WOMAC osteoarthritis index) and two generic instruments (NHP and SF-36) in the same week. The procedure was repeated after 4 weeks. We tested content validity, construct validity, criterion validity, test-retest reliability and internal consistency reliability according to total score, domains and items. We found that both the generic instruments (NHP and SF-36) and the disease-specific test (WOMAC) had a high validity, i.e., measuring what they were supposed to measure (high validity). The questionnaires were also reproducible over time (high reliability). We suggest the Swedish WOMAC to be used after total hip arthroplasty in future studies.     

Validity and reliability of Swedish WOMAC osteoarthritis index: A self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP)

We assessed whether a disease-specific, self-administered questionnaire could replace a generic instrument as an outcome tool after total hip replacement, and tested the validity and reliability of the Swedish WOMAC osteoarthritis index. 58 patients operated on with total hip arthroplasty 2-10 years ago were randomized to the study. All patients were asked to answer one disease-specific questionnaire (WOMAC osteoarthritis index) and two generic instruments (NHP and SF-36) in the same week. The procedure was repeated after 4 weeks. We tested content validity, construct validity, criterion validity, test-retest reliability and internal consistency reliability according to total score, domains and items. We found that both the generic instruments (NHP and SF-36) and the disease-specific test (WOMAC) had a high validity, i.e., measuring what they were supposed to measure (high validity). The questionnaires were also reproducible over time (high reliability). We suggest the Swedish WOMAC to be used after total hip arthroplasty in future studies.     

Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS)

Background and purpose

A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused.

Patients and methods

The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman’s correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach’s alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37).

Results

For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88–0.95), Cronbach’s alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00.

Interpretation

SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.A self-administered ankle questionnaire based on the validated Oxford-12 questionnaire for total hip replacement has been constructed by the New Zealand National Joint Registry. The aim was to collect patient-based data after total ankle replacement (TAR) as an amendment to medically recorded joint-specific data and it proved to be useful, particularly in the prediction of failures (Hosman et al. 2007). However, the original version of the questionnaire has not been validated.Already existing self-administrated foot and ankle scores contain numerous questions and can be complicated to use. For osteoarthritis and inflammatory arthritis of the ankle, there are few validated instruments and they are seldom used (Budiman-Mak et al. 1991, Button and Pinney 2004, Naal et al. 2010). None can be regarded as the gold standard. The generic, self-administered questionnaires short form 36 (SF-36) (Sullivan et al. 1995, Patel et al. 2007) and EuroQol (EQ-5D) (EuroQol Group 1990) are useful when evaluating general health, but they may be less effective when evaluating joint-specific disability.Thus, there is a need for a simple, self-administered and ankle-specific score that is capable of evaluating pain and functional status in patients with osteoarthritis and inflammatory arthritis of the ankle, and the outcome of surgical interventions—not least when collecting data for national surgical registers. We therefore assessed the validity, the reliability, and the responsiveness of the modified Swedish version of the New Zealand total ankle replacement questionnaire, here called the self-reported foot and ankle score (SEFAS), in relation to 3 established self-administered scoring systems. The reason for choosing the foot and ankle outcome score (FAOS) for comparison was that this region-specific score is the only one available in Swedish and the reason for choosing the generic scores SF-36 and EQ-5D was because they are widely used.     

Validity, reliability and responsiveness of a Dutch version of the prolapse quality-of-life (P-QoL) questionnaire

Introduction and hypothesis  

We aimed to test validity, reliability and responsiveness of a Dutch version of a prolapse quality-of-life questionnaire (P-QoL).     

Validity of a self-administered questionnaire, with reference to a clinical stress urinary incontinence test

OBJECTIVE: To estimate the criterion validity of a self-administered questionnaire on urinary incontinence (UI) using a clinical stress UI test as reference. MATERIAL AND METHODS: A total of 4710 women aged 20-59 years randomly selected from the municipalities of Aarhus and Randers (Denmark) participated in a population survey on UI. A sub-sample of 96 women stratified by the duration and frequency of UI answered an assisted, self-administered questionnaire concerning UI during the preceding 6 months. Subsequently, a clinical stress UI test was performed with the researchers being blinded with regard to the questionnaire information. RESULTS: Based on the clinical stress test and questionnaire, 22 (22.7%) and 21 women (21.6%) had stress UI, respectively. UI occurring in more than drops and UI lasting for > 4 weeks were found to be adequate predictors of UI (odds ratio 8.9 and 4.6; p < 0.001 and p < 0.05). Regarding all forms of UI, the agreement between the stress UI test result and the questionnaire data ranged from 51.0% to 77.1%. The probability of finding a positive stress UI test was 62% among women who answered that UI had lasted for > 4 weeks and occurred in more than drops, compared to 22.9% in the total study group. The sensitivity and specificity of the stress UI test among women in whom UI lasted for > 4 weeks and occurred in more than drops were 22.7% and 95.9%, respectively. CONCLUSIONS: These findings suggest that there is a greater probability of finding severe UI if the women have experienced it in more than drops and it has lasted for > 4 weeks and it is therefore necessary to estimate the degree of incontinence further by means of a stress UI test. In contrast, women who experienced UI in less than drops and for a duration of < 4 weeks only suffered from a very mild degree of UI.     

Validation of a self-administered urological questionnaire

Self-administered questionnaires are widely used in clinical practice and as an aid to research. However, their reliability as a means of eliciting symptoms of urological disease has not been established. A questionnaire designed to elicit symptoms of urological disease was validated in 120 patients (36 out-patients, 27 in-patients and 57 community patients). All found the questionnaire acceptable and the completion rate was 99%. Only 3 of 648 answers were changed on the test-retest analysis. Consistency, as assessed by a comparison of responses by clinician and patient, was satisfactory in 11 of 15 questions relating to urological symptoms and the questionnaire successfully identified a high risk group of patients from the community requiring further urological evaluation. The need to include results of a preliminary validation study when reporting results obtained by a self-administered questionnaire is emphasised.     

Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: Test-retest reliability

A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%–91.0% for symptoms and 44.6%–82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.EDITORIAL COMMENT: The development of well designed methods to track patient outcome to treatment modalities remains paramount. An initial step in this process is the design of validated instruments to measure quality of life and symptom distress. The authors present their initial experience with a constructed self-administered patient questionnaire. While this instrument is still in the testing phase (lacking the necessary sample size and necessary validation), and is far from perfect, it represents the necessary groundwork through which all researchers interested in this field of study must progress. Hopefully others attempting to design similar questionnaires will learn from their experience.     

Validity and reliability of the loco-check questionnaire after cross-cultural adaptation for Indonesia

BackgroundA large number of the elderly in Indonesia are affected by an increasing number of disabilities, with reduced mobility being one of the causes. Locomotive syndrome may cause decreased mobility, and its progression can impair the activities of daily living. Early screening is essential to halt its progression. The loco-check, a screening tool for locomotive syndrome, is available in English. A cross-cultural adaptation of this tool for an Indonesian version is important to maintain the validity of the questionnaire for its implementation in Indonesia. The aim of this study was to obtain a valid Indonesian version of the loco-check questionnaire that has been adapted as per Indonesian language and cultural conventions (through a cross-cultural adaptation process).MethodsThe subjects in the study were community-dwelling geriatrics over 65 years of age who were recruited using consecutive non-probability judgment sampling according to the inclusion criteria. This study, conducted from February to October 2019, was divided into two stages consisting of: (1) language and cultural adaptation; (2) validity and reliability testing. The seven items on the loco-check were translated using forward-backward translation. The final questionnaire was generated through an expert panel discussion. The validity and reliability were evaluated using concurrent validity and Cronbach's alpha using SPSS Version 23.0.ResultsIn the first stage, the first and second trials showed a strong correlation between the English and Indonesian versions of the questionnaire with r = 0.997 (p < 0.001) and r = 0.825 (p = 0.003), respectively. The final Indonesian version of the loco-check had a good validity and reliability with r = 0.981 (p < 0.001) and Cronbach's alpha of 0.768, respectively.ConclusionThe Indonesian cross-cultural adaptation of the loco-check questionnaire is a valid and reliable general questionnaire that could enable screening for locomotive syndrome in Indonesia.     

Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy

Background  

The VISA-P questionnaire evaluates severity of symptoms, knee function and ability to play sports in athletes with patellar tendinopathy. This English-language self-administered brief patient outcome score was developed in Australia to monitor rehabilitation and to evaluate outcome of clinical studies. Aim of this study was to translate the questionnaire into Dutch and to study the reliability and validity of the Dutch version of the VISA-P.     

The Oxford ankle foot questionnaire for children: scaling, reliability and validity

We developed the Oxford ankle foot questionnaire to assess the disability associated with foot and ankle problems in children aged from five to 16 years. A survey of 158 children and their parents was carried out to determine the content, scaling, reliability and validity of the instrument. Scores from the questionnaire can be calculated to measure the effect of foot or ankle problems on three domains of children's lives: physical, school and play, and emotional. Scores for each domain were shown to be internally consistent, stable, and to vary little whether reported by child or parent. Satisfactory face, content and construct validity were demonstrated. The questionnaire is appropriate for children with a range of conditions and can provide clinically useful information to supplement other assessment methods. We are currently carrying out further work to assess the responsiveness of questionnaire scores to change over time and with treatment.     

Validity and reliability of a questionnaire for evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population

OBJECTIVES: To validate a new questionnaire evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population of men and women in Denmark. METHODS: The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) emerged from review of the literature and expert consensus. The questionnaire was a subset of a larger questionnaire comprising several domains on health status and voiding. Convergent and discriminatory validity was assessed in an unselected population of 2000 men and 2000 women 60-80 years old. To test reproducibility, 400 respondents were mailed a separate questionnaire 2 weeks apart. A subgroup of men and women with and without nocturia was used for evaluating reliability of number of nocturia episodes. RESULTS: A total of 2825 (70.6%) filled in the questionnaire. A decrease in health status was correlated with increasing bother (range: -0.25 to -0.36, p<0.001, Spearman's r). These findings indicate acceptable convergent validity. Significant discriminatory validity was proven in separate groups of symptom severity (p<0.0001, Kruskal-Wallis test). Median kappa was 0.70 (range 0.58-0.86) indicating substantial agreement in the retest analysis. Number of nocturia episodes in questionnaires correlated with frequency volume charts (Spearman's rho 0.88; p<0.001). CONCLUSION: These data support that the NNES-Q has a good discriminatory and convergent validity, and is reliable over time. The NNES-Q may be useful in epidemiological studies and may also have a potential in daily clinical work up in patients with nocturia and nocturnal enuresis.     

Validity and reliability of Chinese version of the new diabetic foot ulcer assessment scale

A specific assessment tool is urgently needed to guide effective wound care for diabetic foot ulcers. However, the tool has not been available in Chinese. We aimed to culturally translate and verify the validity and reliability of the new Diabetic Foot Ulcer Assessment Scale (DFUAS). The original scale was translated into Chinese according to the Brislin guidelines. Patients satisfying the inclusion and exclusion criteria were recruited. Each of the included foot ulcers was evaluated independently by two wound care specialists using the new DFUAS and by the third wound care specialists at the same time using the Bates-Jensen Wound Assessment Tool according to per guidelines. 210 diabetic foot ulcers were included for data analysis. The S-CVI of the Chinese version of the DFUAS was 0.96, and the I-CVIs ranged from 0.89 to 0.98. The total Cronbach's Alpha of the scale was 0.709, and the corrected item-total correlation of the items ranged from 0.4 to 0.872. The DFUAS had high inter-observer reliability of 0.997, and there were weak, moderate, and strong correlations between each pair of the items. The Bland–Altman plots showed a good agreement between the scale and the Bates-Jensen Wound Assessment Tool. We concluded that the Chinese version of the DFUAS showed good validity and reliability and is a reliable instrument for the assessment of diabetic foot ulcers.     

Urinary continence following radical prostatectomy assessed by a self-administered questionnaire

OBJECTIVES: A total aim of this study was to assess the incidence of urinary incontinence in patients following radical prostatectomy and determine the factors that may influence this incidence. METHODS: A total of 135 men underwent radical retropubic prostatectomy at our center between 1987 and 1997. 120 patients were sent a questionnaire regarding preoperative and postoperative voiding habits. Data collected included preoperative and postoperative continence status, interval to postoperative continence status, associated urinary symptoms, willingness to undergo radical prostatectomy again if need be and additional postoperative procedures. Patient age, date of surgery, number of neurovascular bundles resected at prostatectomy and duration of follow-up were also noted. RESULTS: Of the 120 patients, 116 (96.7%), a mean of 65.2 (range 48-76) years old, responded to the questionnaire. Mean follow-up was 4.3 years (range 1-10.8). Continence was defined as no regular use of pads. Our overall urinary incontinence rate was 14.4%. Of the respondents, 88. 8% (103/116) had achieved final continence status by 6 months postoperatively, and 95% (110/116) would undergo surgery again if need be. Of the patients considered incontinent postoperatively, 66. 6% had associated urgency. Age, year of surgery, number of neurovascular bundles resected at prostatectomy, preoperative urinary leakage of postvoiding dribbling, postoperative pelvic floor exercises, and anastomotic stricture had no significant impact on postoperative continence status. CONCLUSIONS: Using an anonymous self-administered questionnaire, we found a 14.4% incontinence rate after radical prostatectomy. These results allow patients to have realistic expectations when counseled prior to this operation.     

Development of a self-administered questionnaire to screen patients for cervical myelopathy

Background  

In primary care, it is often difficult to diagnose cervical myelopathy. However, a delay in treatment could cause irreversible aftereffects. With a brief and effective self-administered questionnaire for cervical myelopathy, cervical myelopathy may be screened more easily and oversight may be avoided. As there is presently no screening tool for cervical myelopathy, the aim of this study was to develop a self-administered questionnaire for the screening of cervical myelopathy.     

A self-administered questionnaire for basal osteoarthritis of the thumb

Basal osteoarthritis of the thumb is a common condition for which numerous operations have been proposed without any particular one having been shown to be superior. One of the problems in evaluating the results of surgery is that there is no validated outcome score specifically for the condition. The purpose of this study was to construct a self-administered questionnaire (the Nelson score) to assess the outcome following surgery for this condition and to test its properties. Correlating the questionnaire score with physical findings on clinical examination showed external validity and test-retest reliability was high. Simultaneous administration of the score with the DASH score, both before and after surgery, showed it to be more sensitive to change (P=0.056). In addition, it is shorter than the DASH score, which may make it more acceptable to patients.