Which questionnaire is best? The reliability, validity and ease of use of the Patient Evaluation Measure, the Disabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure

The Patient Evaluation Measure (PEM), The Michigan Hand Outcome Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed independent of their originators for reliability, construct and criterion validity and acceptability, using an ease of use questionnaire. These were administered in random order to 100 patients with different hand and wrist disorders and with different impairments of movement, pain, sensation and strength. The internal consistency of all three questionnaires was very high suggesting redundancy in the questions. All questionnaires were reproducible and valid for finger and wrist disorders, but less for nerve disorders. All had poor construct validity. The PEM was the easiest to understand and complete, taking the least time. Correlation between the scales is high and conversion equations were calculated. All three are reliable and reproducible patient completed questionnaires, but the PEM is the easiest to use. The validity of all is suspected for nerve disorders.     

Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity.

The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was developed to evaluate disability and symptoms in single or multiple disorders of the upper limb at one point or at many points in time. PURPOSE: The purpose of this study was to evaluate the reliability, validity, and responsiveness of the DASH in a group of diverse patients and to compare the results with those obtained with joint-specific measures. METHODS: Two hundred patients with either wrist/hand or shoulder problems were evaluated by use of questionnaires before treatment, and 172 (86%) were re-evaluated 12 weeks after treatment. Eighty-six patients also completed a test-retest questionnaire three to five days after the initial (baseline) evaluation. The questionnaire package included the DASH, the Brigham (carpal tunnel) questionnaire, the SPADI (Shoulder Pain and Disability Index), and other markers of pain and function. Correlations or t-tests between the DASH and the other measures were used to assess construct validity. Test-retest reliability was assessed using the intraclass correlation coefficient and other summary statistics. Responsiveness was described using standardized response means, receiver operating characteristics curves, and correlations between change in DASH score and change in scores of other measures. Standard response means were used to compare DASH responsiveness with that of the Brigham questionnaire and the SPADI in each region. RESULTS: The DASH was found to correlate with other measures (r > 0.69) and to discriminate well, for example, between patients who were working and those who were not (p<0.0001). Test-retest reliability (ICC = 0.96) exceeded guidelines. The responsiveness of the DASH (to self-rated or expected change) was comparable with or better than that of the joint-specific measures in the whole group and in each region. CONCLUSIONS: Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH. This study also demonstrated that the DASH had validity and responsiveness in both proximal and distal disorders, confirming its usefulness across the whole extremity.     

Validation of the Korean version of the Roland�CMorris Disability Questionnaire

We evaluated the reliability and validity of an adapted Korean version of the Roland–Morris Disability Questionnaire (RMDQ). Translation/retranslation of the English version of RMDQ was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the Visual Analog Scale (VAS) measure of pain, RMDQ, and the previously validated Oswestry Disability Index (ODI) were mailed to 100 consecutive patients with chronic lower back pain (LBP) of at least 3 months. Eighty-one patients responded to the first mailing of questionnaires and 63 of the first-time responder returned their second survey. The average age of the 63 patients (45 female, 18 male) was 47.8 years. Reliability assessment was determined by estimating kappa statistics of agreement for each item, the intraclass correlation coefficient (ICC), and Cronbach’s α. Concurrent validity was evaluated by comparing the responses of RMDQ with the results of VAS and responses of ODI by using Pearson’s correlation coefficient. The constructed Bland–Altman plot showed a good reliability. All items had a kappa statistics of agreement greater than 0.6. The RMDQ showed excellent test/re-test reliability as evidenced by the high ICC for 2 test occasions (ICC = 0.932, P < 0.001). Internal consistency was found to be very good at both assessments with Cronbach’s α (0.942 and 0.951 at first and second assessments, respectively). The RMDQ was correlated with the VAS (r = 0.692; P = 0.000 and r = 0.668; P = 0.000 at first and second assessments, respectively), and with the ODI (r = 0.789; P = 0.000 and r = 0.802; P = 0.000, respectively). The adapted Korean version of the RMDQ was successfully translated and showed acceptable measurement properties, and as such, is considered suitable for outcome assessments in the Korean speaking patients with LBP.     

Quality of Life following Laparoscopic Adjustable Gastric Banding – the Swedish Band and the Moorehead-Ardelt Questionnaire

Background: Although weight loss is an important immediate outcome after gastric banding operations, quality of life (QOL) has been shown to be an equally important outcome measure. Methods: From 1996 to May 2002, 125 consecutive patients have been operated laparoscopically for morbid obesity at our institution with the Swedish Adjustable Gastric Band (SAGB). We compared the Moorehead-Ardelt QOL scores of the first 60 patients, operated at a median of 2 years earlier, with a group consisting of the following consecutive 65 patients, who answered the questionnaire preoperatively. Results: The QOL scores among the operated patients were significantly better (P<0.0001, unpaired t-test) on all domains of the Moorehead-Ardelt questionnaire compared to those not yet operated. Conclusions: Laparoscopic banding with the SAGB has been a safe procedure, with satisfactory weight loss and significant improvement in QOL scores 2 years postoperatively.     

Validation of the Greek Translation of the Obesity-Specific Moorehead–Ardelt Quality-of-Life Questionnaire II

Morbid obesity adversely affects quality of life. The assessment of health-related quality of life (HRQoL) needs specific measuring instruments. The Moorehead–Ardelt Quality-of-Life Questionnaire II (MA II) is an obesity-specific instrument widely used in bariatric surgery. The objective of this study was to translate and validate the MA II in Greek language. The study included the translation of the MA II followed by cross-validation with the Greek version of 36-item Short Form Health Survey (SF-36) and a Visual Analogue Scale (VAS) in subjects visiting an obesity clinic. Internal consistency was indicated by Cronbach’s alpha coefficient and test–retest reliability by intraclass correlation coefficient (ICC). Construct validity was studied using Pearson’s correlations between the MA II, the SF-36 and the VAS. A total of 175 patients were enrolled in the study. Test–retest analysis was applied to 40 patients with a 15-day interval. A very good internal consistency with Cronbach’s alpha coefficient of 0.85 was shown. Excellent test–retest reliability was observed with an overall ICC of 0.981. Significant correlations between the Greek MA II and the other instruments as well as of each item of the MA II with the scores of SF-36 and the VAS indicated high construct and convergent validity. A negative correlation between the translated MA II total score and BMI confirmed high clinical validity. The Greek version of the MA II questionnaire has been generated and shown to be valid and reliable in measuring HRQoL in morbidly obese patients before and after bariatric surgery.     

Validity and responsiveness of the French version of the Örebro Musculoskeletal Pain Screening Questionnaire in chronic low back pain

Purpose

The assessment of a broad range of biopsychosocial aspects is important in the rehabilitation of patients with chronic low back pain (CLBP) for the prediction of outcome as well as for evaluation. The objective of this study was to test the responsiveness, construct validity and predictive value of the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) compared to other instruments widely used to assess biopsychosocial aspects in patients with CLBP.

Methods

111 patients with CLBP admitted to an inpatient rehabilitation completed a set of questionnaires on biopsychosocial aspects at baseline and at discharge. Ninety-eight patients responded at three months for an assessment of the return to work status. Responsiveness of the OMPSQ, the ability to detect change in the construct of interest, was investigated by a set of hypotheses on correlations with widely used questionnaires. We tested the hypothesis that the changes in the OMPSQ would vary along with the responses in the Patient’s Global Impression of Change. Prediction of disability at discharge, work status at three months and time to return to work was evaluated with linear, logistic and cox regression models.

Results

The OMPSQ showed good predictive values for disability and return to work and construct validity of the instrument was corroborated. Seventy-nine percent of our hypotheses for responsiveness could be confirmed, with the OMPSQ showing the second highest change during the rehabilitation.

Conclusions

The OMPSQ can also be applied in patients with CLBP, but for the assessment of change in psychosocial variables one should add specific questionnaires.

     

Ewings Sarcoma of the Hand—A Case Report

Ewings sarcoma of the hand is relatively rare. Ewings sarcoma can present with minimal pain and swelling of the affected digit. The Erythrocyte sedimentation rate and C-reactive protein may be high. Radiologically, Ewings sarcoma can present with a plethora of features from permeative bone destruction to expansile lesions with or without periosteal reaction. Because of these features, this can be confused with Tuberculosis especially in a country like ours where Tuberculosis is endemic. This leads to starting of inappropriate treatment and delay in diagnosis. We report a case of an 18 year old boy who was initially diagnosed as Tuberculous dactylytis of the proximal phalanx of the little finger. He was started on anti-tuberculous treatment and did not respond to it. Subsequent investigation in our centre which also included an open biopsy, confirmed the diagnosis of Ewings sarcoma. He was treated with ray excision, and chemotherapy. This case is being presented for its rarity and also to emphasize the fact that an open biopsy in suspected cases would be appropriate to confirm the diagnosis. This would prevent delay in diagnosis of rare conditions like Ewings sarcoma.     

The Italian version of the Oxford 12-item Knee Questionnaire—cross-cultural adaptation and validation

Questionnaires must be translated and adapted to suit the cultural characteristics of different countries with different languages; they then need to be validated using a standard process. This was done for the Italian version of the Oxford Knee Questionnaire (OKQ), and its reliability and validity were assessed in a cross-sectional study of 50 consecutive patients referred for gonarthrosis and whose knees were replaced. A "subsample" of 20 patients was assessed prospectively to confirm the reliability of the Italian version, and these results were then compared with other clinical studies. The Italian OKQ scale correlated well with other clinical studies and also showed good results with regard to reproducibility, consistency, and validity when compared to the other published versions of the OKQ.