French translation and validation of 3 functional disability scales for neck pain

OBJECTIVE: To translate and assess the reliability and the construct validity of 3 functional disability scales for neck pain. DESIGN: Reliability and validity study. SETTING: Tertiary care teaching hospital and outpatient clinic. PARTICIPANTS: One hundred one patients (mean age, 49 y). INTERVENTION: French translations were obtained by using the "translation-backward translation" method. Adaptations were made after a pilot study. MAIN OUTCOME MEASURES: Impairment outcome measures (visual analog scale [VAS] pain, neck range of motion, morning stiffness, score of neck sensitivity, radiologic score of Kellgren) and patients' perceived handicap (VAS) were recorded at the baseline visit. Three functional disability scales (Neck Disability Index [NDI], Neck Pain and Disability Scale [NPDS], Northwick Park Neck Pain Questionnaire [NPQ]) were recorded twice, at baseline visit and 24 hours later. Reliability was assessed by using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated by using the Spearman rank correlation coefficient and a factor analysis was performed. RESULTS: Test-retest was excellent for the NPDS and NDI (ICC =.91,.93, respectively) and good for the NPQ (ICC =.84). The Bland and Altman method showed no systematic trend. Expected convergent and divergent validity were observed only for the NPDS; 3 main factors were extracted by factor analysis and explained 78% of the cumulative variance. CONCLUSION: The 3 translated scales are valid, but the NPDS seems to have the best construct validity.     

Self-rated disability,fear-avoidance beliefs,nonorganic pain behaviors are important mediators of ranges of active motion in chronic whiplash patients

Abstract

Purpose: The influence of self-rated disability and fear-avoidance beliefs on whiplash sufferers in their performance of active ranges of motion has not been studied well. We undertook a cross-sectional study to determine this. Methods: Chronic whiplash subjects completed a standard clinical examination. They completed the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK) and pain visual analog scale (VAS). Active ranges of motion (goniometer) and cervical nonorganic simulation signs (C-NOSS) were obtained by the examiner. Univariate and multivariable analyses were conducted on these scores. Results: Sixty-four subjects (37 female) with a mean age of 41.4 (SD 16.1) years completed all scores. NDI, pain VAS and C-NOSS correlated significantly with ROM. In a multivariable model, only the NDI score contributed significantly to the variance of the ROM scores (14%). Conclusion: As chronic whiplash sufferers perform ROM in a clinical examination, these ranges are importantly influenced by their self-perceived disability. Cervical nonorganic simulation signs can be helpful in distinguishing high from very high levels of disability and motion restriction. The lack of correlation with the TSK may present a challenge to the Fear Avoidance Model in whiplash.

• Implications for Rehabilitation

• Self-ratings of disability in chronic whiplash sufferers are influenced by their fear-avoidance beliefs.

• While self-ratings of disability are known to predict chronicity of whiplash, there is less known about how these ratings affect impairment assessment during recovery.

• This study shows that self-ratings of disability influence the presentation of impairment by chronic whiplash sufferers with respect to their ranges of neck motion.

• Signs of nonorganic behavior also influence ranges of motion and self-ratings of disability.

• These findings should be incorporated into the interpretation of impairment findings in chronic whiplash sufferers in order to improve management.

     

Validity of the Neck Disability Index and Neck Pain and Disability Scale for measuring disability associated with chronic, non-traumatic neck pain

The purpose of this study was to evaluate the construct and content validity of the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD) in patients with chronic, non-traumatic neck pain. Twenty patients (mean age=64.5 years) completed a patient-specific questionnaire, the Problem Elicitation Technique (PET), followed by the NDI and NPAD. Content validity was assessed by comparing the items of the NDI and NPAD with problems identified from the PET. Construct validity of the fixed-item questionnaires was examined by establishing the correlation with each other, and with the PET score. Eleven common problems were identified by patients through the PET, of which six were included in the NDI and seven included in the NPAD. The NDI and NPAD scores were strongly correlated (r=0.86, p<0.01), while the correlation between the PET and the fixed-item questionnaires was moderate (NDI: r=0.62, p<0.01; NPAD: r=0.71, p<0.01). Both the NDI and the NPAD include most of the functional problems common to this patient group, and display good content validity. The PET is better able to evaluate the problems specific to the individual patient and is therefore measuring a somewhat different construct to the fixed-item questionnaires.     

Measurement of cervical flexor endurance following whiplash

AIM: To investigate measurement properties of a practical test of cervical flexor endurance (CFE) in whiplash patients including inter-rater reliability, sensitivity to clinical change, criterion related validity against the Neck Disability Index (NDI), and discriminant validity for injured versus uninjured populations. METHODS: Two samples were recruited, 81 whiplash patients, and a convenience sample of 160 subjects who were not seeking treatment and met criteria for normal pain and range of motion. CFE was measured using a stopwatch while the subject, in crook lying, held their head against gravity to fatigue. RESULTS: Inter-rater reliability in whiplash patients was in a range considered 'almost perfect' (Intraclass Correlation=0.96). CFE had greater inter-subject variability than the NDI or range of motion in any of three planes. However, the effect size for improvement in CFE over treatment was as large as the effect sizes for all of those measures. In multivariate regression, CFE changes accounted for changes on the NDI better than the three ranges of motion. CFE discriminated whiplash patients who were within six months of injury (n=71) from age and gender matched normals with high effect size (ES=1.5). CONCLUSIONS: These findings provide evidence of reliability and validity for CFE measurement, and demonstrate that CFE detects clinical improvements. Variance on CFE emphasizes the need to consider inter-, and intra-subject standard deviations to interpret scores.     

Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale

OBJECTIVES: The objective of this study was to test whether a Turkish version of the Neck Pain and Disability Scale retains its reliability and validity of the original English version. METHODS: Sixty-one patients with chronic neck pain were enrolled in the study. The Neck Pain and Disability Scale (NPDS), the Pain Disability Index (PDI) and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbach's alpha and item-total correlation. Validity was examined by correlating the NPDS scores to the Visual Analogue Scale (VAS), PDI and HADS scores. RESULTS: Cronbach's alpha value for NPDS was found to be 0.86 and this was statistically significant (p<0.0001). The item-total correlations of NPDS varied between 0.08 and 0.69. The cross-sectional construct validity coefficients were 0.51 for PDI, 0.45 for VAS, 0.35 and 0.33 for Hospital Anxiety and Depression Scales. CONCLUSION: Despite its major limitations, our results seem to support previous findings of the English and French versions of the Neck Pain and Disability Scale, indicating that this functional scale is valid and reliable.     

The Bournemouth Questionnaire for Neck Pain: Cross-cultural Adaptation,Reliability, and Validity of the Turkish Version

ObjectiveThe aim of this study was first to translate and culturally adapt the BQN, and then to investigate the validity and reliability of the Turkish version of the BQN in Turkish individuals with chronic neck pain.MethodsThe English version of the BQN was translated into Turkish with permission from its authors. That translation was assessed using 85 participants with a mean age of 46.75 years who had chronic neck pain. At the same time, the participants were assessed sociodemographically and with the Neck Disability Index (NDI) and the Neck Pain and Disability Scale (NPAD). A test–retest procedure was performed with 62 participants who underwent a second assessment with the BQN within 24 hours of the first assessment, to test its reliability.ResultsInternal consistency was strong and all Cronbach alpha values were between 0.97 and 0.99. The BQN showed high test–retest reliability (intraclass correlation coefficient ˃ 0.92) for all domains. The total mean (± standard deviation) scores for the 3 questionnaires were as follows: BQN, 30.9 (± 11.18); NPAD, 48.16 (± 12.93); NDI, 17.85 (± 6.29). The results of the Turkish version of the BQN illustrated adequate external construct validity and sensitivity. A Turkish translation of the test has not previously been available for chronic pain.ConclusionThe BQN was successfully translated and culturally adapted into Turkish. The reliability and validity were tested against the NPAD and the NDI. The Turkish version of the BQN is multidimensional, short, practical, and suitable for use with individuals with neck pain.     

Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain

Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.

Objective

To examine the psychometric properties including test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and the numeric rating scale (NRS) for pain in a cohort of patients with neck pain.

Design

Single-group repeated-measures design.

Setting

Outpatient physical therapy (PT) clinics.

Participants

Patients (N=137) presenting to PT with a primary report of neck pain.

Interventions

Not applicable.

Main Outcome Measures

All patients completed the NDI and the NRS at the baseline examination and at a follow-up. At the time of the follow-up, all patients also completed the global rating of change, which was used to dichotomize patients as improved or stable. Baseline and follow-up scores were used to determine the test-retest reliability, construct validity, and minimal levels of detectable and clinically important change for both the NDI and NRS.

Results

Test-retest reliability was calculated using an intraclass correlation coefficient (ICC) (NDI ICC=.50; 95% confidence interval [CI], .25-.67; NRS ICC=.76; 95% CI, .51-.87). The area under the curve was .83 (95% CI, .75-.90) for the NDI score and .85 (95% CI, .78-.93) for the NRS score for determining between stable and improved patients. Thresholds for the minimum clinically important difference (MCID) for the NDI were 19-percentage points and 1.3 for the NRS.

Conclusions

Both the NDI and NRS exhibit fair to moderate test-retest reliability in patients with mechanical neck pain. Both instruments also showed adequate responsiveness in this patient population. However, the MCID required to be certain that the change in scores has surpassed a level that could be contributed to measurement error for the NDI was twice that which has previously been reported. Therefore the ongoing analyses of the properties of the NDI in a patient population with neck pain are warranted.     

The relationship between self-rated disability, fear-avoidance beliefs, and nonorganic signs in patients with chronic whiplash-associated disorder

Objectives

The purpose of this study was to determine the role of standard and novel (cervical) nonorganic signs in patients with chronic whiplash-associated disorder (WAD).

Methods

Chronic WAD I to III patients (>3 months) were recruited from private chiropractic practice in Canada. Subjects completed a Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), pain visual analog scale, and pain diagram. Clinical and demographic data were also obtained. Nine standard nonorganic pain behavior tests and 4 novel cervical nonorganic simulation signs (C-NOSS) tests were applied. Bivariate correlations were obtained with the Pearson correlation coefficient. Items achieving statistical significance on univariate analysis were loaded in a sequential linear regression analysis. Post hoc analyses were conducted with analysis of variance tests of NDI and TSK scores.

Results

Ninety-one subjects were investigated (49 males and 42 females), with a mean age of 41.7 (SD, 14.7) years and a mean duration of 9.4 (SD, 11.2) months. Because mean NDI scores were 57.5 (SD, 17.8) and mean pain scores were 68.3 (SD, 21.0), this sample represents moderate-to-severe WAD. Fair to moderately strong correlations were obtained between the NDI and the TSK, pain visual analog scale and nonorganic symptoms and signs (NOS-9) and C-NOSS scores, but not with “age,” “sex,” or “duration.” The NOS-9 and C-NOSS scores correlated most strongly at 0.70. A multivariate model accounting for 53% of the variance of the NDI scores (P < .001) was obtained with the TSK, pain severity, and NOS-9 scores. There was no significant correlation between C-NOSS and TSK scores. At least 25% of subjects scored either 5 of 9 or 2 of 4 on the NOS-9 and C-NOSS tests, respectively.

Conclusions

Based on the findings of this study, nonorganic signs should be considered in the interpretation of self-rated disability in patients with moderate-to-severe chronic WAD.     

The pediatric-modified total neuropathy score: a reliable and valid measure of chemotherapy-induced peripheral neuropathy in children with non-CNS cancers

Background

Neurotoxicity is a common side-effect of cancer treatment, but no scales have been validated for the pediatric population. The objective of this study was to test the reliability and validity of the pediatric modified-Total Neuropathy Scale (ped-mTNS) to measure chemotherapy-induced peripheral neuropathy in school-aged children.

Methods

Forty-one subjects aged 5–18 years undergoing chemotherapy with vincristine or cisplatin and 41 age- and gender-matched controls completed study measures. Subjects were tested with the ped-mTNS at a specified time during treatment. Standardized measures of balance and hand function were completed concurrently. Internal consistency of the ped-mTNS was evaluated using Chronbach’s alpha. Validity was tested by comparing case and control ped-mTNS scores as well as testing the hypothesis that ped-mTNS scores would be associated with scores on tests of balance and manual dexterity. Inter-rater and test–retest reliability were each assessed in a subset of 10 subjects.

Results

Twenty-three subjects with acute lymphoblastic leukemia, six with lymphoma, and 12 with solid tumors completed measures along with 41 age- and gender-matched controls. Internal consistency was acceptable with a Chronbach’s alpha of 0.76. Children undergoing treatment for cancer had significantly worse scores on the ped-mTNS compared to controls (subjects, 8.7?±?4.2; controls, 1.4?±?0.9; p?<?0.001). As hypothesized, scores on the ped-mTNS were associated with measures of balance and manual dexterity. Inter-rater and test–retest reliability was acceptable (intraclass correlation coefficients >0.9 each).

Conclusions

The ped-mTNS is a reliable and valid measure of chemotherapy-induced peripheral neuropathy in school-aged children that is associated with relevant functional limitations.     

A comparison of five low back disability questionnaires: reliability and responsiveness.

BACKGROUND AND PURPOSE: The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. SUBJECTS AND METHODS: Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. RESULTS: Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other. DISCUSSION AND CONCLUSION: Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.     

Measurement of cervical flexor endurance following whiplash

Aim.?To investigate measurement properties of a practical test of cervical flexor endurance (CFE) in whiplash patients including inter-rater reliability, sensitivity to clinical change, criterion related validity against the Neck Disability Index (NDI), and discriminant validity for injured versus uninjured populations.

Methods.?Two samples were recruited, 81 whiplash patients, and a convenience sample of 160 subjects who were not seeking treatment and met criteria for normal pain and range of motion. CFE was measured using a stopwatch while the subject, in crook lying, held their head against gravity to fatigue.

Results.?Inter-rater reliability in whiplash patients was in a range considered ‘almost perfect’ (Intraclass Correlation?=?0.96). CFE had greater inter-subject variability than the NDI or range of motion in any of three planes. However, the effect size for improvement in CFE over treatment was as large as the effect sizes for all of those measures. In multivariate regression, CFE changes accounted for changes on the NDI better than the three ranges of motion. CFE discriminated whiplash patients who were within six months of injury (n?=?71) from age and gender matched normals with high effect size (ES?=?1.5).

Conclusions.?These findings provide evidence of reliability and validity for CFE measurement, and demonstrate that CFE detects clinical improvements. Variance on CFE emphasizes the need to consider inter-, and intra-subject standard deviations to interpret scores.     

Validity of the neck disability index,Northwick Park neck pain questionnaire,and problem elicitation technique for measuring disability associated with whiplash-associated disorders

The Neck Disability Index (NDI) and Northwick Park Neck Pain Questionnaire (NPQ) were developed to measure self-perceived disability from neck pain, including that which may arise from whiplash injury. However, there is little data specifically concerning their validity for whiplash-associated disorders (WAD). The aim of this study was to assess the validity of the NDI and NPQ as measures of outcome in WAD by comparing them to a patient preference questionnaire, the problem elicitation technique (PET), which identifies problems that are of most importance to the individual patient. A cross-sectional study of 71 patients with varying severity and duration of WAD were recruited from a private physiotherapy practice. All patients completed a standardized self-administered questionnaire that included demographic and clinical details as well as self-perceived pain and severity of symptoms, NDI and NPQ. A trained interviewer administered the PET. Construct validity of the disability measures was examined by determining their correlation with each other and with pain and severity of symptoms by calculating Pearson's correlation coefficients. Content validity of the NDI and NPQ was assessed by comparing the items of both questionnaires to the problems identified by the PET. Participants' mean age was 40.1 years (SD=14.3) and 59 were women (83.1%). Most patients were in WAD category I (n=23, 32.1%), or II (n=42, 59.2%). Mean NDI, NPQ, and PET scores were 40.7 (SD=17.0), 38.7 (SD=15.8), and 160.2 (SD=92.0, range 6.0-509.5), respectively. Correlations between the NDI and PET, NPQ and PET, and NDI and NPQ were r=0.57, 0.56 and 0.88, respectively. The PET identified an average of 7.7 problems per patient (SD=4.2, range 1-17 problems). Problems most commonly identified were work for wages (52.1%), fatigued during the day (50.7%), participation in sports (47.9%), depression (43.7%), drive a car (43.7%), socialize with friends (33.8%), sleep through the night (31.0%), frustration (31.0%), and anger (28.2%). Only three of these problems are included in the NDI (work, driving, and sleeping) and only four are included in the NPQ (work, driving, sleeping, and social activities). While both the NDI and NPQ include some problems that are common in patients with WAD, frequently identified problems, such as emotional and social items are absent. In contrast to the PET, neither instrument captures the full spectrum of disabilities judged to be important by the patient.     

Applicability,validity, and reliability of the Piper Fatigue Scale in postpolio patients

OBJECTIVE: To identify a scale that is potentially applicable for measuring the fatigue in postpolio patients and to evaluate its validity and reliability in this population. DESIGN: Interview survey of 64 individuals with postpolio syndrome and 25 healthy controls of similar age range, with retest in a subset of postpolio patients. The sample was recruited from a postpolio support group, a postpolio clinic, and the general community. Subjects completed the Piper Fatigue Scale, the Beck Depression Inventory, and the Chalder Fatigue Questionnaire during the interview. RESULTS: Face and content validity of the Piper Fatigue Scale was established by a team of experts and by a group of postpolio patients. The postpolio subjects had significantly higher Piper Fatigue Scale scores than the healthy control subjects (P < 0.001), demonstrating extreme groups validity. Convergent validity was shown with a strong positive correlation between Piper Fatigue Scale scores and Chalder Fatigue Questionnaire scores (r = 0.80). Reliability was also demonstrated with the Piper Fatigue Scale's high internal consistency (alpha = 0.98) and strong test-retest agreement (intraclass correlation coefficient = 0.98). CONCLUSIONS: The Piper Fatigue Scale is a valid and reliable tool for measuring postpolio fatigue. This scale may be useful in other studies of postpolio fatigue, including those gauging the effectiveness of various treatments for this fatigue.     

Test-retest reliability and internal consistency of the Quebec-French version of the Survey of Pain Attitudes

OBJECTIVE: To determine the test-retest reliability and internal consistency of the Quebec-French version of the Survey of Pain Attitudes (QAD/F-SOPA). DESIGN: Measurement of test-retest reliability (2-wk interval) and internal consistency. SETTING: Five rehabilitation settings that offer services to chronic pain patients. PARTICIPANTS: Convenience sample of 69 Francophone adults (having either French as the mother tongue or a good mastery of French) with musculoskeletal pain for a minimum of 6 months and stable pain condition during the test-retest interval. INTERVENTIONS: Completion of the QAD/F-SOPA twice within a 2-week interval. MAIN OUTCOME MEASURES: Test-retest reliability (Pearson r , 2-tail paired t test, P <.001) and internal consistency (Cronbach alpha at time 1). RESULTS: Fifty-six subjects completed the QAD/F-SOPA on both occasions. Except for the disability subscale, the r values fell between 0.7 and 0.9 (high correlation). For the paired t test, all subscales (except for control and medication) had a P value greater than .05, confirming their test-retest stability. All subscales showed satisfactory internal consistency estimates (0.7-0.9) except for the harm (.67) and disability (.64) subscales. CONCLUSIONS: Globally, the QAD/F-SOPA has good reliability and validity properties and meets the prerequisites for use for clinical and research purposes. The disability subscale shows weaker properties; further studies would help determine how it could be improved.     

Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale

Objectives:?The objective of this study was to test whether a Turkish version of the Neck Pain and Disability Scale retains its reliability and validity of the original English version.

Methods:?Sixty-one patients with chronic neck pain were enrolled in the study. The Neck Pain and Disability Scale (NPDS), the Pain Disability Index (PDI) and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbach's alpha and item-total correlation. Validity was examined by correlating the NPDS scores to the Visual Analogue Scale (VAS), PDI and HADS scores.

Results:?Cronbach's alpha value for NPDS was found to be 0.86 and this was statistically significant (p?<?0.0001). The item-total correlations of NPDS varied between 0.08 and 0.69. The cross-sectional construct validity coefficients were 0.51 for PDI, 0.45 for VAS, 0.35 and 0.33 for Hospital Anxiety and Depression Scales.

Conclusion:?Despite its major limitations, our results seem to support previous findings of the English and French versions of the Neck Pain and Disability Scale, indicating that this functional scale is valid and reliable.     

The Pain Belief Screening Instrument (PBSI): Predictive validity for disability status in persistent musculoskeletal pain

Purpose. To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated.

Method. Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement.

Results. The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks' lambda = 0.848, p < 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months.

Conclusion. The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.     

Measure of attitude toward menopause using the semantic differential model

A semantic differential instrument that measures adult women's attitudes toward menopause was constructed and validated. A volunteer sample of 504 women, 18 years or older, completed the pilot instrument of 45 bipolar adjective scales. A principal components factor analysis revealed 20 scales that loaded on one dominant factor; this factor accounted for 60% of the variance for the 20 scales. Cronbach alpha reliability was .96. The revised 20-scale instrument was called the Menopause Attitude Scale (MAS). A second sample of 419 women completed the MAS and one additional instrument for assessment of convergent and discriminant validity. Convergent validity was demonstrated by a correlation of r = .63 for the MAS with the Attitudes Toward Menopause Scale. Discriminant validity was demonstrated by a correlation of r = .42 for the MAS with the Attitudes Toward Old People Scale and a correlation of r = -.04 for the MAS with the Attitudes Toward Women Scale. Factor analysis of MAS scores revealed that one factor accounted for 61.5% of the variance for the 20 scales. The test-retest reliability for 39 subjects was .87. Multiple regression analysis identified age and menopausal status as significant explanatory variables for MAS scores.     

The reliability and validity of the physiological cost index in healthy subjects while walking on 2 different tracks

OBJECTIVE: To investigate the reliability and validity of the Physiological Cost Index (PCI) scores, as a measure of energy expenditure, when healthy subjects walk on 2 different tracks (20-m and 12-m figure eight tracks). DESIGN: Intra- and interrater reliability and construct validity. SETTING: Physiotherapy division of a university in London, UK. PARTICIPANTS: Forty healthy subjects (15 men, 25 women; mean age +/- standard deviation, 34.5+/-12.6 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Heart rate (in beats/min) and speed (in m/min) were used to calculate the PCI (in beats/m). Rate of oxygen consumption (VO2, in mL x kg(-1) x min(-1)) and oxygen cost (EO2, in mL x kg(-1) x m(-1)) were used as criterion estimates of energy cost EO2. Pearson correlation coefficients between the PCI, components of the PCI, EO2, and VO2 were used to quantify validity. Intrarater reliability was assessed in all participants and interrater reliability was assessed on a subset of 13 subjects using intraclass correlation coefficients and Bland-Altman plots. RESULTS: Intrarater (r=.73, r=.79) and interrater (r=.62, r=.66) reliability were acceptable between PCI scores from 20-m and 12-m tracks, respectively. Correlations between VO2 and EO2 with PCI were weak. PCI scores from the 20-m track were significantly lower than those on the 12-m track (P=.002). Subjects walked significantly faster on the 20-m track (P<.001). Results suggest a large difference in PCI scores would be necessary to indicate a "true" alteration in performance (52% for 20-m track, 43.4% for the 12-m track). CONCLUSIONS: The PCI is reliable but not valid as a measure of the energy cost of walking in healthy subjects, on either track. The 20-m track is recommended for clinical use because it enables subjects to walk at a faster pace.     

The impact of non-injury-related factors on disability secondary to whiplash associated disorder type II: a retrospective file review

BACKGROUND: There is evidence to suggest that Whiplash Associated Disorders (WADs) are influenced by physical trauma and psychosocial factors, as well as by medicolegal and compensation systems. OBJECTIVE: To investigate the impact of noninjury related variables on self-reported disability at initial assessment among patients presenting with WAD type II injuries. DESIGN AND SETTING: We reviewed a total of 1101 consecutive files of patients presenting to a single chiropractor's office in British Columbia, Canada. We included those who met the inclusion criteria. We extracted demographic variables and noninjury related information from 33 eligible patient files. We calculated correlations between variables and created a multivariable linear regression model to evaluate their relative associations with Neck Disability Index (NDI) scores on presentation. RESULTS: Higher NDI scores on initial assessment correlated with female sex (r = 0.40, P =.02), a greater number of subsequent treatments (r = 0.44, P =.01), a higher number of providers seen before presentation (r = 0.40, P =.02), and most strongly with the involvement of a lawyer (r = 0.73, P <.01). A multivariable linear regression model found that only female sex (P =.03) and the involvement of a lawyer (P =.01) remained significantly associated with higher NDI scores on presentation (adjusted R2 = 0.68 for the model). Female sex was associated with a 10-point increase in NDI scores on presentation (beta coefficient = 10.5; 95% confidence interval [CI] 2.8-18.2), and involvement of a lawyer was associated with a 15-point increase in NDI scores on presentation (beta coefficient = 14.9; 95% CI 5.0-24.7). CONCLUSION: Our analysis of WAD type II patients in receipt of compensation found that higher self-reported disability on initial assessment was associated with female sex and in particular by retaining a lawyer. Large prospective studies are needed to establish the validity of these findings.