Validation of the Hungarian version of the Roland–Morris disability questionnaire

Abstract

Purpose: To create a cross-culturally adapted and clinically valid Hungarian version of the Roland–Morris Disability Questionnaire (RMQ). Methods: After the translation and cross-cultural adaptation process, a total of 133 patients were included into the quality measurement study. Validity and reliability domains of the Hungarian RMQ were tested following the COSMIN guideline. Differences between clinically different patient groups were measured. Correlations of the RMQ with the Oswestry Disability Index (ODI), the World Health Organization Quality of Life-BREF assessment (WHOQoL) and pain were also calculated. To assess the reliability dimension, internal consistency (Cronbach’s α) was determined and the test–retest method was used to calculate the interclass correlation coefficient (ICC), the standard error of measurement (SEM) and the minimal detectable change (MDC). Results: Patients indicated for surgery or having neurological deficit had significantly higher RMQ scores. RMQ strongly correlated with pain (r?=?0.61), ODI (r?=?0.81) and physical subscale of WHOQoL (r?=??0.7). Reliability of the Hungarian RMQ was expressed with a Cronbach’s α of 0.87, ICC of 0.91 (p?<?0.001) and SEM and MDC as 1.71 and 4.74 points, respectively. Conclusions: Translation and cross-cultural adaptation process of the RMQ into Hungarian language was successful resulting in a reliable and valid measurement tool with good psychometric properties.

• Implications for Rehabilitation

• Low back pain (LBP) related disability is a big health, social and economical problem in industrial countries.

• Correct evaluation of spine related disability can be performed using valid and reliable national versions of condition specific patient reported questionnaires such as the Roland–Morris Disability Questionnaire (RMQ).

• After the cross-cultural adaptation and validation of the Hungarian RMQ, it can be reliably used for the evaluation of LBP patients and for their follow-up during a rehabilitation process.

     

Linguistic validation of the Spanish version of the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)

Purpose

The U.S. NCI’s PRO-CTCAE is a library of self-report items for assessing symptomatic adverse events in cancer clinical trials from the patient perspective. The aim of this study was to translate and linguistically validate a Spanish version.

Methods

PRO-CTCAE’s 124 items were translated from English into Spanish using multiple forward and back translations. Native Spanish speakers undergoing cancer treatment were enrolled at six cancer treatment sites. Participants each completed approximately 50 items and were then interviewed using cognitive probes. The interviews were analyzed at the item level by linguistic themes, and responses were examined for evidence of equivalence to English. Items for which ≥20 % of participants experienced difficulties were reviewed, and phrasing was revised and then retested in subsequent interviews. Items where <20 % of respondents experienced difficulties were also reviewed and were considered for rephrasing and retesting.

Results

One hundred nine participants from diverse Spanish-speaking countries were enrolled (77 in Round 1 and 32 in Round 2). A majority of items were well comprehended in Round 1. Two items presented difficulties in ≥20 % of participants and were revised/retested without further difficulties. Two items presented difficulties in <20 %, and when retested exhibited no further difficulties. Two items presented difficulties in <20 %, but were not revised due to lack of alternatives. Sixteen items presented difficulties in ≤12 % and were not revised because difficulties were minor.

Conclusions

The Spanish PRO-CTCAE has been developed and refined for use in Spanish-speaking populations, with high levels of comprehension and equivalence to the English PRO-CTCAE.Trial registration: ClinicalTrials.gov:NCT01436240

     

General motor function assessment scale – reliability of a Norwegian version

Abstract

Purpose: The General Motor Function assessment scale (GMF) measures activity-related dependence, pain and insecurity among older people in frail health. The aim of the present study was to translate the GMF into a Norwegian version (N-GMF) and establish its reliability and clinical feasibility. Methods: The procedure used in translating the GMF was a forward and backward process, testing a convenience sample of 30 frail elderly people with it. The intra-rater reliability tests were performed by three physiotherapists, and the inter-reliability test was done by the same three plus nine independent colleagues. The statistical analyses were performed with a pairwise analysis for intra- and inter-rater reliability, using Cronbach’s α, Percentage Agreement (PA), Svensson’s rank transformable method and Cohen’s κ. Results: The Cronbach’s α coefficients for the different subscales of N-GMF were 0.68 for Dependency, 0.73 for Pain and 0.75 for Insecurity. Intra-rater reliability: The variation in the PA for the total score was 40–70% in Dependence, 30–40% in Pain and 30–60% in Insecurity. The Relative Rank Variant (RV) indicated a modest individual bias and an augmented rank-order agreement coefficient r_a of 0.96, 0.96 and 0.99, respectively. The variation in the κ statistics was 0.27–0.62 for Dependence, 0.17–0.35 for Pain and 0.13–0.47 for Insecurity. Inter-rater reliability: The PA between different testers in Dependence, Pain and Insecurity was 74%, 89% and 74%, respectively. The augmented rank-order agreement coefficients were: for Dependence r_a?=?0.97; for Pain, r_a?=?0.99; and for Insecurity, r_a?=?0.99. Conclusion: The N-GMF is a fairly reliable instrument for use with frail elderly people, with intra-rater and inter-rater reliability moderate in Dependence and slight to fair in Pain and Insecurity. The clinical usefulness was stressed in regard to its main focus, the frail elderly, and for communication within a multidisciplinary team.

• Implications for Rehabilitation

• The Norwegian-General Motor Function Assessment Scale (N-GMF) is a reliable instrument.

• The N-GMF is an instrument for screening and assessment of activity-related dependence, pain and insecurity in frail older people.

• The N-GMF may be used as a tool of communication in a multidisciplinary team.

     

Validation of a French version of Roland–Morris questionnaire in chronic low back pain patients

ObjectiveTo validate a French version of the Roland–Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain (LBP).Material and methodsFifty-eight patients due to participate in a functional rehabilitation programme for chronic low back pain were included prospectively. The RMDQ, the Quebec Back Pain Disability Scale (QBPDS) and the “daily activities” subscale of the Dallas Pain Questionnaire (DPQ) were administered. The RMDQ was assessed for internal consistency, reliability, criterion validity and sensitivity to change.ResultsCronbach's alpha for the RMDQ was 0.84. The intraclass correlation coefficient [95% confidence interval] was 0.89 [0.83–0.93]. The RMDQ score was correlated with the QBPDS score (r = 0.713) and the DPQ's “daily activities” subscore (r = 0.514). The results of assessments before and after functional rehabilitation showed that the French version of the RMDQ had very high sensitivity to change (effect size: 1.49) and was more sensitive than the QBPDS and the DPQ's “daily activities” subscore.ConclusionsOur study validated the French version of the RMDQ in patients suffering from chronic low back pain. Furthermore, we highlighted the questionnaire's very high sensitivity to change.     

Reliability and validity of the Turkish version of ABILHAND-Kids’ questionnaire in a group of patients with neuromuscular disorders

This study was performed to examine the reliability and validity of the Turkish version of ABILHAND-Kids questionnaire which assesses manual functions of children with neuromuscular diseases (NMDs). A cross sectional survey study design and Rasch analysis were used to assess the reliability and validity of the Turkish version of scale. Ninety-three children with different neuromuscular disorders and their parents were included in the study. The scale was applied to the parents with face-to-face interview twice; on their first visit and after an interval of 15 days. The test–retest reliability was assessed with intraclass correlation coefficient (ICC), and internal consistency of the multi-item subscales by calculating Cronbach alpha values. Brooke Upper Extremity Functional Classification (BUEFC) and Wee-Functional Independency Measurement (Wee-FIM) were correlated to determine the construct validity. The ICC value for the test/retest reliability was 0.94. The internal consistency was 0.81. Floor (1.1%) and ceiling (11.8%) effects were not significant. There were moderate correlations between the Turkish version of ABILHAND-Kids and Wee-FIM (0.67) and BUEFC (?0.37). Rasch analysis indicated good item ?t, unidimensionality, and model ?t. The Turkish version of ABILHAND-Kids questionnaire was found to be a reliable and valid scale for the assessment of the manual ability of children with NMDs.     

Cross cultural adaptations and psychometric domains of Brazilian version of PROFILE PD for Parkinson’s disease

Purpose: The PROFILE PD scale was developed specifically to evaluate patients with Parkinson’s disease (PD) within the context of the International Classification of Functioning, Disability and Health, directly applied to physical therapy practice. The study aimed to translate and cross-culturally adapt the PROFILE PD scale to Portuguese-Brazil, and to analyze its psychometric domains.

Methods: Fifty participants with PD participated in the study. We assessed the clarity of the Brazilian version of the scale by physiotherapists, presence of floor and ceiling effects, interrater and test–retest reliabilities, in addition to discriminant, concurrent (UPDRS) and construct validity, internal consistence, minimal detectable change (MDC), and responsiveness.

Results: The scale was considered highly clear for physical therapists. The interrater ICC was 0.74 and Wk was 0.89 for the total score. For test–retest reliability, the total ICC score was 0.99. The analysis of concurrent validity showed the Spearman correlation between Brazilian version of PROFILE PD and UPDRS (ρ?=?0.77; p?α?=?0.99). MDC was 2.41 points and there were no floor and ceiling effects. Also, the scale was responsive to physical therapy intervention, with improvement in 8 points after two months (effect size = 0.85).

Conclusion: The Brazilian version of PROFILE PD is an instrument reliable, valid, and responsive to physical therapy intervention, that can be used to quantify impairments and limitations in patients with PD and can provide an overall summary of the impact of disease, useful for physiotherapy practice.

• Implications for Rehabilitation

• PROFILE PD is a reliable and valid instrument to be applied in Brazilian Parkinson disease patients.

• This scale is design specially to be used in physical therapy practice within the contexts surrounding the International Classification of Functioning, Disability and Health.

• PROFILE PD was able to discriminate between patients in mild and moderate stages of disease which is difficult in clinical practice mainly because the scale used for this relies on balance and gait rather than a global profile.

     

Psychometric evaluation of the Persian version of the Templer’s Death Anxiety Scale in cancer patients

In this study, 398 Iranian cancer patients completed the 15-item Templer's Death Anxiety Scale (TDAS). Tests of internal consistency, principal components analysis, and confirmatory factor analysis were conducted to assess the internal consistency and factorial validity of the Persian TDAS. The construct reliability statistic and average variance extracted were also calculated to measure construct reliability, convergent validity, and discriminant validity. Principal components analysis indicated a 3-component solution, which was generally supported in the confirmatory analysis. However, acceptable cutoffs for construct reliability, convergent validity, and discriminant validity were not fulfilled for the three subscales that were derived from the principal component analysis. This study demonstrated both the advantages and potential limitations of using the TDAS with Persian-speaking cancer patients.     

Translation and cultural adaptation of the brazilian version of Disabkids® Atopic Dermatits Module (ADM)

The objective of this study was to translate and make the cultural adaptation of the Brazilian version of the DISABKIDS? Atopic Dermatitis Module (ADM), an instrument used to measure the health-related quality of life of children and adolescents with atopic dermatitis. The instrument has 12 items answered using a Likert scale, with two versions: self and proxy. The study counted with a sample of 18 Brazilian children and adolescents with atopic dermatitis, of ages ranging between 8 and 18 years, and their respective parents or caregivers. The process involved the following steps of translation-back translation and semantic evaluation. The former revealed good acceptance of the translated version of the instrument, which participants considered having items of easy understanding. After completing the process of validation in the country, the instrument will become available to Brazilian researchers to measure health-related quality of life, as well as to compare results from Brazil to that of other cultures in which the instrument has already been validated.     

Test–retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia

Objectives

To estimate the internal consistency, test–retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients’ personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied.

Design

Test–retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days.

Participants

The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour.

Results

The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test–retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods.

Conclusion

Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test–retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.     

Validity evidence for a modified version of the Orthotics and Prosthetics Users’ Survey

Purpose: To evaluate the validity of a modified version of the Orthotics and Prosthetics Users’ Survey (OPUS) with persons using different prosthetic and orthotic (P&O) devices.Method: Two-hundred-and-eighty-two adults using prosthesis, orthosis, shoe insoles or orthopaedic shoes completed OPUS. OPUS comprises five modules - Lower and Upper Extremity Functional Status, respectively (LEFS and UEFS), Client Satisfaction with Device and Services, respectively (CSD and CSS), and, Health-Related Quality of Life (HRQoL). Eight new items were added to LEFS and six to UEFS. Rasch analysis was used for data analyses.Results: Rating scales functioned satisfactory after some modifications. All modules demonstrated a ceiling effect. Unidimensionality was satisfactory after deleting some items and dividing HRQoL into two subscales, although somewhat weak on CSD and CSS. Item reliability was excellent for all modules and person reliability good for all but CSD and CSS. Some items demonstrated differential item functioning related to sex and age, but the impact on person measures was small.Conclusions: This study supports the validity of a modified version of OPUS for persons using different P&O devices, but also reveals limitations to be addressed in future studies. OPUS could be useful in clinical rehabilitation and research to evaluate P&O outcomes.

Implications for Rehabilitation

• The rehabilitation of individuals with musculoskeletal dysfunction often includes prosthetic or orthotic devices.

• There is a need for validated instruments to assess the outcomes of prosthetic and orthotic (P&O) interventions.

• This study provides validity evidence in support of using the Orthotics and Prosthetics Users’ Survey (OPUS) as an outcome measure for P&O interventions.

     

Reliability and validity of the Chinese version of the Readiness for Hospital Discharge Scale–Parent Form in parents of preterm infants

BackgroundThe Readiness for Hospital Discharge Scale (RHDS)−Parent Form shows satisfactory reliability and validity to assess the readiness of parents to take care of their children discharged from hospitals in Western countries. However, the reliability and validity of this instrument has not been evaluated in Chinese populations.ObjectivesEvaluate the psychometric features of the RHDS−Parent Form among Chinese parents of preterm infants.MethodsThe RHDS−Parent Form was translated into a Chinese version following an international instrument translation guideline. A total of 168 parents with preterm infants were recruited from the neonatal intensive care units of two tertiary-level hospitals in China. The internal consistency of this measure was assessed using the Cronbach's α coefficient; confirmatory factor analysis was conducted to evaluate the construct validity; and Pearson correlation coefficient was used to report the convergent validity.ResultsThe Chinese version of RHDS (C-RHDS)−Parent Form included 22 items with 4 subscales, accounting for 56.71% of the total variance. The C-RHDS−Parent Form and its subscales showed good reliability (Cronbach's α values 0.78–0.92). This measure and its subscales showed positive correlations with the score of Quality of Discharge Teaching Scale.ConclusionThe factor structure of C-RHDS−Parent Form is partially consistent with the original English version. Future studies are needed to explore the factors within this measure before it is widely used in Chinese clinical care settings.     

The Fugl–Meyer assessment of the upper extremity: reliability,responsiveness and validity of the Danish version

Objective: To translate the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) into Danish and to establish the inter-tester reliability, responsiveness, Minimal Clinically Important Difference (MCID) and concurrent validity of the FMA-UE in a population of stroke patients. Method: The translation was conducted in accordance with the principles outlined by the ISPOR Task Force for Translation and Cultural Adaption. Inter-rater reliability was assessed at baseline. Each patient was tested by two examiners and inter class correlation (ICC) was calculated. Responsiveness was assessed using receiver operating characteristic (ROC) curve statistics. The FMA-UE change score was used to assess sensitivity and specificity and to correctly determine which patients had improved. The MCID and the area under the curve (AUC) were established using the ROC. The FMA-UE’s concurrent validity with the Motor Assessment Scale was determined using Spearman’s rank correlation. Setting: The study took place at Skive Neurorehabilition, Denmark from May 2014 to February 2015. Participants: Inpatients, who were in the acute to sub-acute stage of stroke and aged?>?18 years. Interventions: Not applicable. Main outcome measure: The FMA-UE. Results: In 50 inpatients the ICC was 0.95, AUC was 0.87, with a sensitivity of 77%, a specificity of 89% and an MCID?≥?4. Concurrent validity was high, with r?=?0.94–0.95. Conclusion: The FMA-UE was successfully translated into Danish. An MCID?≥?4 was found. This study provides evidence that the FMA-UE is a reliable, responsive and valid instrument for measuring upper limb impairment after stroke.

• Implications for rehabilitation

• One of the most widely recognized measures of upper extremity motor impairment post-stroke is the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE).

• The psychometric properties of a measurement depends on the population and setting in which it is used.

• In this study, the FMA-UE is translated into Danish and the psychometric properties of FMA-UE is determined in a Danish population of patients with stroke.

• The FMA-UE is now available to use for clinicians in Denmark.

     

Rethinking the benefits of an adapted version of 'Alzheimer Café' for individuals with Alzheimer's and their partners

This article reviews dementia care in the context of an adapted version of an Alzheimer's Cafe focusing on eight couples newly diagnosed with dementia. It is primarily a reflective account. The adapted version of an Alzheimer Café focused on providing an informal café with more emphasis on communication, education and support for couples. It also seeks to provide a critical platform to evaluate the impact of developing such approaches like, (Alzheimer Café) in contrast to other approaches like, couple therapy, relationship and person centred approaches.     

The Rehabilitation Complexity Scale – extended version: detection of patients with highly complex needs

Purpose: To describe the extended Rehabilitation Complexity Scale (RCS-E) and its factor structure, and to determine whether it provides added value over the RCS-version 2 to identify patients with highly complex rehabilitation needs. Method: A cohort analysis of prospectively-collected routine clinical data from 331 patients with complex neurological disabilities undergoing inpatient rehabilitation in a tertiary specialist neurorehabilitation unit in the UK. RCS-E and RCS-v2 scores were recorded in parallel by the multi-disciplinary team (MDT) at fortnightly intervals, alongside the Northwick Park nursing (NPDS) and therapy (NPTDA) dependency scales, capturing nursing care and therapy interventions in staff hours/week. Results: Very strong correlations were found between total RCS-v2 and RCS-E scores (ρ?=?0.954); the RCS-E “Care & nursing” subscale and care/nursing hours/week (ρ?=?0.838, p < 0.001); and the RCS-E “Therapy” subscale and total therapy hours/week (p?=?0.697, p < 0.001). The RCS-E showed better discrimination for complex therapy needs than the RCS-v2, but not for complex care/nursing needs. The RCS-E factor structure was similar to the RCS-v2, with moderate internal consistency overall, separating into two distinct dimensions (“Nursing/medical care + Equipment” and “Therapy”). Conclusion: The RCS-E provides an equivalent measure of complexity to the RCS-v2, but offers added value in identifying patients with highly complex therapy and equipment needs.

Implications for Rehabilitation

• Assessing complexity of rehabilitation needs presents a challenge throughout the world.

• The Rehabilitaton Complexity Scales provide a simple measure of complexity of rehabilitation needs, which take account of basic care, specialist nursing, therapy and medical interventions.

• The extended version (RCS-E) presented here may offer a more sensitive tool for detecting patients with highly complex needs for therapy and equipment in specialist rehabilitation settings.

     

Making Great Efforts to Promote the Development and Application of Evidence-Based Medicine （English version）

Since the term “evidence-based medicine ( EBM ) ” was proposed and published firstly in JAMA by a Canadian scholar in 1992, a worldwide campaign of evidence-based practice has been undertaken which has benefited governments, doctors and the public. It has not only brought innovation to the global health industry, but been applied to many other related fields and industries. As a result, EBM was appraised by JAMA as one of the most powerful theories of the 20th century.     

Update of the trauma risk adjustment model of the TraumaRegister DGU?: the Revised Injury Severity Classification,version II

Introduction

The TraumaRegister DGU™ (TR-DGU) has used the Revised Injury Severity Classification (RISC) score for outcome adjustment since 2003. In recent years, however, the observed mortality rate has fallen to about 2% below the prognosis, and it was felt that further prognostic factors, like pupil size and reaction, should be included as well. Finally, an increasing number of cases did not receive a RISC prognosis due to the missing values. Therefore, there was a need for an updated model for risk of death prediction in severely injured patients to be developed and validated using the most recent data.

Methods

The TR-DGU has been collecting data from severely injured patients since 1993. All injuries are coded according to the Abbreviated Injury Scale (AIS, version 2008). Severely injured patients from Europe (ISS ≥4) documented between 2010 and 2011 were selected for developing the new score (n = 30,866), and 21,918 patients from 2012 were used for validation. Age and injury codes were required, and transferred patients were excluded. Logistic regression analysis was applied with hospital mortality as the dependent variable. Results were evaluated in terms of discrimination (area under the receiver operating characteristic curve, AUC), precision (observed versus predicted mortality), and calibration (Hosmer-Lemeshow goodness-of-fit statistic).

Results

The mean age of the development population was 47.3 years; 71.6% were males, and the average ISS was 19.3 points. Hospital mortality rate was 11.5% in this group. The new RISC II model consists of the following predictors: worst and second-worst injury (AIS severity level), head injury, age, sex, pupil reactivity and size, pre-injury health status, blood pressure, acidosis (base deficit), coagulation, haemoglobin, and cardiopulmonary resuscitation. Missing values are included as a separate category for every variable. In the development and the validation dataset, the new RISC II outperformed the original RISC score, for example AUC in the development dataset 0.953 versus 0.939.

Conclusions

The updated RISC II prognostic score has several advantages over the previous RISC model. Discrimination, precision and calibration are improved, and patients with partial missing values could now be included. Results were confirmed in a validation dataset.     

The Swedish version of the PACU‐Behavioural Pain Rating Scale: a reliable method of assessing postoperative pain?

One of the obstacles to effective pain management in the Post-Anaesthesia Care Unit (PACU) is the lack of systematic and comprehensive methods for assessing and treating postoperative pain. Nurses' intuitive knowledge of pain were verbalized and divided into four categories of pain behaviours in the PACU-Behavioural Pain Rating Scale. The aim of the present study was to test the reliability of the Swedish version by performing test-retest and interrater reliability in clinical conditions. Materials for this study were gathered through patient observations. The results showed poor agreement in the item restless, fair agreements in both items tense muscles and frowning and grimacing, while patients' sounds showed moderate agreement. Interrater reliability showed moderate agreement in the item restless, very good agreement in tense muscles and patient sounds, and good agreement in frowning and grimacing. A refined classification of the separate categories and a careful review of the category of behaviours is suggested. A more detailed manual for the categories needs to be developed to establish more acceptable reliability.     

Patients’ perspectives on the use of the Montgomery-Asberg depression rating scale self-assessment version in primary care

Objective: The aim of the current study was to better understand how patients with depression perceive the use of MADRS-S in primary care consultations with GPs.

Design: Qualitative study. Focus group discussion and analysis through Systematic Text Condensation.

Setting: Primary Health Care, Region Västra Götaland, Sweden.

Subjects: Nine patients with mild/moderate depression who participated in a RCT evaluating the effects of regular use of the Montgomery-Åsberg Depression Self-assessment scale (MADRS-S) during the GP consultations.

Main Outcome measure: Patients’ experiences and perceptions of the use of MADRS-S in primary care.

Results: Three categories emerged from the analysis: (I) confirmation; MADRS-S shows that I have depression and how serious it is, (II) centeredness; the most important thing is for the GP to listen to and take me seriously and (III) clarification; MADRS-S helps me understand why I need treatment for depression.

Conclusion: Use of MADRS-S was perceived as a confirmation for the patients that they had depression and how serious it was. MADRS-S showed the patients something black on white that describes and confirms the diagnosis. The informants emphasized the importance of patient-centeredness; of being listened to and to be taken seriously during the consultation. Use of self-assessment scales such as MADRS-S could find its place, but needs to adjust to the multifaceted environment that primary care provides.

• Key Points

• Patients with depression in primary care perceive that the use of a self-assessment scale in the consultation purposefully can contribute in several ways. The scale contributes to

• Confirmation: MADRS-S shows that I have depression and how serious it is.

• Centeredness: The most important thing is for the GP to listen to and take me seriously.

• Clarification: MADRS-S helps me understand why I need treatment for depression.

     

Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

Study design:: Observational inter-rater reliability study.

Objectives: To examine: (1) the inter-rater reliability of a modified version of Delitto et al.’s classification-based algorithm for patients with low back pain; (2) the influence of different levels of familiarity with the system; and (3) the inter-rater reliability of algorithm decisions in patients who clearly fit into a subgroup (clear classifications) and those who do not (unclear classifications).

Methods:: Patients were examined twice on the same day by two of three participating physical therapists with different levels of familiarity with the system. Patients were classified into one of four classification groups. Raters were blind to the others’ classification decision. In order to quantify the inter-rater reliability, percentages of agreement and Cohen’s Kappa were calculated.

Results:: A total of 36 patients were included (clear classification n?=?23; unclear classification n?=?13). The overall rate of agreement was 53% and the Kappa value was 0·34 [95% confidence interval (CI): 0·11–0·57], which indicated only fair inter-rater reliability. Inter-rater reliability for patients with a clear classification (agreement 52%, Kappa value 0·29) was not higher than for patients with an unclear classification (agreement 54%, Kappa value 0·33). Familiarity with the system (i.e. trained with written instructions and previous research experience with the algorithm) did not improve the inter-rater reliability.

Conclusion:: Our pilot study challenges the inter-rater reliability of the classification procedure in clinical practice. Therefore, more knowledge is needed about factors that affect the inter-rater reliability, in order to improve the clinical applicability of the classification scheme.     

Self-reported function and disability in late life – cross-cultural adaptation and validation of the Swedish version of the late-life function and disability instrument

Abstract

Purpose: To translate and perform a cross-cultural adaptation of the Late-Life Function and Disability Instrument (LLFDI) to Swedish, to investigate absolute and relative reliability, concurrent validity, and floor and ceiling effects within a Swedish-speaking sample of community-dwelling older adults with self-reported balance deficits and fear of falling. Method: Translation, reliability and validation study of the LLFDI. Sixty-two community-dwelling, healthy older adults (54 women and 8 men) aged 68–88 years with balance deficits and fear of falling performed the LLFDI twice with an interval of 2 weeks. Results: Test–retest agreement, intra-class correlation coefficient was very good, 0.87–0.91 in the LLFDI function component and 0.82–0.91 in the LLFDI disability component. The standard error of measure was small, 5–9%, and the smallest real difference was 14–24%. Internal consistency (Cronbach’s alpha) was high (0.90–0.96). Correlation with the SF-36 PCS and PF-10 was moderate in both LLFDI function, r?=?0.39–0.68 and r?=?0.35–0.52, and LLFDI disability, r?=?0.40–0.63 and 0.34–0.57, respectively. There was no floor or ceiling effects. Conclusion: The Swedish version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community-dwelling older women with self-reported balance deficits and fear of falling.

• Implications for Rehabilitation

• The Swedish LLFDI is a highly reliable and valid instrument for assessing function and disability in older women with self-reported balance deficits and fear of falling.

• The instrument may be used both in clinical settings and in research.

• The instrument is sensitive to change and a reasonably small improvement is enough to detect changes in a group or a single individual.