A patient-based questionnaire to assess outcomes of foot surgery: Validation in the context of surgery for hallux valgus

Background: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. Methods: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the ‘Manchester-Oxford Foot Questionnaire’ (MOXFQ)), consisting of three domains/scales: ‘Walking/standing’ (seven items), ‘Pain’ (five items) and ‘Social interaction’ (four items) each having good measurement properties. All three domains were unidimensional. Conclusions: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.     

Minimally important change was estimated for the Manchester–Oxford Foot Questionnaire after foot/ankle surgery

ObjectivesTo ascertain the smallest amounts of change for the three Manchester–Oxford Foot Questionnaire (MOXFQ) domains that are likely to be clinically meaningful and beyond measurement error for conditions affecting the foot/ankle. Estimates were compared with those from the Short-Form 36 (SF-36).Study Design and SettingA prospective observational study of 671 consecutive patients undergoing foot or ankle surgery at an orthopedic hospital. Before and 9 months after surgery, patients completed the MOXFQ and SF-36; transition items (anchor) asked about perceived changes in foot/ankle pain or problems since the surgery.ResultsFour hundred ninety-one patients completed pre- and postoperative questionnaires. Anchor-based minimal clinically important change (MCIC) values were ∼13 points for each of the MOXFQ Walking/standing (W/S), Pain, and Social Interaction (S-I) domains [and greater than the standard error of measurement (SEM)]. MCIC values for all SF-36 domains fell within the SEM. Between-group MCIDs for the MOXFQ were W/S, 16.2; Pain, 9.9; S-I, 9.3. Distribution-based minimal detectable change (MDC₉₀) values for the MOXFQ were ∼11, ∼12, and ∼16 score points for the W/S, Pain, and S-I scales, respectively.ConclusionThis article provides information for aiding the interpretability of MOXFQ outcomes data and for planning future studies. The SF-36 is not recommended as a primary outcome for foot/ankle surgery.     

Validity and Reliability of the Fear-Avoidance Beliefs Questionnaire (FABQ) in Workers with Upper Extremity Injuries

Introduction Fear Avoidance Beliefs (FAB) have been associated with increased pain, dysfunction and difficulty returning to work in Upper Extremity (UE) injures. The FABQ is used to assess FAB, but its measurement properties have not been established in UE. The purpose of this study is to evaluate the reliability and validity of the FABQ to screen UE compensated injured workers for FAB. Methods Consenting workers attending a specialty clinic completed a modified FABQ, QuickDASH (Disability), SPADI Pain Score and von Korff Chronic Pain Grade (Pain), SF-36v2 (General Health), and Work Instability Scale (Job Instability). A sub-sample of workers (n = 48) completed the FABQ 2 weeks later for test–retest reliability. Results 187 workers; 54.0% male; mean age 45.2 (sd 9.68); 56% were currently working. Mean subscale scores (FABQ-Work [FABQ-W]/FABQ-Physical Activity [FABQ-PA]) were 35/42 and 20/24. Ceiling effects (23%/38%) existed in both subscales. Cronbach’s alphas were 0.75/0.78. Test–retest analysis (ICC(2,1)) was lower than desired (0.52/0.59). Construct validation was supported by a moderate correlation between FABQ-W/FABQ-PA and QuickDASH Work Module (0.51/0.42) and WIS (0.46/0.38) in those currently working. Low correlations were found between the subscales measures of pain (SPADI: 0.24/0.23; Chronic Pain Grade: 0.25/0.25), and SF-36 MCS (−0.25/−0.30). Conclusions Although FAB is an important concept to measure in compensated UE injured workers, the FABQ had limitations in this population as there was a high ceiling effect, and lower than desired reliability for individual discrimination. A priori hypotheses around construct validity were rejected for 16/22 concepts tested.     

The Psychometric Properties of the Chinese Version of the SF-36 Health Survey in Patients with Myocardial Infarction in Mainland China

Objective To test the reliability and validity of the Chinese Mandarin version of the SF-36 health survey (CM:SF-36) in patients with myocardial infarction (MI) in mainland China.Methods Single group, cross-sectional design to test the measurement performance on a convenience sample of 180 Chinese patients with MI, 30 of whom were retested after 2 weeks to establish reliability.Findings Cronbach’s α coefficients exceeded the 0.70 criterion for all subscales except General Health, indicating good internal consistency. Test–retest reliability was adequate (intraclass correlation coefficient >0.70) for all subscales. The significant differences were detected by the presence or absence of co-morbidities and the number of risk factors in most physical subscales indicating good discriminative validity. Principal components factor analysis with varimax rotation confirmed the presence of the eight factors, though the item loadings of the Vitality and Mental Health subscales were found to differ from the original ones of the SF-36.Conclusion The CM:SF-36 is a psychometrically acceptable instrument for assessing the health status of Chinese patients with myocardial infarction.     

Quality-of-life outcome after hallux valgus surgery

Objective To assess the quality of life before and after hallux valgus surgery. Methods A longitudinal study with 94 consecutive patients undergoing hallux valgus surgery. Assessments were made preoperatively and at 12 month postoperatively. Measures used were the quality of life (QoL) according to SF-36, a disease specific score (the American Orthopaedic Foot and Ankle Society’s clinical rating system for the hallux), the severity of the deformity, the possibility of wearing the preferred choice of shoes and satisfaction with the treatment. The pre- and postoperative QoL scores were compared with the score in the general population. Results QoL outcomes improved significantly postoperatively regarding bodily pain, vitality, mental health and the mental component summary. The correction of the deformity did not affect the QoL. Regardless of the extent of correction, the choice of shoeware and the degree of satisfaction with surgery were associated with a better QoL. Conclusions Hallux valgus patients have worse pain than the general population. Surgery produces a significant improvement in the quality of life. The severity of the deformity did not influence the QoL, however; the free choice of shoeware and the degree of satisfaction with the surgery had a positive effect on the QoL outcome. SF-36 is a relevant tool for evaluating outcome in hallux valgus surgery.     

Reliability and validity of the SF-12v2 in the medical expenditure panel survey

Objective  Evaluate the reliability and validity of the Medical Outcomes Study Short-Form version 2 (SF-12v2) in the 2003–2004 Medical Expenditure Panel Survey (MEPS). Research design  Data were collected in the self-administered mail-out questionnaire and face-to-face interviews of the MEPS (n = 20,661). Internal consistency and test–retest reliability and construct, discriminate, predictive and concurrent validity were tested. The EQ-5D, perceived health and mental health questions were used to test construct and discriminate validity. Self-reported work, physical and cognitive limits tested predictive validity and number of chronic conditions assessed concurrent validity. Results  Both Mental Component Summary Scores (MCS) and Physical Component Summary Scores (PCS) were shown to have high internal consistency reliability (α > .80). PCS showed high test–retest reliability (ICC = .78) while MCS demonstrated moderate reliability (ICC = .60). PCS had high convergent validity for EQ-5D items (except self-care) and physical health status (r > .56). MCS demonstrated moderate convergent validity on EQ-5D and mental health items (r > .38). PCS distinguish between groups with different physical and work limitations. Similarly, MCS distinguished between groups with and without cognitive limitations. The MCS and PCS showed perfect dose response when variations in scores were examined by participant’s chronic condition status. Conclusions  Both component scores showed adequate reliability and validity with the 2003–2004 MEPS and should be suitable for use in a variety of proposes within this database.     

The ORTHO BC-SAT – a satisfaction questionnaire for women using hormonal contraceptives

Objective To assess the reliability and validity of the ORTHO Birth Control Satisfaction Assessment Tool (ORTHO BC-SAT). Design 339 women using 1 of 4 hormonal birth control methods (oral contraceptives, transdermal patch, vaginal ring, injections), completed the questionnaire 1–2 times. Materials and methods The questionnaire was developed based on findings from the literature, focus groups, and interviews. Internal consistency reliability, test–retest reliability, construct validity, and known groups validity were evaluated. Results Based on variable clustering, 8 domains were identified (Ease of Use/Convenience, Compliance, Lifestyle Impact, Symptom/Side Effect Bother, Menstrual Impact, Future Fertility Concerns, Assurance/Confidence, Overall Satisfaction). Internal consistency reliability was demonstrated with Cronbach’s α values ranging from 0.70 to 0.89. All multi-item scales reported acceptable test–retest reliability (0.79–0.87). Construct validity was demonstrated by support of a hypothesized pattern of correlations. Known groups validity was confirmed by examining scale scores of women categorized by levels of symptom bother. As expected, women with the least amount of bother reported higher scores on all satisfaction scales than those with higher bother (p < 0.0001), except on Future Fertility Concerns (p = 0.27). Conclusion Our results support the reliability and validity of the ORTHO BC-SAT. It may be used in future studies to evaluate satisfaction among hormonal contraceptive users.     

Cultural adaptation and application of the IBS–QOL in China: a disease-specific quality-of-life questionnaire

Background Irritable bowel syndrome (IBS) is a chronic and episodic illness characterized by altered bowel habits and associated abdominal pain. At present, IBS is one of the most common functional gastrointestinal and motility disorders affecting countries around the world. Surveys have found that patients with IBS have a significantly lower health-related quality of life. Objectives The aim of this study was to translate and examine the validity of the Irritable Bowel Syndrome–Quality of Life questionnaire (IBS–QOL) in patients suffering from IBS in China. Methods A structured procedure was used for the translation and cultural adaptation of the original English IBS–QOL into Chinese. The questionnaire was administered to 73 clinical patients with IBS and␣70 healthy individuals. Psychometric testing for reliability, validity and responsiveness followed standardized procedures. Test–retest reliability (10–20 hours) was assessed using the clinical patients. Follow-up (4 weeks) was collected for 61 clinical patients. All enrolled patients also completed the Short Form-36 Health Survey (SF-36) at the baseline visit. Responsiveness to treatment (Venlafaxine and traditional Chinese herbal medicine) was assessed by one-way ANOVA methods. Results The average length of time required to complete the questionnaire was short (5.63 min for IBS patients and 5.54 min for healthy subjects by self-administration). Internal consistency (Cronbach’s alpha) values ranged from 0.722 to 0.914 for the Chinese IBS–QOL subscales and test–retest reliability coefficients were higher than 0.920 on all subscales. The convergent and discriminate validity results comparing the Chinese translation of the IBS–QOL overall score and the SF-36 subscales confirmed our predicted hypotheses. The Chinese IBS–QOL scores are more highly correlated with social functioning, vitality and general health (SF-36) and show weaker associations with physical functioning, role physical, mental health, and bodily pain (SF-36). The Chinese translation of the IBS–QOL was responsive to treatment. Conclusion In general, the Chinese translation of the IBS–QOL, after cultural adaptation and revision, possesses good reliability, validity and responsiveness. It is a reliable and valid instrument to assess the quality of life in Chinese patients suffering from IBS and is an appropriate measure to use in further clinical trials or for related research projects in China.     

Validation of the Tutotest in a hybrid problem-based learning curriculum

The Tutotest is one of the few structured instruments developed for the assessment of students’ learning skills in a problem-based learning (PBL) curriculum. This study was designed to validate the Tutotest in a hybrid PBL curriculum. Forty-four tutors completed 370 evaluations on second to fourth year medical students at the end of the first semester in 2004 using the Chinese version of the Tutotest. There was significant correlation between global rating and Tutotest-C (r = 0.44, P < 0.001). The Cronbach’s α coefficient was 0.97. Two-week test–retest correlation coefficient was 0.85. Factor analysis revealed four factors, where three were similar to the factors of “effectiveness in group”, “communication and leadership skills”, and “respect for others” identified in the original Tutotest. “Hypothesis forming and testing” instead of “scientific curiosity” became the fourth factor in our data. Our study validated the Tutotest-C in a hybrid PBL curriculum and students from the Chinese educational system. The test–retest reliability measure with a 2-week interval at the end of the PBL tutorial confirmed the stability of the Tutotest, which has not been previously reported. Since most Asian medical schools adopted a hybrid PBL curriculum, a valid student evaluation instrument for this type of curriculum is valuable.     

Validity and Reliability of the Italian Version of the Quality of Life,Enjoyment and Satisfaction Questionnaire

The Quality of Life, Enjoyment and Satisfaction Questionnaire (Q-LES-Q) is increasingly used in psychiatry because it gives emphasis to the subjective perspective of patients on physical, psychological and social domains. This paper reports on the validation of the Italian version of the Q-LES-Q in a large multicenter study (EQUIP) conducted at five Italian sites on outpatients in treatment for anxiety disorders. Study participants underwent a broad assessment of psychopathology including the MINI-International Neuropsychiatric Interview, the Symptom Checklist (SCL-90) and the Clinical Global Impression (CGI). Cronbach’s alpha was used to determine the internal consistency of the Q-LES-Q areas and Pearson’s r was used to analyze the correlation between the areas of Q-LES-Q and those of the other instruments. The internal consistency of the Q-LES-Q proved to be substantial (>0.80 in each of the areas) as well as the test–retest reliability. The convergent validity of the Q-LES-Q vs. the Work and Social Adjustment Scale was examined. High correlations were found between scales measuring similar constructs in the two instruments and lower correlation between scales measuring different constructs. In conclusion, the Italian version of the Q-LES-Q proved to be as valid and reliable as the original English version.     

Development of a questionnaire to assess ‘Hie’ symptoms using an evidence-based analysis

Objectives  Certain symptoms and signs are culturally specific. ‘Hie’ (chill sensation) is a major symptom experienced by Japanese people; however, it is not easily understood by Westerners. Although Hie is not life-threatening, it greatly hampers the quality of life in sufferers. To develop a remedy for Hie, valid and reliable measures are required. This is the first study aimed at developing a standardized questionnaire to quantitatively measure Hie symptom. Methods  This was a cross-sectional study. To identify question items, we conducted a literature search using published books that mention Hie and related symptoms. The first draft of the questionnaire was prepared by selecting 31 items, including three empirically used items, using the Delphi method. A total of 744 Japanese volunteers completed the draft questionnaire. Simple correlation and factor analyses were performed to select items for the final version of Hie questionnaire and for evaluating its test–retest reliability. Results  The following ten question items were ultimately selected: feeling a breeze, shivery feeling, tolerance, sensitivity to cold, Hie-like sensation in an airplane, dislike of air conditioning, use of gloves, use of an electric blanket, use of heavy clothing and need for heating devices. Of the ten Hie-related question items, five pertained to physical symptoms and the other five to daily behaviours. The internal consistency of the ten-item questionnaire was high, with a Cronbach’s alpha of 0.85. The test–retest reliability of the questionnaire was preserved by the paired two-tailed t test. Conclusions  A new questionnaire was developed to evaluate the subjective symptom of Hie. This questionnaire demonstrated sufficient reliability and could be used as a tool to assess this symptom.     

Validation of the Chinese version of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) in Taiwanese patients with schizophrenia

We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). One hundred Taiwanese individuals with schizophrenia were recruited. The internal consistency reliability was satisfactory for both the psychosocial and vitality domains (Cronbach’s α = 0.92, 0.84). The test–retest reliability was also high (psychosocial: ICC = 0.84, vitality: ICC = 0.84) for those individuals whose psychological conditions remained stable between the two-week interval. However, the responsiveness coefficient for those with considerable changes in psychological conditions ranged from very small to moderate, suggesting either low responsiveness for the vitality domain or a complex relationship between the change of psychological conditions and quality of life, and the need to estimate responsiveness more conclusively in a future intervention study. The convergent validity was supported by moderate-to-large correlations between domains measuring related constructs of the SQLS-R4 and SF-36 (r = −0.65 to −0.67). Overall, the results of this study provide preliminary evidence for the reliability and validity of the SQLS-R4 used in Taiwanese individuals with schizophrenia. This study provides a common ground for international researchers to understand quality of life in Taiwanese patients with schizophrenia.     

Psychometric properties of the WHODASII in rehabilitation patients

Background To evaluate function and disability, the WHO has developed the WHO Disability Assessment Schedule II (WHODASII), an instrument arising from the same conceptual basis as the International Classification of Functioning, Disability, and Health (ICF). Objectives The general objective of this study was to investigate whether the WHODASII––German version—is a valid instrument to measure functioning and disability across various conditions. Specific aims were (1) to assess its psychometric properties (reliability, validity, and sensitivity to change) based on the traditional test theory and (2) to compare its sensitivity to change after a rehabilitative intervention to the Short Form 36 (SF-36). Research design This was a multi-center study with convenience samples of patients with different chronic conditions undergoing rehabilitation. Patients completed the WHODASII and the SF-36 before and after a rehabilitation treatment. Health professionals rated in cooperation with the patients the pain of the patients based on the ICF category “sensation of pain.” Results 904 patients were included in the study. The Cronbach’s range from 0.70 to 0.97 for the different subscales of WHODASII. With exception of the subscale Activities, the exploratory-factor structure of the WHODASII corresponds highly with the original structure. The effect size (ES) of the WHODASII total score ranged from 0.16 to 0.69 depending on the subgroup. The ES of the SF-36 summary scores ranged from 0.03 to 1.40. Conclusions The WHODAS II (German version) is a useful instrument for measuring functioning and disability in patients with musculoskeletal diseases, internal diseases, stroke, breast cancer, and depressive disorder. The results of this study support the reliability, validity, dimensionality, and responsiveness of the German version of the WHODASII. However, the reproducibility in test–retest samples of stable patients, as well as the question to what extent a summary score can be constructed, requires further investigation.     

Reliability and construct validity of the SF-36 in Turkish cancer patients

In this study, we assessed the reliability and construct validity of the SF-36, Turkish version on 419 cancer patients. Cronbach’s α coefficients surpassed the 0.70 criterions for all subscales indicating good internal consistency. Results of the test–retest method showed that the stability coefficients for the eight subscales of the SF-36 ranged between 0.81 and 0.94. Principal components factor analysis with varimax rotation confirmed the presence of seven factors in the SF-36: physical functioning, role limitations due to physical and emotional problems, mental health, general health perception, bodily pain, social functioning, and vitality. In conclusion, the Turkish version of the SF-36 is a suitable instrument that could be employed in cancer research in Turkey.     

Psychometric validation of the S-QoL Chinese (Taiwan) version for patients with schizophrenia

We translated the S-QoL into the Chinese (Taiwan) language and evaluated the score distributions of the translated S-QoL in terms of ceiling/floor effect, internal consistency, test–retest reliability, and convergent and discriminant validity. To ensure conceptual and semantic equivalence of the S-QoL, the researchers performed both forward translation and back translation, consulted professionals, and completed a pilot trial on college students. Forty-one patients with schizophrenia were recruited. No significant ceiling/floor effects (<20%) were found in subscales of the translated S-QoL. The internal consistency reliabilities were acceptable to good for the whole scale and 7 of the subscales (Cronbach’s alpha = 0.71–0.93), but not for the sentimental life subscale (Cronbach’s alpha = 0.44). The test–retest reliabilities were moderate to high (ICC = 0.64–87, P < 0.001 to <0.0001). The convergent validities were supported by satisfactory correlations among subscales measuring related constructs of the translated S-QoL and those of the SQLS-R4, WHOQoL-BREF, and RESE (r = 0.36–0.82, P < 0.05 to <0.01). Discriminant validity was demonstrated between groups with different numbers of episodes and hospitalization. The S-QoL Chinese (Taiwan) version was found to have good psychometrics and is suggested as a feasible choice of disease-specific measure for capturing HRQoL in patients with schizophrenia.     

The Greek Version of the Quality of Life in Epilepsy Inventory (QOLIE-31)

This study is presenting the translation and cultural adaptation into Greek of the Quality of Life in Epilepsy Inventory (QOLIE-31). We adapted the QOLIE-31 to Greek through a procedure of translation–back-translation. Sixty-three patients were interviewed and completed the QOLIE-31 and the GHQ questionnaires. We re-examined a subset of them after a period of 2–5 weeks to evaluate the test–retest reliability of the questionnaire. We assessed the convergent validity by comparison of the QOLIE-31 and the GHQ and QOLIE-31 subscales and external measures. Discriminative validity was evaluated using the method of known-groups comparisons. The internal consistency was high for the QOLIE-31 and its’ subscales (Cronbach’s α 0.92 and 0.59–0.83 respectively). Test–retest reliability was acceptable (intra-class correlation coefficient 0.49–0.89 and Pearson’s coefficient 0.53–0.92) for the group of patients who were re-examined. Comparison of the QOLIE-31 and GHQ scores showed agreement between the two questionnaires (Pearson’s coefficient −0.61). We demonstrated the discriminative validity by the difference in the QOLIE-31 scores between patients with different seizure frequencies and different employment status. We concluded that the Greek version of the QOLIE-31 has psychometric properties equivalent to those of the original American-English version and is a valid and reliable instrument.     

Equivalence of Chinese and US–English Versions of the SF-36 Health Survey

This study evaluated the equivalence of Chinese and US–English versions of the SF-36 Health Survey in a convenience sample of 309 Chinese nationals bilingual in Chinese and English living in a US city. Snowball sampling was used to generate sufficient sample size. Internal consistency, test–retest, and equivalent-forms reliability were estimated. Patients were randomized to one of four groups: (1) English version completed first, followed by Chinese version (same occasion); (2) Chinese version completed first, followed by English version (same occasion); (3) English version completed once and then again 1-week later; (4) Chinese version completed once and then again 1-week later. Internal consistency reliability estimates for the Chinese and US–English versions of the SF-36 scales ranged from 0.60 to 0.88; test–retest reliability estimates (1 week time interval) ranged from 0.67 to 0.90. Reliability estimates for corresponding Chinese and US–English SF-36 scales tended to be similar and not significantly different. Equivalent-forms reliability estimates (product–moment correlations) ranged from 0.81 to 0.98. Mean SF-36 scale scores were comparable for both versions of the instrument. This study provides support for the equivalence of the Chinese and US–English versions of the SF-36.     

The Italian version of the Lower Extremity Functional Scale was reliable,valid, and responsive

ObjectiveTo determine the measurement properties of an Italian Version of the Lower Extremity Functional Scale (LEFS) in patients with lower extremity musculoskeletal dysfunction.Study Design and SettingThis is a prospective methodological study of repeated measures with a sample of 250 consecutive patients. Reliability, validity, and responsiveness were evaluated.ResultsThe Italian version of the LEFS showed a high degree of internal consistency with a Cronbach alpha of 0.94 (95% confidence interval [CI]: 0.91, 0.96). The test–retest reliability was high for both intra-interviewer and inter-interviewer measures with an ICC_{(2,1 and 2,k)} of 0.91 (95% CI: 0.86, 0.93) and 0.89 (95% CI: 0.83, 0.91), respectively. The LEFS showed a better correlation with the 36-Item Short-Form Health Survey (SF-36) physical component summary score rather than with the SF-36 mental component summary score both at the initial assessment (r = 0.61 and 0.26, respectively) and at the discharge (r = 0.72 and 0.22, respectively). Receiver operating characteristic curve analysis revealed a large responsiveness for the LEFS (area under the curve [AUC] = 0.97) and a moderate responsiveness for the SF-36 (AUC = 0.68).ConclusionThe Italian version of the LEFS is a valid, reliable, and responsive tool that can be used to measure function in Italian patients with lower extremity musculoskeletal dysfunction.     

A Study of the Construct Validity of the Health Utilities Index Mark 3 (HUI3) in Patients with Schizophrenia

This study assessed the construct validity of the Health Utilities Index Mark 3 (HUI3) in patients with schizophrenia. Patients with schizophrenia recruited from a tertiary mental hospital in Singapore completed the HUI3, the Short-Form 36 Health Survey (SF-36) and the Schizophrenia Quality of Life Scale (SQLS). Patients were assessed for presence and absence of 22 common psychiatric symptoms. Construct validity was assessed using 6 a priori hypotheses. Two hundred and two patients (mean age: 37.8 years, female: 52%) completed the survey. As hypothesized, overall HUI3 utility scores were correlated with SF-36 measures (Spearman’s rho: 0.19 to 0.51), SQLS scales (Spearman’s rho: −0.56 to −0.36), and the number of psychiatric symptoms (Spearman’s rho: −0.49). The HUI3 emotion attribute was moderately correlated with SF-36 mental health (Spearman’s rho: 0.45) and SQLS psychosocial scales (Spearman’s rho: −0.43), and HUI3 pain attribute was strongly correlated with SF-36 bodily pain scale (Spearman’s rho: 0.58). The mean HUI3 overall, emotion, cognition, and speech scores for patients with schizophrenia were 0.07, 0.09, 0.04 and 0.04 points lower than respective age-, sex- and ethnicity-adjusted population norms (p<0.001 for all, ANCOVA). This study provides evidence for the construct validity of the HUI3 in patients with schizophrenia.     

The Validity and Reliability of the Functional Impairment Checklist (FIC) in the Evaluation of Functional Consequences of Severe Acute Respiratory Distress Syndrome (SARS)

Severe acute respiratory distress syndrome (SARS) contributed to significant mortality and morbidity worldwide. We aimed to establish the validity, reliability and responsiveness of the functional impairment checklist (FIC) as a measurement tool for physical dysfunction in SARS survivors. One hundred and sixteeen (65 females and 51 males, mean age 45.6) patients who joined the SARS rehabilitation programme were analysed. The factor analysis yielded two latent factors. The mean FIC-symptom and FIC-disability score were 24.12 (SD ± 20.2) and 26.11 (SD ± 27.32), respectively. Based on the item-scale correlation coefficients, the Cronbach’s alpha coefficients reflecting the internal consistency reliability of scale score were 0.75 for FIC-symptom and 0.86 for FIC-disability. Test–retest reliability in 23 patients showed no statistical significant difference in the FIC scores between tests with intraclass correlation coefficient (ICC) 0.49–0.57. The FIC scales correlated both with 6 munute walking test (6MWT) distance (−0.26 and −0.38) and handgrip strength (HGS) (−0.20 and −0.27). Moreover, the FIC scales correlated with St. George’s respiratory questionnaire (SGRQ) (0.19 to 0.52) and short form 36 Hong Kong (SF-36) domains (−0.19 to −0.59). Both FIC scales correlated stronger with physical component summary (PCS) (−0.41 and −0.55) than with mental component summary (MCS) (−0.30 and −0.23). FIC reduced significantly at 6 months while the SF-36 PCS and MCS did not show any change. In conclusion, the study results indicate the FIC is reliable, valid and responsive to change in symptom and disability as a consequence of SARS, suggesting it may provide a means of assessing health related quality of life (HRQOL) outcomes in a longitudinal follow up.