A physiotherapist-led exercise and education program for preventing recurrence of low back pain: a randomised controlled pilot trial

Background

Before beginning a large and complex trial it is considered good practice to run a pilot study to assess the feasibility and acceptability so that quality is maintained and resources are not wasted.

Validation of the Greek Version of the Diabetes Management Self-Efficacy Scale (GR-DMSES)

Introduction

Self-efficacy has been found to have a direct relation with self-care in diabetes. Several tools have been developed and used for evaluating self-efficacy of diabetic patients, the most widely used being the Diabetes Management Self-Efficacy Scale (DMSES). The aim of the present study was to translate, culturally adapt, and validate the Greek DMSES (GR-DMSES) in order for it to be used in the ATTICA pilot study of the SmartCare EU-funded project.

Methods

Using standard procedures, the original version of DMSES was translated and culturally adapted into Greek. Content validity was assessed by an expert panel with the calculation of a content validity index of the overall scale. Α convenient sample was recruited to complete the questionnaire. Psychometric testing of the produced instrument included internal consistency test (Cronbach’s alpha), construct validity (factor analysis), and stability (intraclass correlation coefficient).

Results

One hundred and sixteen patients, aged 36–86 years, with type 2 diabetes (T2D) participated in the study. There were no items excluded from the original scale after the content validity procedure. The coefficient Cronbach's alpha for the internal consistency was 0.93 and the intraclass correlation coefficient for the stability with a 5-week time interval was 0.87 (P < 0.001). Factor analysis yielded four factors related to diet, medical therapy, medication and feet check, and physical activity.

Conclusion

The findings supported that the GR-DMSES was reliable and valid in measuring self-efficacy related to diabetes self-management, thus providing a quick and easy-to-use tool for health professionals dealing with Greek adults with T2D.

     

Validation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD) in patients with painful TMD

Background

The aim of the study was to validation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD) for use in patients with painful TMD.

Methods

The original TSK-TMD was translated and cross-culturally adaptated following international guidelines. A total of 160 patients with temporomandibular disorders (TMD) were enrolled to fill out the scale. The internal consistency and test-retest methods were used to evaluate the reliability of the TSK-TMD. The validity of the TSK-TMD was analyzed by content validity, construct validity and convergent validity. Construct validity was assessed based on exploratory factor analysis (EFA), and convergent validity by examining the correlation between the global rating of oral health question and TSK-TMD scores.

Results

Cronbach’s alpha value for the total TSK-TMD score was 0.919 and the intraclass correlation coefficient (ICC) value for the TSK-TMD was 0.797. Construct validity was assessed by EFA, extracting two factors, accounting for 71.9% of the variance. The factor loadings of all items were higher than 0.40. In terms of convergent validity, the TSK-TMD subscales showed good correlations to the global rating of oral health question.

Conclusion

These findings show that the Chinese version of TSK-TMD has satisfactory psychometric properties and is appropriate for use in patients with painful TMD in China.

     

External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome

Purpose

Mortality prediction in ARDS is important for prognostication and risk stratification. However, no prediction models have been independently validated. A combination of two biomarkers with age and APACHE III was superior in predicting mortality in the NHLBI ARDSNet ALVEOLI trial. We validated this prediction tool in two clinical trials and an observational cohort.

Methods

The validation cohorts included 849 patients from the NHLBI ARDSNet Fluid and Catheter Treatment Trial (FACTT), 144 patients from a clinical trial of sivelestat for ARDS (STRIVE), and 545 ARDS patients from the VALID observational cohort study. To evaluate the performance of the prediction model, the area under the receiver operating characteristic curve (AUC), model discrimination, and calibration were assessed, and recalibration methods were applied.

Results

The biomarker/clinical prediction model performed well in all cohorts. Performance was better in the clinical trials with an AUC of 0.74 (95% CI 0.70–0.79) in FACTT, compared to 0.72 (95% CI 0.67–0.77) in VALID, a more heterogeneous observational cohort. The AUC was 0.73 (95% CI 0.70–0.76) when FACTT and VALID were combined.

Conclusion

We validated a mortality prediction model for ARDS that includes age, APACHE III, surfactant protein D, and interleukin-8 in a variety of clinical settings. Although the model performance as measured by AUC was lower than in the original model derivation cohort, the biomarker/clinical model still performed well and may be useful for risk assessment for clinical trial enrollment, an issue of increasing importance as ARDS mortality declines, and better methods are needed for selection of the most severely ill patients for inclusion.

     

Cultural influences on exercise participation and fall prevention: a systematic review and narrative synthesis

Purpose: We aim to provide a systematic review of qualitative research evidence relevant to the experiences and perceptions of program providers and participants from culturally and linguistically diverse (CALD) backgrounds regarding (i) exercise and (ii) fall prevention programs for older people. Method: Using a narrative synthesis approach, we reviewed published journal articles reporting qualitative data. Electronic and manual literature searches were conducted to identify 19 publications that met the inclusion criteria. Of these, 16 discussed exercise and three focused on broader fall prevention programs. However, no studies were identified that explored the perspective of the program providers. Results: An overarching theme emerged identifying the influence of cultural values and perceptions on program participation. Also, identified were motivational, social and environmental influences. Conclusion: Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family. While these findings can be used to inform the delivery of programs to these population groups, future studies should focus specifically on experiences and perceptions of older CALD people of fall prevention programs as well as the perspectives of program providers.

• Implications for Rehabilitation

• Program participation is influenced by cultural values and motivational, social and environmental factors.

• The meaning and importance of exercise can vary between and within cultures.

• Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family.

• Providing information that falls can be prevented and the reasons why behaviours need to change will be more likely to encourage older people from CALD backgrounds to contemplate participation.

     

Preadmission testing in a children's facility

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NURSES IN A SAME DAY SURGERY (SDs) UNIT used their hospital's quality model to identify a long-term problem, establish a project, analyze the problem, and make recommendations for changes to improve patient care.

•

THE PROCESS included conducting a review of the literature, collecting data about procedure delays and cancellations, making a site visit to another children's hospital, and presenting pertinent findings to the OR committee.

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THE NURSES initiated a pilot program to bring surgical patients into the SDS area for a preadmission testing visit.

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DELAYS AND CANCELLATIONS decreased, and satisfaction among nurses working in the SDS unit increased as a result of this program. AORN J 78 (October 2003) 604-617.

     

Patients in 24-hour home care striving for control and safety

Background

Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday.

Methods

A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently.

Results

The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent.

Conclusions

Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation.     

Public perception of female paramedics at King Abdulaziz Medical City,Saudi Arabia

Background

Although emergency medical service (EMS) providers recognize that both male and female paramedics are necessary, Saudi EMSs are currently fully staffed by men. Cultural bias against care provision by male paramedics to female victims in the absence of male guardians underscores the need for female paramedics. Consequently, we explored public perception of female paramedics at King Abdulaziz Medical City (KAMC), Riyadh.

Method

This observational, cross-sectional study used convenience sampling to assess the perceptions of patients, visitors, and employees at the emergency rooms in KAMC and King Abdullah Specialized Children’s Hospital via self-administered English- and Arabic-language questionnaires. Questionnaire reliability and validity were assessed in a pilot study.

Results

Three hundred twelve respondents completed the survey (67.30% men). The sample included 43.27% medical (40% paramedics, 22% physicians, 12% nurses, and 23% other) and 56.73% nonmedical participants, of whom 53% and 63%, respectively, strongly agreed regarding the importance of female paramedics. Moreover, in the male participant group, 6% of medical and 8% of nonmedical participants strongly disagreed with treatment of their female relatives by male paramedics, and 20% of medical and 30% of nonmedical participants declined medical help because female paramedics were unavailable.

Conclusions

Respondents rated the importance of trained female paramedics in the EMS system. Most strongly agreed that female and male paramedics had equal patient-management capabilities and skills.

     

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n?=?29) or the control (n?=?34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability??0.51; QALY??0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive “e-health” technologies.

• IMPLICATIONS FOR REHABILITATION

• The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities.

• The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees.

• The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data.

• The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

     

Psychometric assessment of the Chinese version of the MASCC Antiemesis Tool (MAT) for measuring chemotherapy-induced nausea and vomiting

Purpose

This paper aims to assess the psychometric properties of the Chinese version of the MASCC Antiemesis Tool (MAT) for measuring chemotherapy-induced nausea and vomiting (CINV).

Methods

This was a psychometric study using a panel of experts and a prospective observational design. Six experts were invited to identify the content validity and face validity of the MAT, and 115 cancer patients were then recruited from three provincial medical centers in Fuzhou, China. The MAT was self-completed by the patients on the first and the fifth day after receiving the most recent chemotherapy, and patients also rated daily the Index of Nausea, Vomiting, and Retching (INVR) during the first 5 days after chemotherapy. Content validity was measured by the index of the content validity (CVI). Construct validity was estimated by the contrasted groups approach. Concurrent validity was measured by exploring the correlations between the INVR and MAT scores. The reliability of the MAT was examined by Cronbach’s alpha and item-to-total correlations.

Results

One hundred and eleven subjects returned the completed measures. High content validity was determined. Contrasted groups analysis clearly discriminated the differences on the CINV symptom experiences between different age and gender groups. Excellent concurrent validity was identified, with the Spearman’s correlation coefficient between the MAT total score and the INVR overall total score of 0.94 (P < 0.001). Cronbach’s alpha for the MAT was 0.73, and the item-to-total correlations ranged from 0.50 to 0.71.

Conclusions

The MAT Chinese version is a valid, reliable, and convenient instrument for measuring CINV in Chinese cancer patients.

     

Is Socioeconomic Position Related to the Prevalence of Metabolic Syndrome?: Influence of social class across the life course in a population-based study of older men

OBJECTIVE—To examine whether adult social class and childhood social class are related to metabolic syndrome in later life, independent of adult behavioral factors.RESEARCH DESIGN AND METHODS—This was a population-based cross-sectional study comprising 2,968 men aged 60–79 years.RESULTS—Adult social class and childhood social class were both inversely related to metabolic syndrome. Mutual adjustment attenuated the relation of metabolic syndrome with childhood social class; that with adult social class was little affected. However, the relation with adult social class was markedly attenuated by adjustment for smoking status, physical activity, and alcohol consumption. High waist circumference was independently associated with adult social class.CONCLUSIONS—The association between adult social class and metabolic syndrome was largely explained by behavioral factors. In addition, central adiposity, a component of metabolic syndrome, was associated with adult social class. Focusing on healthier behaviors and obesity, rather than specific efforts to reduce social inequalities surrounding metabolic syndrome, is likely to be particularly important in reducing social inequalities that affect people with coronary disease.There has been increasing interest in the relationship between socioeconomic position and metabolic syndrome, which is postulated to form a direct pathway linking adverse social conditions and coronary heart disease (CHD), possibly working through neuroendocrine mechanisms causing obesity, dyslipidemia, hypertension, and insulin resistance (1,2). However, the association between socioeconomic position and metabolic syndrome has not been completely consistent between studies (1,3,4), and the relationship is possibly confounded by behavioral factors, which are strongly related to metabolic syndrome, and to socioeconomic position (3–6). Additionally, few studies have explored the independent relationships of adult and early-life social circumstances with metabolic syndrome (4,7,8). We have, therefore, examined whether adult and childhood social class may be associated with metabolic syndrome in older men (aged 60–79 years) independently of adult behavioral factors.     

Chinese cross-cultural adaptation and validation of the Foot Function Index as tool to measure patients with foot and ankle functional limitations

Purpose: To perform a cross-cultural adaptation and validation of the Foot Function Index (FFI) questionnaire to develop the Chinese version.

Materials and methods: Three hundred and six patients with foot and ankle neuromusculoskeletal diseases participated in this observational study. Construct validity, internal consistency and criterion validity were calculated for the FFI Chinese version after the translation and transcultural adaptation process.

Results: Internal consistency ranged from 0.996 to 0.998. Test–retest analysis ranged from 0.985 to 0.994; minimal detectable change 90: 2.270; standard error of measurement: 0.973. Load distribution of the three factors had an eigenvalue greater than 1. Chi-square value was 9738.14 (p?r?=??0.634 (Factor 2) and r?=??0.191 (Factor 1). Foot Function Index (Taiwan Version), Short-Form 12 (Version 2) and EuroQol-5D were used for criterion validity. Factors 1 and 2 showed significant correlation with 15/16 and 14/16 scales and subscales, respectively.

Conclusions: Foot Function Index Chinese version psychometric characteristics were good to excellent. Chinese researchers and clinicians may use this tool for foot and ankle assessment and monitoring.

• Implications for rehabilitation

• A cross-cultural adaptation of the FFI has been done from original version to Chinese.

• Consistent results and satisfactory psychometric properties of the Foot Function Index Chinese version have been reported.

• For Chinese speaking researcher and clinician FFI-Ch could be used as a tool to assess patients with foot disease.

     

Assessing validity of observational intervention studies – the Benchmarking Controlled Trials

Background: Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations.

Aims: To create and pilot test a checklist for appraising methodological validity of a BCT.

Methods: The checklist was created by extracting the most essential elements from the comprehensive set of criteria in the previous paper on BCTs. Also checklists and scientific papers on observational studies and respective systematic reviews were utilized. Ten BCTs published in the Lancet and in the New England Journal of Medicine were used to assess feasibility of the created checklist.

Results: The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies.

Conclusions: The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. However, the piloted checklist should be validated in further studies.

• Key messages

• Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations.

• This paper presents a checklist for appraising methodological validity of BCTs and pilot-tests the checklist with ten BCTs published in leading medical journals. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies.

• The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies.

     

Motivations of nursing students regarding their educational preparation for mental health nursing in Australia and the United Kingdom: a survey evaluation

Background

There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice.

Methods

This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received.

Results

The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care.

Conclusions

A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing.

     

Assessing nursing staff’s competences in mobility support in nursing-home care: development and psychometric testing of the Kinaesthetics Competence (KC) observation instrument

Background

Between 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as well as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote and maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a training concept used to increase nursing staff’s interaction and movement support skills for assisting care-dependent persons in their daily activities. This study aims to develop and test an observation instrument for assessing nursing staff’s competences in kinaesthetics.

Methods

The Kinaesthetics Competence (KC) observation instrument was developed between January and June 2015 based on a literature review, a concept analysis and expert meetings (18). The pilot instrument was evaluated with two expert panels (n?=?5, n?=?4) regarding content validity, usability and inter-rater agreement. Content validity was assessed by determining the content validity index (CVI). The final instrument was tested in a cross-sectional study in three nursing homes in the German-speaking part of Switzerland between July 2015 and February 2016. In this study nursing staff (n?=?48) was filmed during mobilization situations. Based on this video data two observers independently assessed nursing staff’s competences in kinaesthetics with the KC observation instrument. Inter-rater reliability and inter-rater agreement was evaluated using the intra-class correlation coefficient (ICC) and percentage of agreement. Construct validity was assessed by a discriminating power analysis. Internal consistency was evaluated using Cronbach’s alpha coefficient and item analysis.

Results

The final version of the KC observation instrument comprised of four domains (interaction, movement support of the person, nurses’ movement, environment) and 12 items. The final instrument showed an excellent content validity index of 1.0. Video sequences from 40 persons were analysed. Inter-rater reliability for the whole scale was good (ICC 0.73) and the percentage of inter-rater agreement was 53.6% on average. Cronbach’s alpha coefficient for the whole instrument was 0.97 and item-total correlations ranged from 0.76 to 0.90. The construct validity of the instrument was supported by a significant discrimination of the instrument between nursing staff with no or basic and with advanced kinaesthetics training for the total score and 3 of 4 subscales.

Conclusions

The KC observation instrument showed good preliminary psychometric properties and can be used to assess nursing staff’s competences in mobility care based on the principles of kinaesthetics.

     

Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes

OBJECTIVE

To perform the first comprehensive psychometric evaluation of the Hypoglycemia Fear Survey-II (HFS-II), a measure of the behavioral and affective dimensions of fear of hypoglycemia, using modern test-theory methods, including item-response theory (IRT).

RESEARCH DESIGN AND METHODS

Surveys completed in four previous studies by 777 adults with type 1 diabetes were aggregated for analysis, with 289 subjects completing both subscales of the HFS-II and 488 subjects completing only the Worry subscale. The aggregated sample (53.3% female, 44.4% using insulin pumps) had a mean age of 41.9 years, diabetes duration of 23.8 years, HbA_1c value of 7.7%, and 1.4 severe hypoglycemic episodes in the past year. Data analysis included exploratory factor analysis using polychoric correlations and IRT. Factors were analyzed for fit, trait-level locations, point-measure correlations, and separation values.

RESULTS

Internal and test-retest reliability was good, as well as convergent validity, as demonstrated by significant correlations with other measures of psychological distress. Scores were significantly higher in subjects who had experienced severe hypoglycemia in the past year. Factor analyses validated the two subscales of the HFS-II. Item analyses showed that 12 of 15 items on the Behavior subscale, and all of the items on the Worry subscale had good-fit statistics.

CONCLUSIONS

The HFS-II is a reliable and valid measure of the fear of hypoglycemia in adults with type 1 diabetes, and factor analyses and IRT support the two separate subscales of the survey.The Hypoglycemia Fear Survey (HFS), first published in 1987 (1), originally was developed to measure behaviors and worries related to fear of hypoglycemia (FOH) in adults with type 1 diabetes. Both the original HFS (HFS-I) and the revised version (HFS-II) are composed of two subscales, the Behavior (HFS-B) and Worry (HFS-W). HFS-B items describe behaviors in which patients may engage to avoid hypoglycemic episodes and/or their negative consequences (e.g., keeping blood glucose [BG] levels above 150 mg/dL, making sure other people are around, and limiting exercise or physical activity). HFS-W items describe specific concerns that patients may have about their hypoglycemic episodes (e.g., being alone, episodes occurring during sleep, or having an accident). Since it was first published, the HFS, in its original form and subsequent revisions, has been used in >60 published studies and numerous clinical trials and has been translated into over 50 languages. The survey also is commonly used in studies of people with type 2 diabetes to better understand their experiences of hypoglycemia (2). In addition, the authors have developed alternative versions of the HFS for use with pediatric patients with type 1 diabetes and their parents, as well as spouses and significant others of adults with diabetes (3–5).Despite its widespread use, the only comprehensive study to address the psychometric properties of the U.S. HFS was published >15 years ago and focused on the HFS-I, which is no longer in use (6). Since then, based on subsequent studies, the scale has been significantly revised, leaving only 18 of 33 items unchanged from the original version from 1987. Although there is some evidence for the reliability and validity of the HFS-II (2,7), no comprehensive study of its psychometric properties has been conducted with a large sample. In addition, psychometric results of previous studies included only classical test-theory methods that have not acknowledged the categorical nature of HFS data. Modern test procedures, such as item-response theory (IRT), are better suited to analyze categorical data and can provide valuable information about item quality, including response option use, fit, and endorsement difficulty (8).For researchers and clinicians interested in using the HFS-II, this lack of supporting psychometric data presents many obstacles not the least of which is the inability to interpret scores in a clinically meaningful way. The purpose of the current study was to conduct a comprehensive psychometric investigation of the HFS-II U.S. English adult version using a large aggregate sample of data collected at our laboratory over the past decade and using modern test-theory methods. The following were the hypotheses tested: 1) that the HFS-II is a reliable and valid measure of FOH and 2) that factor analysis will yield a two-factor structure reflecting the two subscales of the survey.     

Development and structural validation of a shortened version of the Participation Scale

Purpose: To validate a shortened version of the Participation Scale (P-scale) that will be quicker to use and to describe the factor structure found in the P-scale data in various study samples. Methods: A large multi-country and multi-cultural database was compiled consisting of 5125 respondents. Item analysis, explanatory factor analysis and confirmatory factor analysis were applied to identify items for deletion and investigate the factor structure of the P-scale. Results: The multi-country database included 11 databases from six different countries. Respondents were affected by a range of health conditions, including leprosy, HIV/AIDS, dermatological conditions and various disabilities. Of the respondents included 57% were male. The P-scale Short (PSS) contains 13 items. A two-factor structure, with factors named “work-related participation” (three items) and “general participation” (10 items), showed the best model fit (Comparative Fit Index = 0.983, Tucker Lewis Index = 0.979, Rooted Mean Square Error of Approximation = 0.061). The Cronbach’s alphas were very good for both the whole scale and the subscales, 0.91, 0.83 and 0.90, respectively. Correlation between the two factors was high (r = 0.75) indicating that interpreting the P-scale as measuring an overall factor “participation” is still valid. A very high correlation (r = 0.99) was found between the full P-scale and the PSS. Conclusions:The findings suggest good validity of the P-scale across a range of languages and cultures. However, field testing needs to confirm the validity of the PSS to measure the level of social participation restrictions across cultures and health conditions.

Implications for Rehabilitation

• The Participation Scale can be used to measure restrictions in social participation.

• The Participation Scale showed consistent structural validity across many different cultural settings and target groups.

• A shorter version of the scale was developed, namely the Participation Scale Short.

• The Participation Scale Short needs field testing before application to test its reliability, validity, reduction in administration time and usefulness.

     

Internet Psycho-Education Programs Improve Outcomes in Youth With Type 1 Diabetes

OBJECTIVE

The purpose of this study was to determine the efficacy of two Internet-based psycho-educational programs designed to improve outcomes for youth with type 1 diabetes transitioning to adolescence.

RESEARCH DESIGN AND METHODS

The study was a multisite clinical trial of 320 youth (aged 11–14 years; 37% minority; 55% female) randomized to one of two Internet-based interventions: TeenCope or Managing Diabetes. Primary outcomes were HbA_1c and quality of life (QOL). Secondary outcomes included coping, self-efficacy, social competence, self-management, and family conflict. Data were collected at baseline and after 3, 6, and 12 months online. Youth were invited to cross over to the other program after 12 months, and follow-up data were collected at 18 months. Analyses were based on mixed models using intent-to-treat and per-protocol procedures.

RESULTS

Youth in both groups had stable QOL and minimal increases in HbA_1c levels over 12 months, but there were no significant differences between the groups in primary outcomes. After 18 months, youth who completed both programs had lower HbA_1c (P = 0.04); higher QOL (P = 0.02), social acceptance (P = 0.01), and self-efficacy (P = 0.03) and lower perceived stress (P = 0.02) and diabetes family conflict (P = 0.02) compared with those who completed only one program.

CONCLUSIONS

Internet interventions for youth with type 1 diabetes transitioning to adolescence result in improved outcomes, but completion of both programs was better than only one, suggesting that these youth need both diabetes management education and behavioral interventions. Delivering these programs via the Internet represents an efficient way to reach youth and improve outcomes.Youth with type 1 diabetes in transition to adolescence are a vulnerable population. They exhibit deteriorating metabolic control (1,2), poorer self-management, and increased social stressors and psychosocial distress, as well as lower quality of life (QOL) compared with children with type 1 diabetes at other ages (2). Resolving independence/dependence issues and acquiring positive acceptance by peers within the context of a complex treatment regimen are particularly challenging for these youth. Having diabetes involves fear of hypoglycemia, fear of future complications, feelings of guilt for possible wrongdoing, and feelings of stress associated with challenging self-management tasks (3). In addition, these stressors occur within the broader context of increased expectations for adolescents to maintain excellent metabolic control (4), despite the insulin resistance associated with puberty (5).As youth transition to adolescence and take on greater responsibility for their diabetes self-management, educational needs are higher. Standards of care for youth with type 1 diabetes identify the importance of education; yet, the provision of education in the clinical setting is mostly informal and inconsistent. Considerable evidence indicates that in-person psycho-educational interventions, such as Coping Skills Training (CST), improve metabolic control of type 1 diabetes as well as psychosocial adjustment and QOL in youth (6–8). However, implementing these evidence-based programs in clinical care is challenging because of provider and organizational barriers, such as lack of time, resources, and expertise (9). Rapid advances in technology and access to the Internet have made it not only a viable mode for the delivery of psycho-educational interventions but also a platform that can be widely disseminated and implemented. Internet interventions allow for standardization of program content, can be targeted to specific ages and developmental phases, allow for social interaction, and can be easily updated. Access to the Internet is increasingly available nationwide and has risen to its highest level ever, with 93% of youth using the Internet regularly for school assignments, hobbies or special interests, entertainment, and connection with others (10,11). The Internet, therefore, represents an efficient way to deliver psycho-educational interventions to youth with type 1 diabetes.Psycho-educational interventions delivered via the Internet have demonstrated efficacy in improving symptoms and health behaviors in youth of different ages and illness experiences (12–14). In a pilot study, youth with type 1 diabetes who completed an Internet program with a focus on problem solving and social networking demonstrated improved self-management and problem solving compared with a control group (15). Internet-based interventions that can reach large numbers of youth with diabetes have the potential to result in significant improvements in long-term health, as well as reductions in the costs of care for diabetes-related complications. They also have the potential to improve access for diverse youth with type 1 diabetes. While there is ongoing evidence of the digital divide, this has been decreasing over time, particularly with English-speaking youth in the U.S. (10).TeenCope, a new Internet-based version of CST, was developed by our group. It is based on social cognitive theory and posits that improving coping skills will lead to improved self-efficacy and self-management of diabetes that result in better outcomes, as has been demonstrated in studies of CST delivered in a group-based in-person format (16). Managing Diabetes was developed to serve as the control condition and was a diabetes education and problem-solving program.Thus, the purpose of this multisite randomized clinical trial was to compare the efficacy of two Internet-based programs on the primary outcomes of HbA_1c and QOL and on the secondary outcomes of stress, coping, self-efficacy, self-management, social competence, and family conflict at 12 months. At 12-month follow-up, youth were invited to participate in the alternate program, allowing us to explore the effect of participating in two programs compared with participating in only one. We hypothesized that youth who participated in TeenCope would have lower HbA_1c levels and better QOL after 12 months than those who participated in Managing Diabetes.     

The English and Chinese versions of the five-level EuroQoL Group's five-dimension questionnaire (EQ-5D) were valid and reliable and provided comparable scores in Asian breast cancer patients

Objective

To examine the measurement properties of and comparability between the English and Chinese versions of the five-level EuroQoL Group??s five-dimension questionnaire (EQ-5D) in breast cancer patients in Singapore.

Methods

This is an observational study of 269 patients. Known-group validity and responsiveness of the EQ-5D utility index and visual analog scale (VAS) were assessed in relation to various clinical characteristics and longitudinal change in performance status, respectively. Convergent and divergent validity was examined by correlation coefficients between the EQ-5D and a breast cancer-specific instrument. Test?Cretest reliability was evaluated. The two language versions were compared by multiple regression analyses.

Results

For both English and Chinese versions, the EQ-5D utility index and VAS demonstrated known-group validity and convergent and divergent validity, and presented sufficient test?Cretest reliability (intraclass correlation?=?0.72 to 0.83). The English version was responsive to changes in performance status. The Chinese version was responsive to decline in performance status, but there was no conclusive evidence about its responsiveness to improvement in performance status. In the comparison analyses of the utility index and VAS between the two language versions, borderline results were obtained, and equivalence cannot be definitely confirmed.

Conclusion

The five-level EQ-5D is valid, responsive, and reliable in assessing health outcome of breast cancer patients. The English and Chinese versions provide comparable measurement results.