Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures

AIM: The purpose of the study was to verify test criteria of the upper-limb DASH questionnaire in patients with Colles' fractures. METHODS: 107 of 139 patients with Colles' fractures treated operatively were examined and asked to complete the questionnaire. To establish reliability, the item answers of all questionnaires were analysed by using Cronbach's Alpha correlation coefficient and corrected item total correlation. Construct validity was evaluated by comparing the DASH points with clinical measures according to Gartland/Werley and Castaing (Spearman correlation coefficient). Discriminant validity was assessed by comparing the DASH points of patients with AO-type A/B fractures and AO-type C fractures (Mann-Whitney U-Test). RESULTS: 2.7 percent of all questionnaires were unusuable. The time to fill out the questionnaire was on average 12 minutes. Cronbach's alpha values were high in all scales (alpha > 0.8). No items were found unsuitable (corrected item total correlation > 0.5 in 28 of 30 questions). DASH scores were correlated with ROM deficits and clinical measures of wrist function (r = 0.53; r = 0.59; r = 0.52, p < 0.01). The questionnaire could discriminate patients with different fracture types (p < 0.05). CONCLUSIONS: DASH is a workable, reliable and valid instrument for patients with Colles' fractures.     

The Upper Limb Functional Index: development and determination of reliability, validity, and responsiveness.

PURPOSE: Current upper limb regional self-report outcome measures are criticized for poor clinical utility, including length, ease, and time to complete and score, missing responses, and poor psychometric properties. To address these concerns a new measure, the Upper Limb Functional Index (ULFI), was developed with reliability, validity, and responsiveness being determined in a prospective study. METHODS: Patients from nine Australian outpatient settings completed the ULFI and two established scales, the Disabilities of the Arm, Shoulder, and Hand (DASH) (n=214) and the Upper Extremity Functional Scale (UEFS) (n=64) concurrently to enable construct and criterion validity to be assessed. Two subgroups were used to assess test-retest reliability at 48-hour intervals (n=46) and responsiveness through distribution-based methods (n=29). Internal consistency, change scores, and missing responses were calculated. Practical characteristics of the scale were assessed. RESULTS: The ULFI correlated with the DASH (r=0.85; 95% CI) and UEFS (r=0.78; 95% confidence interval [CI]), demonstrated test-retest reliability (intraclass correlation coefficient=0.96; 95% CI) and internal consistency (Cronbach alpha=0.89). The change scores of the ULFI with standard error of the measurement was 4.5% or 1.13 ULFI-points and minimal detectable change at the 90% CI was 10.4% or 2.6 ULFI-points. Responsiveness indices were standardized response mean at 1.87 and effect size at 1.28. The ULFI demonstrated an impairment range of 0-100%, with no missing responses and a combined patient completion and therapist scoring time of less than 3 minutes. CONCLUSIONS: The ULFI demonstrated sound psychometric properties, practical characteristics, and clinical utility thereby making it a viable clinical outcome tool for the determination of upper limb status and impairment. The ULFI is suggested as the preferred upper limb regional tool due to its superior practical characteristics and clinical utility, and comparable psychometric properties without a tendency toward item redundancy.     

The cross-cultural adaptation of the DASH questionnaire in Canadian French.

The purpose of this study was to perform a cross-cultural adaptation of the original version of the Disability of Arm, Shoulder and Hand (DASH) questionnaire to Canadian French. The cross-cultural adaptation followed five steps: forward translations into Canadian French, a synthesis of the translations, back translations into English, revision by a committee of experts, and test of the prefinal version. The content validity and the internal consistency of the Canadian French version of the questionnaire were assessed by experts involved in the study and by subjects who participated in the pilot study. Results indicate that the scores were adequately distributed without floor or ceiling effect. Item completion was excellent and item responses had a good distribution. Internal consistency of the total score was high (Cronbach alpha = 0.94) and item-total correlations were substantial for most items (0.43-0.88). These results are similar to previous studies on the DASH questionnaire supporting linguistic and conceptual equivalence of the Canadian French version.     

The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH

Background  

The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item QuickDASH, has been developed. Little is known about the discriminant ability of score changes for the QuickDASH compared to the DASH. The aim of this study was to assess the performance of the QuickDASH and its cross-sectional and longitudinal validity and reliability.     

Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand

OBJECTIVE: To establish the validity of three self-report scales used to measure function following arthroplasty for osteoarthritis (OA) of the carpometacarpal joint. METHOD: Persons with OA of the carpometacarpal joint (n=122) were assessed on one occasion 9-117 months following tendon interposition arthroplasty. They completed three self-report measures of hand/upper limb disability: the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist Hand Evaluation (PRWHE), and the Disabilities of Arm, Shoulder and Hand (DASH). They also completed the Short Form 36 (SF-36) and performed tests of strength, range of motion (ROM), and dexterity. Factor analysis and correlations were used to determine the association among the scales and subscales considered to measure similar constructs (e.g., pain and physical disability). Correlations between the scales and measures of impairment were also conducted to examine construct validity of the disability measures. t-Tests evaluated the hypotheses that subjects with isolated hand OA would have lower scores than those with additional joint involvement. RESULTS: All three scales or their subscales loaded on one factor. Convergent validity of the disability measures was demonstrated by high correlations between similar subscales (r>0.75), and divergent validity by a lack of correlation between the measures and self-report hand appearance. As expected, correlations between disability and strength, dexterity, or a global measure of ROM were higher than with ROM of individual joints. The AUSCAN and the DASH were better able to discriminate those with localized hand OA from those with involvement of other joints. CONCLUSIONS: The AUSCAN, PRWHE, and DASH are valid assessments of pain and/or disability of hand OA, and provide information distinct from impairment measures.     

Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH)

We developed a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH) by performing cross-cultural adaptation and evaluated the reliability and validity of the K-DASH. The K-DASH, SF-36, and Visual Analog Scale (VAS) for pain were administered to 161 patients with arm, shoulder, and hand problems. The internal consistency of the disability/symptom scores of the K-DASH was high (Cronbach's alpha 0.94). The retest assessed 131 of the 161 patients. The intraclass correlation coefficient was 0.91. The construct validity was evaluated using the correlations between the K-DASH and the SF-36 and VAS. The physical and mental component summary scales of the SF-36 and the VAS at rest and during activity were significantly correlated with the DASH disability/symptom scores. Despite the linguistic and cultural differences, the reliability and validity of the K-DASH were just as excellent as those of the original DASH.     

Reliability and validity of the Brachial Plexus Outcome Measure in children with obstetric brachial plexus palsy

Study DesignClinical measurement and cross-sectional study.IntroductionNumerous scales have been developed to examine activities of daily living and function in children with brachial plexus palsy. The Brachial Plexus Outcome Measure (BPOM) scale was developed in 2012 by Emily S. Ho and contains 14 items that measure activity and self-evaluation.Purpose of the StudyThe aim of the study was to cross-culturally translate the BPOM scale into Turkish and test its measurement properties in children with brachial plexus palsy.MethodsThe scale was translated into Turkish using standard cross-cultural translation procedures. Forty-eight children with obstetric brachial plexus palsy (OBPP) were included in psychometric evaluations. Internal structure consistency and test-retest reliability were measured for reliability analyses. For each item on the scale, Cronbach alpha coefficient and item-total score correlations for all subscales were calculated. The scale was administered at baseline and 1 week later by 2 different physiotherapists to evaluate test-retest reliability. Concurrent construct validity was assessed using Pearson correlations between the OBPP and the Mallet classification system.ResultsEighteen (37.5%) girls and 30 (62%) boys, in total 48 children, whose mean age was 8.7 ± 2.4 (minimum-maximum = 5-14) years were included in the study; 9 (18.9%) have a history of both early microsurgery and tendon transfers and 39 (81.3%) have a history of only tendon transfer. Cronbach alpha ranged from 0.89 to 0.96, and for the whole scale, it was calculated as 0.938.DiscussionTest-retest reliability was high. Moderate correlations were observed between the measures.ConclusionThe Turkish BPOM scale is a valid and reliable measurement for assessing function in children with OBPP in the Turkish population.     

Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems

IntroductionFoot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients’ quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems.Method215 people aged 17–60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach’s alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively.ResultsA strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach’s alpha were 0.981 and 0.98 for SAFE-Q, respectively.ConclusionThe results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.     

The disabilities of the arm,shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery

Background

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery.

Methods

The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6–21 months) change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DASH as a measure of treatment effectiveness was assessed after surgery for subacromial impingement and carpal tunnel syndrome by calculating the effect size and standardized response mean.

Results

Among the 109 patients, the mean (SD) DASH score preoperatively was 35 (22) and postoperatively 24 (23) and the mean score change was 15 (13). The effect size was 0.7 and the standardized response mean 1.2.The mean change (95% confidence interval) in DASH score for the patients reporting the status of the arm as "much better" or "much worse" after surgery was 19 (15–23) and for those reporting it as "somewhat better" or "somewhat worse" was 10 (7–14) (p = 0.01). In measuring effectiveness of arthroscopic acromioplasty the effect size was 0.9 and standardized response mean 0.5; for carpal tunnel surgery the effect size was 0.7 and standardized response mean 1.0.

Conclusion

The DASH can detect and differentiate small and large changes of disability over time after surgery in patients with upper-extremity musculoskeletal disorders. A 10-point difference in mean DASH score may be considered as a minimal important change. The DASH can show treatment effectiveness after surgery for subacromial impingement and carpal tunnel syndrome. The effect size and standardized response mean may yield substantially differing results.

     

Reliabilität und Veränderungssensitivität der deutschen Version des Fragebogens Arm, Schulter und Hand (DASH)

BACKGROUND: Whilst there are some studies which have focussed on the validity and also others partially on the reliability of the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), studies regarding test-retest reliability and responsiveness do not exist. The purpose of this study was to analyse these two meaningful properties of the officially approved German version of the DASH. METHODS: Of 101 consecutive patients with distal radius fractures, 72 were followed prospectively at three time intervals. To evaluate the reliability, internal consistency (Cronbach's alpha) and correlation between the DASH points from the 12- and 13-week examinations (Spearman's correlation coefficient and intra-class coefficient) were calculated. Responsiveness was assessed using the parameters change score, standardised effect size and standardised response mean. These values were compared with the same values obtained from the traditional measures of grip strength and range of motion. RESULTS: Internal consistency and test-retest reliability of the DASH were excellent (Cronbach's alpha >0.95, Spearman's correlation coefficient r=0.912, ICC=0.945). Responsiveness of the DASH was moderate (change score=8.93, SRM=0.55, SES=0.41). Responsiveness of the ROM deficit and grip strength were larger than that for data from the DASH. CONCLUSION: The German DASH is a reliable and responsive measure. It can detect changes in disabilities over time in patients with distal radius fractures. Traditional impairment measures reflect important functional aspects and should be included in clinical outcome evaluation.     

Validation of the Korean Version of the Oxford Knee Score in Patients Undergoing Total Knee Arthroplasty

Background

Although translated versions of the Oxford Knee Score (OKS) in several languages are available, the absence of a Korean version precludes comparing data from Korea with that from other countries using the OKS.

Questions/purposes

We therefore evaluated the reliability and validity of the adapted Korean version of the OKS.

Methods

We first translated the English version of the OKS into Korean, then back into English, then held expert committee discussions to finalize the Korean version. We then mailed the Korean version of the VAS for pain, OKS, and the previously validated SF-36 to 142 patients who underwent TKAs for knee osteoarthritis. Factor analysis and reliability assessment using the kappa statistic of agreement for each item, the intraclass correlation coefficient, and Cronbach’s alpha were conducted. To determine the subscales of the OKS, we used the factor analysis. We also evaluated concurrent and construct validity by comparing the responses to the OKS with the results of the VAS and SF-36 using Pearson’s correlation coefficient.

Results

All items had a kappa statistic of agreement greater than 0.6. The OKS showed test and retest reliability as follows: OKS, 0.848; Factor 1, 0.867; and Factor 2, 0.819. Internal consistency of Cronbach’s alpha was as follows: OKS, 0.932; Factor 1, 0.907; Factor 2, 0.867. The OKS correlated (r = 0.692) with the VAS. The Korean version of the OKS correlated with the SF-36 total and individual domain (physical functioning, role physical, bodily pain) scores.

Conclusions

The adapted Korean version of the OKS was translated and showed acceptable measurement properties. The data suggest it is suitable for assessing outcomes in Korean-speaking patients having TKAs.     

Validation of the Spanish version of the liver disease quality of life instrument among candidates for liver transplant

OBJECTIVE: To validate a Spanish version of the Liver Disease Quality of Life Questionnaire (LDQOL 1.0) among patients awaiting hepatic transplantation. METHODS: This observational, cross-sectional study was performed between May 2002 and June 2006. We included ambulatory or hospitalized patients aged 18 or over with chronic liver disease awaiting transplantation. Patients completed the LDQOL 1.0. The feasibility of the LDQOL for clinical use was tested by examining the administration time and values for the questionnaire's 12 disease-specific scales. Reliability was tested by examining the internal consistency of the scales (Cronbach's alpha). Known group validity was tested by examining the questionnaire's ability to discriminate between patients with hepatocellular (HCC), liver cirrhosis (CH), hepatitis C virus infection, and alcohol-induced CH. RESULTS: A total of 200 patients were included in the analysis. Their mean age (SD) was 52.6 (9.8) years; 73% of the sample were men. The most common indication for liver transplant was HCC (34%). The mean (SD) time to complete the LDQOL 1.0 was 35 minutes (21 minutes). Over 20% of patients scored at the ceiling (maximum possible score) on seven of the 12 disease-specific scales. Floor effects were less marked. All dimensions had Cronbach alpha coefficients over 0.60. The lowest value (0.64) was found in the sexual problems (women) dimension. Patients with HCC had significantly higher scores on several scales, including symptoms of liver disease (P = .000), effects of liver disease (P = .000), concentration (P = .002), memory (P = .015), quality of social interaction (P = .030), sleep (P = .000), loneliness (P = .043), and stigma (P = .028). Statistically significant differences were found between HCC patients and alcohol-induced CH patients in only two dimensions. CONCLUSIONS: Among pretransplant patients, the Spanish version of the LDQOL 1.0 showed substantial ceiling effects and the length of administration makes its application in clinical practice difficult. This preliminary analysis showed good internal consistency for the disease-specific scales and acceptable known group validity.     

The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Reliability and validity of the Swedish version evaluated in 176 patients

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered regionspecific outcome instrument developed to measure upperextremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale. We performed cross-cultural adaptation of the DASH to Swedish, using a process that included double forward and backward translations, expert and lay review, as well as field-testing to achieve linguistic and conceptual equivalence. The Swedish version's reliability and validity were then evaluated in 176 patients with upper-extremity conditions. The patients completed the DASH and SF-12 generic health questionnaire before elective surgery or physical therapy. Internal consistency of the DASH was high (Cronbach alpha 0.96). Test-retest reliability, evaluated in a subgroup of 67 patients who completed the DASH on two occasions, with a median interval of 7 days, was excellent (intraclass correlation coefficient 0.92). Construct validity was shown by a positive correlation of DASH scores with the SF-12 scores (worse upper-extremity disability correlating with worse general health), stronger correlation with the SF-12 physical than with the mental health component, correlation of worse DASH scores with worse self-rated global health, and ability to discriminate among conditions known to differ in severity. The Swedish version of the DASH is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in upper-extremity musculoskeletal conditions.     

The disabilities of the arm,shoulder and hand (DASH) outcome questionnaire: Reliability and validity of the Swedish version evaluated in 176 patients

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered regionspecific outcome instrument developed to measure upperextremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale. We performed cross-cultural adaptation of the DASH to Swedish, using a process that included double forward and backward translations, expert and lay review, as well as field-testing to achieve linguistic and conceptual equivalence. The Swedish version's reliability and validity were then evaluated in 176 patients with upper-extremity conditions. The patients completed the DASH and SF-12 generic health questionnaire before elective surgery or physical therapy. Internal consistency of the DASH was high (Cronbach alpha 0.96). Test-retest reliability, evaluated in a subgroup of 67 patients who completed the DASH on two occasions, with a median interval of 7 days, was excellent (intraclass correlation coefficient 0.92). Construct validity was shown by a positive correlation of DASH scores with the SF-12 scores (worse upper-extremity disability correlating with worse general health), stronger correlation with the SF-12 physical than with the mental health component, correlation of worse DASH scores with worse self-rated global health, and ability to discriminate among conditions known to differ in severity. The Swedish version of the DASH is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in upper-extremity musculoskeletal conditions.     

The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed to measure upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale. We performed cross-cultural adaptation of the DASH to Swedish, using a process that included double forward and backward translations, expert and lay review, as well as field-testing to achieve linguistic and conceptual equivalence. The Swedish version's reliability and validity were then evaluated in 176 patients with upper-extremity conditions. The patients completed the DASH and SF-12 generic health questionnaire before elective surgery or physical therapy. Internal consistency of the DASH was high (Cronbach alpha 0.96). Test-retest reliability, evaluated in a subgroup of 67 patients who completed the DASH on two occasions, with a median interval of 7 days, was excellent (intraclass correlation coefficient 0.92). Construct validity was shown by a positive correlation of DASH scores with the SF-12 scores (worse upper-extremity disability correlating with worse general health), stronger correlation with the SF-12 physical than with the mental health component, correlation of worse DASH scores with worse self-rated global health, and ability to discriminate among conditions known to differ in severity. The Swedish version of the DASH is a reliable and valid instrument that can provide a standardized measure of patient-centered outcomes in upper-extremity musculoskeletal conditions.     

Validation of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) in a Dutch population

Introduction and hypothesis

The objective of this study was to validate the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) in Dutch women.

Methods

Patients with pelvic floor dysfunction completed the Dutch questionnaires at (1) inclusion to evaluate internal consistency, (2) 1 week later to assess test-retest reliability, and (3) 6 months later to assess responsiveness and interpretability of change. To assess validity, floor and ceiling effects and construct validity were tested. A population-based sample (reference group) completed the questionnaires once.

Results

Data of 111 patients and 283 reference group participants were analyzed. Internal consistency of baseline scores in patient and reference groups was moderate (Cronbach’s alpha 0.52–0.60) to adequate in the PFDI-20 (Cronbach’s alpha 0.71–0.84) and adequate in the PFIQ-7 (Cronbach’s alpha 0.88–0.94). Both measures presented adequate test-retest reliability (intraclass correlation coefficient 0.79–0.91) and adequate responsiveness (area under the receiver-operating characteristic curve both 0.77). Interpretability was adequate for PFDI-20 and acceptable for PFIQ-7 with a clinically relevant minimally important change of ?23 and ?29 points, respectively. At baseline, the scales of the PFIQ-7 showed floor effects (44–55 %) in patients, though the PFIQ-7 summary score did not. No ceiling effects were observed. Construct validity was adequate with all predefined hypotheses confirmed regarding subgroup discrimination using pooled patient and reference group baseline data.

Conclusions

For assessing distress and health-related quality of life of pelvic floor dysfunction, the Dutch PFDI-20 and PFIQ-7 are reliable and valid in the general Dutch population, and also responsive and interpretable among tertiary care-seeking women.     

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

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

Spanish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR): Transcultural validation

Introduction and hypothesis

The aim of this study was to transculturally adapt the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR) into Spanish and to validate the new version.

Methods

We carried out a two-stage observational cross-sectional study: translation and back-translation, followed by a validation stage in which the final version was administered to 268 consecutive women (118 not sexually active [NSA] and 150 sexually active [SA]) older than 18 from an Urogynecology Unit. Besides PISQ-IR, women also completed the following questionnaires: Incontinence Severity Index (ISI); Female Sexual Function Index (FSFI); Pelvic Floor Distress Inventory (PFDI-20); and question #35 from the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ). Feasibility (percentage of valid cases), internal consistency (Cronbach’s alpha), and construct validity (structural, by factor analysis, and convergent validity by Spearman’s Rho) were evaluated.

Results

The sample was formed by 118 NSA and 150 SA women, with a mean age (SD) of 59.2 (11.5) years; mean body mass index (BMI) of 29.6 kg/m² (5.6), and mean parity of 2.6 deliveries (1.2). PISQ-IR showed a high response rate (98.3% NSA and 94.7% SA), and elevated internal consistency (Cronbach’s alpha for NSA and SA of 0.79 and 0.91 respectively). Factor analysis confirmed the structure of the original questionnaire and the convergent validity showed moderate to strong correlation between PISQ-IR and the ISI, PFDI-20, and FSFI scores, in addition to item #35 of the EPIQ.

Conclusions

The Spanish version of the PISQ-IR has adequate psychometric properties; therefore, it can be a useful tool for assessing sexual function in women with pelvic floor disorders.

     

Construct validity of the Chinese version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong Version).

With increasing economic globalization, including health care, it is important to use standardized outcome measures applicable to a broad spectrum of patients in a wide array of countries. The purpose of this study was to verify construct and content validity and reliability of the Chinese version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong version). The PRWE was translated into Chinese, and face validity was established by inviting experts and patients to participate in the panel review of the questionnaire. A correlation field study was performed using a convenience sample of 47 patients with wrist injuries. Patients were assessed at baseline and six weeks after the initial measurement. The following measures were taken: the Chinese version of the PRWE and the Medical Outcome Short Form (36) Health Survey (SF-36), Visual Analogue Scale (VAS) for pain, active wrist range of motion, grip strength, and the Jebsen Hand Function Test. Statistical analysis consisted of Pearson correlation coefficients (convergent validity), factor analysis (content validity), paired t-test (convergent validity), and the Cronbach alpha (internal consistency). Clinically relevant correlations existed between "Pain at rest" and the VAS "resting pain" (r=0.785, p<0.0001) as well as between "Pain on repeated wrist movement" and the VAS "exertion pain" (r=0.872, p<0.0001). The "Physical Component Summary" of the SF-36 was found significantly correlated with the PRWE function subset total score (r=-0.618, p<0.0001), and the PRWE total score (r=-0.645, p<0.0001). The specific function subset score also correlated with the wrist flexion range (r=-0.308, p<0.0001) and the grip strength (r=-0.488, p=0.035). Two factors were found that accounted for 61% of the variance. The Cronbach alpha coefficients ranged from 0.7805 to 0.9502, indicating that the internal consistency of the questionnaire items was sound and reliable. Positive correlations between the wrist ranges of motion (ROM) and the specific function subset score showed that the function subset measured dimensions related to wrist-specific performance in activities of daily living. Factor analysis results supported the construct validity of the PRWE-Hong Kong version in wrist-injured patients. Internal consistency testing results suggested that item consistency within subset items was good and persisted over time. In conclusion, the Chinese version of the PRWE is a reliable and valid self-rated tool in measuring treatment outcome. It supplements traditional objective clinical measures and is potentially applicable in Hong Kong clinical settings.