Measurement of mood states in stroke patients: validation of the visual analog mood scales.

OBJECTIVE: The Visual Analog Mood Scales (VAMS) were recently developed by Stern and colleagues to assess mood state in neurologically impaired patients. These brief scales require that a patient place a single pen mark along a 100mm vertical line to indicate how he or she presently feels. Although previous studies have garnered evidence in support of the validity of these brief scales when administered to psychiatric patients and healthy young adult and geriatric control subjects, it is presently unknown whether the VAMS are valid measures of internal mood state in neurologically impaired stroke patients. The purpose of the present investigation was to assess reliability and validity of the VAMS in a stroke-patient population. PARTICIPANTS: Participants were 41 (21 men and 20 women) inpatients admitted for either acute stroke or rehabilitation following stroke. DESIGN: Participants completed both the VAMS and a modified version of the Profile of Mood States (POMS). Nonparametric multitrait-multimethod analyses were performed using the Pearson correlations among and between the six subscales of the VAMS and the POMS. CONCLUSION: The VAMS possess good convergent and discriminant validity when administered to stroke inpatients, providing further support for the utility of these brief, easily administered scales.     

Development and evaluation of a self‐care assessment inventory for workers

Aim: To develop and evaluate a self‐care assessment inventory for workers (SCAI‐W). Methods: A study using a self‐care assessment inventory for workers consisting of 27 self‐care items, the Japanese version of the Beck Depression Inventory (BDI), and the Japanese version of the University of Wales Institute of Science and Technology Mood Adjective Checklist (JUMACL) was conducted. These questionnaires were distributed to 2297 workers. There were 893 valid responses (39.9%, 584 men and 309 women, mean age 37.2 ± 10.2 years). Results: Three primary and eight secondary factors were established for the conceptual structure of self‐care and validated by structural equation modeling. “Positive attitude” comprised the secondary factors, “hope” and “sense of fulfillment”, and was influenced by another secondary factor, “social support”. “Positive attitude” contributed to “attitude toward health”. “Attitude toward health” comprised the secondary factors, “care about one's health” and “correction of bad habits”. “Attitude toward health” influenced a primary factor, “everyday behavior”, comprised of “wakefulness”, “eating in moderation”, and “lack of self‐control”. The primary factors “positive attitude” and “everyday behavior” influenced the BDI scores. A multiple regression analysis indicated that JUMACL subscale scores (energetic arousal and tense arousal), demographic data (living alone, sex, and age) and health‐related data (exercise, smoking, body mass index, drinking more than three alcoholic drinks/day, and gambling) predicted the scores of the self‐care assessment inventory for workers. Conclusion: This assessment inventory could be a useful measure of workers' self‐care because it establishes a relationship between psychological and behavioral concepts that are important for health promotion.     

The Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM): An assessment of validity,reliability, and responsiveness

Background

In response for the need of a freely available, stand‐alone, validated outcome measure for use within musculoskeletal (MSK) physiotherapy practice, sensitive enough to measure clinical effectiveness, we developed an MSK patient reported outcome measure.

Objectives

This study examined the validity and reliability of the newly developed Brighton musculoskeletal Patient‐Reported Outcome Measure (BmPROM) within physiotherapy outpatient settings.

Methods

Two hundred twenty‐four patients attending physiotherapy outpatient departments in South East England with an MSK condition participated in this study. The BmPROM was assessed for user friendliness (rated feedback, N = 224), reliability (internal consistency and test–retest reliability, n = 42), validity (internal and external construct validity, N = 224), and responsiveness (internal, n = 25).

Results

Exploratory factor analysis indicated that a two‐factor model provides a good fit to the data. Factors were representative of “Functionality” and “Wellbeing”. Correlations observed between the BmPROM and SF‐36 domains provided evidence of convergent validity. Reliability results indicated that both subscales were internally consistent with alphas above the acceptable limits for both “Functionality” (α = .85, 95% CI [.81, .88]) and ‘Wellbeing’ (α = .80, 95% CI [.75, .84]). Test–retest analyses (n = 42) demonstrated a high degree of reliability between “Functionality” (ICC = .84; 95% CI [.72, .91]) and “Wellbeing” scores (ICC = .84; 95% CI [.72, .91]). Further examination of test–retest reliability through the Bland–Altman analysis demonstrated that the difference between “Functionality” and “Wellbeing” test scores did not vary as a function of absolute test score. Large treatment effect sizes were found for both subscales (Functionality d = 1.10; Wellbeing 1.03).

Conclusion

The BmPROM is a reliable and valid outcome measure for use in evaluating physiotherapy treatment of MSK conditions.     

Systematic review of the emotional state and self‐management of widows

The death of a partner in later life is generally experienced as the most stressful normative life event. This study reviewed evidence about the emotional state of widows. Both qualitative and quantitative studies were included in the review. A systematic search was made of the OVID Medline, PubMed, ProQuest, and EBSCOhost/Academic Search Premier databases using the following search words: “depression”, “elderly”/“older”, “emotional state”, “mood”, “self‐management”, “widows”, and “women” for the period January 2000 to December 2010. Thirteen articles met the inclusion criteria, and a qualitative content analysis was used to review them. The findings revealed one main theme: “A struggle to perceive meaning in the meaningless”, which was based on three themes: “Numbing the pain and struggling to control feelings”, “Feeling sad, yet trying to maintain close emotional relationships and meaningful activities”, and “The process of change and self‐management dominated by resilience”. The widows seemed overwhelmed by the need to overcome an unbearable emotional state. The resilience process was experienced as a struggle, and they required time to improve their well‐being and self‐management. To achieve self‐management, nurses should strengthen widows' optimism, control, well‐being, and the pathways that lead to recovery.     

Supporting stress management for women undergoing the early stages of fertility treatment: A cluster‐randomized controlled trial*

Aim: The purpose of this study was to determine the effects of a support program for the stress management of women undergoing fertility treatment to reduce stress related to infertility and treatment. Methods: We randomly assigned seven institutions into an experimental group (four institutions, n = 96) and a control group (three institutions, n = 44) using cluster randomization. The women in the experimental group were asked to continue stress management homework for 3 months. A nurse provided feedback on the homework every month. Those in the control group were given only the booklet. The primary outcomes were the risk ratios of “depression” and “anxiety” according to the Hospital Anxiety and Depression Scale. The secondary outcomes were “health status” from the Medical Outcomes Study Short‐Form 36‐item Health Survey (SF‐36) v2 and “satisfaction” from the Visual Analogue Scale. We excluded 15 women who became pregnant and performed an intention‐to‐treat analysis of 125 women. Results: There were no differences in the incidence of depression and anxiety between the experimental and control groups. There were significant interaction effects between the program and time in the scores of the two subscales of SF‐36 and the summary. There was no difference in satisfaction. The use of ovulation‐enhancing agents showed that the scores of “role functioning physical” and “physical component summary” in the non‐use subgroup were higher at 2 and 3 months in the experimental group, compared to the control group. Conclusions: Positive effects of the support program were observed on two subscales of the SF‐36 in the subgroup that did not use ovulation‐enhancing agents.     

Psychometric testing of the Chinese Mandarin version of the Mental Health Inventory among Chinese patients with coronary heart disease in Mainland China

This study aimed to develop a Chinese Mandarin version of the Mental Health Inventory (CM:MHI). The English version MHI was translated into Chinese (simple Chinese character) using the forward‐backward translation method while establishing the semantic equivalence and content validity. A convenience sample of 204 coronary heart disease (CHD) patients was recruited to evaluate the internal consistency, concurrent validity and construct validity of the CM:MHI. Forty patients completed the CM:MHI to evaluate the test–retest reliability after 2 weeks. The CM:MHI demonstrated good semantic equivalent rate (92%) and satisfactory content validity index (0.91). The internal consistency was acceptable for total and all subscales with Cronbach's alpha greater than 0.70, with the exception of the subscale of Emotional Ties (Cronbach's alpha = 0.64). The test–retest reliability was also satisfactory with intraclass correlation coefficients higher than 0.75. The concurrent validity was acceptable with significantly strong correlations between the CM:MHI and the Chinese Mandarin versions of Short Form 36 Health survey and Hospital Anxiety and Depression Scale. Confirmatory factor analysis further supported the five‐factor structure of the CM:MHI. The CM:MHI demonstrated to be a valid and reliable measure for assessing psychological distress and well‐being in Chinese‐speaking CHD patients.     

Translation and Linguistic Validation of the Self‐Completed Leeds Assessment of Neuropathic Symptoms and Signs (S‐LANSS) Scale for Use in a Libyan Population

Background: The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale is used to identify pain of neuropathic origin and has been validated as a self‐completed tool (S‐LANSS). We translated the S‐LANSS into Arabic and evaluated its reliability and linguistic validity for use by Libyan people. Methods: Thirteen of 45 Libyan nationals living in the UK were identified as having chronic pain and completed an English and Arabic S‐LANSS 1 week apart. In addition, 23 of 104 respondents to a telephone interview in Derna City, Libya, were identified as having chronic pain and completed the Arabic S‐LANSS. Seven of these 23 completed the S‐LANSS again 1 week later. Results: Cronbach’s alpha was 0.72 (P < 0.001) for the Arabic S‐LANSS and 0.71 (P < 0.001) for the English S‐LANSS. There was good measurement of agreement of individual items in Arabic and English S‐LANSS tools with kappa coefficients ranging from 0.69 to 1.00. Twelve of the 23 (52.2%) individuals with chronic pain scored 12 or more on the Arabic S‐LANSS and were classified as possibly having neuropathic pain. There was good measurement of agreement of individual items in Arabic S‐LANSS tools with kappa coefficients ranging from 0.462 to 1.00. There were strong intraclass correlations in both versions for test‐retest reliability of total score. Conclusion: The Arabic S‐LANSS is reliable and linguistically valid to use in Libya. Perspective: Our translation of the S‐LANSS into Arabic was shown to be linguistically valid and reliable for use in a Libyan population.     

Body Awareness Rating Questionnaire: Measurement properties

The purpose of present study was to investigate important measurement properties of the Body Awareness Rating Questionnaire (BARQ) subscales: Function; Mood; Feelings; and Awareness. Samples of 50 patients with prolonged musculoskeletal pain and psychosomatic disorders, and 50 gender and age-matched healthy persons participated in the study. Relative (ICC 2,1) and absolute reliability (S_w) were calculated. Construct validity was examined by testing hypothesis using Pearson (r) or Spearman rank (r_s) correlation. Discriminate ability was examined using a receiver operating characteristic (ROC) curve, the area under the curve (aROC) being the measure of discriminative validity. All patients reported more or less improvement after treatment, using the Patient Global Impression of Change (PGIC) as an external indicator of important change. Responsiveness to important change was therefore examined by one-way repeated measures analysis of variance (ANOVA), relating change scores of BARQ subscales to the PGIC categories. Relative and absolute reliability values were within recommended limits for all four subscales. Construct and discriminate validity was indicated for Function, Feelings and Awareness, but not for Mood. Responsiveness was indicated for the subscales Function and Awareness, but not for Feelings and Mood. Further research is needed to complement the subscales of BARQ, found with appropriate measurement properties.     

Integrating the online nursing evidence‐based information resources for evidence‐based nursing study in China

At present Chinese nurses could not get the up‐to‐date and high‐quality evidences efficiently and conveniently due to language barrier and other practical difficulties. This program built a Chinese website of integrated evidence‐based network information resources for EBN studies. Researchers hope to provide practical guidance and advice for nurses in non‐English‐speaking countries..     

Body Awareness Rating Questionnaire: Measurement properties

The purpose of present study was to investigate important measurement properties of the Body Awareness Rating Questionnaire (BARQ) subscales: Function; Mood; Feelings; and Awareness. Samples of 50 patients with prolonged musculoskeletal pain and psychosomatic disorders, and 50 gender and age-matched healthy persons participated in the study. Relative (ICC 2,1) and absolute reliability (S(w)) were calculated. Construct validity was examined by testing hypothesis using Pearson (r) or Spearman rank (r(s)) correlation. Discriminate ability was examined using a receiver operating characteristic (ROC) curve, the area under the curve (aROC) being the measure of discriminative validity. All patients reported more or less improvement after treatment, using the Patient Global Impression of Change (PGIC) as an external indicator of important change. Responsiveness to important change was therefore examined by one-way repeated measures analysis of variance (ANOVA), relating change scores of BARQ subscales to the PGIC categories. Relative and absolute reliability values were within recommended limits for all four subscales. Construct and discriminate validity was indicated for Function, Feelings and Awareness, but not for Mood. Responsiveness was indicated for the subscales Function and Awareness, but not for Feelings and Mood. Further research is needed to complement the subscales of BARQ, found with appropriate measurement properties.     

ADHD Symptoms Related to Profiles of Self‐Esteem in a Longitudinal Study of Twins A person‐oriented approach

PROBLEM: There are conflicting research data regarding the relationship between attention deficit hyperactivity disorder (ADHD) and low self‐esteem. METHODS: A person‐oriented approach was used to study the relationships between ADHD symptoms and self‐esteem in a longitudinal study of twins starting when they were 8 years old. A cluster analysis was performed at age 13 using five subscales from a self‐esteem questionnaire. FINDINGS: High scores of ADHD symptoms were linked to profiles characterized by lower scores in the domains “skills and talents” and “psychological well‐being”. CONCLUSION: Children with high scores of ADHD symptoms often have specific problem profiles of self‐esteem.     

Modification of the SF-36 for a headache population changes patient-reported health status

Background.— Using standard quality of life and disability measures may not accurately capture these constructs in specific health populations such as headache patients. Modifying the wording of standard measures such as the Short‐Form 36 (SF‐36) should be considered in order to make them more applicable to specific patient populations. Objective.— To investigate the possibility that headache patients may not consider their headaches when responding to SF‐36 questions pertaining to health, physical health, pain, and bodily pain. Methods.— The wording of several SF‐36 questions were adapted for a headache population by making specific reference to “headaches” when asking people to rate the impact of health issues on their life. The results of the modified “Headache” SF‐36 were compared with a similar population of transformed migraine patients who had completed the “Standard” SF‐36. Results.— Significant differences were found between scores for the “Standard” SF‐36 group and the “Headache” SF‐36 group across all SF‐36 variables except for “General Health.” Conclusions.— Misinterpretation of the concepts of “health,”“physical health,”“pain,” and “bodily pain,” although commonly used by the SF‐36 in many populations, could influence responses on this measure, as respondents may not relate their head/headaches to these constructs. To ensure that accurate data are obtained in relation to the quality of life of headache patients, consideration should be given to using a form of the SF‐36 that has been modified to allow appropriate interpretation of the questions completed by headache patients.     

Psychometric validation of Emotional Reaction Instrument‐English to measure American children’s emotional responses to hospitalisation

Aims and objectives.  The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument‐English with hospitalised American children, ages 7–12 years, in the USA. Background.  Children’s negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self‐report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence. Design.  A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument‐English. Methods.  Two hundred hospitalised American children, 7–12 years of age, who were admitted to a Children’s Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument‐English, the Facial Affective Scale, and a demographic form. Results.  Internal consistency was supported by a Cronbach’s alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59–0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument‐English being significantly correlated with the Facial Affective Scale (r = 0·18–0·59). The instrument can be administered to hospitalised children in 5–10 minutes. Conclusions.  The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument‐English with hospitalised American children ages 7–12 years. Further testing of the Emotional Reactions Instrument‐English is required to validate the subscales and evaluate the instrument’s use with children of different ages, race and ethnicity. Relevance to clinical practice.  This study introduces a new, clinically feasible instrument to measure children’s diverse emotional responses to hospitalisation.     

Health locus of control questionnaire for patients with chronic low back pain: psychometric properties of the Brazilian–Portuguese version

Background and Purpose . Low back pain is common among Brazilians, especially affecting those who are working. Psychosocial factors, such as the health locus of control, are associated with low back pain prognoses. Although the multidimensional health locus of control questionnaire is widely employed in individuals with low back pain, a Brazilian–Portuguese version is not yet available. The aim of the present study was to translate and adapt the multidimensional health locus of control (MHLC) questionnaire, and to investigate its psychometric properties in a Brazilian population with non‐specific chronic low back pain. Method . Translation and adaptation of the questionnaire was carried out in the first phase of the study. In the second phase it was administered to Brazilians with non‐specific chronic low back pain to evaluate its intra‐examiner reliability (n = 20), concurrent validity, internal consistency (n = 40), and floor and ceiling effects. To evaluate concurrent validity the Brazilian–Portuguese version of the Roland–Morris disability questionnaire was used as the comparison. Results . The sub‐scales demonstrated good to excellent reliability with intra‐class coefficient (ICC) values of 0.75 for the external subscale (95% confidence interval (95% CI): 0.46–0.89), 0.87 for the internal sub‐scale (95% CI: 0.69–0.94) and 0.90 for the chance sub‐scale (95% CI: 0.77–0.96). For concurrent validity, the external and chance sub‐scales correlated positively with disability (Pearson's r = 0.58; p < 0.001 and Pearson's r = 0.35; p = 0.025), respectively, while the internal sub‐scale correlated negatively with disability (Pearson's r = ?0.33; p = 0.037). The questionnaire had acceptable internal consistency, with a Cronbach's alpha value of 0.65 (95% CI: 0.46–0.80) for external sub‐scale, 0.77 (95% CI: 0.64–0.87) for internal sub‐scale and 0.83 (95% CI: 0.73–0.90) for chance sub‐scale. Conclusions . The Brazilian–Portuguese version of the MHLC questionnaire has acceptable measurement properties similar to that observed with the original English language version. Copyright © 2008 John Wiley & Sons, Ltd.     

Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium

Objective.— To review and analyze published reports on the acute treatment of migraine headache with triptans, dihydroergotamine (DHE), and magnesium in emergency department, urgent care, and headache clinic settings. Methods.— MEDLINE was searched using the terms “migraine” and “emergency,” and “therapy” or “treatment.” Reports from emergency department and urgent care settings that involved all routes of medication delivery were included. Reports from headache clinic settings were included only if medications were delivered by a parenteral route. Results.— Acute rescue treatment studies involving the triptans were available for injectable and nasal sumatriptan, as well as rizatriptan. Effectiveness varied widely, even when the pain‐free and pain‐relief statistics were evaluated separately. As these medications are known to work best early in the migraine, part of this variability may be attributed to the timing of triptan administration. Multiple studies compared triptans with anti‐emetics, dopamine antagonists, and non‐steroidal anti‐inflammatory drugs. The overall percentage of patients with pain relief after taking sumatriptan was roughly equivalent to that recorded with droperidol and prochlorperazine. Sumatriptan was equivalent to DHE when only paired comparisons were performed. While the data extracted suggest that magnesium may be effective in treating all symptoms in patients experiencing migraine with aura across all migraine patients, its effectiveness seems to be limited to treating only photophobia and phonophobia. Conclusions.— Although there are relatively few studies involving health‐care provider‐administered triptans or DHE for acute rescue, they appear to be equivalent to the dopamine antagonists for migraine pain relief. The relatively rare inclusion of a placebo arm and the frequent use of combination medications in active treatment arms complicate the comparison of single agents with each other.     

Outpatient Home‐Based Continuous Intravenous Dihydroergotamine Therapy for Intractable Migraine

(Headache 2010;50:852‐860) Background.— Established consecutive‐day inpatient intravenous dihydroergotamine protocols administered by bolus intravenous injection or continuous infusion injection in the hospital have demonstrated efficacy and safety in modifying the course of daily intractable headache. We conducted a study to determine efficacy, tolerability, and feasibility to treat patients with daily intractable headache with continuous intravenous dihydroergotamine in an outpatient home‐based setting. Methods.— A total of 31 patients fulfilling ICHD‐II criteria for chronic daily headache, 25 with chronic migraine and 6 with medication overuse headache, were treated with outpatient home‐based continuous intravenous dihydroergotamine for 3 days. Patients were pretreated with 10 mg intravenous metoclopramide prior to the first day of infusion and administered 3 mg dihydroergotamine given continuously at a rate of 42 mL/hour on day 1 and 2, and administered 1.5 mg on day 3 at the rate of 21 mL/hour. The primary end point was a change in pain intensity, as measured by an 11‐point numeric pain intensity scale at the end of 3 days. The secondary end point was reduction in headache frequency at long‐term follow‐up. Results.— Patients reported an average of 63.4% reduction in the intensity of migraine pain by the end of the 3‐day infusion. Side effects were minimal and no serious adverse effects occurred. Approximately one‐third of patients became completely headache‐free after day 3, and 1 patient had no improvement. Long‐term follow‐up data indicated an average 86% reduction in headache frequency and almost every patient converted from chronic daily headache to episodic migraine except for 1 patient. Patients with medication overuse headache were no longer consuming the daily offending medication. Conclusions.— Efficacy and safety of our outpatient home‐based intravenous dihydroergotamine program compared favorably to that of established inpatient intravenous pulse injection and continuous infusion protocols for the treatment of intractable migraine. The use of outpatient continuous intravenous dihydroergotamine is an effective and well‐tolerated therapy for intractable migraine but without the added cost and inconvenience of hospitalization.     

Sustained Safety and Efficacy of Once‐Daily Hydromorphone Extended‐Release (OROS® hydromorphone ER) Compared with Twice‐Daily Oxycodone Controlled‐Release Over 52 Weeks in Patients with Moderate to Severe Chronic Noncancer Pain

Abstract Once‐daily hydromorphone extended‐release (OROS^® hydromorphone ER) and oxycodone controlled‐release (CR) are semisynthetic, ER opioid analgesics with established efficacy. An open‐label, randomized, 24‐week, parallel group, flexible‐dose study demonstrated noninferiority of OROS hydromorphone ER vs. twice‐daily oxycodone CR in patients with chronic noncancer pain. In total, 112 patients were enrolled in a 28‐week, open‐label extension study; 60 patients received OROS hydromorphone ER and 52 received oxycodone CR. The primary efficacy measure was the change from baseline to Weeks 38 and 52 in Brief Pain Inventory item “pain right now.” Global assessments of efficacy, dosing convenience, and tolerability were secondary endpoints. Mean change in “pain right now” from baseline to Week 38 was ?3.0 (OROS hydromorphone ER) vs. ?2.8 (oxycodone CR), and from baseline to Week 52 was ?2.9 vs. ?2.8; these changes were similar to the changes in the core phase (?2.1 vs. ?2.1). Similar improvements were demonstrated for secondary assessments, including pain, pain interference, and quality of life. At Week 52, global assessment of efficacy was rated as “very good” or “good” by the majority of patients (OROS hydromorphone ER, 91.7%; oxycodone CR, 86.5%). More patients in the OROS hydromorphone ER group (35.0% vs. 21.2%) assessed mode of drug intake as “very convenient.” The majority of patients receiving OROS hydromorphone ER (88.3%) and oxycodone CR (88.5%) rated tolerability as “good” or “very good” at Week 52; few patients discontinued treatment because of an adverse event (1.6% vs. 0.4%, respectively). The effectiveness of OROS hydromorphone ER and oxycodone CR was maintained through 1 year.     

The role of current mood and stop rules on physical task performance: An experimental investigation in patients with work‐related upper extremity pain

Patients with work‐related upper extremity pain (WRUED) experience disability in daily life activities. The factors that influence levels of disability are still unclear. Both excessive avoidance and persistence have been suggested, but the affective and motivational processes that underlie these behaviours have not been scrutinized. This study was aimed at examining the role of current mood and stop rules on physical task performance, controlling for gender, pain severity, pain catastrophizing, and pain‐related fear. An additional focus was the role of the interaction between current mood and stop rules as predicted by the novel Mood‐as‐Input (MAI) model. Following MAI, it is the informational value of current mood within a goal context (stop rule), rather than mood per se that predicts behaviour. A 2 (mood)×2 (stop rule)×2 (physical task order) factorial design was used in which 62 WRUED patients performed an upper and lower extremity physical task. A stress interview was used to induce positive and negative mood. Patients received either an “as‐much‐as‐can (AMAC)” stop rule instruction, or a “feel‐like‐discontinuing (FLDC)” stop rule instruction. Results showed that physical task performance was predicted by pain‐related fear, current mood, stop rule. However, the predicted mood×stop rule interaction was not found, and there was no influence of gender, pain severity, and pain catastrophizing on task performance. The findings suggest that not only pain‐related fear, but current mood and goal context factors independently affect physical performance in patients with WRUED.     

The Norwegian version of the chronic obstructive pulmonary disease self‐efficacy scale (CSES): a validation and reliability study

Scand J Caring Sci; 2010; 24; 600–609
The Norwegian version of the chronic obstructive pulmonary disease self‐efficacy scale (CSES): a validation and reliability study The aim of this study was to evaluate the feasibility, internal consistency and face and construct validity of the Norwegian version of the Chronic Obstructive Pulmonary Disease Self‐Efficacy Scale (CSES). The CSES was translated into Norwegian according to standard procedures for forward and backward translation, and administered to 100 patients with chronic obstructive pulmonary disease (COPD) (51% men, mean age 66.1 years, range 42–82) prior to their participation in an outpatient pulmonary rehabilitation programme. The CSES‐N (translated version) consists of 34 items comprising five subscales describing negative affect, intense emotional arousal, physical exertion, weather/environment and behavioural risk factors. Each scale ranges from 1 to 5, with higher scores indicating better self‐efficacy. For validation purposes, we measured lung function (FEV₁, FEV₁% predicted) and exercise capacity (ISWT), and administered the St. George’s Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS). A pilot study confirmed that the CSES‐N was clear, understandable and easy to self‐administer. Cronbach’s alpha was 0.98 for the total score (0.80–0.96 for subscales). Results showed small to medium negative correlations between all CSES‐N scales and anxiety, depression (HADS), physical activity, psychosocial impact of disease and total health status (SGRQ) (?0.20 to ?0.49). Small or negligible negative correlations between different CSES‐N scales and respiratory symptoms (SGRQ) (?0.03 to ?0.23) were found. Any correlations among exercise capacity, lung function and different socio‐demographic variables (age, gender and education) and CSES‐N were also small or negligible (0.00 to 0.23). This study shows acceptable feasibility, internal consistency and face and construct validity for the CSES‐N in a sample of Norwegian COPD patients.     

Description and validation of an Italian ICHD-II-based questionnaire for use in epidemiological research

Background.— In the absence of biological markers, the diagnosis of primary headache in epidemiological studies rests on clinical findings, as reported through ad‐hoc interviews. Objectives.— The aim of this study was to validate a specially designed headache questionnaire to be administered by a physician for the diagnosis of primary headaches or of probable medication overuse headache in the general population according to the 2004 International Classification of Headache Disorders, 2nd edition (ICHD‐II). Methods.— The questionnaire comprises 76 questions based on the ICHD‐II diagnostic criteria for migraine (codes 1.1, 1.2.1, 1.2.2, 1.2.3, 1.5.1, and 1.6), tension‐type headache (codes 2.1, 2.2, 2.3, and 2.4), primary stabbing headache (code 4.1), and probable medication‐overuse headache (code 8.2.7), as well as on other clinical features (eg, age at onset, relation between headache and pregnancy, etc). The answers to each question could be of the following types: (1) numbers (ie, age at onset); (2) “Yes” or “No” (eg, as in reply to “Do you have nausea during headache?”); and (3) predefined answers (eg, quality of pain). We assessed the validity and reliability of the questionnaire and its sensitivity and specificity for migraine and tension‐type headache. Results.— The study population consisted of 50 patients (37 women and 13 men) aged 18‐76 years (mean, 40.7) seen for the first time on a consecutive basis at the University of Parma Headache Centre. The questionnaire was administered independently by 2 trained physicians (E1 and E2) prior to the visit performed by a headache specialist taken as the gold standard (GS). GS, E1, and E2 were blind to the diagnosis made by each others. If appropriate, more than 1 headache type were considered. When present, we defined the 2 different headache types in the same subject as Diagnosis 1 and Diagnosis 2. Questionnaire‐based diagnosis was compared with the diagnosis established by GS. For Diagnosis 1 (n = 50), we found an agreement rate of 98% (K‐value: 0.96; 95% confidence interval [CI]: 0.88‐1.00) between E1 and GS and between E2 and GS, and of 96% (K‐value: 0.91; 95% CI: 0.80‐1.00) between E1 and E2. For Diagnosis 2 (n = 24), we found an agreement rate of 83.3% (K‐value: 0.80; 95% CI: 0.63‐0.98) between E1 and GS, of 62.5% (K‐value: 0.62; 95% CI: 0.41‐0.82) between E2 and GS, and of 70.8% (K‐value: 0.66; 95% CI: 0.45‐0.87) between E1 and E2. Sensitivity and specificity were 100% and 93.3%, respectively, for migraine without aura (code 1.1) and 100% for frequent episodic tension‐type headache (code 2.2). Conclusion.— Our findings support the use of this questionnaire as a valid and reliable tool for diagnosis of headaches in epidemiological studies.