Reported quality of randomized controlled trials of physiotherapy interventions has improved over time

Objective

To describe the change with time of the reported methodological quality of randomized controlled trials of physiotherapy interventions.

Study Design and Setting

For all trials of physiotherapy interventions indexed on the Physiotherapy Evidence Database (PEDro), year of publication, and methodological quality scores (11-item PEDro scale and total PEDro score [range, 0-10]) were extracted. The relationship between trial quality and time was evaluated using regression analyses for the PEDro total score and individual quality items. The study was carried out in a university research center.

Results

Data from 10,025 trials published since 1960 were analyzed. The total PEDro score was related to time (year of publication), with the total score increasing by an average of ∼0.6 points each decade between 1960 and 2009. The reported use of eight of the 11 individual items from the PEDro scale (intention-to-treat analysis, concealed allocation, groups similar at baseline, reporting of results of between-group statistical comparisons, point measures and measures of variability reported, subjects randomly allocated to groups, eligibility criteria specified, and blinding of assessors) also improved with time.

Conclusion

The reported methodological quality of randomized controlled trials of physiotherapy interventions has improved over time. Further improvement is still necessary.     

Patient satisfaction with hospital services: development and testing of a measuring instrument.

The present study was undertaken with the aim of developing and testing an instrument that could be used to measure patient satisfaction with hospital services in Kuwait. The instrument, which comprised 57 items, and measured satisfaction with 7 specific dimensions of hospital services, was administered to 493 patients using the interview technique. Statistical analysis showed that the instrument yields good response variability. Reliability of the instrument, measured in terms of the internal consistency coefficient alpha, exceeded the acceptable criterion level, the coefficients ranging between 0.73 and 0.86. Evidence of the construct validity of the instrument was found in significant positive correlation between the dimension specific satisfaction scale scores and scores for allegiance scale and for overall rating of quality of hospital services. Construct validity was further supported by convergent discriminant analysis, which showed that correlations between items of all 7 scales and their total scale scores were greater than correlations between scale items and the total scores of scales they do not represent. Analysis of an open-ended question about dissatisfying aspects of hospital services not included on the interview was undertaken to examine the instrument's content validity. Results indicated that patients identified 11 items, 8 of which were identified more than once, and 2 of which were not classifiable to the 7 dimensions assessed by the instrument. It was suggested to add the 8 items that were identified more than once, and to reassess the reliability and validity of the revised instrument. Assessment of the test-retest reliability, by comparing scale scores over time, was also suggested.     

Reliability and Validity of a Chinese Version's Health-Related Quality of Life Questionnaire for Hepatitis B Patients

ObjectivesTo culturally adapt a Chinese version of the Hepatitis Quality of Life Questionnaire (HQLQ) and assess its suitability for use in Chinese-speaking hepatitis B virus (HBV patients in Singapore.StudyReliability was assessed using Cronbach's alpha coefficients and intra-class correlation coefficients. Item-to-scale correlation was assessed using Spearman's rank correlations (ρ) between scale scores and their constituent items. Convergent and divergent construct validities were tested in three and two a priori hypotheses, respectively, and the correlations were assessed using Spearman's rank correlation coefficients.ResultsWhen tested in 134 HBV patients, the test-retest reliability was supported with all scales showing acceptable correlation coefficients (i.e., α > 0.7). Item-to-scale correlations were good with most items highly correlated with their hypothesized scales. Convergent and divergent construct validities were supported by the hypothesized correlations between the HQLQ and the EQ-5D domains.ConclusionsThe culturally adapted questionnaire has good validity and reliability for use in Singapore.     

Cross-Cultural Validation of the Scales for Outcomes in Parkinson's Disease-Psychosocial Questionnaire (SCOPA-PS) in Four Latin American Countries

ObjectiveTo conduct a cross-national validation of the Scales for Outcomes in Parkinson's Disease-PsychoSocial questionnaire (SCOPA-PS) in four Latin American Countries.MethodsData quality (missing items), scale assumptions (item–test correlation), internal consistency (Cronbach's alpha, item homogeneity), factor structure, content validity, and precision (standard error of measurement, SEM) of the scale were explored, as was convergent validity with motor symptoms (Clinical Impression of Severity Index [CISI-PD], Scales for Outcomes in Parkinson's Disease-Motor Scale), emotional status (Hospital Anxiety and Depression Scale) and health-related quality of life (Parkinson Disease Questionnaire-39). Known-groups validity was studied by category of severity, based on Hoehn and Yahr staging (HY), CISI-PD, and disease duration.ResultsThree hundred thirty-one Parkinson's disease (PD) patients with usable data participated (mean age 64.7 years; 42.3% female; mean PD duration 8.5 years; HY, 1 to 5). Data quality (missing items <10%), scale assumptions (item–total correlation = 0.43 ? 0.71) and internal consistency of SCOPA-PS (Cronbach's alpha = 0.87; item homogeneity = 0.38) were satisfactory. Factor analysis suggested a unifactorial structure. High convergent validity was found for depression (r_S = 0.61), anxiety (r_S = 0.62), and health-related quality of life (r_S = 0.82). Known-groups validity analyses indicated a gradual influence of severity category and disease duration on SCOPA-PS scores (P < 0.0001). SEM value was 8.24 (7 to 12 in previous studies). These magnitudes may be indicative of the threshold for a real change and a minimum important difference.ConclusionsThe Latin American versions of the SCOPA-PS displayed appropriate psychometric attributes.     

Impact factor,eigenfactor, article influence,scopus SNIP,and SCImage journal rank of occupational therapy journals

Background: Journals are currently assessed and ranked using a number of different quantitative performance metrics.

Aim: To compare and correlate the publication metrics of English-language occupational therapy journals published in 2015.

Method: Bibliometric data was sourced for 14 English-language occupational therapy journals including the Journal Citations Report (JCR) 2-year impact factor (IF), Eigenfactor Score (EFS), Article Influence Score (AIS), Scopus Source Normalized Impact per Paper (SNIP), Scopus Citescore, and SCImago Journal Rank (SJR) score. The JCR, Scopus, and SJR 2015 bibliometric data were correlated.

Results: The top six English-language occupational therapy journals in relation to JCR IF, EFS, AIS, SNIP, Citescore, SJR score, and SJR IIF were AJOT, AOTJ, POPT, CJOT, SJOT, and BJOT. JCR IF, EFS, JCR AIS, SNIP, Citescore, SJR score and SJR IIF were all significantly correlated with coefficients ranging from 0.751 to 0.961 (p?<?0.05; p?<?0.01). The calculated SJR IIF was on average 0.335 larger than the JCR IFs reported.

Conclusions: The findings indicate that the range of available bibliometric measures should be used collectively to yield a more comprehensive assessment of journal and article rankings rather than the singular use of IF scores that currently and frequently occurs in many jurisdictions.     

Shoulder-specific disability measures showed acceptable construct validity and responsiveness

ObjectiveTo compare the construct validity and responsiveness of the Shoulder Pain and Disability Index (SPADI), Croft Index, and disabilities of the arm, shoulder, and hand (DASH) for patients with adhesive capsulitis and to compare these with pain on a visual analog scale, the Health Assessment Questionnaire, and the problem-elicitation technique.Study Design and SettingTwo randomized double-blind placebo-controlled trials of interventions for adhesive capsulitis were performed. Both trials recruited patients from community-based physiotherapy practices. Responsiveness at 3 weeks postbaseline was assessed using four responsiveness parameters and three external criteria for improvement.ResultsCorrelations between the shoulder-specific measures ranged from 0.55 to 0.65 at baseline and 0.49–0.55 for the 3-week change scores. Greater responsiveness was seen for the SPADI. The effect size for the SPADI ranged from 1.20 to 1.64, for the Croft Index from 0.87 to 1.21, and for the DASH from 0.55 to 0.83. Rankings were similar across the four responsiveness parameters and the three external criteria for improvement. Correlations between the shoulder-specific and generic measures for baseline and 3-week change scores were lower than those among the shoulder-specific measures (range: 0.17–0.60).ConclusionThe shoulder-specific disability measures showed acceptable construct validity and responsiveness with a small but consistent overall advantage for the SPADI.     

Development and normative validation of Developmental Assessment Tool for Anganwadis for 3- to 4-year-old children (DATA-II)

ObjectiveTo develop, standardize, and validate a developmental scale for children, 3–4 years old, attending Anganwadis (Integrated Child Development Scheme) in India, as a follow-up assessment, using a normative approach.Study Design and SettingAfter the development of the 12-item Developmental Assessment Tool for Anganwadis (DATA-II), its internal consistency as well as face, content, and construct validities were studied in 100 children in Anganwadis and were found to be appropriate. A total of 385 children with a mean (standard deviation) age of 43.05 (5.02) months from randomly selected 36 Anganwadis were recruited for its standardization. Raw scores were converted to standardized T scores. Scoring pattern for domains and aggregate developmental scores were formulated.ResultsExcept for four items in the original scale, all the items were endorsed by parents suggesting a good content validity, and Kuder–Richardson Formula 20 coefficient of 0.80 suggested a high internal consistency. Factor analysis replicated the six-factor structure explaining 76.5% of variance. An aggregated developmental score based on the standardized T scores demonstrated that a DATA-II score between 29 and 33 suggested “at risk” for developing developmental delays. A score of 28 or less suggested already delayed milestones. A score of 19–28 suggested a “mild delay,” 8–18 suggested a “moderate delay,” and 7 or less suggested a “severe delay” in development.ConclusionThe DATA-II is a measure for use in Anganwadis for identifying children at risk or with developmental delays during the first follow-up assessment, in India, for appropriate referrals and interventions.     

Reliability and validity of the Cystic Fibrosis Questionnaire-Revised for children and parents in Turkey: cross-sectional study

Purpose

The purpose of study was to translate Cystic Fibrosis Questionnaire-Revised (CFQ-R) into Turkish for children with cystic fibrosis (CF) and evaluate its reliability and validity. This is the first CF-specific health-related quality of life (HRQOL) measure validated in a Muslim country.

Methods

Fifty-one children aged 6–13 years treated at four centers in Turkey and 30 parents participated in this cross-sectional study. Demographic characteristics and disease severity parameters were recorded for all participants. All participants completed the parent or child versions of CFQ-R and KINDL questionnaires at enrollment. Reliability and construct validity analysis were carried out.

Results

Both children and parents endorsed a range of responses, with no evidence of floor or ceiling effects. Item-to-total correlations indicated that most items were more highly correlated with their intended scale than competing scales. Good internal consistency was found for majority of child and parent scales. CFQ-R scales correlated significantly with clinical indices of disease severity. Good evidence of convergent validity with a generic HRQOL scale was found.

Conclusion

Turkish versions of CFQ-R Child and Parent instruments have demonstrated adequate reliability and validity and can be utilized in clinical trials or integrated into clinical evaluation and follow-up of Turkish children with CF.     

A measure of satisfaction with food-related life

A measure of satisfaction with food-related life is developed and tested in three studies in eight European countries. Five items are retained from an original pool of seven; these items exhibit good reliability as measured by Cronbach's alpha, good temporal stability, convergent validity with two related measures, and construct validity as indicated by relationships with other indicators of quality of life, including the Satisfaction With Life and the SF-8 scales. It is concluded that this scale will be useful in studies trying to identify factors contributing to satisfaction with food-related life.     

Development and construct validation of the Client-Centredness of Goal Setting (C-COGS) scale

Abstract

Background: Client-centred philosophy is integral to occupational therapy practice and client-centred goal planning is considered fundamental to rehabilitation. Evaluation of whether goal-planning practices are client-centred requires an understanding of the client’s perspective about goal-planning processes and practices. The Client-Centredness of Goal Setting (C-COGS) was developed for use by practitioners who seek to be more client-centred and who require a scale to guide and evaluate individually orientated practice, especially with adults with cognitive impairment related to acquired brain injury. Aims: To describe development of the C-COGS scale and examine its construct validity. Material and methods: The C-COGS was administered to 42 participants with acquired brain injury after multidisciplinary goal planning. C-COGS scores were correlated with the Canadian Occupational Performance Measure (COPM) importance scores, and measures of therapeutic alliance, motivation, and global functioning to establish construct validity. Results: The C-COGS scale has three subscales evaluating goal alignment, goal planning participation, and client-centredness of goals. The C-COGS subscale items demonstrated moderately significant correlations with scales measuring similar constructs. Conclusion: Findings provide preliminary evidence to support the construct validity of the C-COGS scale, which is intended to be used to evaluate and reflect on client-centred goal planning in clinical practice, and to highlight factors contributing to best practice rehabilitation.     

Validity and reliability of the Italian translation of the MOS-HIV health survey in persons with AIDS

Objectives: To evaluate the validity and reliability of the Italian version of the 35-item Medical Outcome Study HIV Health Survey (MOS-HIV) when applied to persons with AIDS. Methods: The study population consisted of 185 adults with AIDS residing in Rome and participating in a randomised controlled trial on home-care. Diagnosis was made between 1 October 1994 and 1 April 1996, and enrollment took place within 2 months of diagnosis. The MOS-HIV, which measures 10 dimensions of health-related quality of life (QoL), was administered at baseline and every 3 months thereafter during the 1-year follow-up. Tests of convergent and concurrent construct validity were conducted for all scales. Results: Of the 185 trial participants, 146 responded to the questionnaire; 82 responded at least twice (including baseline collection) during follow-up. For the role functioning, general health, and vitality scales, the distribution of scale scores was concentrated at the lower half of the range. Internal consistency reliability was adequate (>0.80) for all scales. Baseline scores tended to increase with decreasing AIDS severity and with increasing age. There were improvements over time in the role functioning, vitality, and health distress scales. Conclusions: The MOS-HIV had good reliability among persons with AIDS. There was a moderate floor effect for some of the subscales. Tests of convergent and construct validity were generally confirmed. Additional studies are needed to evaluate the responsiveness to changes over time.     

Robustness of the EUROPEP questionnaire as regards data quality,reliability, and construct validity: The Greek experience before and after the economic crisis

ObjectivesTo assess the data quality, reliability, and construct validity of the Greek EUROPEP and to examine the instrument’s robustness in terms of its psychometric properties in a pre- and post-economic crisis period.MethodsTaking into account the two key factors that affect the accuracy and quality of survey data, that is the representativeness of the sample selected from the population, and the response rate, four hundred ninety-two and five hundred thirty-two patients (492 and 532 patients) pre- and post-crisis, respectively, consulting GPs at 16 Primary Health Care Centers (PHCCs) in Greece were invited to complete the Greek EUROPEP. We assessed item missing, ceiling and floor effects, and used factor analysis to assess the structure of the 23 items of the EUROPEP. Scales were tested for reliability and construct validity. We further examined if the scales of EUROPEP need to be refined, taking into account the external validity across economic crises.ResultsFactor analysis identified three groups of questions that formed scales with satisfactory internal consistency reliability, and validity. The clinical behavior scale, the support, and services scale, and the organization of care scale, all met the criterion of 0.7 for Cronbach’s alpha. All scales were found to have a significant correlation with the majority of the examined variables. Moreover, the EUROPEP was found to be robust in effectively detecting differences in patients’ views over time in different economic contexts.ConclusionsThe study identified three scales in the Greek EUROPEP-questionnaire with satisfactory psychometric properties, and its Greek version could be used in the recent primary health care (PHC) reform in this country.     

Measuring health-related quality of life: psychometric evaluation of the Tunisian version of the SF-12 health survey

Background

The 12-item short-form health survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies as an applicable instrument for measuring health-related quality of life. The main purpose of this study was to evaluate the psychometric properties of the Tunisian version of the SF-12.

Methods

A stratified representative sample (N = 3,582) of the general Tunisian population aged 18 years and over was interviewed. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Reliability was estimated using internal consistency, and construct validity was investigated with “known groups” validity testing and via convergent and divergent validity.

Results

SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education and socioeconomic status, thus providing evidence of construct validity. Mean scores in the total sample were 50.11 (SD 8.53) for the physical component summary (PCS) score and 47.96 (SD 9.82) for the mental component summary (MCS) score. The results showed satisfactory internal consistency and acceptable convergent validity for both summary scores. Cronbach’s α coefficient for PCS-12 and MCS-12 was 0.73 and 0.72, respectively. Known groups comparison showed that the SF-12 discriminated well between groups of respondents on the basis of gender, age, education and socioeconomic status. In addition, no floor or ceiling effects at baseline were observed. The PCA confirmed the two-factor structure of the SF-12 items. Items belonging to the physical component correlated more strongly with the PCS-12 than those with the MCS-12. Similarly, items belonging to the mental component correlated more strongly with the MCS-12 than those with the PCS-12.

Conclusion

The findings suggest that the SF-12 appears to be a valid and reliable measure that can be used for measuring of population health status. However, for optimal measurement, modifications to traditional scoring methods for the SF-12 should be considered.     

Evaluation of a new measure of mood intolerance,the Tolerance of Mood States Scale (TOMS): Psychometric properties and associations with eating disorder symptoms

ObjectiveThis research aimed to (i) validate a new measure of mood intolerance, the Tolerance of Mood States (TOMS) scale, and (ii) to examine associations between TOMS scores and eating pathology.MethodsThe original TOMS was developed and evaluated using the data from 258 adult participants. The measure consisted of two separate scales, initially with a total of 64 items, with this reduced to 34 items through exploratory factor analyses. The 34-item TOMS was administered to a new sample of adult participants recruited from a university setting (N = 227), along with the Distress Tolerance Scale (DTS-C; Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007) and other measures of psychological distress and eating disorder symptoms. The reliability and validity of the 34-item TOMS scales were examined through confirmatory factor analysis, inspection of alpha coefficients, and inspection of correlations between TOMS scores and those on other relevant measures. Associations between TOMS scores and eating disorder symptoms were considered using continuous and categorical analyses.ResultsAnalyses provided support for the reliability and validity of the scale two of the TOMS. This scale consists of 11 items on two subscales, and assesses the tendency to engage in maladaptive behaviours when confronted with intense moods. Scores on this scale were significantly higher amongst participants who reported binge eating and purging than amongst participants who did not, and they correlated significantly with a global index of eating disorder symptoms. The 11-item scale was retained as the final version of the TOMS.ConclusionsPreliminary support is provided for the validity of a new measure of mood intolerance, the TOMS. Scores on the TOMS subscales were significantly associated with eating disorder symptoms in this non-clinical sample.     

AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews

ObjectiveOur purpose was to measure the agreement, reliability, construct validity, and feasibility of a measurement tool to assess systematic reviews (AMSTAR).Study Design and SettingWe randomly selected 30 systematic reviews from a database. Each was assessed by two reviewers using: (1) the enhanced quality assessment questionnaire (Overview of Quality Assessment Questionnaire [OQAQ]); (2) Sacks' instrument; and (3) our newly developed measurement tool (AMSTAR). We report on reliability (interobserver kappas of the 11 AMSTAR items), intraclass correlation coefficients (ICCs) of the sum scores, construct validity (ICCs of the sum scores of AMSTAR compared with those of other instruments), and completion times.ResultsThe interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 (95% confidence interval [CI]: 0.57, 0.83) (range: 0.38–1.0). Kappas recorded for the other instruments were 0.63 (95% CI: 0.38, 0.78) for enhanced OQAQ and 0.40 (95% CI: 0.29, 0.50) for the Sacks' instrument. The ICC of the total score for AMSTAR was 0.84 (95% CI: 0.65, 0.92) compared with 0.91 (95% CI: 0.82, 0.96) for OQAQ and 0.86 (95% CI: 0.71, 0.94) for the Sacks' instrument. AMSTAR proved easy to apply, each review taking about 15 minutes to complete.ConclusionsAMSTAR has good agreement, reliability, construct validity, and feasibility. These findings need confirmation by a broader range of assessors and a more diverse range of reviews.     

The EORTC computer-adaptive tests measuring physical functioning and fatigue exhibited high levels of measurement precision and efficiency

ObjectivesThe European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is developing a computer-adaptive test (CAT) version of the EORTC Quality of Life Questionnaire (QLQ-C30). We evaluated the measurement properties of the CAT versions of physical functioning (PF) and fatigue (FA) and compared these with the corresponding QLQ-C30 scales.Study Design and SettingBased on international samples of more than 1,000 cancer patients, we simulated CAT administration of varying numbers of items and compared the resulting scores with those based on all items in the respective item pools. Furthermore, the relative validity (RV) of CATs was compared with that of the QLQ-C30 scales using known groups validity.ResultsFor both dimensions, CATs of all lengths resulted in unbiased score estimates. CATs consisting of five or more items had reliability>0.90, correlated ≥0.97 with the full scale, and had root mean square error <0.25. The average RVs for these CATs ranged 1.02–1.33, indicating possible savings in sample size requirements of 3–42% using CAT.ConclusionThe CAT versions of PF and FA exhibited high levels of measurement precision and efficiency. The potential savings in sample size requirements using CATs compared with those using the original QLQ-C30 scales were typically 20% or more.     

Measuring Health-Related Quality of Life in Leukemia: The Functional Assessment of Cancer Therapy – Leukemia (FACT-Leu) Questionnaire

ObjectiveDevelop and validate a health-related quality-of-life (measure for patients with acute and chronic leukemia.MethodsThe study consisted of two phases: scale construction and scale validation. For the item-generation phase, a summary of the literature combined with qualitative results from item-generation interviews with 29 acute or chronic leukemia patients and 16 health care providers yielded an initial item pool reflecting leukemia-specific concerns and symptoms. Items underwent iterations of review and reduction according to defined retention criteria to support content validity, as defined by priority concerns of patients. Seventeen final leukemia-specific items were combined with the Functional Assessment of Cancer Therapy–General to create the FACT-Leukemia (FACT-Leu) scale. For the validation phase, 79 individuals with acute or chronic leukemia completed questionnaires at three time points.ResultsAll FACT-Leu subscale and aggregated scores showed high internal consistency (αs ranging from 0.75 to 0.96). Test-retest reliability was adequate for all subscales (intraclass correlation range 0.765–0.890). The FACT-Leu scale demonstrated good convergent validity, with significant correlations with quality-of-life criteria and performance status, in the expected direction. FACT-Leu subscale scores were significantly different among the three performance status change groups, suggesting good responsiveness to change.ConclusionsThe FACT-Leu scale is a valid, reliable, and efficient measure of leukemia-specific health-related quality of life for acute and chronic disease.     

Measurement properties of the Groningen Frailty Indicator in home-dwelling and institutionalized elderly people

ObjectivesTo enable prevention of poor outcome in elderly people, a valid instrument is required to detect individuals at high risk. The concept of frailty is a better predictor than age alone. The Groningen Frailty Indicator (GFI) has been developed to identify frailty. We assessed feasibility, reliability, and construct validity of the self-assessment version of the GFI.DesignCross-sectional.SettingCommunity-based.ParticipantsHome-dwelling and institutionalized elderly persons were included in the study (n = 353) who met the following inclusion criteria: persons 65 years and older who were able to fill out questionnaires.MeasurementsThe feasibility of the GFI was assessed by determining the proportion of missing values per item. The internal consistency reliability of the GFI was established by calculating the KR-20. Mann-Whitney and Kruskal-Wallis tests were applied to assess discrimination between specific subgroups (known group validity). Convergent and discriminant validity was assessed using Spearman Rank correlations between GFI and diseases and disorders, case complexity, and health care needs (INTERMED), life satisfaction (Cantril Ladder of Life), activities of daily living (Katz), quality of life (EQ-5D), and mental health (SF-36). Finally, we used multivariate regression analyses to evaluate the cutoff score of the GFI (<4 versus ≥4).ResultsA total of 296 (84%) of the participants completed all items of the GFI; the internal consistency was 0.68. The GFI yielded statistically significant GFI scores for subgroups (known group validity). The correlations for the convergent (range 0.45 to 0.61) and discriminant validity (range 0.08 to 0.50) were also as hypothesized. In contrast with nonfrail participants, frail older persons had higher levels of case complexity, disability, and lower quality of life and life satisfaction.ConclusionsThis study supports the feasibility, reliability, and validity of the self-assessment version of the GFI in home-dwelling and institutionalized elderly people.