Inter- and Intrajudge Reliability for Videofluoroscopic Swallowing Evaluation Measures

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinician's repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.     

Assessing quality of life in primary biliary cirrhosis.

BACKGROUND AND AIMS: Assessment of health-related quality of life (HRQOL) is not routinely reported in the literature on chronic liver disease (CLD). Few studies have examined quality of life (QOL) in patients with primary biliary cirrhosis (PBC) despite its significant functional impact. One of the reasons for the lack of HRQOL measurement in patients with PBC may be the absence of a well-recognized and widely used measure that clinicians can use in ordinary clinical practice. The aim of this study is to evaluate HRQOL measures used in patients with PBC and examine the suitability of the measures for these patients. METHODS: A literature search identified reports that focused on any aspect of QOL in patients with PBC. Key texts were identified containing generic, domain-specific, and condition-specific measures. The identified measures were systematically evaluated for appropriateness, acceptability, reliability, validity, precision, and responsiveness. RESULTS: Twenty measures were identified from 9 key texts. Six of the measures were previously validated generic measures; 10 were domain-specific measures previously used to measure fatigue, depression, and psychological distress in general and psychiatric populations; and 4 measures had been developed in patients with CLD. Reporting of reliability and validity generally was consistent for all measures used. However, reporting of the remaining criteria was variable, particularly in relation to responsiveness over time and acceptability of the measures to patients with PBC. CONCLUSIONS: A clearer and more rigorous approach is needed in reporting the properties of HRQOL measures used in patients with PBC to help clinicians decide which measures are most suitable for these patients.     

Validation of a German version of the 'Disabilities of Arm,Shoulder and Hand' questionnaire (DASH-G)

OBJECTIVE: In 1994 the American Academy of Orthopedic Surgeons' outcome research committee developed and validated a functional outcome questionnaire for disabilities of the upper extremity (DASH). The objective of our study was to translate the DASH into German and to evaluate its reliability and validity for German-speaking patients with shoulder pain. METHODS: Translation-backtranslation of the DASH was performed according to published guidelines. Psychometric properties and validity were assessed in 49 consecutive patients with shoulder pain originating from within the shoulder girdle. Age, duration of symptoms and current pain were obtained. Test-retest reliability was assessed in a subset of 18 patients who filled in the questionnaire 10 days later. Internal consistency was evaluated with Cronbach's alpha coefficient. Test-retest reliability was assessed using Spearman correlations and the Bland and Altman plot. To study the validity, we examined the correlation of the DASH with other measures of function of the upper extremity including the HAQ subscales relating to the upper extremity and pain measures (e.g. numerical rating scale, SF-36 pain scale). We also examined our hypothesis that the DASH is moderately correlated with measures of range-of-motion (e.g., forward flexion and abduction). RESULT: Translation-backtranslation revealed no major difficulties. The mean age of the patients was 59 years, mean duration of symptoms 60 months and current pain score 5.6 (NRS). Test-retest reliability was 0.90 for the total DASH. The internal consistency was 0.96. Strong correlations (p<0.01) were found between the DASH and the mean among the five subscales of the HAQ representing upper extremity function (0.88) and pain as measured with the SF-36 bodily pain scale (-0.79). As hypothesized, the DASH was also moderately correlated with measures of range-of-motion (e.g. forward flexion rho=-0.49; abduction rho=-0.57). CONCLUSION: Our data confirm that the German version of the DASH retains the characteristics of the American original and is a reliable and valid instrument to measure functional disability in German speaking patients with shoulder pain.     

Spinal mobility in ankylosing spondylitis: reliability, validity and responsiveness

OBJECTIVE: To evaluate the measurement properties of an evidence-based selection of measures of spinal mobility in patients with ankylosing spondylitis (AS). METHODS: Measurements of spinal mobility were taken by trained observers within a UK rheumatology centre. Inter-observer reliability was assessed. Intra-observer reliability was assessed in patients reporting no change in AS-specific health at 2 weeks. Validity was assessed and scores were correlated with responses to health transition questions. Responsiveness was evaluated for patients reporting change in health at 6 months. RESULTS: Reliability estimates support the use of all measures in individual evaluation (intraclass correlation>0.90). Correlations between measures of spinal mobility were in the hypothesized direction; the largest was between the modified Schober index (15 cm) (MSI) and the other measures. As hypothesized, small to moderate levels of correlation were found between mobility measures and patient-assessed health status. There was no significant linear relationship between mobility measures and self-reported health transition. Fingertip-to-floor distance following trunk forward flexion (FFD) was the most responsive mobility measure but was not as responsive as two AS-specific patient-assessed instruments, the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The MSI and cervical rotation (Crot) also had evidence of responsiveness. Low levels of responsiveness were found for the remaining measures. CONCLUSION: All mobility measures had adequate levels of reliability and validity. The MSI had a strong relationship with all mobility measures, and the FFD and Crot were the most responsive to self-perceived changes in health at 6 months. The MSI, FFD and Crot are recommended for clinical practice and research.     

Depression, fatigue, and pain in systemic lupus erythematosus (SLE): relationship to the American College of Rheumatology SLE neuropsychological battery

OBJECTIVE: To examine the frequency and reliability of depression, fatigue, and pain self-report measures in patients with systemic lupus erythematosus (SLE) and healthy controls, and to examine the relationship between a cognitive impairment index (CII) derived from the American College of Rheumatology neuropsychology research battery of tests for SLE (ACR-SLE battery) and measures of depression, pain, fatigue, and perceived cognitive dysfunction. METHODS: Thirty-one patients with SLE with a history of overt neuropsychiatric symptoms (neuropsychiatric SLE [NPSLE]), 22 patients with SLE without overt neuropsychiatric symptoms (non-NPSLE), and 25 healthy controls completed the following measures at baseline and 1-month followup: ACR-SLE battery, perceived cognitive difficulties, depression, fatigue, and pain. RESULTS: Patients with SLE (both NPSLE and non-NPSLE) showed higher symptoms of depression, higher levels of fatigue, greater pain, and more perceived cognitive problems. All measures except the Center for Epidemiologic Studies Depression scale (CES-D) demonstrated adequate reliability across the SLE groups at retest. Only patients with NPSLE had significant correlations between CII and depression, fatigue, and pain. Neither the non-NPSLE patients nor the controls had significant relationships with the CII and these behavioral measures. CONCLUSION: Patients with SLE report higher levels of cognitive difficulties, depression, pain, and fatigue compared with controls. Reliability for all measures, except the CES-D, was established in the SLE group. Overall, results suggest that cognitive dysfunction, pain, fatigue, and depression in patients with NPSLE may represent global changes in the central nervous system that require ongoing evaluation and treatment.     

Simplified composite disease activity measures in rheumatoid arthritis: should they be used in standard care?

OBJECTIVE: To examine the validity, reliability, and predictive value of two recently developed composite disease activity measures, the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) in rheumatoid arthritis (RA) patients. METHODS: A systematic review of the published literature was performed between February 2003 and November 2007. Data was extracted regarding correlations of the SDAI and CDAI with standard clinical trial measures, the predictive ability of the measures and correlations with changes in radiographic scores. The ability of the measures to categorize patients according to their disease activity status compared to standard categories was also examined. RESULTS: Among 17 studies initially identified, 12 provided information on the validity and reliability of the SDAI and CDAI. These measures were found to be strongly correlated with the Disease Activity Score (DAS28) with correlation coefficients ranging from 0.80 to 0.93. Areas under the curve (AUC), from receiver operating characteristic (ROC) curve analysis predicting physician responses, varied from 0.821 to 0.923. Moderate association with changes in the HAQ and radiographic scores was found with correlation coefficients ranging from 0.30 to 0.59. Several studies reported mixed results between the measures when categorizing patients according to disease severity with the SDAI and CDAI the more stringent at remission. CONCLUSION: The SDAI and the CDAI were found to have concurrent validity and were highly predictive of a change in therapy, but not predictive of future functional capacity or joint damage. Differences were found when categorizing patients according to disease activity level. Further studies should be conducted, especially at remission and low disease activity status, before these measures are used independently in a clinical setting.     

Analyzing reliability of change in depression among persons with rheumatoid arthritis

OBJECTIVE: To examine several methods of determining reliability of change constructs in depressive symptoms in patients with rheumatoid arthritis (RA) and to demonstrate the strengths, weaknesses, and uses of each method. METHODS: Data were analyzed from a cohort of 54 persons with RA who participated in a combined behavioral/pharmacologic intervention of 15 months duration. These longitudinal data were used to examine 3 methodologies for assessing the reliability of change for various measures of depression. The specific methodologies involved the calculations of reliable change, sensitivity to change, and reliability of the change score. RESULTS: The analyses demonstrated differences in reliability of change performance across the various depression measures, which suggest that no single measure of depression for persons with RA should be considered superior in all contexts. CONCLUSION: The findings highlight the value of utilizing reliability of change constructs when examining changes in depressive symptoms over time.     

Value of the time trade off method for measuring utilities in patients with rheumatoid arthritis

OBJECTIVE: To assess the feasibility, reliability, and validity of the time trade off (TTO) in patients with rheumatoid arthritis (RA). METHODS: The TTO was applied in 194 patients with RA with increasing difficulty in performing activities of daily living. The test-retest reliability was determined in 35 of these patients and was calculated by the intraclass correlation coefficient (ICC). Construct validity was evaluated with the following sets of variables: measures of utility (rating scale), quality of life (RAND 36 item Health Status Survey (RAND-36) and RAQoL), functional status (Health Assessment Questionnaire, grip strength, and walk test), and disease activity (doctor's global assessment, disease activity score, pain, and morning stiffness). RESULTS: Ten patients (5%) did not complete the TTO. The median value of the TTO was 0.77 (range 0.03-1. 0). The test-retest ICC of the TTO was 0.85 (p<0.001). Construct validity testing of the TTO showed poor to moderate correlations (Spearman's r(s) between 0.19 and 0.36, p<0.01) with all outcome measures except for the subscale role limitation (physical problem) of the RAND-36, the walk test, the doctor's global assessment of disease activity, and morning stiffness. Multiple regression analysis showed that only 17% of the variance of the TTO scores could be explained. CONCLUSIONS: The TTO method appeared to be feasible and reliable in patients with RA. The poor to moderate correlations of the TTO with measures of quality of life, functional ability, and disease activity suggest that the TTO considers additional attributes of health status. This may have implications for the application of the TTO in clinical trials in patients with RA.     

A validation study of the Italian Short-Form Leeds Dyspepsia Questionnaire

Assessment of symptoms should be one of the main outcome measures in dyspepsia clinical trials. This requires a reliable, valid and responsive questionnaire that measures the frequency and severity of dyspeptic symptoms. The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) has been proven to fulfil these criteria in its original version in the English language. The aim of the study was to assess the internal consistency, reliability, validity and responsiveness of the Italian version of the SF-LDQ in primary and secondary care. Unselected primary and secondary care patients completed the Italian version of the SF-LDQ. Test–retest reliability was assessed after 2 days. Validity was measured by comparison with diagnosis made by physicians. Responsiveness was determined before and after treatment for endoscopically proven disease. The SF-LDQ was administered to 311 patients in primary care and 179 in secondary care patients. Internal consistency, as judged by the Cronbach’s α, was 0.90. Pearson’s correlation coefficient for test–retest reliability was 0.92. The SF-LDQ had a sensitivity of 80% and a specificity of 82%. A highly significant response to change was also observed (p = 0.001). The Italian SF-LDQ is a reliable, valid and responsive self-completed outcome measure for quantifying the frequency and severity of dyspeptic symptoms.     

Validation of a tool to assess medication treatment satisfaction in patients with Type 2 diabetes: the Diabetes Medication System Rating Questionnaire (DMSRQ)

Diabet. Med. 29, 1060–1066 (2012) Aim To assess the reliability and validity of the Diabetes Medication System Rating Questionnaire among 537 US adults with Type 2 diabetes using five different diabetes medication regimens (oral agents with and without insulin; insulin only by syringe and by pen; glucagon‐like peptide 1 agents). Methods The Diabetes Medication System Rating Questionnaire assesses the treatment experience of patients using any diabetes medication system that uses nine measures (Convenience, Negative Events, Interference, Self‐Monitoring of Blood Glucose Burden, Efficacy, Social Burden, Psychological Well‐Being, Treatment Satisfaction, Treatment Preference). It was administered via an initial online survey, along with other validated measures of treatment satisfaction and medication adherence, with a retest administered within 2 weeks. Participants were 52.5% male, 57.4% aged 40–64 years, 83.6% white and 95.2% non‐Hispanic. Most (75.6%) had attended college and 58.3% had been diagnosed with diabetes for more than 10 years. Results Median inter‐item agreement was 0.86. Median test–retest reliability was also 0.86. All correlations between Diabetes Medication System Rating Questionnaire measures and criterion measures of treatment satisfaction and adherence were statistically significant (P < 0.01) in the expected direction. Correlations between Diabetes Medication System Rating Questionnaire and the corresponding criterion measures of treatment satisfaction ranged from 0.349 to 0.629 (absolute values; interpolated median 0.568); correlations of the same measures with adherence ranged from 0.384 to 0.450 (absolute values; mean 0.411). Diabetes Medication System Rating Questionnaire measures differentiated among groups taking different medications and those using different delivery systems for the same medication. Conclusions This study suggests that the Diabetes Medication System Rating Questionnaire has good reliability and validity and provides a more comprehensive set of measures than existing medication satisfaction questionnaires.     

Quality of life measurement in patients with transfusion-dependent myelodysplastic syndromes

The myelodysplastic syndromes (MDS) are clonal disorders characterized by dysplasia in at least two myeloid cell lines. Fatigue is one of the most significant symptoms. MDS patients are treated with blood transfusions to improve their health-related quality of life (HRQoL). A cross-sectional pilot study was performed for psychometric evaluation of three internationally established HRQoL measures in MDS patients, and for investigation of the association between the severity of chronic anaemia and HRQoL. Fifty consecutive MDS patients completed the Short Form 36, the Multidimensional Fatigue Inventory and the EuroQoL-5D Visual Analogue Scale. Hb level was measured during the same visit. Psychometric analysis focused on feasibility, construct validity and reliability. The questionnaires showed a high feasibility, reliability and validity. MDS patients had worse HRQoL scores than the age- and sex-matched general population. We found a positive correlation between haemoglobin (Hb) level and HRQoL. This study provides insights into the suitability of established HRQoL measures for the evaluation of interventions in MDS patients. Hb value and HRQoL are complementary variables for evaluation of the severity of chronic anaemia in patients with MDS.     

The value of a continuous ambulatory activity monitor to quantify the amount and intensity of daily activity in patients with rheumatoid arthritis

OBJECTIVE: To examine the reliability, validity, and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis (RA). METHODS: Forty-one patients with RA, participating in a randomized controlled trial examining the effect of an intensive exercise program, were assessed by means of the Dynaport ADL (activities of daily living) monitor (AM). The time spent on activities (locomotion, standing, and active sitting) during 24 hours and the intensity of trunk movement during these activities were recorded. To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment. Construct validity of the AM was determined by comparing the AM results with physical fitness measures (muscle strength, endurance, joint mobility), disease activity, and functional status. As well, 37 patients were assessed 18 months after the first assessment to determine responsiveness. RESULTS: All AM measurements showed satisfactory test-retest reliability (ICC 0.63-0.76). AM measures were significantly associated with physical fitness, functional status, and disease activity, indicating construct validity of the AM. The AM could discriminate between patients with improvement and deterioration in physical fitness, indicating sufficient responsiveness of AM variables. CONCLUSION: This study shows the value of an ambulatory activity monitor to quantify both the amount and intensity of physical activity of patients with RA during a day in their own environment. The ambulatory activity monitor seems to be a promising instrument for research into rehabilitation of patients with RA.     

Reliability and validity of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus

OBJECTIVE: To examine the reliability and validity of the proposed American College of Rheumatology (ACR) neuropsychological battery for patients with systemic lupus erythematosus (SLE). METHODS: Thirty-one SLE patients with a history of neuropsychiatric symptoms (NPSLE), 22 SLE patients without a history of neuropsychiatric symptoms (non-NPSLE), and 25 healthy controls completed measures of cognition at baseline and after 1 month. The 1-hour proposed ACR-SLE battery was compared with a 4-hour comprehensive battery (CB). RESULTS: Seven of 12 measures from the ACR-SLE battery were lower in SLE patients compared with controls. Overall agreement between impairment on the ACR-SLE battery and the CB was 90%. This was established using previously defined impairment on the CB and 4 of 12 scores impaired on the ACR-SLE battery. Almost perfect agreement between the 2 batteries was found for non-NPSLE patients and healthy controls (95-96%) and moderate agreement was reported for NPSLE patients (81%). Intraclass correlation coefficients for ACR-SLE tests ranged from 0.40 to 0.90, indicating adequate reliability. CONCLUSION: Reliability and validity of the ACR-SLE battery was established in this study. Agreement regarding classification for impairment was almost perfect for non-NPSLE and moderate for the NPSLE patients. The ACR battery is well designed for general classification of cognitive impairment in SLE. However, comprehensive testing may be useful in identifying specific deficits in NPSLE.     

Development and testing of the Survey of Illness Beliefs in Heart Failure tool

This study establishes reliability and construct validity of the Survey of Illness Beliefs in Heart Failure (HF) tool, which measures the accuracy and certainty of illness beliefs people have about HF. Factor analysis produced a 2-component structure of 14 items that revealed accurate and inaccurate illness beliefs (alpha=0.87 and 0.71, respectively). Construct validity was supported with significantly greater accuracy in illness belief scores in patients evaluated or listed for heart transplantation or enrolled in an HF research study (P=.008 and .02, respectively). The reliability and validity of the tool is sufficient to support its use in clinical research.     

Measuring episodic abdominal pain and disability in suspected sphincter of Oddi dysfunction

AIM:To evaluate the reliability of an instrument that measures disability arising from episodic abdominal pain in patients with suspected sphincter of Oddi dysfunction(SOD).METHODS:Although several treatments have been utilized to reduce pain and associated disability,measurement tools have not been developed to reliably track outcomes.Two pilot studies were conducted to assess test-retest reliability of a newly developed instrument,the recurrent abdominal pain intensity and disability(RAPID) instrument.The...     

Validation of the Social Appearance Anxiety Scale in Patients With Systemic Sclerosis: A Scleroderma Patient‐Centered Intervention Network Cohort Study

Objective

Systemic sclerosis (SSc) is an autoimmune disease that can cause disfiguring changes in appearance. This study examined the structural validity, internal consistency reliability, convergent validity, and measurement equivalence of the Social Appearance Anxiety Scale (SAAS) across SSc disease subtypes.

Methods

Patients enrolled in the Scleroderma Patient‐centered Intervention Network Cohort completed the SAAS and measures of appearance‐related concerns and psychological distress. Confirmatory factor analysis (CFA) was used to examine the structural validity of the SAAS. Multiple‐group CFA was used to determine whether SAAS scores can be compared across patients with limited and diffuse disease subtypes. Cronbach's alpha was used to examine internal consistency reliability. Correlations of SAAS scores with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression were used to examine convergent validity. SAAS scores were hypothesized to be positively associated with all convergent validity measures, with correlations significant and moderate to large in size.

Results

A total of 938 patients with SSc were included. CFA supported a 1‐factor structure (Comparative Fit Index 0.92, Standardized Root Mean Residual 0.04, and Root Mean Square Error of Approximation 0.08), and multiple‐group CFA indicated that the scalar invariance model best fit the data. Internal consistency reliability was good in the total sample (α = 0.96) and in disease subgroups. Overall, evidence of convergent validity was found with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression.

Conclusion

The SAAS can be reliably and validly used to assess fear of appearance evaluation in patients with SSc, and SAAS scores can be meaningfully compared across disease subtypes.

     

Development of scoring criteria for the clock drawing task in Alzheimer's disease.

OBJECTIVE: To investigate the reliability and validity of free-hand clock drawings, a frequently used measure of constructional apraxia, in patients with Alzheimer's disease. DESIGN: Survey for the purpose of testing reliability and validity of a new scale. SETTING: Memory Disorder Clinic at a university-affiliated hospital in the Upper Midwest. PATIENTS: Forty-six patients were diagnosed with clinically probable dementia of the Alzheimer type after a dementia evaluation, and 26 normal elderly controls were research volunteers without a history of cognitive dysfunction. MEASUREMENTS: Neuropsychological tests, dementia-related scales, and clock drawings rated by a new 20-item Clock Drawing Interpretation Scale. Reliability measures, correlations, and clustering of items in the CDIS. RESULTS: The CDIS had inter-rater reliability (r = .94), internal consistence (rtt = .95), and reproducibility over a 6-month interval. CDIS scores were significantly correlated with two dementia-related scales and all neuropsychological tests and had the highest correlations with other measures of constructional apraxia. All but four Alzheimer patients (91%) and none of the controls had CDIS scores of 18 or less. CONCLUSION: Clinicians may reliably screen patients with Alzheimer's disease with the clock-drawing task, a measure sensitive to deficits in constructional apraxia.     

Measuring utilities by the time trade-off method in Tunisian rheumatoid arthritis patients

The objective of this study was to determine the feasibility, reliability and validity of the time trade-off (TTO) in Tunisian rheumatoid arthritis (RA) patients. The TTO was used to measure the utility in 122 RA patients with increasing difficulty in performing activities of daily living. The 1-week test–retest reproducibility was studied in 57 patients using the intraclass correlation coefficient (ICC). Validity was evaluated by comparison with other outcome measures: utility rating scale (RS), quality of life (QOL) [arthritis impact measurement scale 2 (AIMS2), rheumatoid arthritis quality of life (RAQOL)], functional status [health assessment questionnaire (HAQ), Lee index] and disease activity score (DAS). Eight patients (6.6%) did not complete the TTO. The median value of the TTO score was 0.655 (0.019–1.000). The ICC for reliability of the TTO was 0.89 (p<0.001). The TTO showed poor to moderate correlation (Spearmans correlation coefficients between 0.2 and 0.409, p<0.01) with AIMS2, RAQOL, HAQ and Lee index. We did not find any correlation between TTO and DAS. Multiple regression analysis showed that only 32% of TTO scores could be explained. The TTO method appeared to be reliable in a group of Tunisian RA patients, but TTO values were poorly to moderately related to measures of QOL, functional ability, and disease activity. We think that TTO and RS are not feasible for use in RA patients.     

Can self-reported height and weight be used among people living with HIV/AIDS?

To assess the reliability and validity of self-reported height and weight in adults living with HIV/AIDS (ALWHA) we assessed 508 ALWHA of both genders on antiretroviral therapy. Height and weight were directly measured in a subsample. Sensitivity and specificity analysis were performed to determine the validity of self-reported measures. Bland-Altman's method was used to calculate the limits of agreement between values while reliability was assessed using intraclass coefficients. Regression equations were devised to determine actual measures from self-reported values. Mean differences among measured and self-reported weight were -0.96 kg for men and -0.54 kg for women. Mean height differences were less than 2 cm, yielding good reliability for body mass index (BMI). Overweight (BMI ≥ 25 kg/m(2)) diagnosis sensitivity was 90.6% and specificity was 81.2%. Corrected measures determined by regression equations had stronger correlation with self-reported values (r > 0.980). Self-reported height and weight showed good reliability and validity compared with directly measured height and weight. However, measures should be corrected whenever possible to achieve higher accuracy.     

Development and initial evaluation of a measure of self-management for adults with antineutrophil cytoplasmic antibody-associated small-vessel vasculitis

OBJECTIVE: To develop a measure of illness self-management for adults living with antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (ANCA-SVV) and to gather evidence of its reliability and validity. METHODS: Development of the Vasculitis Self-Management Scale (VSMS) was guided by previous research on self-management in other chronically ill populations, a review of the current treatment literature for ANCA-SVV, interviews with patients, and consultation with experts. A total of 205 patients living with ANCA-SVV or a closely related condition then completed the VSMS, along with measures of sociodemographic and clinical variables, social desirability bias, and general adherence to medical recommendations, using a self-administered mailed questionnaire. A principal components analysis was conducted on the VSMS items. Internal consistency reliability and construct validity of the resulting subscales were assessed. Forty-four patients completed the VSMS a second time, for the purpose of assessing test-retest reliability. RESULTS: Analyses suggested an 8-factor solution. The final VSMS consisted of 43 items representing these 8 behavioral domains. Correlations among the 8 domains were null to modest in magnitude. The internal consistency reliability of the 8 subscales ranged from minimally acceptable (alpha = 0.67) to excellent (alpha = 0.94), and correlations between subscale scores at time 1 and time 2 suggested good temporal stability. Preliminary evidence for validity was mixed. CONCLUSION: These findings suggest that the VSMS is a promising method for assessing illness self-management in adults with ANCA-SVV. More research exploring the validity of the measure is warranted.