Validation of the translation and cross-cultural adaptation into Finnish of the Abdominal Symptom Questionnaire,the Hospital Anxiety and Depression Scale and the Complaint Score Questionnaire

Background: Epidemiological surveys require questionnaires to be validated in the native language of the participants. The aim of this study was to validate the Finnish translations of the Abdominal Symptom Questionnaire (ASQ), the Hospital Anxiety and Depression Scale (HAD) and the Complaint Score Questionnaire (CSQ). Methods: A random sample of adults (n?=?3000) in a northern Swedish bilingual district was surveyed using a mailed ASQ offered in both Swedish and Finnish, and 2122 responded (239 in Finnish). A random subsample of the responders (n?=?1001, 123 preferring Finish) was then surveyed once more using the ASQ, the HAD and the CSQ. The first 50 responders of the latter survey were then given the three questionnaires again within two weeks. The Finnish versions had been put through a comprehensive translation procedure Results: A factor analysis comparison between the responders using either language in the mailed survey gave a comparable factor construction, and this was also comparable with an earlier analysis of the Swedish version. The Finnish responses to the second survey were further evaluated by testing internal consistency reliability, convergent validity towards previously validated relevant instruments (ShortForm-36 and the Gastrointestinal Symptom Rating Scale) and the test/re-test accuracy of the three questionnaires. These were found to be reliable, as was the correlation between the ASQ and the CSQ, for relevant domains. Conclusion: The Finnish translations of the ASQ, HAD and CSQ questionnaires all seem to be robust and usable for population-based surveys among Finnish adults.     

A Rasch-based validation of a short version of ABILHAND as a measure of manual ability in adults with unilateral upper limb amputation

Purpose.?To evaluate the measurement properties of ABILHAND (a generic measure developed to assess functioning in people with upper limb impairments) when used in adults with unilateral upper limb amputation (ULA).

Methods.?A convenience sample of 72 adults who had unilateral ULA and completed rehabilitation at the Institute for Rehabilitation in Ljubljana at least 1 year prior to the study. They filled in the ABILHAND questionnaire. Rating scale analysis (Rasch model) was used to evaluate functioning of the rating scale categories, the validity of the measure by examining fit of the items to the latent trait and the hierarchy of item difficulties compared with expectations of the construct.

Results.?Rasch analysis allowed us to improve ABILHAND by rescoring to reduce the response categories from 5 to 4, and identifying 22 of 46 items that are useful to measure upper limb function in people with ULA. The results indicate that high confidence can be placed in the consistency of both person-ability and item-difficulty estimates.

Conclusions.?This revised ABILHAND for people with unilateral ULA (ABILHAND-ULA 1.0) is a promising instrument for measuring their degree of manual functioning.     

Brain electrical activity (quantitative EEG and bit-mapping neurocognitive CNV components), psychometrics and clinical findings in presenile subjects with initial mild cognitive decline or probable Alzheimer-type dementia

Clinical, neuropsychological and neuropsychophysiological data (Q-EEG, ERPs and CNV/RT activity) were obtained from 24 patients who had more or less severe presenile primary cognitive decline without depression, and compared with similar data from 10 age-matched healthy volunteers (mean age, 59.4 years). All of the patients (15 M and 9 F; mean age 59.6 years) were selected according to the DSM III-R, ICD-10 and NINCDS-ADRDA criteria and underwent CT and MRI scanning, in addition to a standard clinical examination, a battery of psychometric tests, spectral EEG, and bit-mapped CNV complex and RT to S2 analyses. Twelve of the 24 patients presented an initial presenile idiopathic cognitive decline (PICD) but did not wholly fulfil the clinical and neuropsychological criteria for primary dementia or for a diagnosis of probable AD; the remaining 12 patients showed characteristic clinical signs and symptoms of a very probable early stage of presenile Alzheimer-type dementia (PAD). ANOVA, correlational and discriminant analyses of the neuropsychological test scores, and the neurophysiological and RT to S2 data revealed 22 highest-ranked between-group discriminant factors (all with a significance level of p<0.01). The conclusive discriminant analysis retained 13 of these factors as final canonical functions, and these showed a 97% grouping accuracy (33 of the 34 subjects examined); the same percentage of correct classifications was also achieved using only the 15 best indicators in the group of CNV/RT findings. Using both of these sets of highest-ranked discriminators, all of the normal subjects and all of the PAD patients were correctly classified; only 1 PICD patient was misclassified as normal when the first group of 13 factors was used, and another PICD patient was misclassified as PAD using the second group of 15 factors. Our findings suggest that, providing they are correctly performed and interpreted, these non-invasive techniques may be an important tool for identifying incipient stages of presenile Alzheimer-type dementia.This investigation was supported by National Research Council Grants (Aging Program Project: CNR No. 02854.04; 00394. PF40; 00467. PF40; Code No 954569).     

A critical review of dimension-specific measures of health-related quality of life in cross-cultural research

This article reviews six dimension-specific health-related quality of life (HRQL) measures which have been used cross-culturally. The instruments reviewed are: the Beck Depression Inventory (BDI); the McGill Pain Questionnaire (MPQ); the Center for Epidemiologic Studies—Depression (CES-D); the Zung Self-Rating Depression Scale (SDS); the General Health Questionnaire (GHQ); and the Psychological General Well-Being Index (PGWB). These instruments primarily represent the psychological or emotional dimension of HRQL, and are scales that were developed and validated in the USA, Canada or the UK. The review of specific studies for each of the six instruments was not meant to be exhaustive, but rather to give an indication of the ways in which the instruments have been assessed or used in various countries. The focus throughout this article is on the psychometric properties (reliability, validity and responsiveness) of these scales in different cultures, as well as the processes used to translate the instruments from English into another language. Implications of the results of this review for cross-cultural use of dimension-specific HRQL instruments are drawn.     

Factor analysis and reduction of a Fear Survey Schedule among dental phobic patients

A fear survey instrument, based on the Fear Survey Schedule-II and five additional fear items, was administered to 109 patients (70 women and 39 men) on a waiting list at a specialized dental fear clinic. The fear survey was analyzed to identify its factorial structure. Five fear factors, explaining 54% of the total variance, were identified concerning areas of "illness and death", "failures and embarrassment", "social situations", "physical injuries", and "animals and natural phenomena". An ad hoc reduction of items was carried out to form a shorter, more practical to use questionnaire, which resulted in factors of four or five items with loadings greater than 0.50. The factors intercorrelated significantly (r_p varying between 0.33 and 0.59) and "illness and death" correlated highly with "physical injuries" (r_p=0.59) and "animals and natural phenomena" (r_p=0.56), while "failures and embarrassment" correlated highly to "social situations" (r_p= 0.54). Statistically significant, but generally lower correlations were found between each factor and the dental fear measures. The highest correlations were found between fear of "physical injuries" and dental fear. There was also a high and significant correlation between sex and fear of "animals and natural phenomena".     

Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory

This article describes short form versions of the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI). These instruments assess life impact and symptom distress, respectively, of urinary incontinence and related conditions for women. All subsets regression analysis was used to find item subsets that best approximated scores of the long form versions. The approach succeeded in reducing the 30-item IIQ and the 19-item UDI to 7- and 6 item short forms, respectively. The short form versions may be more useful than the long form versions in many clinical and research applications. © 1995 Wiley-Liss, Inc.     

Demographical, odontological, and psychological variables in individuals referred for osseointegrated dental implants

Edentulism and/or the wearing of a removable denture always requires adaptation, not only on a functional, but also on an emotional, level. Four hundred and seventy-three patients referred for treatment with osseointegrated implants due to problems with removable prostheses entered the study and 315 (66.6%) completed it. The average age was close to 60 yr, and the majority of patients were women. The average time of edentulousness was 14.3 yr. Twelve percent experienced profound negative effects from wearing dentures, this to an extent that it led to overt psychological and social effects. Subjective ratings revealed that functional and/or intra-personal effects were of higher significance than social consequences. The group was found to be more depressed than average as well as having an external health locus of control orientation.     

Assessment Instrument for Problem-focused Coping

A new self-report instrument, the Assessment Instrument of Problem-focused Coping (APC) developed from qualitative interviews, is described. This instrument provides knowledge of the patients' own competence in coping with activities of daily living (ADL), the patients' own assessment of what they experience as problems, and the extent to which they are satisfied with their ADL. The purpose of the study was to test the reliability of the instrument with regard to intra-rater reliability and internal consistency. The study group comprised 40 patients with muscular weakness and other symptoms relating to the postpolio syndrome. The result showed an acceptable internal consistency (alpha 0.70), which confirms the construct validity of the instrument. The test-retest showed that the stability over a period of time varied from low to high for a total of 28 items. At the same time, it is evident that the instrument does not achieve the aim of being a good evaluation instrument, because the stability over a period of time was unsatisfactory. The test-retest should be repeated with a larger test group in future research projects.     

Provider attitudes toward pay-for-performance programs: development and validation of a measurement instrument

OBJECTIVE: To develop an instrument for assessing physician attitudes toward quality incentive programs, and to assess its reliability and validity. DATA SOURCES: Study involved primary data collection. A 40-item paper and pencil survey of primary care physicians in Rochester, New York, and Massachusetts was conducted between May 2004 and December 2004. Seven-hundred and ninety-eight completed questionnaires were received, representing a response rate of 32 percent (798/2,497). STUDY DESIGN: Based on an extensive review of the literature and discussions with experts in the field, we developed a conceptual framework representing the features of pay-for-performance (P4P) programs hypothesized to affect physician behavior in that context. A draft questionnaire was developed based on that conceptual model and pilot tested in three groups of physicians. The questionnaire was modified based on the physician feedback, and the revised version was distributed to 2,497 primary care physicians affiliated with two of the seven sites participating in Rewarding Results, a national evaluation of quality target and financial incentive programs. DATA COLLECTION: Respondents were randomly divided into a derivation and a validation sample. Exploratory factor analysis was applied to the responses of the derivation sample. Those results were used to create scales in the validation sample, and these were then subjected to multitrait analysis (MTA). One scale representing physicians' perception of the impact of P4P on their clinical practice was regressed on the other scales as a test of construct validity. PRINCIPAL FINDINGS: Seven constructs were identified and demonstrated substantial convergent and discriminant validity in the MTA: awareness and understanding, clinical relevance, cooperation, unintended consequences, control, financial salience, and impact. Internal consistency reliabilities (Cronbach's alpha coefficients) ranged from 0.50 to 0.80. A statistically significant 25 percent of the variation in perceived impact was accounted for by physician perceptions of the other six characteristics of P4P programs. CONCLUSIONS: It is possible to identify and measure the key salient features of P4P programs using a valid and reliable 26-item survey. This instrument may now be used in further studies to better understand the impact of P4P programs on physician behavior.     

Identification of borderline personality disorders among substance abuse inpatients

By means of a structured interview procedure, individuals with borderline personality disorders were identified among a sample of 50 patients admitted to an inpatient substance abuse treatment program. When given a series of psychological tests, borderline patients were shown to be more pathological than a nonborderline group of substance abusers in a number of areas including depression, impulse control, antisocial tendencies and reality testing. Time spent in treatment was also shorter for the borderline group. Implications for substance abuse treatment programs and the potential impact of these patients on such programs is discussed.