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At least 235 records · Page 13Linked to original sources

Performance of the WHO Rose angina questionnaire in post-menopausal women: are all of the questions necessary?

OBJECTIVE: To assess the performance of a shortened version of the Rose angina questionnaire focusing on exertional chest pain. METHODS: Cross sectional analysis of 3987 women aged 60 to 79 years from 23 British towns. The performances of definite Rose angina (using data from the full Rose angina questionnaire) and exertional chest pain (using data from a subset of three questions from the Rose angina questionnaire) were assessed against a medical record of angina. RESULTS: The sensitivity (the proportion with a medical record of angina who were identified as having angina by the questionnaire) was 29.9% (95% confidence intervals 25.7% to 34.4%) comparing definite Rose angina to any medical record of angina since 1978 and 50.7% (45.9% to 55.5%) comparing exertional chest pain to any medical record diagnosis of angina. The positive predictive values of both questionnaires were similar. When the two questionnaires were compared with a gold standard of a primary care consultation for angina symptoms within the past five years the sensitivity of definite Rose angina was 33.0% (26.9% to 39.6%) and that of exertional chest pain was 51.8% (45.1% to 58.5%). Although the sensitivity of both versions of the questionnaire was greater in those aged 60-69 years compared with those aged 70-79 years, it remained higher in the exertional chest pain version of the questionnaire than for definite Rose angina based on the full version of the questionnaire in both age groups. Performance of either version of the questionnaire was not affected by occupational social class. CONCLUSIONS: With respect to identifying women with a medical diagnosis of angina or those presenting to primary care with anginal symptoms, these results suggest that a shortened version of the Rose angina questionnaire focusing on exertional chest pain performs better than the full version. Other studies suggest that exertional chest pain is the crucial element of the Rose angina questionnaire with respect to predicting future coronary events. It is concluded that using a shortened version of the Rose angina questionnaire is adequate in epidemiological studies.

Aged↗

Increasing response rates to postal questionnaires: a randomised trial of variations in design.

OBJECTIVES: Low response rates to postal questionnaires can threaten the validity of studies by reducing the effective sample size and introducing bias. The identification of methods with which to optimise response rates could, therefore, improve the quality of studies. In an attempt to identify such methods, we undertook a randomised trial of two simple variations in questionnaire design. METHODS: Using a 2 x 2 factorial design, we conducted a randomised trial to test two variations in questionnaire design; the questionnaires were printed on either single-sided or double-sided paper and had either a single- or multiple-booklet layout. Using equal random allocation, 3836 women were randomised to receive one of these questionnaires as part of a study investigating risk factors for osteoporotic fractures. RESULTS: One thousand eight hundred and seventy questionnaires were returned, giving an overall response rate of 48.7%. There were no significant differences in the overall response to each of the four questionnaire designs. When the number of responders who completed at least 50% of each of the three sections was identified, it was found that single-booklet questionnaires had a better response than the multiple-booklet questionnaires and that single-sided questionnaires had a better response than double-sided questionnaires. However, these results were not significant at the 5% level. There were no significant differences in the response to questions on the odd (left-hand side) pages for the single- compared with the double-sided questionnaires. CONCLUSION: As the most cost-effective use of resources, we would advocate the use of double- rather than single-sided questionnaires, and use of a single- rather than multiple-booklet design.

Aged↗

The assessment of functional impairment in fibromyalgia (FM): Rasch analyses of 5 functional scales and the development of the FM Health Assessment Questionnaire.

OBJECTIVE: Functional assessment by self-report questionnaire plays an important role in most rheumatic conditions, but psychometric properties of questionnaires have not been studied in fibromyalgia (FM), particularly by Rasch analysis, which allows for examining adequacy of the questionnaire scale. To assess currently used instruments, we examined the Fibromyalgia Impact Scale (FIQ), 4 versions of the Health Assessment Questionnaire (HAQ), and the Medical Outcome Survey Short Form (SF-36). METHODS: More than 2,500 patients from 4 sites (3 US, 1 Israel) completed the FIQ. The HAQ questionnaires were completed by 1438 patients participating in the US National Data Bank for Rheumatic Diseases. Seven hundred sixty patients from Wichita, Kansas, completed the SF-36. Rasch analysis was applied separately to each of these data sets. RESULTS: The FIQ systematically underestimated functional impairment by its handling of activities not usually performed. All questionnaires had problems with non-unidimensionality and ambiguous items when applied to patients with FM. In addition, scales were found to be non-linear. Because of these findings we used the 20 item HAQ questionnaire as an item bank to develop a new questionnaire more suitable for use in FM, the fibromyalgia HAQ (FHAQ). This questionnaire fits the Rasch model well, is relevant, is linear, and has a long, well spaced scale. CONCLUSION: No available functional assessment questionnaire works well in FM. A new questionnaire, the FHAQ, was developed. It has appropriate metric properties and should function well in this condition. Since the FHAQ is a subset of the larger HAQ questionnaire, a new questionnaire is not required; only a different method of scoring is needed. Additional studies regarding sensitivity to change are required to fully validate the FHAQ.

Disability Evaluation↗

Prevalence of childhood asthma and allergy in an inner city Malaysian community: intra-observer reliability of two translated international questionnaires.

OBJECTIVES: (a) To examine the intra-observer reliability of the Malay language versions of two international respiratory questionnaires i.e. the International Study of Asthma and Allergy in Children (ISAAC) and the American Thoracic Society (ATS) questionnaires, and (b) using the more reliable of these questionnaires, to estimate the prevalence of asthma and allergy related symptoms in an ethnically homogenous inner city community in Kuala Lumpur. METHODS: The study was conducted among 7 to 12 year old school children of Malay ethnic origin living in an inner city area of Kuala Lumpur. The sample consisted of 787 children attending the only primary school in the area. The Malay versions of both questionnaires were administered twice, one month apart, and were completed by parents. Agreement between the first and second responses to the same questions were assessed by Cohen's kappa. Kappa values < 0.4 were indicative of poor intra-observer reliability, 0.4-0.59 moderate reliability, 0.6-0.79 good reliability and > 0.79 excellent reliability. RESULTS: 77.9% and 36.3% of parents responded to the first and second administrations of the questionnaires respectively. Kappa values of > 0.4 were obtained in 15/16 (93.8%) and 17/27 (63.0%) questions of the ISAAC and ATS questionnaires respectively. Excellent kappa values were obtained in 4/16 (25%) questions of the ISAAC questionnaire versus only 1/27 (3.7%) questions of the ATS questionnaire. From the ISAAC questionnaire, all questions on wheeze had good reliability while those on asthma had excellent reliability. Questions on allergic symptoms had poor to moderate reliability. In contrast, from the ATS questionnaire, questions on wheeze had moderate reliability while questions on asthma were excellently reliable. Questions on allergic symptoms had moderate to good reliability while those on cough, phlegm and bronchitis had poor reliability. According to the ISAAC questionnaire the prevalence of ever wheeze, wheeze in the last 12 months, ever asthma and wheeze with exercise in the last 12 months was 12.5%, 6.6%, 10.3% and 5.9% respectively. The prevalence of ever sneeze or runny nose, sneeze or runny nose in the last 12 months, watery eyes in the last 12 months and ever eczema was 15.2%, 11.1%, 4.4% and 8.5% respectively. CONCLUSIONS: The translated ISAAC questionnaire was more reliable than the translated ATS questionnaire. Asthma and related symptoms were common among Malay school children in inner city Kuala Lumpur.

Asthma↗

[Validation of a self-administered functional evaluation questionnaire after surgical treatment of lumbar spine stenosis].

PURPOSE OF THE STUDY: The main aim of this prospective, multicentric, observational study was to validate a self-administered quality-of-life questionnaire for patients with lumbar spine stenosis treated surgically. MATERIAL AND METHODS: The self-administered questionnaire was composed of eight questions exploring three dimensions: lumbalgia, radiculalgia, radicular ischemia. This questionnaire was associated with an index of neurological involvement (to take into account objective neurological data), and with an index of patient satisfaction (to assess the patient's perception of the impact of surgery on lumbalgia, radiculalgia, and gait disorders). The scoring scale was validated by studying the structure of the questionnaire (to ascertain the pertinence of the proposed three dimensions), by determining the questionnaire's reproducibility (intraobserver variability) and sensitivity to change, and by examining the contents of the questions (to assess the capacity of the scale to effectively measure the parameters it was designed to measure). Cronbach's alpha coefficient and principal component analysis were used to assess the questionnaire's structure. Reproducibility was tested on 49 patients who completed the self-administered questionnaire twice at a 15-day interval; intraclass correlation coefficients were determined. Sensibility was tested by correlating variation in the scores obtained pre- and postoperatively with the index of satisfaction; mean standard responses were determined. The validity of the questionnaire's content was assessed by correlating the scores obtained with the questionnaire to those obtained with three other self-administered questionnaires: SF36, EIFEL2 and GHA38. RESULTS: This work included 104 patients, 96 of whom were reviewed at consultations 6 and 12 months after surgery. The principal components analysis confirmed the presence of the three dimensions. The global Cronbach alpha coefficient was 0.86. The global intraclass coefficient of correlation was 0.95, varying from 0.86 to 0.97 depending on the dimension studied. There was a good correlation (0.82) between changes in the score studied and the index of satisfaction. All the mean standardized responses were higher than 1, indicating good sensitivity to change. There was also a good correlation between the questionnaire tested and the EIFEL2 self-administered questionnaire and the following dimensions of the SF36: physical activity, physical pain, vitality, and limitation due to physical pain. DISCUSSION AND CONCLUSION: Associating a simple 8-question self-administered questionnaire with an index of satisfaction (4 questions) and an objective index of neurological involvement provided a reliable, sensitive, and reproducible assessment of the changes in functional disorders resulting from lumber stenosis before and after surgical treatment.

Activities of Daily Living↗

Development of a questionnaire measuring student attitudes to working and living in rural areas.

INTRODUCTION: Student attachments in rural locations have been instigated, in part to foster positive attitudes to rural practice and encourage rural recruitment. Based on medical and allied health literature, it was hypothesised that students' attitudes to rural practice and rural life encompasses the following three dimensions: (1) community and social issues; (2) family and personal issues; and (3) professional issues. However, there are limited studies assessing attitudinal change before and after rural placement and no valid and reliable tools which examine change across all three dimensions. This article reports on the development, reliability and validity of such a tool to fill this gap in the rural health research literature. METHODS: Students who undertook a rural placement in South Australia or a rural placement organised by the Mt Isa Centre for Rural and Remote Health in Queensland, Australia, during 2001 were invited to complete a pre- and post-placement questionnaire (n = 243). The response rate for the pre-placement questionnaire was 74.9% (n = 182) and 50.2% (n = 122) for the post-placement questionnaire. A literature review informed the content of the initial questionnaire, which consisted of a series of statements to which respondents were instructed to indicate how strongly they agreed or disagreed on a Likert scale of one to six. The assessment of validity and reliability of the questionnaire involved three main processes. Content validity was assessed by discussion and rating by academics and students, resulting in 18 questionnaire items. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach's alpha. RESULTS: The Cronbach's alpha coefficient for the post-questionnaire was 0.68, acceptable for newly developed scales. Exploratory factor analysis and varimax rotation was conducted for pre- and post-placement (n = 110) questionnaires. The pre-placement questionnaire did not lend itself to logical interpretation, probably due to the diverse attitudes students may have pre-rural placement. However the factors on the post-placement questionnaire were interpretable. The Scree Plot indicated four factors, explaining 60.82% of the total variance. The factors were rotated using the normalised varimax rotation method. The factors extracted were: (1) friendliness and support in rural areas; (2) isolation and socialisation problems associated with living and working in rural areas; (3) enjoyable aspects of living in a rural area; and (4) opportunities that working in a rural area provides. CONCLUSIONS: Analysis of the Student Attitudes to Rural Practice and Life Questionnaire provides evidence of validity. The study identified four factors associated with student attitudes to living and working in rural areas, which differ from those hypothesised. The main deviation was Factor 2, grouping all the negative aspects of isolation and socialisation in a rural area. The resulting factors provide a more integrated reflection of the rural experience, rather than the rigid categorisation of professional, social and personal issues. Reliability was found to be adequate. The questionnaire is able to measure student attitudes to rural practice and rural life, and may be used to evaluate the impact of rural placement on student attitudes.

Attitude of Health Personnel↗

The suitability of quality-of-life questionnaires for psoriasis research: a systematic literature review.

OBJECTIVE: To critically appraise the suitability of current quality-of-life (QOL) questionnaires for psoriasis research. DATA SOURCES: Computerized searches of 5 bibliographic databases. QUESTIONNAIRE SELECTION: Predefined criteria were used to identify QOL questionnaires in dermatologic studies. Two investigators independently assessed and agreed on multidimensional generic, dermatology-specific, and psoriasis-specific QOL questionnaires for inclusion. DATA EXTRACTION: Data were extracted on the internal structure, reliability, and validity of the included questionnaires. DATA SYNTHESIS: Three generic, 3 dermatology-specific, and none of the psoriasis-specific questionnaires met the inclusion criteria: the Nottingham Health Profile (NHP), the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the Sickness Impact Profile (SIP), the Dermatology Quality of Life Scales (DQOLS), the Dermatology-Specific Quality of Life Instrument (DSQL), and the Skindex-29. The generic NHP, SF-36 and SIP are well established, reliable, and valid. Although the data are not conclusive, the SF-36 was useful to assess effects of psoriasis on its component scales. The dermatology-specific DQOLS, DSQL, and Skindex-29 are relatively new and, therefore, less widely tested. Available psychometric data demonstrated the reliability and validity of all 3 dermatology-specific questionnaires. The Skindex-29 was also useful to assess change. CONCLUSIONS: None of the identified psoriasis-specific questionnaires met the inclusion criteria. Data on the suitability of the included questionnaires for psoriasis research were relatively sparse. The included generic questionnaires allow comparisons with nondermatologic diseases but do not allow assessment of relevant dermatology-specific aspects and are not sensitive to subtle effects of psoriasis on QOL. On the basis of the psychometric data of the present review, we find the Skindex-29 to be the most valuable dermatology-specific questionnaire for psoriasis research. Combination of the Skindex-29 with the generic SF-36 combines the merits of both types of questionnaires and we therefore recommend this combination.

Adaptation, Psychological↗

Feasibility of using web-based questionnaires in large population-based epidemiological studies.

To date, few large web-based epidemiological studies have been performed in a population-based setting. Sweden has optimal prerequisites for web-based studies with more than 80% of the general population having access to the Internet. Our aim was to investigate (I) response rates in an epidemiological study using primarily the web as a tool for data collection and (II) whether socio-demographic patterns vary between responders to a web and a paper questionnaire. In 2003, we invited 47,859 women to complete a web questionnaire. Two reminders were sent to non-responders; in the first a random sample received a paper questionnaire and in the second the majority received a paper questionnaire. All other non-responders received web questionnaires. Differences in response rates between responders to web and paper questionnaires with regard to socio-demographic and other variables were analyzed, and estimates of the bias introduced by these differences were estimated. In total, 41% of the women responded to the web questionnaire and 31% to the paper questionnaire (overall response rate 72%). The web-, paper- and non-responders respectively did not differ significantly in age, physical activity levels, and body mass index. Women answering web or paper questionnaires had a higher level of education and income and a lower level of smoking than non-responders. The bias associated with collecting information using web questionnaires was not greater than that caused by paper questionnaires. We conclude that web-based questionnaires are a feasible tool for data collection in large population based epidemiological studies in Sweden.

Adult↗

Evaluation of computerised questionnaires designed for patients referred for gastrointestinal endoscopy.

The aim of this prospective study was to assess the applicability of a computerised medical history system at the open-access endoscopy unit of a University Hospital during routine clinical practice. We studied feasibility, acceptability and reproducibility of computerised questionnaires designed for patients referred for endoscopy of either the upper or lower gastrointestinal (GI) tract, partly in comparison with almost identical paper questionnaires. In the first period of the study 1134 patients were referred of whom 73% answered the paper questionnaire, and during the second period 537 patients were referred of whom 64% answered the computerised questionnaire (P less than 0.001). There was no sex dependency regarding the ability to answer both types of questionnaires. A significant age dependency regarding the ability to answer the paper questionnaires was observed for patients referred for upper and lower GI endoscopy (P less than 0.0001 and P less than 0.0001). Corresponding with this observation, the ability to answer the computerised questionnaires significantly decreased with increasing age for both groups of patients (P less than 0.0001 and P less than 0.0001). The average completion times of both computerised questionnaires, designed for the upper and lower GI tract, were 11 min. The completion times did not depend on sex, but there was a slight positive correlation with age (P less than 0.0001 with multiple R = 0.27 and P = 0.0593 with multiple R = 0.12). Answering our computerised questionnaires was consistently reported to be interesting and easy, and did not last too long according to the respondents. After patients had answered the computerised history system, the insight into their complaints had increased in 40%, and 45% could put their complaints into words more easily. Only 25% of the patients were unable to express all their complaints. A reproducibility of medical history data of 85% was observed between paper and computerised questionnaires. Our computerised questionnaires can provide us with a detailed and uniformly acquired medical history of most patients referred for GI endoscopy. They are well accepted by the patients and can be completed during the normal waiting period. The medical history data obtained with these questionnaires are quite reproducible.

Adult↗

Results of an inner-city school-based asthma and allergy screening pilot study: a combined approach using written questionnaires and step testing.

BACKGROUND: A questionnaire alone may not be an adequate screening tool for asthma. OBJECTIVE: To determine whether an asthma questionnaire used in combination with an exercise step test is better than a questionnaire alone in screening for asthma in children and to evaluate the validity of a rhinitis questionnaire in determining atopy. METHODS: The International Study of Asthma and Allergies in Childhood (ISAAC) asthma core questionnaire was used to screen for asthma in 307 inner-city first through third graders. All children who had scores consistent with a diagnosis of asthma underwent step testing, as did a subset of children who had negative overall scores. All children who had inconsistent asthma scores and step test results underwent methacholine challenge testing. The same 307 children underwent rhinitis screening and children who had one or more positive responses on the ISAAC rhinitis questionnaire underwent skin testing as did a subset of children who had all negative responses. RESULTS: Three hundred of 307 asthma and rhinitis questionnaires were returned. Twenty-eight children (9%) had global asthma scores that were considered to be positive (5 or above). Twenty-four of these children underwent step testing as did 34 randomly selected children who had negative global asthma scores. Thirty-one (91%) of the 34 children who had negative global asthma scores had negative step tests. Similarly, 20 of 24 children (83%) of the children who had positive global asthma scores had negative step tests. Only 4 children who had positive global asthma scores were step test-positive or had reversible airway obstruction at baseline. Using a positive methacholine challenge as the gold standard for establishing bronchial hyperresponsiveness, the global asthma score derived from the eight-item ISAAC asthma questionnaire yielded a sensitivity of 64%, a specificity of 11%, a positive predictive value of 47%, and a negative predictive value of 20%. Comparing the six-item ISAAC rhinitis questionnaire results to the gold standard, skin test reactivity, the questionnaire yielded a sensitivity of 76%, a specificity of 21%, a positive predictive value of 56%, and a negative predictive value of 40%. CONCLUSIONS: Step testing was not useful as a screening tool for asthma. In addition, the ISAAC asthma questionnaire may not be a good asthma screening tool for inner-city pediatric populations, especially if the form is self-administered. Investigators should first validate both the ISAAC asthma and rhinitis screening questionnaires in the particular population to be studied before widespread asthma and allergy screening efforts are initiated using these tools.

Asthma↗

Development of the Short Form Endometriosis Health Profile Questionnaire: the EHP-5.

OBJECTIVE: To develop and validate a short form version of the Endometriosis Health Profile-30 questionnaire which consists of a 30-item core questionnaire and a 23 item modular questionnaire. METHODS: Three studies were carried out to develop the Endometriosis Health Profile-5. Study 1: a short form version of the Endometriosis Health Profile-30 core questionnaire was developed. Study 2: the results were verified in a new data set. Study 3: a short form version of the 23 item modular questionnaire was produced. The modular questionnaire contains six dimensions which may not be applicable to every woman with endometriosis and is used to supplement the five scales on the core questionnaire when required. RESULTS: The final instrument contained 11 items: five items from the core questionnaire and six items from the modular questionnaire. The 95% confidence intervals for Study 1 indicated that the scale scores overlapped with each item score and were confirmed in the second analysis (study 2). Each item was most highly correlated to its parent scale and less with the remaining four core questionnaire scales which was verified in study 2. In both studies all correlations were significant at the 0.01 level (two tailed test). CONCLUSION: The Endometriosis Health Profile-5 is a reliable and valid short form questionnaire which can also be supplemented with a short form version of the modular questionnaire when required. It will be especially useful in clinical settings where a short and economical endometriosis health status measure is required.

Adolescent↗

Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery.

BACKGROUND: In 1996, the Swedish National Register for Gynecological Surgery started to collect pre- and postoperative information on patients using questionnaires given out as part of routine medical care. The information is used in providing clinical care to the patient and for quality assessment. AIMS: To evaluate patients' acceptance of questionnaires as a means of collecting information, and to investigate whether the questionnaire is a suitable tool for follow-up of patients. METHODS: In 1998, evaluations of the ordinary questionnaires were done by an evaluation questionnaire mailed to 80 patients who had been recently hysterectomized. The results were triangulated with results from the register's database and data from interviews with physicians and secretaries. RESULTS: The majority of the patients appreciated the questionnaires. Patients did not report any major problems in filling in the questionnaires. Most problems were due to administrative errors of the departments. Up to 36% of the patients missed the scheduled follow-up visit 2 months after the operation. Two out of four departments regarded the follow-up visit necessary and requested by the patients. Out of 1226 patients followed up postoperatively by questionnaire, 75% stated that they did not need any medical care. Among physicians, some distrust of questionnaires was noted. CONCLUSIONS: The patients in this study preoperatively, and for short- and long-term follow-up, accepted the questionnaire as an instrument of data collection. Questionnaires provide a more complete collection of post-treatment information than follow-up visits do. A large number of unnecessary follow-up visits can be avoided through use of a questionnaire.

Adult↗

A parental questionnaire to evaluate children's Auditory Behavior in Everyday Life (ABEL).

The Auditory Behavior in Everyday Life (ABEL) questionnaire was developed to assess parental perceptions of their children's auditory behavior. The original 49-item questionnaire was intended to assess auditory communication, environmental awareness, functional independence, and social/ communication skills. Our goal was to capture some of the changes in children's everyday auditory behavior in a reliable and easily quantifiable manner. Parents of 28 children aged 4 to 14 years with varying degrees of hearing loss (mild-profound) completed the questionnaire. The results were used to examine the reliability and factor structure of the questionnaire. Eleven items had poor item-total correlations. After these items were removed, the questionnaire had an overall reliability of 0.94 (Cronbach's alpha), and three factors accounted for 20.5% of the variance in the data. In a pilot investigation of the ABEL to determine its appropriateness for children with cochlear implants, questionnaires were also given to a separate group of parents of seven children aged 3 to 12 years who were about to receive a cochlear implant. Questionnaire and speech perception results were obtained preimplant and at 6, 12, 18, 24, and 36 months. Complete (6 visits) or near-complete (4 visits) results were obtained for four children. There were significant improvements over time for both speech perception and questionnaire ratings and there was significant agreement between the two measures. Overall the results indicate excellent reliability and validity of the ABEL questionnaire. Our intent was to develop a simple, quick tool for parents to rate children's auditory skills in everyday life. A shorter questionnaire can be achieved by eliminating items with the poorest reliability and factor loadings. The resultant 24-item ABEL questionnaire has an excellent overall reliability of 0.95. The items fall within three factors, "Aural-oral," "Auditory Awareness," and "Social/Conversational Skills." Children's auditory behavior can be assessed using an overall rating or separately for the three factors. Further research is needed to evaluate this short version of the questionnaire in children wearing hearing aids and cochlear implants.

Adolescent↗

Doubly labelled water validation of three physical activity questionnaires.

This study investigated the validity of the Baecke Questionnaire, the Five City Project Questionnaire, and the Tecumseh Community Health Study Questionnaire in 19 Flemish males, using correlation and multiple stepwise regression analyses. The three questionnaires are commonly used physical activity questionnaires in epidemiological studies. The physical activity level (PAL) as measured with the doubly labelled water method was used as the criterion. The Baecke total activity index showed the highest correlation coefficient with PAL (r = 0.69, p < 0.001). Also the sweat index from the Five City Project Questionnaire, and total daily energy expenditure from the Tecumseh Community Health Study Questionnaire showed significant associations with PAL, respectively 0.57 (p < 0.05) and 0.64 (p < 0.01). Multiple stepwise regression analyses supported the findings from the correlation study. The largest individual contribution in PAL was from the activity index (45%) for the Baecke Questionnaire, the sweat index (29%) for the Five City Project Questionnaire, and total daily energy expenditure (38%) for the Tecumseh Community Health Study Questionnaire. In conclusion, the questionnaires, and certainly the Baecke Questionnaire, can provide valid data about physical activity. Therefore they are useful in epidemiological studies.

Adult↗

A comparison of two diet history questionnaires that measure usual food intake.

This study was conducted during the preparation of a case-control study on patients with adenomatous polyps or cancer of the large bowel. It was done to compare two dietary history methods for assessing individual current dietary intakes. Subjects were interviewed concerning their food consumption by meal in one of the questionnaires and by broad food groups in the other questionnaire. Two groups of 20 volunteers, comparable according to sex and age, were interviewed by a dietitian who used one of the questionnaires. Data on diets obtained with the questionnaire were compared with those of a 14-day dietary record. The subjects were informed of the importance of the validation procedure. Whatever the type of questionnaire, mean daily intakes of nutrients and foods were rather similar for the questionnaires and for the 14-day records. Thus, there were more significant correlations between the questionnaire by meal and the record than between the questionnaire by food group and the record. When using tertiles, it appears that the questionnaire by meal was better at classifying individuals with regard to their food intake than the questionnaire by food groups. Although extrapolating these results to a patient population is not straightforward, it seemed likely that interviewing patients on diet without using a pattern of meals would prove even less reliable than for healthy subjects. The questionnaire by meal was preferred to the questionnaire by food groups for the ongoing case-control study. Further studies are needed to know whether these results could be extrapolated to studies on past diet and to non-Latin populations.

Adult↗

Inaccessible novel questionnaires in published medical research: hidden methods, hidden costs.

Although critical analysis of survey research is limited when reviewers and readers cannot view a study's questionnaire, access to novel questionnaires used in published research has not been systematically examined. The authors identified publications reporting the results of novel questionnaires in three medical journals (JAMA, The New England Journal of Medicine, and The Lancet) in January 2000-May 2003 and searched portable document format (PDF) versions of the studies for the complete questionnaire or a Uniform Resource Locator (URL) providing access to the questionnaire. When the questionnaire was not provided in the publication or a published URL, the authors requested it from the corresponding author in writing up to three times over a 6-week period. Of 93 publications with novel questionnaires, four printed the questionnaire in the article and three provided online access. Corresponding authors failed to provide questionnaires for 37 of 81 (46%) studies. Novel questionnaires used in published research are frequently not available to readers or researchers. Policies that improve access to novel questionnaires will allow better assessment of study results, reduce duplicated efforts, and improve authorship attribution for questionnaire design.

Access to Information↗

Validation in London of a physical activity questionnaire for use in a study of postmenopausal osteopaenia.

STUDY OBJECTIVE: To determine the validity of a self administered physical activity questionnaire to be used as part of a screening device for postmenopausal osteopaenia (with additional questions on medical history and calcium intake). DESIGN: A questionnaire was posted to 86 perimenopausal women to enquire about weekly hours spent in non-sedentary activity at work, in the household, and during leisure hours. Subjects who returned the questionnaire were visited at home and asked to complete a four day activity diary and subsequently to undertake a submaximal estimate of VO2 MAX, carried out using a treadmill ergometer. They were interviewed to clarify questionnaire and diary entries. Questionnaire validity was assessed in comparison with the diary estimates of hours of activity and with VO2 MAX. PARTICIPANTS: A total of 86 perimenopausal women aged 43-54 years were randomly selected from a GP list in Hammersmith, London. Thirty five women (41%) returned the questionnaire. They were visited at home, given the diary to complete, and invited to attend the physiology laboratory for VO2 MAX measurements. Twenty six of the 35 (74%) completed the study and were included in the final analysis. MAIN RESULTS: Women spent an average of 51 hours per week in non-sedentary activities. Questionnaire and diary yielded similar results (51.05 versus 51.30 h/wk), and there was a good correlation between diary and questionnaire estimates of total weekly hours of non-sedentary activity (r = 0.45, p < 0.05). Other significant correlations were for standing (r = 0.69, p < 0.01), leisure activities (r = 0.66, p < 0.01), and for light household activities (r = 0.42, p < 0.05). Correlations were better for employed than non-employed subjects. In relation to the diary, the questionnaire correctly classified 60% into the top or bottom half of the distribution activity. Sensitivity and specificity of the questionnaire were both equal to 61.5%. CONCLUSIONS: The questionnaire is useful for classifying subjects according to their level of activity, especially when administered in conjunction with an interview. The four day diary provided a useful reference measure and a focus for discussing activity patterns during an interview related to the questionnaire responses.

Activities of Daily Living↗

Response rate according to title and length of questionnaire.

The purpose of this study was to investigate how response rates to a postal questionnaire are affected by title and length of the survey instrument. Five questionnaires, which differed according to title and length, were designed. Each questionnaire was mailed to a random sample of one thousand Norwegian women aged, 35-49 years. A total of 3,106 questionnaires were returned (62.1%). The highest response rate (70.2%) was achieved by a two-page questionnaire entitled "Women and Cancer". An otherwise identical questionnaire entitled "Oral Contraceptives and Cancer" had a response rate of 60.7%. Questionnaires entitled "Women and Cancer" with a length of four and six pages had a response rate of 62.8% and 63.3%, respectively. The four page questionnaire entitled "Women, Lifestyle and Health" had the lowest response rate of 57.1%. This study shows that in a general population of Norwegian women the title of a postal questionnaire influences the response rate. The results indicate that although the shortest questionnaire had the highest response rate, the most extensive survey instrument did not have the lowest response rate. The distribution of risk factors for breast cancer did not vary according to response rate or design of questionnaire. The overall findings of this study suggest that the benefits from the increased information obtained from extensive postal questionnaires out-weighs a potential non-response bias due to a somewhat lower response rate.

Adult↗