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A new clinical outcome measure of glenohumeral joint instability: the MISS questionnaire.

Many standard shoulder outcome measures do not adequately cover the range of problems and issues specifically encountered in glenohumeral joint instability and have been shown not to be sensitive enough to detect clinical change with intervention adequately. The purpose of this report is to present a prospective evaluation of a new self-administered patient questionnaire specifically designed to assess glenohumeral joint instability. The evaluation involved test-retest reliability and comparison with the Shoulder Rating Questionnaire (SRQ). Sixty-four patients with confirmed glenohumeral joint instability were assessed with both the Melbourne Instability Shoulder Scale (MISS) and SRQ 12 preoperatively and at 6 months after shoulder reconstructive surgery. Twenty-two patients were recruited into a reliability study of the MISS questionnaire. The test-retest reliability of the MISS was found to be 0.98 (interclass correlation coefficient, mixed-model analysis of variance, absolute agreement). Assessment of agreement between the MISS and SRQ questionnaires indicated very poor pretest agreement (0.33) and moderate agreement at 6 months (0.66). The differences between the MISS and SRQ were statistically significant both before surgery (paired t = 13.2, degrees of freedom [ df ] = 63, P < .001) and at 6 months' follow-up (paired t = 7.9, df = 63, P = .001). Change in the questionnaire scores measured from surgery to 6 months' follow-up was significantly greater in the MISS (mean, 30; SD, 19.1; median, 30.8) than in the SRQ (mean, 16.6; SD, 12.8; median, 14.3) (Wilcoxon test: z = -5.8, P = .0001). The results of this study show that the MISS questionnaire is a reliable outcome questionnaire and has a greater range to detect changes in shoulder instability than more global outcome questionnaires such as the SRQ. The higher scores encountered on the SRQ may mean that it underestimates the severity of a patient's instability problem.

Adult↗

Efficiency of questionnaires used to screen for interstitial cystitis.

PURPOSE: Questionnaires for the evaluation of interstitial cystitis are widely used, but their value in discriminating interstitial cystitis from other diagnoses among patients with urological symptoms has not been determined. We assessed the validity of 2 frequently used interstitial cystitis questionnaires-the O'Leary-Sant Symptom Index and Problem Index and the Pain, Urgency, Frequency Symptom Scale-for screening for interstitial cystitis. MATERIALS AND METHODS: The Pain, Urgency, Frequency Symptom Scale and the O'Leary-Sant Symptom Index and Problem Index were administered to the same 220 patients at a urology clinic before diagnosis. Questionnaire scores between patients with and without interstitial cystitis, as well as among diagnostic groups, were compared by parametric and nonparametric analyses. Receiver operating characteristic curves were constructed to determine the efficiency of each questionnaire in discriminating between patients with and without interstitial cystitis. RESULTS: Interstitial cystitis was distinguishable from the other diagnoses using both questionnaires (p <0.001). Separate analyses of bother and symptom scores yielded similar results. Receiver operating characteristic curves demonstrated the Pain, Urgency, Frequency Symptom Scale to be more efficient than the O'Leary-Sant Symptom Index and Problem Index in detecting interstitial cystitis in this population with an optimal cutoff value of 13 or greater. CONCLUSIONS: While the Pain, Urgency, Frequency Symptom Scale and the O'Leary-Sant Symptom Index and Problem Index questionnaires distinguish interstitial cystitis from other urinary tract pathologies, neither questionnaire demonstrates sufficient specificity to serve as the sole diagnostic indicator. These questionnaires should not be used to define interstitial cystitis, but can be used to screen patients with urinary tract symptoms to identify those who should be further examined for interstitial cystitis or to follow those who have already been diagnosed.

Cystitis, Interstitial↗

Determining the importance of change in the overactive bladder questionnaire.

PURPOSE: The overactive bladder questionnaire assesses symptom bother and health related quality of life in patients with overactive bladder. It has been shown to be reliable, valid and responsive. We established the minimally important difference of the overactive bladder questionnaire. MATERIALS AND METHODS: Post hoc analyses from 2 clinical trials were performed. Distribution based, eg effect size, and anchor based analyses using perception of treatment benefit and clinical variables were used. RESULTS: The mean age of the 2 study populations was 58.8 and 58.7 years, respectively. Patients were predominantly female (51.8% and 75.1%) and white (83.9% and 87%, respectively). Half SD of the overactive bladder questionnaire symptom bother subscale was 9.1 to 9.3, and half SD of the overactive bladder questionnaire health related quality of life subscales (coping, concern, sleep and social interaction) was 9.8 to 13.2. Questionnaire subscales had moderate to large effect sizes with the largest effect sizes for symptom bother (-0.85 to -1.09). Anchor based analyses showed that significantly greater change scores were associated with greater patient perceived treatment benefit and satisfaction. The difference between change scores in patients perceiving no and little benefit was 7.4 to 16.5 for all questionnaire scales except social interaction with the majority greater than 10 points. Greater change scores were consistently associated with greater improvements in micturition diary variables. CONCLUSIONS: Multiple methodologies provide strong justification for the recommendation of a 10-point minimally important difference for all overactive bladder questionnaire subscales. This minimally important difference may be conservative for some subscales, although a uniform minimally important difference is recommended to facilitate interpretation of the overactive bladder questionnaire.

Female↗

Domestic abuse in pregnancy: A comparison of a self-completed domestic abuse questionnaire with a directed interview.

OBJECTIVE: The purpose of this study was to compare the results of a standardized self-completed domestic abuse questionnaire with those of a directed interview in the identification of domestic abuse in pregnant patients. STUDY DESIGN: All patients with a first prenatal visit between March 1 and September 30, 1997, were assessed for self-reported domestic abuse with a standardized domestic abuse questionnaire. This was followed by a directed interview that involved verbal review of the standardized domestic abuse questionnaire. Self-reported domestic abuse was defined as any positive response to the domestic abuse questionnaire or the directed interview. The number of patients with a positive response to either the standardized questionnaire or the directed interview, or both, were recorded. The 2 techniques were compared by the McNemar chi(2) test. The group demographics and characteristics were evaluated. RESULTS: Among the 224 patients evaluated, a total of 36% (n = 80) of the patients reported domestic abuse by either method. The standardized domestic abuse questionnaire identified 85% (n = 68) compared with 59% (n = 47) by a directed interview (P =.03). The use of the standardized domestic abuse questionnaire and the directed interview in parallel identified an additional 15% (n = 12) of patients with domestic abuse. CONCLUSION: A standardized domestic abuse questionnaire is superior to a directed interview in identifying self-reported domestic abuse in pregnancy. Utilizing both methods in parallel further increases the number of patients identified.

Adult↗

Physician-derived asthma diagnoses made on the basis of questionnaire data are in good agreement with interview-based diagnoses and are not affected by objective tests.

BACKGROUND: Defining the phenotype is critical for investigating the genetic etiology of asthma. As part of the Collaborative Study on the Genetics of Asthma (CSGA), the primary objective of which is to identify asthma susceptibility loci, an algorithm was designed to determine diagnoses of definite asthma, probable asthma, less than probable asthma, or no asthma. A respiratory questionnaire was designed to assist in the process of characterizing the asthma phenotype. OBJECTIVE: This study was designed to determine the validity of the CSGA algorithm for the diagnosis of asthma, to determine agreement in assessing an asthma diagnosis between the information obtained by the CSGA questionnaire versus a patient interview by a panel of specialist physicians, and to determine the degree to which objective tests would alter the questionnaire-based certainty of asthma diagnosis. METHODS: An expert panel of asthma clinicians (n = 4) indicated to what degree they were certain that a subject (n = 48) had asthma as determined by using a 6-point Likert scale based on a 20-minute interview (phase I), a review of the CSGA questionnaire (phase II), a review of the questionnaire plus skin test and peripheral blood eosinophilia data (phase III), and a review of phase III information plus pulmonary data (spirometry and methacholine-reversibility testing; IV). Intraclass correlation coefficients (ICCs) were calculated between the physicians' interpretation of the likelihood of asthma based on the information they received during each of the phases and between the CSGA algorithm and each of the phases. RESULTS: Interjudge reliability with regard to the degree of certainty with which an asthma diagnosis could be made by interview was excellent (ICC, 98; 95% confidence intervals [95% CIs], 0.87-0.99). We also found that the agreement between the physicians' interview with the patients (phase I) and the CSGA algorithm was good and at least as good with the addition of the CSGA questionnaire data and objective data (ICC, 0. 65-0.75). Good agreement was also observed between the average certainty score from the interview and the CSGA questionnaire (ICC, 92; 95% CI, 0.76-0.93), and ICCs determining the agreement on asthma diagnosis between phase I and phases III and IV, in which objective data were introduced, did not change from the ICCs comparing phase I with phase II (ICC of 0.93 [95% CI, 0.79-0.96] and ICC of 0.91 [95% CI 0.73-0.95], respectively). CONCLUSION: We conclude that the CSGA algorithm is a valid tool for which the diagnosis of asthma can be made at an acceptable level of certainty and that the CSGA questionnaire, interpreted by an asthma specialist, is a useful tool for the diagnosis of asthma in clinical or epidemiologic studies.

Algorithms↗

Evaluation of the use of a questionnaire to detect hearing loss in Kenyan pre-school children.

In developing countries, there is a lack of trained personnel and testing equipment to facilitate the early detection of hearing impairment in children. A questionnaire offers a low cost option and the value of this for detecting hearing impairment in pre-school children was determined in several districts in Kenya. The questionnaire was completed by either teachers, parents/carers or community nurses. The children were subsequently tested using pure tone audiometry and visual examination of the ear by ENT Clinical Officers, who were not given prior access to the results of the questionnaire. A total of 757 (88%) questionnaires were completed. Of the 735 children, who could be tested using pure tone audiometry, four were found to have a unilateral hearing impairment and one was detected by the questionnaire. A total of 13 children had a bilateral hearing impairment >40 dB HL. All were detected using the questionnaire. There were eight males and five females with ages ranging from 4.2 to 6.9 years, mean age 5.7 years and median age 5.8 years. Eight had a sensorineural hearing impairment and two a mixed hearing impairment. Three of the children with a sensorineural hearing loss had a family history of hearing impairment. No question detected all children with a hearing impairment and some questions were more discerning than others. There was 100% sensitivity for the questionnaire when a hearing loss of >40 dB was considered, but specificity was lower at 75%. Negative predictive value was 100%, but the positive predictive value was low, 6.75%. It was concluded that a questionnaire of this nature could be usefully applied at Primary Health Care level for detecting hearing impairment at the pre-school stage. There would be need for services available for diagnosis, treatment and habilitation before a screening programme was introduced.

Audiometry, Pure-Tone↗

Problems translating a questionnaire in a cross-cultural setting.

Questionnaires are widely used in veterinary epidemiological studies. With careful design, assessment and administration, questionnaires can collect accurate data. In cross-cultural settings, questionnaire design is complicated by the added step of translation. As part of a cross-sectional study of smallholder pig raisers in the Philippines, we assessed the importance of translation as a source of error in our questionnaire. The questionnaire contained 120 questions that collected data for entry into 361 separate data-entry fields in a computerised database. The translation was verified using the methods of back-translation and pilot-testing to identify and quantify errors of literal translation, omission and mistranslation. Errors were identified in 44 (37%) questions that obtained data for 147 (41%) data-entry fields. Although errors might have remained in the final translated version of the questionnaire, we have no doubt that the verification procedures substantially improved the internal validity of the questionnaire. It is important that veterinary epidemiologists use such procedures to check the internal validity of translated questionnaires.

Animal Husbandry↗

Catquest questionnaire for use in cataract surgery care: assessment of surgical outcomes.

PURPOSE: To demonstrate the outcome for patients after cataract extraction using the Catquest cataract questionnaire and discuss the models validity in assessing outcome. SETTING: Thirty-five Swedish departments of ophthalmology. METHODS: Patients having cataract extraction performed by surgeons from 35 Swedish departments of opthalmology participated in the study. The questionnaire was given to 2970 consecutive patients having surgery during March 1995 at the participating surgical units. The questionnaire was sent by mail to patients and completed on a voluntary basis. It focuses on visual disabilities in daily life, activity level, cataract symptoms, and degree of independence. The results form the questionnaire are interpreted using a benefit matrix that credits not only a decrease in visual disabilities and cataract symptoms but also an improvement in or maintenance of a preoperative activity level. RESULTS: Complete surgical outcome data and completed preoperative and postoperative questionnaires were available in 1933 cases (65.1%). Benefit from surgery according to the model was achieved by 90.9% of the patients. Patients having their second cataract extraction had the highest frequency of the greatest benefit form surgery. There was good agreement between the different levels of benefit from surgery according to the model and the patient's global rating of his or her vision or achieved visual acuity after surgery, respectively. Patients with missing data (did not return postoperative questionnaire or had missing surgical result variables) were older and had a higher frequency of other diseases and handicaps. CONCLUSION: The Catquest cataract questionnaire allowed the outcome of cataract surgery to be graded by different levels of benefit. There seemed to be good agreement between this model of assessment and the patient's global rating of his or her vision. Missing data may be a problem when a postal questionnaire is used.

Activities of Daily Living↗

Assessing the reliability and responsiveness of 5 shoulder questionnaires.

The purpose of this study was to compare the test-retest reliability and responsiveness of 5 different shoulder questionnaires in a sample of patients with shoulder pain. Ninety-nine patients completed the following shoulder questionnaires on 2 occasions: Subjective Shoulder Rating Scale, Simple Shoulder Test, Modified-American Shoulder and Elbow Surgeons Form, Shoulder Severity Index, and the Shoulder Pain and Disability Index. The Short Form-36 was also included. Test-retest reliability was assessed with intraclass correlation coefficients. Standardized response means were calculated to assess responsiveness. This procedure was done on 33 subjects who underwent rotator cuff surgery or total shoulder arthroplasty and who believed that they had improved between testings. All questionnaires had acceptable reliability (coefficients > 0.75) except the Subjective Shoulder Rating Scale (coefficient = 0.71) and were more responsive (0.65 < Standardized response mean < 1.23) than the Short Form-36 (0.08 < Standardized response mean < 0.43) except for pain (0.91). In this longitudinal study a direct comparison of 5 shoulder questionnaires was carried out. We found the Subjective Shoulder Rating Scale to have lower reliability and responsiveness. The other 4 questionnaires including 1 developed to measure whole extremity function (Modified American Shoulder and Elbow Surgeons Form) rather than the shoulder only were comparable with good reliability and responsiveness. The results indicate that the shoulder questionnaires were more sensitive to change in patients with shoulder pain than the generic questionnaire (Short Form-36), and both types of questionnaires should be used in outcome evaluations.

Activities of Daily Living↗

Reproducibility of a food frequency questionnaire used in the New York University Women's Health Study: effect of self-selection by study subjects.

OBJECTIVE: The aim of the study was to investigate the reproducibility of a food frequency questionnaire (FFQ) used in a cohort of 14,290 women enrolled in the NYU Women's Health Study. DESIGN: A subset of 474 cohort subjects who completed the dietary questionnaire at baseline (FFQ-1) were approached again on the occasion of a second visit to the mammography study centre and asked to complete the questionnaire a second time (FFQ-2) two to four years after FFQ-1. Two to three months later the questionnaire was mailed to the subjects, and they were asked to complete it a third time (FFQ-3). SETTING: A breast cancer screening clinic. SUBJECTS: Of the 474 subjects selected, 100% completed the second questionnaire while only 56% completed and mailed back FFQ-3. This made it possible to compare the long-term reproducibility of dietary intake measurements and baseline dietary habits between the two groups of subjects 'respondents', who agreed to complete the questionnaire a third time, and 'non-respondents', who did not. RESULTS: Among respondents (56% of study subjects), energy-adjusted correlation coefficients for short-term reproducibility between FFQ-2 and FFQ-3 ranged from 0.50-0.64 for nutrients, and from 0.44-0.67 for foods. The long-term reproducibility was lower, ranging from 0.36-0.53 for nutrients, and from 0.31-0.48 for specific food groups. Among those who did not respond to FFQ-3, crude correlations for long-term reproducibility, unadjusted for energy intake, were generally lower than among respondents. Nevertheless, after adjustment for energy intake, correlations for long-term reproducibility (FFQ-2 to FFQ-1) were of similar magnitude in both groups. In addition, 'non-respondents' reported lower intake of fruit and vegetables and higher intake of meat. CONCLUSIONS: The results of this study suggest that subjects who volunteer to participate in substudies on the validity or reproducibility of dietary questionnaire measurements may tend to provide more accurate responses to the questionnaire. The phenomenon seems related more to accuracy of reporting of absolute intake levels than of the relative composition of diet, self-selection may be associated with differences in dietary habits.

Adult↗

Impact of various questionnaires on the prevalence of erectile dysfunction. The ENIGMA-study.

The prevalence estimates of erectile dysfunction (ED) vary considerably across studies. These differences may be attributed to used definitions of ED. Quantitative data on the effect of different definitions of ED on the prevalence are lacking, because precise information on the used definition and questionnaire is often absent. Aim of this study was to quantify the effect of using different questionnaires for ED on the prevalence estimates. In all, 5721 mail surveys on sexual problems and ED were sent to all men (aged >18 y) in 12 general practices in the middle of the Netherlands of which 2117 were completed. The questionnaire contained Enigma (WHO), International Index of Erectile Function (IIEF), Cologne Erectile Inventory (KEED) and one question (Boxmeer, Krimpen). The prevalence of ED based on the various questionnaires and the effect of these questionnaires on risk factor relationships was compared. IIEF gave the highest age specific and overall ED prevalence, KEED the lowest. The difference in prevalence was 16.8%. The agreement (kappa coefficient) between the various ED definitions varied from 0.52 (IIEF & KEED) to 0.95 (Enigma & Boxmeer). The number of risk factor relations were similar for the Dutch studies, reduced for the IIEF and KEED. This study provides evidence that differences in questionnaires to assess ED have a considerable effect on the (age specific) prevalence estimates and little on the risk factor relations. The number of questions of the survey appears not to be responsible for differences in the prevalence of ED and risk factor relations, however they affect the response rate. Uniform use is strongly recommended, since a 'golden standard' for ED assessment (by questionnaire) is lacking. A short questionnaire with one or two questions is recommended for example the one from the Boxmeer-study. These data may be used to adjust (age-specific) prevalence rates comparing ED prevalence in the open population across studies.

Adolescent↗

Prevalence of childhood asthma based on questionnaires and methacholine bronchial provocation test in Korea.

BACKGROUND: In most epidemiological survey studies, only subjective symptoms and past medical history of asthma have been used as diagnostic criteria. Even though a questionnaire survey can be performed in a large population study at low cost, limitations such as lack of objectivity and poor predictability in non-specific bronchial hyperresponsiveness cannot be avoided. OBJECTIVES: The purpose of this study was to elucidate the prevalence of current asthma based on questionnaires and methacholine bronchial provocation test, and the prevalence of atopy in Korea. METHODS: We performed modified ATS respiratory questionnaires and allergen skin-prick test with 10 common inhalant allergens among 3219 subjects aged 7-19 years in Seoul and a rural part of a small city, Chungju in Korea. Methacholine bronchial provocation tests were also performed among those who had asthma symptoms according to the questionnaire. The criteria of asthma was presence of both asthma symptoms and non-specific bronchial hyperresponsiveness. Atopy was defined as when an allergen induced weal size is same or larger than that caused by histamine. RESULTS: The prevalence of asthma based on questionnaires and methacholine bronchial provocation tests was 4.6%, while the prevalence of wheeze was 8.2% and 19.3% of total population complained of one or more respiratory symptoms related to asthma on the questionnaires. There was no significant difference according to age, sex and living area. The mean prevalence of atopy was 35.0% and the most common allergens were Dermatophagoides farinae (30.9%), Dermatophagoides pteronyssinus (27.5%), cat fur (20.4%) and cockroach (11.8%). The atopy prevalence in Chungju area was higher than that in Seoul and males showed a higher prevalence than females. The asthma prevalence was higher among atopics (6.8%) than among non-atopics (2.7%). None of questionnaire items were enough to predict the presence of bronchial hyperresponsiveness in terms of sensitivity, specificity and positive predictive value. CONCLUSION: The prevalence rate of current asthma in Korea was 4.6% and the prevalence rate of atopy in Korea was 35.0%. Questionnaire-based surveys are not enough to predict the actual prevalence of asthma.

Adolescent↗

Approaches to learning: psychometric testing of a study process questionnaire.

BACKGROUND: One method of evaluating students' learning is to measure surface, deep and achieving approaches to learning using a questionnaire. In comparison with research on student nurses' learning styles, there has been little examination of their 'approaches to learning'. Much of the 'approaches to learning' research has been conducted with higher education students in Australia and Hong Kong and this kind of measurement is viewed as a valid and reliable way to assess learning. AIM: The aim of study reported here was to establish the validity of an 'approaches to learning' questionnaire, the study process questionnaire, for use with student nurses by undertaking psychometrical testing, including exploratory factor analysis. METHOD: The study process questionnaire is a 42-item questionnaire measuring surface, deep and achieving approaches to learning. It was distributed to 300 student nurses attending a common foundation programme in a higher education establishment in the United Kingdom (UK) in July 2000. Principal components analysis was conducted to determine the validity of the deep, surface and achievement scales in the questionnaire. RESULTS: A new factor structure was identified comprising three main scales which were similar in content but not identical to the original questionnaire. The deep factor correlated positively and significantly with grade performance average and sociology examination results. CONCLUSION: The study process questionnaire is a valid and useful tool for nurse teachers to gain knowledge about student nurses' approaches to learning. Deep learning appears to influence academic performance. More work is required to elucidate the complex nature of deep learning.

Achievement↗

Development, reliability and validity of the Diabetes Illness Representations Questionnaire: four studies with adolescents.

AIMS: This article reports on the development and validity of a Diabetes-specific Illness Representations Questionnaire (DIRQ) to assess all five dimensions of an individual's perception of diabetes, for adolescents with Type 1 diabetes mellitus. METHODS: There were two development studies. Study 1: participants (n = 115) completed a questionnaire assessing perceptions of the consequences of diabetes and the effectiveness of treatment, along with a questionnaire assessing self-care. Study 2: participants (n = 79) completed a questionnaire assessing their identity, timeline and causal beliefs, along with a diabetes self-efficacy and barriers to adherence questionnaire. Subsequently there were two validation studies. Study 3: participants (n = 44 adolescents and 28 parents) completed the DIRQ and questionnaires assessing their self-care and psychological well-being. Glycaemic control was assessed through retrieval of routine assay results. Study 4: participants (n = 70) completed the DIRQ and questionnaires to assess their psychological well-being, with glycaemic control assessed through retrieval of routine assay results. RESULTS: The development studies suggest that the perceived consequences of diabetes consist of two subscales, perceived threat and perceived impact, and provide further support for the distinction between treatment effectiveness to control diabetes and treatment effectiveness to prevent complications. Along with the validation studies, the results indicate that the questionnaire scales showed good internal consistency and construct validity through their associations with measures of self-care and psychological well-being. CONCLUSION: The data reported here suggest that the DIRQ has the potential to be a useful tool for clinical assessment and evaluating the impact of psycho-educational and medical interventions.

Adaptation, Psychological↗

Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease.

BACKGROUND: Patients on dialysis are less physically active than sedentary persons with normal kidney function. To assess the consequences of inactivity and the results of efforts to increase activity in the end-stage renal disease (ESRD) population, valid instruments to measure physical activity and physical functioning in this group are needed. METHODS: We performed a cross-sectional study to establish the validity in ESRD of several questionnaires designed to measure physical activity or physical functioning in the general population. Questionnaires studied included the Stanford 7-day Physical Activity Recall questionnaire (PAR), the Physical Activity Scale for the Elderly (PASE), the Human Activity Profile (HAP), and the Medical Outcomes Study Short Form 36-item questionnaire (SF-36). Physical activity was measured using three-dimensional activity monitors (accelerometers) over a seven-day period (the "gold standard"). Patients also underwent physical performance tests, including measurement of gait speed, stair climbing time, and chair rising time. Study questionnaires were administered, and questionnaire results were compared with each other and with activity monitor and physical performance test results. RESULTS: Thirty-nine maintenance hemodialysis patients participated in the study. Dialysis patients scored worse than previously published healthy norms on all tests. All questionnaires correlated with seven-day accelerometry and with at least one measure of physical performance. The HAP correlated best with accelerometry (r = 0.78, P < 0.0001). Seventy-five percent of the variability in physical activity measured by accelerometry could be explained by a model that combined information from the HAP and the PASE. The HAP and the physical functioning scale of the SF-36 were about equally well correlated with physical performance measures. CONCLUSIONS: These questionnaires are valid in patients on hemodialysis and should be used to study the physical activity and rehabilitation efforts in this population further.

Cross-Sectional Studies↗

The occurrence of recall bias in pediatric headache: a comparison of questionnaire and diary data.

OBJECTIVE: To investigate whether children and adolescents can recall prior headache complaints accurately and to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety are related to recall errors, causing recall bias. METHODS: A retrospective headache questionnaire and a prospective 4-week headache diary were filled out by 181 children aged 9 to 16 years who experienced headache at least weekly. In addition, several other questionnaires were administered, measuring coping strategies, depression, somatization, and trait anxiety. Headache frequency, intensity, and duration, as scored on the questionnaire and the diary, were compared using Wilcoxon tests. Regression analyses were performed to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety can predict the size of differences between the diary and the questionnaire. RESULTS: Compared with the diary, headache intensity and headache duration were overestimated on the questionnaire. At group level, median headache frequency as measured by the diary and the questionnaire was equal. Regarding headache frequency and headache intensity, age and headache severity were statistically related to errors in recall. For headache frequency, depression was also predictive of the size of recall error. CONCLUSIONS: Recall errors occur when children are asked to report their headaches on a retrospective questionnaire. As compared to a prospective diary, pain complaints are evaluated more negatively on a questionnaire. Other factors such as age, depression, and headache severity influence the way children and adolescents recall their headaches. To minimize bias, the use of a diary when studying recurrent headache complaints in children is recommended.

Adolescent↗

What's all that noise? The effect of co-morbidity on health outcome questionnaire results after knee arthroplasty.

BACKGROUND: We modified the Charnley Classification for hips to facilitate its use with knee arthroplasty patients and investigated what affect the different classes of co-morbidity had on the results of a spectrum of outcome questionnaires. PATIENTS AND METHODS: 3600 patients from the Swedish Knee Arthroplasty Registry were surveyed by post with a variety of questionnaires ranging from multiple-item general health, to a single-item knee arthroplasty specific questionnaire. All patients also completed a co-morbidity questionnaire, from which a modified Charnley Classification was generated for each patient. We then investigated the correlation and relationship between the results of the questionnaires and the different classes of co-morbidity. RESULTS: The results of the questionnaires tested varied significantly by Charnley Class, regardless of the specificity of the questionnaire used. INTERPRETATION: We suggest that co-morbidity should be taken into account in outcome studies utilizing general health or disease/site specific questionnaires.

Aged↗

An assessment of neck and upper extremity disorders by questionnaire and clinical examination.

To study the usefulness of a screening questionnaire for neck/upper extremity complaints, 165 women in either repetitive industrial, or mobile and varied work, were studied by the questionnaire and by a detailed clinical physical examination. A total of 94 subjects recorded complaints in the questionnaire. In 140 subjects findings were recorded at the examination. Most subjects with findings at the clinical examination of shoulders reported complaints in the questionnaire (sensitivity 80%). For the other anatomical regions, the sensitivity was rather low (42-65%). For all regions, most subjects without findings reported no complaints (specificity 77-97%). A total of 75 subjects were given clinical diagnoses according to a set of predetermined diagnostic criteria. The capacity of the questionnaire to identify diagnoses of shoulders was higher (sensitivity 92%) than for the other regions (66-79%). Of subjects who did not qualify for diagnosis, a majority (specificity 71-81%) did not report complaints in the questionnaire. We conclude that the questionnaire approach gives a fairly good picture of the neck/upper extremity status of a working female population. However, a clear view of the size of a problem is obtained only by a detailed clinical examination, particularly as regards the neck, elbows and hands, for which the questionnaire gave an underestimate.

Adult↗