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PubMed1993

A diet history questionnaire ranks nutrient intakes in middle-aged and older men and women similarly to multiple food records.

We evaluated the reproducibility of a modified version of the National Cancer Institute diet history questionnaire and also studied comparability of nutrient estimates from this questionnaire to those from four 2-d food records. Subjects (n = 211) were from a population-based sample of middle-aged and older adults participating in the Beaver Dam Eye Study in south-central Wisconsin. Median age-specific correlation coefficients between the questionnaire, administered twice at a 3-mo interval, were 0.8 in men and 0.7 in women (range = 0.5 to 0.9). Questionnaire estimates of protein, cholesterol, thiamin, niacin, iron and zinc were consistently lower than food record estimates whereas estimates of fat were higher. Correlation coefficients between estimates from the questionnaire and records were generally > 0.5, indicating overall good agreement in ranking. However, the range in correlation coefficients was wide [ranging from 0.06 for iron (without supplements) in middle-aged women to 0.8 for alcohol in middle-aged men and women]. Questionnaire estimates similarly classified persons into the lowest two food record quintiles of intake 50 to 93% of the time depending on nutrient. These results suggest that the questionnaire produces nutrient estimates that rank individuals on the basis of intake of most nutrients similarly to estimates from multiple food records.

Adult↗
PubMed2003

Interview data versus questionnaire data in the diagnosis of carpal tunnel syndrome in epidemiological studies.

AIMS: In most epidemiological studies on carpal tunnel syndrome (CTS), the case definition is based on questionnaire data with or without neurophysiological testing. The aim of this study was to test if the use of questionnaire data results in misclassification of cases. METHODS: In two studies, involving 940 and 311 participants, respectively, the people indicating CTS symptoms (tingling) in a questionnaire were clinically interviewed. In a subpopulation (n = 404), all went through an interview regardless of their questionnaire answers. RESULTS: Only 35-45% of the participants reporting tingling once a week or more in the questionnaire actually had symptoms consistent with CTS when interviewed. The remaining 55-65% had no or infrequent symptoms or symptoms because of other disorders. Few potential CTS cases were missed. The positive predictive values were 0.48 (95% CI = 0.30-0.66) and 0.52 (95% CI = 0.38-0.67) on the right and left hands, respectively. The sensitivities, specificities and negative predictive values ranged from 0.87 to 1.00. CONCLUSIONS: Questionnaire information overestimates the prevalence of CTS symptoms. However, asking about tingling in a questionnaire is a simple and sensitive first step to detect potential CTS cases, but symptoms should be confirmed by interview.

Adult↗
PubMed1996

Dietary assessment in epidemiology: comparison on food frequency and a diet history questionnaire with a 7-day food record.

The validity of two types of diet assessment methods, a self-administered food frequency questionnaire and and interviewer-administered detailed diet history, was assessed relative to a 7-day food record on a population- based sample of 95 men and 108 women in Toronto, Canada, between May 1989 and July 1990. Each study subject completed both questionnaire methods, a food frequency questionnaire and an interviewer-administered diet history, as well as a 7-day food record in a crossover design. Data were analyzed for both unadjusted and energy-adjusted nutrients to estimate Pearson's and intraclass correlations and agreement within the categories. Mean values for the intake of most nutrients assessed by the two questionnaire methods were similar. Average, energy-adjusted Pearson's correlation coefficients for men between a food frequency questionnaire and a 7-day food record were 0.55 for macronutrients and 0.48 for micronutrients compared with 0.47 for macro- and 0.48 for micronutrients between an interviewer-administered diet history and a 7-day food record. For women, they were 0.48 for macro- and 0.54 for micronutrients between a food frequency questionnaire and a 7-day food record and 0.46 and 0.49, respectively, between an interviewer-administered diet history and a 7-day food record. The energy-adjusted Pearson correlations were generally higher than were the energy-unadjusted Pearson correlations and the intraclass correlations. The present study suggests that a food frequency questionnaire is comparable with an interviewer-administered diet history as a predictor of nutrients as estimated form a 7-day food record.

Adult↗
PubMed1998

Controlled trial of the effect of length, incentives, and follow-up techniques on response to a mailed questionnaire.

Mailed questionnaires are an economical method of data collection for epidemiologic studies, but response tends to be lower than for telephone or personal interviews. As part of a follow-up study of volunteers who provided a brief health history and blood sample for a blood specimen bank in 1989, the authors conducted a controlled trial of the effect of length, incentives, and follow-up techniques on response to a mailed questionnaire. Interventions tested included variations on length of the questionnaire, effect of a monetary incentive, and effect of a postcard reminder versus a letter accompanied by a second questionnaire. Response was similar for the short (16-item, 4-page) and long (76-item, 16-page) questionnaire groups. The non-monetary [corrected] incentive did not improve the frequency of response. The second mailing of a questionnaire was significantly better than a postcard reminder in improving responses (23% vs. 10%). It is important to systematically test marketing principles to determine which techniques are effective in increasing response to mailed questionnaires for epidemiologic studies.

Adolescent↗
PubMed1999

The quest for better questionnaires.

The development of questionnaires is a neglected enterprise in epidemiology. It has recently been proposed that a prestigious health authority such as the World Health Organization establish a committee to tackle issues of questionnaire quality, moving eventually toward standardized instruments. However, standardization may not be the best way to invigorate this enterprise. As an alternative, the author suggests that the first step in improving questionnaires would be to make them more accessible. Ideally, questionnaires should be as easily scrutinized as a study's methods or results. To this end, the author suggests that when a research paper is published, the entire questionnaire be made available on the worldwide web. Electronic access to questionnaires could stimulate a new era of awareness about the importance of questionnaire design.

Data Collection↗
PubMed1978

A historical and epidemiologic perspective on respiratory symptoms questionnaires.

Since 1960 the British Medical Research Council (MRC) standardized questionnaire on respiratory symptoms has been used in epidemiologic investigations of chronic respiratory diseases. This review describes the validity, reliability, and susceptibility to bias of the MRC questionnaire. The validity of the phlegm questions as a sensitive index of sputum production has been established but adequate validation of other symptom questions has been hindered by the absence of appropriate, independent criteria for comparison. Consistency of response averages 80 per cent for symptom questions and may reach 99 per cent for reporting of smoking habits. With proper use, the results of the MRC questionnaire are not biased by the observer, by the season of administration, or by method of administration. Modification of the questionnaire by individual investigators may lead to bias when comparisons are made between studies. Because a large literature based on the MRC questionnaire is now available, any new respiratory symptoms questionnaires should be compatible with the MRC questionnaire, and should be calibrated against it.

Boston↗
PubMed1988

Reproducibility and validity of dietary assessment instruments. I. A self-administered food use questionnaire with a portion size picture booklet.

A self-administered food use questionnaire which included 276 food items and mixed dishes and a portion size picture booklet with 122 photographs was developed for a large lung cancer intervention trial among approximately 27,000 Finnish men aged 50-69 years. The reproducibility and validity of this questionnaire were studied from March to October 1984. In the reproducibility study, 121 men aged 55-69 years completed the questionnaire three times, at three-month intervals. The intraclass correlations varied from 0.56 for vitamin A to 0.88 for alcohol, with most falling between 0.60 and 0.70. In the validity study, 190 men of similar age kept food consumption records for 12 two-day periods, distributed evenly over a period of six months, and filled in the questionnaire both before and after this period. Correlations between nutrient intake values from the food records and the food use questionnaires ranged from 0.40 for selenium to 0.80 for alcohol. Among subjects who belonged to the lowest quintile on the basis of the food record measurement, an average of 51 per cent fell into the same quintile and 76 per cent fell into the lowest two quintiles when they were categorized on the basis of the food use questionnaire. Findings were similar for the upper tail of the distribution. These data indicate that the self-administered food use questionnaire is useful for measuring individual or group intakes for a variety of nutrients.

Aged↗
PubMed1988

Validation of a self-administered questionnaire for assessing occupational and environmental exposures of pregnant women.

The present investigation sought to determine whether a self-administered questionnaire could be used to obtain occupational information from pregnant women attending the obstetrical clinics at the University of California, San Francisco from July to November 1986. The authors compared the accuracy of responses of 57 women on the self-administered questionnaire with those obtained on a detailed clinical interview by an occupational health professional. The self-administered questionnaire and the clinical interview included information on the woman's job title, the type of company she worked for, the level of physical activity, her exposures on the job and at home, and her partner's occupation. The authors also examined whether the "validity" of the self-administered questionnaire could be improved on review by an industrial hygienist. The questionnaire took less than 20 minutes to complete, with over 90% of the women answering three-quarters of it. It was "substantially" accurate in obtaining information on number of hours worked during pregnancy, type of shift worked, and stress level in the workplace; exposure to radiation, video display terminals, fumes, gases, and cigarette smoke in the workplace; and exposure to pesticides, paint, and cigarette smoke at home. On those variables for which the responses on the self-administered questionnaire were less accurate, review by the industrial hygienist improved the level of accuracy considerably. These findings suggest that a self-administered questionnaire can be used to obtain valid information from pregnant women attending a prenatal clinic.

Adult↗
PubMed2001

Variations on the CAGE alcohol screening questionnaire: strengths and limitations in VA general medical patients.

BACKGROUND: Several variations on the CAGE alcohol screening questionnaire have been recommended. This report evaluates modifications and additions to the CAGE. METHODS: Alcohol screening questionnaires were evaluated in male VA general medicine patients (n = 227; mean age, 65.8). Mailed questionnaires included two scoring options for the CAGE (standard and last-year time frames), questions about quantity and frequency of drinking, two questions about episodic heavy drinking, and the question "Have you ever had a drinking problem?" Main analyses compared alcohol screening questions, at various cut-points, to a gold standard of hazardous drinking during the past year (> or =14 drinks/week or > or =5 drinks on an occasion) and/or DSM-III-R alcohol abuse or dependence, based on standardized interviews. RESULTS: The CAGE questionnaire with a past-year time frame was much less sensitive (0.57 vs. 0.77) but more specific (0.82 vs. 0.59) than the standard CAGE for detecting hazardous drinking during the past year and/or DSM-III-R alcohol abuse or dependence. An eight-item questionnaire that included the standard CAGE was most sensitive (0.92) but had low specificity (0.50). A single question about the frequency of drinking > or =6 drinks on an occasion, included in the eight-item questionnaire, was both relatively sensitive (0.77) and specific (0.83). CONCLUSION: The CAGE questionnaire with a past-year time frame was an insensitive alcohol-screening test. An eight-item augmented version of the standard CAGE was the most sensitive. A question about the frequency of drinking > or =6 drinks on an occasion performed better than the standard CAGE, which made it the optimal brief screening test for at-risk drinking.

Aged↗
PubMed1990

Use of adjustment factors with a brief food frequency questionnaire to obtain nutrient values.

The 100-item National Cancer Institute (Block) Food Frequency Questionnaire was created to measure an individual's relative nutrient intake as well as absolute nutrient values. A 60-item, brief questionnaire was then developed; its results correlate well with results from the 100-item questionnaire and with food record data. Adjustment factors, presented here, were developed that allow investigators to use the shorter questionnaire while obtaining nutrient values nearer the correct absolute values than those from the brief questionnaire alone. Data from the National Health and Nutrition Examination Survey II (1976-1980) and the first quarter of the National Health Interview Survey (1987) were used in developing the adjustment factors. The brief questionnaire was administered to approximately 22,000 subjects in the National Health Interview Survey. When the adjustment factors were applied to data from the second, third, and fourth quarters of the National Health Interview Survey, the adjusted values of 17 micro- and macronutrients were on average within 0.51% and 1.17% of estimates obtained by 24-hour recall in the National Health and Nutrition Examination Survey II, for men and women, respectively. Correlations between the adjusted nutrient values and absolute nutrient consumption, as measured by diet diaries in three smaller studies, were nearly the same or somewhat better than correlations with the unadjusted brief questionnaire.

Adolescent↗
PubMed1993

A patient survey system to measure quality improvement: questionnaire reliability and validity.

This study describes the results of a four-year research effort to develop inpatient and outpatient questionnaires that have sufficient validity and reliability to be used to measure patient perceptions of quality. As part of this effort, over 50,000 inpatients, emergency room patients, and ambulatory surgery patients from over 300 hospitals representing every US census region were surveyed. Separate questionnaires, called Quality of Care Monitors, were developed for inpatients and outpatients. The inpatient questionnaire consisted of 8 scales: Physician Care, Nursing Care, Medical Outcome, Courtesy, Food Service, Comfort and Cleanliness, Admissions/Billing, and Religious Care. The outpatient questionnaire had 7 scales: Physician Care, Nursing Care, Medical Outcome, Facility Characteristics, Waiting Time, Testing Services and Registration Process. The study found strong evidence of construct validity, predictive validity, and internal consistency for both questionnaires. Each questionnaire is capable of measuring separate dimensions of patient experience. A data bank developed from these questionnaires is currently accessed regularly by participating hospitals to assess quality improvement and to make benchmark comparisons with similar hospitals.

Health Services Research↗
PubMed1996

Can comorbidity be measured by questionnaire rather than medical record review?

Comorbidity generally is measured by medical record abstraction, which is expensive and often impractical. The aim of this study was to assess the reproducibility and validity of a comorbidity questionnaire. The authors developed a brief comorbidity questionnaire that included items corresponding to each element of the medical record-based Charlson index. The questionnaire was administered to 170 inpatients. Charlson scores were abstracted from these patients' medical records. We assessed test-retest reliability of the questionnaire and the Charlson index, the correlation between the questionnaire and the Charlson index, and correlations between each comorbidity measure and indicators of health resource utilization including medication use, hospitalizations in the past year, and hospital charges. Test-retest reliability, assessed with the intraclass correlation coefficient, was 0.91 for the questionnaire and 0.92 for the chart-based Charlson index. The Spearman correlation between these two measures was 0.63. The correlation between comorbidity measures was weaker in less educated patients. Correlations with indicators of resource utilization were similar for the two comorbidity instruments. The authors found that a questionnaire version of the Charlson index is reproducible, valid, and offers practical advantages over medical record-based assessments.

Aged↗
PubMed2001

Validity of a physical activity questionnaire among African-American Seventh-day Adventists.

INTRODUCTION: Physical activity has been identified as an important predictor of chronic disease risk in numerous studies in which activity levels were measured by questionnaire. Although the validity of physical activity questionnaires has been documented in a number of studies of U.S. adults, few have included a validation analysis among blacks. We have examined the validity and reliability of a physical activity questionnaire that was administered to 165 black Seventh-day Adventists from Southern California. METHODS: Subjects completed a self-administered physical activity questionnaire and then "reference" measures of activity (7-d activity recalls, pedometer readings) and fitness (treadmill test) were completed in subsets of this population. RESULTS: The authors found that 7-d recall activity levels correlated well with the corresponding questionnaire indices among women (total activity, r = 0.65; vigorous, r = 0.85; moderate, r = 0.44; inactivity, r = 0.59; sleep duration, r = 0.52) and men (total activity, r = 0.51; vigorous, r = 0.65; moderate, r = 0.53; inactivity, r = 0.69; sleep duration, r = 0.39). Vigorous activity from 7-d recalls was best measured by gender-specific indices that included only recreational activities among men and emphasized nonrecreational activities among women. Correlations between questionnaire data and the other "reference" measures were lower. Test-retest correlations of questionnaire items over a 6-wk interval were high (r = 0.4-0.9). CONCLUSION: Simple questions can measure activities of different intensity with good validity and reliability among black Adventist men and women.

Adult↗
PubMed2003

The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis.

STUDY DESIGN: Outcome study to determine response distribution, internal consistency, reproducibility, and concurrent validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. OBJECTIVES: Further refinement of an HRQL questionnaire specific for idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Previous experience with the original and modified SRS HRQL questionnaires suggested a need for further refinement and more complete validation. METHODS: The SRS-22 and Short Form 36 (SF-36) HRQL questionnaires were mailed to 83 previously surveyed postoperative idiopathic scoliosis patients. RESULTS: Fifty-eight (70%) patients returned the first set of questionnaires. Their average age at surgery was 14.6 years, and their average follow-up interval since surgery was 10.8 years. Fifty-one (88%) of the 58 returned the second set of questionnaires an average of 28 days later. The psychometric attributes of the instruments were comparable: score distribution, SRS-22 56.9% ceiling and 1.7% floor, SF-36 79.3% ceiling and 1.7% floor; internal consistency (Cronbach alpha), SRS-22 0.92 to 0.75, SF-36 0.91 to 0.36; and reproducibility (intraclass correlation coefficient), SRS-22 0.96 to 0.85, SF-36 0.92 to 0.61. Concurrent validity, determined by Pearson Correlation Coefficients between SRS-22 and SF-36 domains, was 0.70 or greater ( < 0.0001) for 17 relevant comparisons. CONCLUSION: The SRS-22 HRQL questionnaire is reliable with internal consistency and reproducibility comparable to SF-36. In addition, it demonstrated concurrent validity when compared to SF-36. It is shorter and more focused on the health issues related to idiopathic scoliosis than SF-36.

Adolescent↗
PubMed2003

Greek versions of the Oswestry and Roland-Morris Disability Questionnaires.

Disability questionnaires are increasingly used for clinical assessment, outcome measurement of treatment and research methodology of low back pain. Their use in different countries and cultural groups must follow certain guidelines for translation and cross-cultural adaptation. The translation of such an instrument must be tested for its reliability and validity to be applied and to allow comparability of data. The Oswestry Disability Index and the Roland-Morris Disability Questionnaire are two disability questionnaires most commonly used as outcome measures in patients with low back pain. The two questionnaires were translated for use with the Greek population, were back translated and tested, and became available in a final version. The Greek versions of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire were tested in 697 patients with low back pain. Internal consistency reliability for the Greek translation of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire reached a Cronbach's alpha coefficient of 0.833 and 0.885 respectively. Face validity and content validity were ensured. Concurrent validity was assessed using a six-point pain scale as a criterion. The correlation of both scales was significant. The Greek translation of these disability questionnaires provided reliable and valid instruments for the evaluation of Greek-speaking patients with low back pain.

Adolescent↗
PubMed2006

Development and psychometric testing of Korean language versions of 4 neck pain and disability questionnaires.

STUDY DESIGN: Cohort study. OBJECTIVES: To develop and establish the psychometric properties of Korean versions of 4 neck pain and disability questionnaires: the Neck Disability Index, Neck Pain and Disability Scale, Functional Rating Index, and Short Form McGill Pain Questionnaire (SFMPQ). SUMMARY OF BACKGROUND DATA: To our knowledge, there are no published Korean language neck pain and disability measures. METHODS: Versions of each questionnaire in idiomatic modern Korean were developed with a process involving initial independent translation, synthesis of the translations, independent back translation, and review by an expert committee to achieve equivalence with the original English. Psychometric testing of the questionnaires with 261 subjects was undertaken to examine test-retest reliability, internal consistency, discriminative validity, and longitudinal construct validity. RESULTS: Test-retest reliability of the translated versions of the 3 disability questionnaires was excellent (intraclass correlation coefficient[2,1] = 0.86-0.90). High internal consistency was found in the 3 disability questionnaires (Cronbach-alpha ranged from alpha = 0.88 for the Functional Rating Index to alpha = 0.96 for the Neck Pain and Disability Scale, and 0.82 for the SFMPQ). The visual analog scale subscale of the SFMPQ was the most responsive of the subscales (effect size = 1.44, standardized response mean = 1.37). The visual analog scale was also the most responsive pain and disability index in internal responsiveness analysis, although disability indexes showed marginally better responsiveness when compared with external standards. No floor or ceiling effects were observed. CONCLUSIONS: We conclude that the questionnaires were successfully translated and show acceptable measurement properties, and, as such, are suitable for use in clinical and research applications.

Adolescent↗
PubMed2004

Assessment of a one-page questionnaire on long-term recreational physical activity.

BACKGROUND: Physical activity is associated with a reduced risk of several chronic diseases. Although there is considerable published research on methods to assess current or recent recreational physical activity, there are few short, self-administered questionnaires designed to assess long-term physical activity. METHODS: We developed a one-page questionnaire to capture data on usual recreational physical activity during the preceding 10 years. This questionnaire was used in a cohort study of adults age 50 to 75 years residing in western Washington state. To examine the measurement characteristics of this questionnaire, we compared metabolic equivalent task (MET)-hours derived from this short questionnaire to MET-hours estimated from a detailed comparison interview in a subsample (n = 217) and to current body mass index (BMI; weight in kilograms/height in square meters) in the full sample of 57,811 persons. RESULTS: The age- and sex-adjusted partial Pearson correlation coefficient for total recreational activity between the 2 instruments was 0.68. In the full cohort, BMI was inversely correlated with physical activity as assessed by the one-page questionnaire (r = -0.22). CONCLUSIONS: This short questionnaire measures long-term physical activity at a level of precision appropriate to the examination of associations in studies of physical activity and disease.

Age Factors↗
PubMed2005

Validated questionnaire on diagnosis and symptom severity for functional constipation in the Chinese population.

BACKGROUND: Functional constipation is a common problem in clinical practice. No validated questionnaire is available in Chinese. AIM: To develop a validated questionnaire for diagnosis and symptom assessment in functional constipation for the Chinese population. METHODS: One hundred and eleven patients with constipation and 110 healthy controls were presented with a 24-item constipation questionnaire in the Chinese language. Quality of life in constipation patients was assessed by Short Form-36. Polyethylene glycol was prescribed, for 4 weeks, to 20 patients with newly diagnosed constipation. The questionnaire was administered before and 4 weeks after treatment. Concept, content, construct, discriminant validity and reliability of the questionnaire were assessed. RESULTS: Six items were selected by logistic regression to account for most of the differences between controls and constipated patients with a good reproducibility and internal consistency. A cut-off score of > or =5 was determined to discriminate between controls and constipated patients with a sensitivity of 91% and a specificity of 91%. The constipation questionnaire correlated negatively with seven domains of the Short Form-36 and discriminated between constipated patients who reported symptomatic improvement during polyethylene glycol treatment. CONCLUSIONS: The Chinese constipation questionnaire could be used in epidemiological studies to assess the frequency and severity of constipation in patient populations and in interventional studies of constipation.

Adolescent↗