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PubMed1985

Case history questionnaires in the study of doctors' use of resources. Are they measuring what we want?

A set of 15 self-administered case histories were developed, each consisting of a short case followed by a standard format on which desired tests were checked. After pilot testing the case histories within a group of doctors, the authors selected the ten cases with the highest item-total correlations that also provided a broad clinical spectrum. Using a different group of 19 doctors, test-ordering on the questionnaire was compared with actual test-ordering in clinical practice. Questionnaire test-ordering did not reflect practice behavior; in fact, the relationship tended to be inverse (r = -0.43: P less than 0.10). Adjusting for case-mix variation by including only those practice cases with diagnoses similar to questionnaire cases did not improve its performance (r = -0.50: P less than 0.05). These findings suggest that test-ordering on case history questionnaires may not reflect actual practice behavior. Conclusions about test-ordering behavior and management strategies to alter it should not be based on results from questionnaires that have not been validated against actual practice.

Clinical Laboratory Techniques↗
PubMed1999

Development and validation of the Diabetes Quality of Life Clinical Trial Questionnaire.

OBJECTIVE: The objective of this study was to develop a valid and reliable health-related quality of life (HRQOL) questionnaire for use in multinational clinical trials of patients with type I and type II diabetes. METHODS: Through patient focus groups and expert clinician panels in the United States (US) and France, relevant HRQOL domains for patients with type I and type II diabetes were identified. A draft questionnaire was developed by including validated, widely used generic and diabetes-specific domains and by developing original questions as required. A pilot study (n = 123) was conducted to evaluate the psychometric properties of the draft questionnaire with revisions being subsequently made. Data collected from two multinational clinical trials of patients with type I and type II diabetes were used to further validate and enhance the questionnaire (DQLCTQ). RESULTS: A total of 942 patients were recruited in the clinical trials from Canada, France, Germany, and the United States. The mean age was 33.8 years for patients with type I diabetes (n = 468) and 58.2 years for patients with type II diabetes (n = 474). The mean HbAlc level at baseline was 8.6. The revised version of the questionnaire (DQLCTQ-R) contains a total of 57 questions comprising 8 generic and disease-specific domains, as follows: Physical Function; Energy/Fatigue; Health Distress; Mental Health; Satisfaction; Treatment Satisfaction; Treatment Flexibility; and Frequency of Symptoms. Intraclass correlation coefficients range from 0.74 to 0.90 and Cronbach's alphas range from 0.77 to 0.90. With very few exceptions, all eight domains were able to discriminate between type I and type II diabetes, tight and poor metabolic control, male and female, and good and poor self perceived control of diabetes. Four domains (Treatment Satisfaction, Health/Distress, Mental Health, and Satisfaction) were responsive to clinical change in metabolic control. CONCLUSION: The DQLCTQ-R is a reliable, valid, and comprehensive HRQOL instrument. It is suitable in multinational clinical trials to evaluate new or alternative treatments for patients with type I and type II diabetes.

Adult↗
PubMed1998

The lifetime total physical activity questionnaire: development and reliability.

OBJECTIVE: To develop and test the intra-rater reliability of an interview-administered questionnaire that assesses lifetime patterns of total physical activity including occupational, household, and exercise/sports activities. METHODS: The questionnaire was developed and pretested using cognitive interviewing techniques on a sample of women with and without previous breast cancer diagnoses. A pilot study was conducted with 115 women who were interviewed twice, 6 to 8 wk apart by interviewers trained in cognitive interviewing methods. Respondents used recall calendars to record their education, occupations, life events, and physical activity patterns before the interviews. Interviewers helped respondents recall their lifetime exposures, including their occupational, household, and exercise/sports activities, using these calendars and memory-probing strategies. Activity levels were estimated as the average number of hours of activity per week over different time periods. Means and correlation coefficients were estimated and compared for the two time periods. RESULTS: The questionnaire was found to be highly reliable. The test-retest correlations for hours per week spent in total lifetime physical activity was 0.74, for lifetime occupational activity was 0.87, for household activity was 0.77, and for exercise/sports activities was 0.72. CONCLUSIONS: This is the first questionnaire to measure lifetime physical activity by collecting data on each type of physical activity separately over lifetime and by measuring frequency, intensity, and duration of each activity. It is also the first physical activity questionnaire to be developed, refined, and administered using cognitive-based methods employed in survey research. Respondents were able to reliably recall their lifetime physical activity patterns. This instrument can be used for any disease outcome for which physical activity may be a risk factor.

Breast Neoplasms↗
PubMed1999

Comparison of four habitual physical activity questionnaires in girls aged 7-15 yr.

PURPOSE: Questionnaires provide a practical approach to measuring physical activity in children and adolescents, particularly for large-scale epidemiological studies. The purpose of the present study was to compare four habitual physical activity questionnaires and to assess their long-term reliabilities. METHODS: Subjects were female, aged 7-15 yr (and their parents), who participated in a cohort study in which predictors of the onset of menarche were being investigated. Questionnaires consisted of three single-item and one multi-item habitual physical activity questions and were sent to the 640 participants. Test-retest reliability of the questionnaires was assessed on 100 randomly selected participants 11 months later. RESULTS: The Spearman's correlation coefficient was highest (r = 0.40) between the Godin-Shephard Score and the Perspiration Score and was lowest (r = 0.10) between the Stairs Score and the Specific Activity Score. The correlation coefficients were higher when the questionnaires were reported to have been completed by the parents alone, rather than by parents with the assistance of their daughters. The test-retest reliabilities were r = 0.44 for the Perspiration Score, r = 0.59 for the Stairs Score, r = 0.48 for the Godin-Shephard Score, and r = 0.53 for the Specific Activity Score. The reliabilities were higher when the retest was reported to have been completed by the parents alone. CONCLUSIONS: This study suggests that the Perspiration Score, the Godin-Shephard Score, and the Specific Activity Score may provide simple and practical measures of habitual physical activity for children and adolescents.

Female↗
PubMed2000

Self-administered questionnaire compared with interview to assess past-year physical activity.

PURPOSE: The Modifiable Activity Questionnaire (MAQ) is a physical activity questionnaire shown to be both valid and reliable and was initially designed to be interviewer-administered. After translation and adaptation into French, the objective of the study was to compare past-year physical activity data obtained by self-administration of this questionnaire and by interviewer-administration. METHODS: 84 subjects (22 men, 62 women, age 36-63 yr) enrolled in an ongoing prospective study in France (the SUpplementation en VItamines et Minéraux AntioXydants or SU.VI.MAX study) completed both versions of the questionnaire in a randomized order with a mean (SD) delay of 7.9 (5.8) d between the two modes. Past-year leisure and occupational physical activity were expressed as both h x wk(-1) and MET-h x wk(-1) of activity, and television watching was expressed as h x d(-1). Analysis of variance on ranks was used to compare activity variables obtained by self-administration and interview. Agreement was assessed by nonparametric intraclass correlation coefficients. RESULTS: A significant effect of the mode of administration was found only for past-year leisure physical activity with lower values reported in self-administered conditions compared with interview. However, a high level of concordance between the two modes of administration was observed for all variables as shown by the intraclass correlation coefficients: 0.90 for leisure physical activity (h x wk(-1)), 0.82 for occupational activity (h x wk(-1)), 0.83 for total (leisure and occupational combined) physical activity (h x wk(-1)), and 0.97 for television viewing (h x d(-1)). CONCLUSIONS: The agreement between the two modes of administration of the questionnaire suggests that the self-administered version of the MAQ is a valuable tool to assess past-year physical activity and inactivity in self-administered conditions. This instrument could be used in large-scale population studies investigating the relationships between physical activity and health outcomes.

Adult↗
PubMed2004

The Quality of Life Impact of Refractive Correction (QIRC) Questionnaire: development and validation.

BACKGROUND: The purpose of the study was to develop a questionnaire that could quantify the quality of life (QOL) of people with refractive correction by spectacles, contact lenses, and refractive surgery in the prepresbyopic age group. METHODS: The questionnaire was developed and validated using traditional methods and Rasch analysis. A 90-item pilot questionnaire was developed through extensive literature search and use of professional and lay focus groups. Pilot study data were obtained from 306 subjects for item reduction to produce the 20-item Quality of Life Impact of Refractive Correction (QIRC) questionnaire. Validity and reliability studies (test-retest reliability with intraclass correlation coefficient and Bland-Altman limits of agreement, and internal consistency with Rasch fit statistics, factor analysis, and Cronbach's alpha) were performed from data of an additional 312 subjects. RESULTS: Rasch analysis demonstrated QIRC has good precision, reliability, and internal consistency (person separation, 2.03; reliability, 0.80; root-mean-square measurement error, 3.25; mean square +/- SD infit, 0.99 +/- 0.38; outfit, 1.00 +/- 0.39; item infit range, 0.70 to 1.24; and item outfit range, 0.78 to 1.32). The items (mean score, 50.3 +/- 7.3) were well targeted to the subjects (mean score, 47.8 +/- 5.5) with a mean difference of 2.45 (scale range, 0 to 100) units. Test-retest reliability (intraclass correlation coefficient, 0.88; coefficient of repeatability, +/-6.85 units), factor loading range (0.40 to 0.76), and Cronbach's alpha (0.78) also indicated the reliability and validity of QIRC. CONCLUSIONS: The 20-item QIRC questionnaire, which quantifies the QOL of people with refractive correction by spectacles, contact lenses, and refractive surgery in the prepresbyopic age group, was developed using Rasch analysis and shown to be valid and reliable. The use of Rasch scaling allows scores to be treated as a valid continuous variable. QIRC has broad applicability for cross-sectional and outcomes research.

Adult↗
PubMed2003

Scoliosis research society-22 patient questionnaire: responsiveness to change associated with surgical treatment.

STUDY DESIGN: Prospective observational consecutive case series. OBJECTIVES: To determine the responsiveness to change of the Scoliosis Research Society-22 (SRS-22) patient questionnaire after surgical treatment. SUMMARY OF BACKGROUND DATA: The SRS-22 outcomes questionnaire is the outgrowth of prior research that led to modifications and improvements of the original SRS questionnaire. METHODS: Fifty-eight patients with an average age of 16 years and an average Cobb size of 63 degrees enrolled. They were tested preoperatively and at 3- (within 4 months), 6- (5-8 months), 12- (9-16 months), and 24-month (22-36 months) intervals postoperatively using the SRS-22 outcomes questionnaire. The paired Student test with multiple comparison adjustment was used to test significance of change score over time. Only patients with data on both time points of interest were included in the analysis. RESULTS: Self-image was significantly improved at 3 months ( < 0.0001) and maintained improvement through 24 months. Function was significantly decreased at 3 months ( < 0.0001), but returned to baseline by 6 months. Pain was significantly worse at 3 months ( = 0.0099), but was significantly less at 6 ( = 0.0011), 12 ( < 0.0001), and 24 ( = 0.0037) months when compared to 3 months. CONCLUSION: The SRS-22 questionnaire is responsive to changes in the postsurgical period.

Activities of Daily Living↗
PubMed2003

Discrimination validity of the scoliosis research society-22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size.

STUDY DESIGN: Prospective observational study. OBJECTIVE: To determine the discriminant validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire for idiopathic scoliosis patients based on curve pattern and curve size. SUMMARY OF BACKGROUND DATA: An important psychometric attribute of the HRQL questionnaire is the capacity to discriminate between and among patients with differing condition severity. METHOD: Three study groups, with subjects ranging in age from 10 to 16 years, were set up: a control group (C) of 19 persons with scoliosis suspected but unproven with an average age of 13 years; a nonsurgical group (NS) of 68 patients with an average age of 14 years and an average scoliosis (Cobb) of 30 degrees; and a presurgical group (PS) of 32 patients with an average age of 14 years and an average scoliosis of 61 degrees. The NS group was subdivided into untreated (NSU) (n = 54) and braced (NSB) patients (n = 14). Also created were subgroups of the NS and PS groups having similar curve sizes: nonsurgical similar (NSS) and presurgery similar (PSS). Statistical significance of the SRS-22 domain scores by comparison groups was tested by ANOVA. Relationships between the SRS-22 questionnaire and scoliosis deformity measurements were calculated using the Pearson Correlation Coefficients. RESULTS: There were no significant differences between the control (C) and nonsurgical (NS) groups. The presurgical group (PS) scored significantly lower in the pain and self-image domains than the C or NS groups and lower than group C in the mental health domain. A subgroup of the nonsurgical group (NSS) with curves comparable to the presurgical subgroup (PSS) had significantly better self-image scores. There were no significant correlations between SRS-22 scores and curve pattern. For persons with scoliosis, curve size (Cobb) correlated with pain, self-image, and function; trunk asymmetry correlated with self-image. CONCLUSION: The SRS-22 HRQL questionnaire successfully discriminated among persons with no scoliosis or moderate scoliosis and large scoliosis. It did not discriminate among patients with single, double, or triple curves. Self-image and, to a lesser extent, pain and function domain scores correlated with radiographic and trunk asymmetry severity. The SRS-22 HRQL questionnaire may be useful in choosing nonsurgical versus surgical treatment in borderline cases.

Adolescent↗
PubMed2002

Stability of questionnaire items measuring behaviours, attitudes and stages of change related to sun exposure.

The use of questionnaires in epidemiological studies needs more methodological research. The time and effort spent on questionnaire design is often limited. Studies on the construction of questionnaires could lead to a higher quality of data, enhanced comparability and improved credibility of epidemiological findings. The aim of the present study was to examine the test-retest reliability of some common items measuring sun-related variables. A sample of 52 female Swedish nurses attending a postgraduate course in research methodology was chosen. They completed a questionnaire on two occasions spaced 3 weeks apart in the winter of 2000. When the results were analysed, items on sun-related behaviours and sunbed use were sufficiently reliable. The items on skin type and sunburn showed moderate stability. Stage of change related to sunlight exposure, items measuring beliefs about sunbathing along with items assessing self-efficacy and risk perception with regards to sunbathing showed lower stability. The results showed that many essential items concerning exposure to ultraviolet radiation and sunburns were sufficiently stable, but other items were less stable and could be improved upon; suggestions for improving these items are presented. The study illustrates the value of reliability testing in the process of item construction. Using methodological studies to improve the reliability and validity of data is an important step toward higher standards for questionnaire surveys.

Adult↗
PubMedDate not supplied

A new functional status outcome measure of dyspnea and anxiety for adults with lung disease: the dyspnea management questionnaire.

PURPOSE: To develop and psychometrically test the Dyspnea Management Questionnaire (DMQ), a new multidimensional measure of dyspnea in adults with chronic obstructive lung disease. PARTICIPANTS: Eighty-five participants were recruited with diagnoses of chronic obstructive pulmonary disease (COPD, n = 73) and asthma (n = 12). The total sample was predominately female (65%) and married (34%), with 64.9% white and a mean age of 75 years (SD = 9.6, n = 76), diagnosed with pulmonary disease 4.8 years ago (SD = 4.4), 32% requiring the use of supplemental oxygen. Participants were also African American (29.9%), Asian (2.6%), and Hispanic (2.6%); n = 77. METHODS: An initial item pool of 74 items was drawn for the DMQ aided by qualitative interview data, literature review, and pilot testing with 3 adults with COPD. Several analyses were used to reduce the item pool. An interdisciplinary panel of 12 experts evaluated the content validity of the DMQ items. To evaluate test-retest reliability, respondents with stable COPD (n = 26) completed the questionnaire twice within a mean interval of 18 days (SD = 7.17). The DMQ was compared with the Medical Outcomes Study 12-Item Short-Form (SF-12) Health Survey, the Seattle Obstructive Lung Disease Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: The resulting DMQ is a 30-item scale that measures 5 conceptually derived dimensions: dyspnea intensity, dyspnea-related anxiety, fearful activity avoidance, self-efficacy for activity, and satisfaction with strategy use. It has a 7-point Likert-type scale and third Flesch-Kincaid reading grade level. A panel of 12 experts supported the content validity of the DMQ. It showed high internal consistency (alpha = .87 to .96) and test-retest reliability over 2.5 weeks (intraclass correlation coefficient = 0.71 to 0.95). Dyspnea intensity, dyspnea-related anxiety, and fearful activity avoidance subscales of DMQ-30 and composite score were moderately to highly correlated with 3 Seattle Obstructive Lung Disease Questionnaire dimensions (r = 0.44-0.83), Medical Outcomes Study 12-Item Short-Form scales (r = 0.41-0.57), and Hospital Anxiety and Depression Scale-Anxiety (r = -0.59 to -0.65). Two of DMQ's subscales, self-efficacy for activity and satisfaction with strategy use, correlated mildly with Seattle Obstructive Lung Disease Questionnaire (r = 0.28 and 0.27, respectively). Some very low correlations for DMQ-30's satisfaction with strategy use compared with the Medical Outcomes Study 12-Item Short-Form provided preliminary support for its divergent construct validity. The DMQ-30 discriminated adults with COPD requiring supplemental oxygen from those not requiring it. CONCLUSIONS: The DMQ addresses the need for a more comprehensive, multidimensional assessment of dyspnea, especially for anxious patients with COPD, in order to better guide the appropriate application of dyspnea management interventions and measure pulmonary rehabilitation outcomes. The DMQ can help add insights into the benefit of adjunctive therapies such as psychoeducation, controlled breathing strategies, and cognitive-behavioral approaches in pulmonary rehabilitation for anxious patients with COPD.

Aged↗
PubMed2004

Evaluating quality of life after endolymphatic sac surgery: The Ménière's Disease Outcomes Questionnaire.

OBJECTIVE: To develop a disease-specific instrument to measure the quality of life in patients with Ménière's disease and to assess quality-of-life outcomes after endolymphatic sac decompression. STUDY DESIGN: Retrospective survey. PATIENTS: Patients with Ménière's disease who underwent endolymphatic sac decompression from June 1996 to June 2001, after failing a course of medical management. Two hundred fifteen potential subjects were identified; completed questionnaires were returned by 159 patients. MAIN OUTCOME MEASURES: The Ménière's Disease Outcomes Questionnaire was developed, and consists of questions in three domains that determine quality of life: physical, emotional, and social well-being. The Ménière's Disease Outcomes Questionnaire consisted of 18 multiple-choice questions that were paired for pre- and postoperative conditions, and one global quality-of-life question. The preoperative quality-of-life score (total score for preoperative items) was compared with the postoperative quality-of-life score. The main outcomes measure was the change in quality-of-life score. RESULTS: Overall, the mean change in quality-of-life score was +25.6 points (range, -34 to 83) (p < 0.001). The change in Ménière's Disease Outcomes Questionnaire quality-of-life score was highly correlated with the change in the global question score (p < 0.01). Quality of life was improved in 87% of respondents, unchanged in 3% of patients, and poorer in 9% of patients after endolymphatic sac decompression. CONCLUSIONS: The Ménière's Disease Outcomes Questionnaire is a new disease-specific quality-of-life tool that is a valid measure of quality of life in patients with Ménière's disease, and is responsive to measuring change in quality of life after treatment. Significant improvement in quality of life was reported by 87% of patients after endolymphatic sac decompression.

Adult↗
PubMed2006

The attitudes to back pain scale in musculoskeletal practitioners (ABS-mp): the development and testing of a new questionnaire.

OBJECTIVES: Little is known about practitioners' beliefs and attitudes to the treatment of low back pain, and whether these influence their clinical decisions, intervention strategies, and patient-centered outcomes. This study aimed to develop, test, and explore the underlying dimensions of a new questionnaire, the Attitudes to Back Pain Scale (ABS), in a specific group of clinicians, practitioners who specialize in musculoskeletal therapy. METHODS: Items for the draft questionnaire were derived from interviews with practitioners (chiropractors, osteopaths, and physiotherapists). The draft questionnaire (52 items) sought to assess practitioners' attitudes concerning role and self-image plus their beliefs about treatment goals and prognosis of low back pain. The questionnaire was sent to a random selection of 300 practitioners from each professional group, and 546 (61%) responded. Split-sample analyses were performed using exploratory and confirmatory factor analysis. RESULTS: Separate exploratory analyses were done for attitudes concerned with personal interaction (34 items) and attitudes about treatment orientation (18 items), producing six domains: limitations on sessions, psychologic, connection to health care system, confidence and concern, reactivation, and biomedical. Confirmatory analyses indicated that the model tested presented a good fit. Validity interviews revealed high agreement of categorization and low levels of difficulty in categorizing the items. CONCLUSIONS: The internal structure of the new questionnaire not only shows excellent psychometric properties and good face validity, but also has the added advantage of being developed with a specific clinical context in mind. Additional evaluation is required to fully describe the psychometric integrity of this instrument.

Adult↗
PubMed2005

Consistency of reported alcohol use by pregnant women: anonymous versus confidential questionnaires with item nonresponse differences.

BACKGROUND: Self-report is the best method to attain information about moderate alcohol consumption. However, reported alcohol consumption before and during pregnancy is sensitive to response bias. METHODS: We compared identical questionnaires completed either confidentially or anonymously by pregnant women. A representative half of the pregnant women in Oslo attending ultrasound screening between June 2000 and May 2001 were invited to join a confidential questionnaire study. Another group of pregnant women, selected in the identical manner, were asked to answer the same questionnaire anonymously during the summer of 2001. The questionnaire was completed by 1749 confidentially and 191 anonymously (response rate 93.4% vs 84.4%). For the current study, only women with Scandinavian ethnicity were included: 1707 and 178, respectively. Measures were T-ACE (screening measure for pregnancy risk drinking), reported frequency of alcohol use, Standard Units (SU) per occasion (po), SU per week, and binge drinking (>or=5 SU po), before and during pregnancy. RESULTS: There were no significant differences in reported alcohol consumption between the confidential and the anonymous group for the sample as a whole. Any alcohol consumption was reported by 22.6% and 23.3% during pregnancy week 7-12 and 13+ (confidential group) versus 22.5% and 25.8% (anonymous group). Differences between the groups tended to be larger for SU per week (p=0.07 both before pregnancy and after week 12 of pregnancy) than for the indirect alcohol (T-ACE) and the binge drinking questions. In the confidential group, the women with lower education had close to twice as high item nonresponse on the direct alcohol questions during pregnancy compared with those with higher education. This difference was smaller in the anonymous group. The rate of smoking was not reported differently in the anonymous group. CONCLUSIONS: Among pregnant women, there was no significant difference in self-reported alcohol consumption obtained by confidential or anonymous questionnaires.

Adult↗
PubMedDate not supplied

Measuring physical function in children with spina bifida and dislocated hips: the Spina Bifida Hips Questionnaire.

The objective of this study was to develop a questionnaire to evaluate the activities of daily living that are important to children with spina bifida and dislocated hips and their families. Ninety-six items were generated from a review of the literature and interviews with clinicians, parents, and children with spina bifida and dislocated hips. Items were rated independently for "importance" and "severity" by the children and their parents. The 26 most important and severe items were formatted into a self-administered questionnaire, the Spina Bifida Hips Questionnaire (SBHQ). Parents and children completed 2 weeks apart the SBHQ, the Activities Scale for Kids (ASK), and the Pediatric Outcomes Data Collection Questionnaire (PODCQ). The SBHQ showed excellent test-retest reliability (intraclass correlation = 0.97). Construct validity was established by correlations with the ASK (r = 0.79, P < 0.01) and the PODCQ (r = 0.84, P < 0.01). In conclusion, the SBHQ is a valid and reliable questionnaire for the evaluation of treatment outcomes for children with spina bifida and dislocated hips.

Activities of Daily Living↗
PubMed2004

The possibility to use simple validated questionnaires to predict long-term health problems after whiplash injury.

STUDY DESIGN: A prospective follow-up study. OBJECTIVES: To evaluate the relation of the state of health before the accident and the significance of the symptoms reported soon after the injury to the situation 3 years after the injury. To evaluate the possibility of using simple validated questionnaires to predict long-term health problems after the injury. SUMMARY OF BACKGROUND DATA: A whiplash injury is generally benign in its natural course. However, some of the patients have diverse and prolonged symptoms. Although several prognostic factors have been suggested for the poor recovery, in most cases the factors leading to prolonged disability remain unclear. METHODS: In collaboration with traffic insurance companies, we gathered information of neck injuries that occurred in traffic accidents in Finland in 1998. After the insurance company received a notification of a neck injury and consent from the injured party to participate in the study, they sent the information to the research team. The first inquiry was sent to the patients as soon as possible. One- and three-year follow-up questionnaires were posted to those who responded to the first inquiry. A total of 144 persons returned the 3-year follow-up questionnaires and form the material of this study. RESULTS A poor state of health or frequent neck pain or headache before the accident did not have any significant relation to the poor outcome 3 years after the accident. The extent of neck pain and lower back pain reported soon after the accident was significantly associated to a poor outcome in the follow-up. The Neck Disability Index questionnaire was significantly related to the poor outcome after 3 years. CONCLUSIONS: The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.

Accidents, Traffic↗
PubMed2004

Validity and sensitivity to change of the NASS questionnaire for patients with cervical spine disorders.

STUDY DESIGN: Study of two cohorts with a differing severity of disease before and after treatment. OBJECTIVES: The aim of this study was to examine the validity and sensitivity to change of the German version of the cervical NASS patient questionnaire. SUMMARY OF BACKGROUND DATA: To the authors' best knowledge, there are no data revealing the psychometric properties of the cervical NASS patient questionnaire. PATIENTS AND METHODS: The validity and sensitivity in patients with cervical spine disorders who were referred by their physician either to an inpatient rehabilitation program or to an outpatient physiotherapy were examined. They were consecutively recruited. Their functioning and health status were assessed when entering the study and after the treatment by the NASS questionnaire and the Medical Outcome Survey Short Form-36 (SF-36). RESULTS: Criterion validity was demonstrated by the statistically significant correlations between the NASS subscores and all subscores of SF-36. As expected, the SF-36 subscores Physical Function and Pain showed the strongest associations to the NASS subscore Pain and Disability (rho = 0.75 and 0.65, respectively), demonstrating construct validity of the latter. Discriminative validity of NASS subscores was shown in two ways. First, a statistically significant difference was found between functional and health status of the two cohorts with better scores in the patients referred to outpatient physiotherapy as compared with those sent to an inpatient rehabilitation program. Second, statistically significant and clinically important improvements recorded by the NASS subscores were demonstrated in both patient groups after the treatment in accordance with improved SF-36 subscores. Moreover, the NASS subscores demonstrated good sensitivity to change (Pain and Disability with a standard response mean ranging from 0.64 to 1.24). CONCLUSIONS: The German version of the cervical NASS patient questionnaire (NASS) is a valid instrument for patients with cervical spine health problems. As this instrument is also sensitive to change, it is recommended for use. Moreover, the present study gives evidence for the validity of the original cervical NASS questionnaire in English.

Cervical Vertebrae↗
PubMed2003

Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure.

PURPOSE: We developed the ureteral stent symptom questionnaire (USSQ), a psychometrically valid measure to evaluate symptoms and impact on quality of life of ureteral stents. MATERIALS AND METHODS: A total of 309 patients were asked to participate during different phases of our study. In phase 1 a structured literature search, 9 patient interviews and studies of 90 patients using existing instruments formed the foundation for the initial draft of our new questionnaire. In phase 2 the USSQ was pilot tested, reviewed by experts and field tested in 40 patients to produce a final 38-item draft. In phase 3 formal validation studies were performed in 55 patients to assess validity, reliability and sensitivity to change. Discriminant validation was performed by administering the questionnaire to 3 groups of patients without stents. RESULTS: The final draft addressed various domains of health (6 sections and 38 items) affected by stents covering urinary symptoms, pain, general health, work performance, sexual matters and additional problems. The validation studies showed the questionnaire to be internally consistent (Cronbach's alpha > 0.7) with good test-retest reliability (Pearson's coefficient > 0.84). The questionnaire demonstrated good construct validity and sensitivity to change shown by significant changes in the score with and after removal of stents. The new USSQ discriminated patients with stents from healthy controls (p < 0.001) and patients with urinary calculi without stents and lower urinary tract symptoms. CONCLUSIONS: Indwelling ureteral stents have a significant impact on health related quality of life. The new USSQ is a valid and reliable instrument that is expected to become a standard outcome measure to evaluate the impact and compare different types of stents.

Adolescent↗
PubMed2006

Outcome-based assessment of endolymphatic sac decompression for Ménière's disease using the Ménière's disease outcome questionnaire: a review of 90 patients.

OBJECTIVE: To evaluate the quality of life (QOL) of patients treated by endolymphatic sac decompression (ELSD) for Ménière's disease (MD) with a dedicated questionnaire, while recording the results of this surgery on vertigo attacks using the American Academy of Otolaryngology-Head and Neck Surgery criteria. STUDY DESIGN: Retrospective case review in a tertiary referral care center. MATERIAL AND METHODS: Ninety patients who have MD were treated by ELSD at our institution between 1986 and 2004. They were sent a 40-question Ménière's Disease QOL dedicated questionnaire (Ménière's Disease Outcome Questionnaire) concerning physical, mental, and social well-being. Five scores out of 100 were calculated (S1-S5): S3 for preoperative QOL score, S4 for postoperative QOL score, S5 for change in QOL score (S5 = S4 - S3), and S1 and S2 representing the answers to two other paired questions about the "overall" feeling of the patients. In parallel, results of ELSD on vertigo attacks and hearing were evaluated using the Academy of Otolaryngology-Head and Neck Surgery criteria. RESULTS: Fifty-nine interpretable answers (65.6%) to the Ménière's Disease Outcome Questionnaire were obtained from 28 men and 31 women (mean age, 56 yr and 9 mo), all suffering from "definite" MD. The mean S3 was 32.5 (range, 9.7-84.7), and the mean S4 was 60.8 (range, 0-98.6). Consecutively, S5 score was 28.3 (range, -34.7 to 77.4). QOL improved in 81.4% of cases with an average duration of follow-up of 57.5 months (range, 4-156 mo) (p < 0.001), worsened in 11.9% and was stable in 6.8%. There was no statistically significant difference as a function of sex (p = 0.7) or length of follow-up (p = 0.6). There was a significant correlation between S1 and S3 (p < 0.0001), and S2 and S4 (p < 0.0001), validating the whole questionnaire. In addition, 71% of satisfactory control of vertigo at 2 years postoperatively was noted. Hearing was improved or unchanged in 79% of cases at 3 months postoperatively. CONCLUSION: These results show that ELSD significantly improves the health of patients. It represents a first-line procedure that preserves the vestibular and afferent structures, unlike vestibular neurotomy and chemical labyrinthectomy, which may be indicated as a second line.

Adult↗