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Questionnaire for early detection of occult anemia.

BACKGROUND/AIMS: Anemia is a common condition that is often missed. We aimed to devise a questionnaire for detection of occult anemia. METHODOLOGY: A questionnaire survey was done of 442 new gastroenterology outpatients to detect potential symptoms of anemia. Then hematology tests were performed and anemia was defined by World Health Organization criteria. Data were analyzed by the stepwise logistic regression method to determine adjusted odds ratios and extract relevant items. After further selection of variables, the sensitivity and specificity of three potential questionnaires were analyzed using receiver operating characteristic curves. RESULTS: Seven items were selected and a new questionnaire was devised to detect occult anemia. It showed a sensitivity of 70% and also a specificity of 70% when back-tested on the subjects. CONCLUSIONS: This new questionnaire may be useful for detecting occult anemia.

Adult↗

Validity of self-assessment outcome questionnaires: patient-physician discrepancy in outcome interpretation.

Patient outcome following total hip arthroplasty (THA) was evaluated using a previously described patient assessment outcome index questionnaires. The questionnaire was distributed to 263 patients who underwent cementless THA. One hundred and three patients responded to the self-administered questionnaire and had updated clinical evaluation. We obtained a modified Harris Hip Score (HHS) based on patient assessments of their own pain and function and compared it with the clinical HHS obtained at the patients' last office visit. The mean follow up period was 4 years. Statistical analysis was performed between the two scores. The correlation between the scores from the self-administered questionnaire and the patients' last office visit revealed a fairly low correlation coefficient (r = 0.467, p < 0.001). Relative lack of correlation between the HHS's obtained from these two sources was especially noted for patients with a pain score of 30 points or less. These 26 patients were subsequently interviewed in detail about their pain to further explain these differences. The etiology of the perceived "hip pain" was found to be secondary to trochanteric bursitis in 13 patients, lumbar spondylosis in 7 patients, arthrosis of the contralateral hip in 5 patients, and from other causes in 8 patients. Pain that was hip related (anterior thigh or groin) was present in only 5 out of the 26 patients with a pain score of 30 or less. Another source of discrepancy between the total scores of the HHS was found to be on behalf of the physician in evaluating the presence of a limp. We also found that patients' expectations had changed from their preoperative expectations. Although outcome measures developed and administered by clinicians are subject to bias from several sources, results of this study suggest that self administered patient outcome measures also have their limitations. The validity of self-administered patient outcome questionnaires can be severely impacted by the patients' understanding of the questions asked, as even the most seemingly simple questions are subject to misinterpretation.

Activities of Daily Living↗

[Evaluation of a questionnaire for measuring nasal symptoms in subjects with allergic rhinitis].

BACKGROUND: For the assessment of nasal symptoms in allergic rhinitis patients, most of the questionnaires evaluate the impact of symptoms on patient's quality life. OBJECTIVE: To assess the consistent and reliability of a nasal symptom questionnaire in patients with allergic rhinitis. MATERIAL AND METHODS: 224 patients (10 to 19 years old) accepted to participate in the study. All the patients completed a questionnaire, which evaluates the severity and frequency of four nasal symptoms using a maximum total score of 12 points. The consistent was studied after the questionnaire was administered to 62 patients with allergic rhinitis and 62 patients without it. The reliability after one to four weeks was studied on 100 healthy subjects with the Bland and Altman's method. RESULTS: The total score of patients with allergic rhinitis was significantly different to the score of the patients without it (7.1 +/- 2 and 1.9 +/- 1, respectively). The alpha coefficient for the total score was 0.86. The repeated measures showed a repeatability of 96% with a repeatability coefficient of 2. CONCLUSION: The nasal symptom questionnaire is a reliable tool for the follow up of allergic rhinitis during periods of one to four weeks.

Follow-Up Studies↗

Cross cultural adaptation and validation of the Arabic version of the Childhood Health Assessment Questionnaire for measuring functional status in children with juvenile idiopathic arthritis.

OBJECTIVE: To cross culturally adapt the American-English version of the Childhood Health Assessment Questionnaire (CHAQ) and to evaluate the validity and reliability of the modified translated version on children with juvenile idiopathic arthritis (JIA). METHODS: A cohort of 62 children suffering from JIA (32 Egyptian, 30 Saudi Arabian) were recruited and asked to participate in the study. Two questions had been changed to suit the Arabic culture and to tackle some aspects that are more typical of the Arabic culture. After modification, translation and back translation of the questionnaire, it was administered to the selected patients as well as their parents and tested for internal consistency, reliability and construct validity by correlating the yield of the questionnaire with other disease activity parameters. The questionnaire was administered again after a one-week interval for evaluation of the reliability of this test. The modified questions were tested for their loyalty to the principal component and their correlation with that of the other unchanged items was compared. RESULTS: CHAQ proved to be valid in clinically discriminating between healthy subjects and patients with different patterns of JIA. Test-retest showed strong reliability with a high percentage of agreement and high kappa values. Internal consistency showed a high value for the standardized Cronbach's alpha (0.951), and this value did not show any significant change when any one of the items was eliminated. The modified questionnaire showed a strong and significant validity when its results were correlated with disease activity parameters. CONCLUSION: The Arabic CHAQ is a reliable and valid instrument that can be administered to Arabic children suffering from JIA and to their parents, to evaluate the patients' functional disability. Its measurement properties were comparable to versions in other languages.

Activities of Daily Living↗

Development and content validation of family practice residency recruitment questionnaires.

BACKGROUND AND OBJECTIVES: The residency recruitment process involves a substantial time and financial commitment on the part of medical students and residency programs. This paper describes the development and content validation process of two written questionnaires designed to assess the application and interview process at our family practice residency program. METHODS: Two written questionnaires were developed after completion of a literature review and from areas deemed important by our academic faculty. Drafts of each questionnaire were sent to nine jurors to assess content validity. Content reviewers provided both a qualitative and a quantitative assessment of each questionnaire. RESULTS: The inclusion of both open- and closed-ended questions/items was deemed necessary and appropriate by the panel of content jurors. Assessing faculty, residents, curriculum, program's reputation, geographic location, and spouse/family influence were considered the most important factors to include on the questionnaires when assessing a family practice residency program. CONCLUSIONS: With increasing pressure to fill positions across many family practice residency programs, it is important for faculty involved in the recruitment process to recognize that both factors within and out of their control contribute to the selection process.

Family Practice↗

[A short questionnaire as a means of screening for psychiatric disorders in the aged].

The authors elaborated a brief questionnaire of mental health of old people. They discuss the the suitability of the self-evaluating part of the questionnaire for detection of mental disorders. Hundred and forty subjects above 65 years of age were examined: living in their homes or hospitalized at the psychiatric clinic. The mean score of the self-evaluating part of the questionnaire in the group of healthy and mentally ill differs significantly. The sensitivity of the self-evaluating part for the non-differentiated group of patients is 62.07% and the specificity is 73.08%. Self-evaluation with the best reliability differentiates from healthy subjects the group of depressive patients (sensitivity 82.76%). It was revealed that self-evaluation can help also with detection of dementia (sensitivity (61.11%). An enhanced discriminating sensitivity of the questionnaire is expected from a combination of self-evaluation with items expressing objective evaluation. The authors emphasize the possibility to entrust the questionnaire to paramedical workers, and its non-pretentious character which makes it suitable for old people.

Aged↗

Development of resource-use and expenditure questionnaires for use in rheumatology research.

OBJECTIVE: To develop a self-completion and postal resource-use and expenditure questionnaire for use in economic studies of early inflammatory polyarthritis (IP). METHODS: Identification of cost-generating events associated with early IP through a literature review and focus groups of IP patients and their partners. The information obtained was used to inform the development of self-completion postal resource-use and expenditure data collection instruments/questionnaires in terms of structure and content. Finally, the developed questionnaire was pilot-tested and validated in populations in 2 geographically different areas. RESULTS: The main cost categories identified through the focus groups, and used in the development of the questionnaires, included forgone leisure time and activities, reliance on other people, life events, emotions, help with everyday chores, travel, and over-the-counter medication. Pilot-testing the questionnaires resulted in high unit and item response rates, and high acceptability and ease of completion by respondents, as well as generalizability to different geographical settings. Where possible, collected data were validated against alternative data sources, and agreement was good. CONCLUSION: Overall, resource-use and expenditure questionnaires developed in this study were shown to be highly acceptable to respondents, easy to complete, and generalizable to different geographical settings within the UK.

Arthritis↗

Counseling adolescents with hearing loss with the use of self-assessment/significant other questionnaires.

After adapting a pair of adult Self-Assessment/Significant Other questionnaires, the first author explored the value of the modified questionnaires in providing counseling to adolescents with hearing loss. Twenty adolescents with hearing loss served as subjects; peers with normal hearing were selected as their Significant Other to capitalize on the importance of peer relationships and opinions during adolescence. Each dyad completed a 12-item questionnaire designed to explore the communicative, emotional, and social impact of hearing loss. Responses to each pair of questionnaires were reviewed by the adolescent and the audiologist and served as a basis for counseling. Subsequent dialogues revealed recurring themes as the teens attempted to face age-appropriate developmental challenges as individuals with hearing loss. Based on their responses to a follow-up questionnaire, most of the adolescents found the counseling process beneficial.

Adolescent↗

[Validation of an asthma knowledge questionnaire].

INTRODUCTION: A patient's knowledge of his disease and its treatment is an essential part of the evaluation of an educational process. It is useful therefore to use a rapid, easy and valid means of collecting the information necessary to produce an educational programme adapted to the needs of the patient. METHODS: Following a review of the literature an initial questionnaire was constructed. It included four domains: biomedical, signs and symptoms of severity, general knowledge and treatment. The questionnaire was administered to 73 asthmatics in order to assess its clarity and comprehensibility. It was then reviewed and modified in both format and content by 10 French experts. The revised questionnaire was completed by 108 asthmatics distributed throughout 10 French respiratory centres, a group of 83 non-asthmatic subjects and 203 sixth year medical students at the Bordeaux University School of Medicine. RESULTS: The mean scores were: 19 for the non-asthmatics (range 2-36), 25.7 for the asthmatics (range 4-38) and 32.9 for the students (range 17-40), p 0.0001. The questionnaire was shown to be discriminating with good reliability and reproducibility: alpha Cronbach coefficient=0.82; intra-class correlation coefficient=0.70. CONCLUSIONS: This study has validated a French language asthma knowledge questionnaire.

Adolescent↗

Evaluation of a diagnostic questionnaire for nasal polyposis: an observational, cross-sectional study.

Nasal polyposis (NP) represents actually a matter of concern for most ear, nose and throat (ENT) specialists. In France, we lack data on NP prevalence due to the unavailability of a validated diagnostic questionnaire easily usable in population-based studies. The present study tested the sensitivity and specificity of an 11-item questionnaire for NP diagnosis from which an algorithm of diagnosis decision was inferred. Outpatients from 3 ENT departments were asked to complete the questionnaire prior to their visit. After the visit, the investigator had to write his final diagnosis (FD) on the envelope containing the questionnaire, without reading the patient's responses. Data from 406 patients showed a good specificity and sensitivity of most items. Awareness of NP, previous cortisone therapy for nasal pathology, and history of nasal surgery were shown to be the most discriminating items. An algorithm was elaborated by aggregation of the different items; its specificity and sensitivity were close to 90%. These diagnostic questionnaire and algorithm, although not substitutable to a clinical diagnosis, should be very useful for population-based studies.

Algorithms↗

Development of a questionnaire to measure perceptions of, and concerns derived from, dental fluorosis.

OBJECTIVE: To develop a questionnaire in English and Spanish to measure concerns caused by children's (and their parents') perceptions of dental appearance. MATERIALS AND METHODS: The questionnaire addressed concerns in the physical, mental, and social domains, perceptions about discolourations and other oral conditions including tooth colour. Test-retest and internal reliability, and construct and criterion validity, were assessed as part of the development process. Children in Mexico City, Mexico and Indianapolis, Indiana answered the questionnaire and were examined for fluorosis using the TSIF index. Data were analysed using Cronbach's alpha, Pearson's, Spearman's and intraclass correlations, and percentage agreement tests. RESULTS: Ninety-five children and 28 parents participated in Mexico City; fluorosis was diagnosed in 66% of children. Seventy-one children and 65 parents participated in Indianapolis; fluorosis was diagnosed in 63% of children. English and Spanish questionnaires had acceptable test-retest performance, and moderate internal reliability. Criterion validity was acceptable, and the translated versions retained acceptable construct validity. Perceptions of discolourations were associated with concerns of the participants. Level of concern was higher in Indianapolis than in Mexico City, generally. Many participants reported that they were at least occasionally distressed or worried over the appearance of the children's teeth, that it hindered children from smiling freely, and that it was an unsatisfactory appearance. CONCLUSION: The developed questionnaire allowed children and parents to report perceived dental appearance problems and concerns.

Adult↗

Inter-observer and intra-observer reliability of a sleep questionnaire in Indian population.

UNLABELLED: Sleep disorders are a cause of significant morbidity and mortality. These are however still not widely detected/treated. Though various questionnaires have been designed for screening purposes, none are available in India. AIM: To construct a questionnaire for detection of sleep disorders and determine its reliability and validity. MATERIAL AND METHOD: The questionnaire was prepared from the Case Western Health Research Questionnaire, translated into Hindi and then back into English, prior to its use. This was administered to 20 subjects at an interval of 2 weeks by the same observer to determine the intra-observer reliability. For estimation of validity, 275 subjects were evaluated by a trained health worker and a specialist in sleep disorders. The specialist's opinion was taken as the 'gold standard' to calculate sensitivity and specificity. RESULTS: The kappa statistic was 0.94 for intra-observer reliability. The sensitivity and specificity were calculated for the question, presence/absence of sleep disorders and for all the other questions also. The sensitivity ranged from 70-91% and specificity 80-100%. CONCLUSION: This questionnaire is simple to use, reliable and has good sensitivity and specificity. It can be used in epidemiological community surveys.

Adult↗

[The patient experiences questionnaire PasOpp in somatic outpatient clinics].

BACKGROUND: The purpose of this paper is to describe the development and evaluation of the patient experiences questionnaire (PEQ) for somatic outpatients. MATERIAL AND METHODS: Literature review, focus groups, interviews with patients and clinicians, and pre-testing of questionnaire items were used. A postal survey among 12,525 patients of 23 outpatient clinics for adults in two Norwegian health regions was conducted during 2003. RESULTS: 6824 (55%) patients responded to the questionnaire. Low levels of missing data suggest that the questionnaire is acceptable to patients. Factor analysis of items deemed applicable to all patients produced three scales: clinic access (2 items), communication (6 items) and organisation (4 items). The remaining items contributed to the hypothesised scales of information (6 items), hospital standards (3 items), and pre-visit experience (3 items). With the exception of the pre-visit experience scale, the levels of Cronbach's alpha met the criterion of 0.7. The great majority of the results of validity testing were as hypothesised. Correlations between the scales ranged from 0.30 (clinic access and information) to 0.72 (communication and information). As hypothesised, scores were significantly related to responses to questions about overall satisfaction, general health, and age. INTERPRETATION: The outpatient experience questionnaire is a self-administered instrument that includes the most important aspects of experience from the outpatients' perspective. Three core dimensions for use in a shortened version have been identified.

Adult↗

Translation and validation of a quality of life questionnaire for chronic lower limb venous insufficiency into greek.

AIM: In order to provide a practical instrument for quality of life measures, for researchers and primary care physicians in Greece, we decided to translate and validate the published postal questionnaire CIVIQ (Chronic Venous Insufficiency Questionnaire) into the Greek language. METHODS: The study took place in 2 vascular surgical clinics. Fifty patients with known chronic venous insufficiency (CVI) were asked to complete the questionnaire. A debriefing method was used for the cultural adaptation. To measure test-retest reliability, 50 patients with known CVI disease, were asked to complete the questionnaire. RESULTS: The adaptation of CIVIQ questionnaire in the Greek language demonstrated its good validity (Cronbach's alpha=0.92) and reproducibility (coefficient = 0.98). CONCLUSIONS: CIVIQ seems to be a reliable tool in helping to assess the health status of the Greek general population and could be used to contribute to the identification of the magnitude of the problem of CVI in the Greek setting.

Adult↗

[Development and validation of a modified quality of life questionnaire for patients treated by antireflux surgery].

INTRODUCTION: Past decade witnessed a growing interest in scientific medical publications on health related quality of life (HRQoL), which has yielded an increasing number of generic and disease-specific instruments. To date, several studies have evaluated the impact of GERD on HRQoL. AIMS: To develop a QoL questionnaire for patients with GERD underwent laparoscopic fundoplication (LF). This questionnaire was developed to be more comprehensive than existing measures. MATERIALS AND METHODS: We undertook a retrospective analysis of 116 patients underwent laparoscopic fundoplication for GERD between 1994 and 2002 in the 1st Department of Surgery, Semmelweis University. These patients--included 55 men and 61 women, with mean age of 46 years (14-77)--were used in the psychometric evaluation. Our questionnaire was developed using internationally accepted, valid QoL instruments and scales. RESULTS: Internal-consistency reliability was high (alpha value overall 0.95; dimensions 0.74-0.96). Using convergent and divergent validity, construct validity was evaluated by examining Pearson correlation coefficients between items and scales. Construct validity was demonstrated based on observed correlations. Known-groups validity of questionnaire is proved to. CONCLUSIONS: Our questionnaire is a short and user-friendly instrument. It has excellent reliability, construct and known-groups validity.

Adolescent↗

Surveying the prevalence of asthma, allergic rhinitis and eczema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase III.

This is the second survey of schoolchildren in Khon Kaen, Northeastern Thailand, using the Thai version of the ISAAC questionnaire to examine the trend in the prevalence of asthma, allergic rhinitis and eczema, and to compare the results with the ISAAC Phase I data. We analyzed 5,075 questionnaires comprising 2,119 six- to seven- and 2,956 thirteen- to fourteen-year-old children (48 and 42 percent male, respectively). The cumulative vs. 12-month prevalence according to the written questionnaires were: 14.3 vs. 9.8% for wheezing, 42.6 vs. 33.3% for rhinitis and 13.5 vs. 11.2% for eczema, respectively. The cumulative vs. 12-month prevalence for the wheezing module, based on the video questionnaire, was 9.2 vs. 6.3%, respectively. Most Phase III prevalence was significantly lower than the first survey except for the steady, 12-month prevalence of wheeze. Our study confirms the high prevalence of allergic diseases among school-children in Northeastern Thailand; albeit, prevalence has not increased in recent years. The Thai version of the English-language ISAAC questionnaire needs to be validated before further use in epidemiological research.

Adolescent↗

Correlation between preoperative symptom scores, quality-of-life questionnaires, and staging with computed tomography in patients with chronic rhinosinusitis.

BACKGROUND: This study evaluates the correlation between preoperative symptoms, quality-of-life questionnaires (chronic sinusitis survey and 20-Item Sinonasal Outcome Test [SNOT-20]), and staging on computer tomography (CT). It consisted of a prospective cohort study of all consecutive patients undergoing surgery for medically nonresponsive chronic sinusitis, which took place at a tertiary care center. METHODS: Two hundred twenty-one patients completed the Chronic Sinusitis Survey (CSS) questionnaire and the SNOT-20. A visual analog scale (VAS) symptom score was completed also. The average age of the patients was 44.5 years and the male/female ratio was 1.3:1. The symptom scores of all three questionnaires were compared with the Lund-MacKay CT scan score of the sinuses. RESULTS: The median Lund-MacKay CT score was 12 (mean +/- SD, 12.7 +/- 5.7). There was no significant correlation between the SNOT-20 questionnaire and the Lund-MacKay CT score (p = 0.026; p = 0.764) and between the CSS and the Lund-MacKay CT score (p = -0.158; p = 0.058). Furthermore, there was no significant correlation between a single VAS symptom score relating to overall sinonasal symptom severity and the Lund-MacKay CT scan score (p = 0.135; p = 0.121). However, a weak but statistically significant correlation was found between the VAS score based on the sum of five sinonasal symptoms and the Lund-MacKay CT scan score (p = 0.197; p = 0.020). CONCLUSION: The score, based on the sum of five sinonasal VAS symptoms, correlates to the disease severity as measured by the Lund-MacKay CT scan score. The SNOT-20 questionnaire and the CSS symptom score do not correlate to the Lund-MacKay CT scan score, although a correlation was found between the CSS score and the Lund-MacKay CT score in various sub-groups of our patient population.

Adolescent↗

[Clinical validity of our new patient satisfaction questionnaire for allergic rhinitis].

Patient satisfaction is recommended as a parameter to evaluate medical care from the aspect of patient. Currently, we developed a new patient satisfaction questionnaire in allergic rhinitis by means of internationally standardized psychometric validation and reliability studies. Using this questionnaire, we evaluated patient satisfaction with Japanese cedar pollinosis in 2004, who visited our own clinic (JAAC) or patients, who were sampled from the list of a health research company (JSR), in addition of literature data. As a result, there were marked differences between ours and others. The purpose of this study is to elucidate whether or not our questionnaire has a good and reliable clinical validity, and, if yes, why there were marked differences in various studies. The satisfaction (very good plus good) was 94.4% in the JAAC group and 41.2% in the JSR group respectively. We compared the mean scores of each item in questionnaire in both groups, and found higher scores in the majority of items in the former group than the latter group in accordance with difference in satisfaction. This suggested a good clinical validity in questionnaire. In nasal treatment modality, the JAAC group was. characterized by continuous use of combined topical steroid with per oral anti-allergic compound and immunotherapy during whole pollen season, when compared with the JSR group. A persistent contact with patients in immunotherapy plays an important role in establishing good doctor-patient relation and treatment outcome, resulting in increased patient satisfaction.

Adult↗