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Psychometric evaluation of the restructured clinical scales of the MMPI-2.

Conceptual overlap and heterogeneity have long been noted as weaknesses of the Minnesota Multiphasic Personality Inventory's clinical scales. Restructured clinical (RC) scales recently were developed to address these concerns (A. Tellegen et al., 2003). The authors evaluated the psychometric properties of the RC scales in psychology clinic clients (N=285) and military veterans (N=567). The RC scales were as internally consistent as the clinical scales and correlated strongly with their original counterparts (except for RC3/Hysteria). They also were less intercorrelated, produced conceptually clearer relations with measures of personality and psychopathology, and yielded somewhat greater incremental utility than the clinical scales. Thus, the RC scales demonstrated several psychometric strengths while utilizing 60% fewer items, but the 2 sets of scales cannot be used interchangeably. Interpretive considerations are discussed.

Adult↗

Not too big, not too small: the appropriate scale.

The tools we use at the human scale, whether mechanical, medical or microelectronic, depend on materials for which some other scale of length or time is critical. Often this is the mesoscale, between the scales of engineering and of atomic science. Linking underlying processes to what we handle is sometimes called 'spanning' (or 'bridging') length scales, giving the impression that the mesoscale is a swamp to be crossed without getting mud on our boots. This is misleading: we do not wish to span the mesoscale, but to work at the appropriate scale, and to connect that to our human needs. The appropriate scale need not rule out multiscale computer modelling, in which some supercode integrates relevant scales in one pass, hoping to combine the best of methods for two or more levels. But the reality for such attempts, too often, is that the worst of both regimes are found. Happily, simpler strategies at a judicious scale will often suffice.

Bone and Bones↗

Validation of a brief, reliable scale to measure knowledge about the health risks associated with obesity.

BACKGROUND: Obesity represents a serious threat to health through its association with conditions such as type 2 diabetes mellitus, coronary heart disease and certain types of cancer. Knowledge regarding risk to health is an important determinant of behaviour and is the focus of many health education strategies. To the authors' knowledge, there is no valid and reliable measure of knowledge regarding the health risks associated with obesity. AIM: To validate a short, reliable psychometric scale measuring knowledge regarding the effects of obesity on health, the Obesity Risk Knowledge (ORK-10) scale. METHODS: The ORK-10 scale was administered to a sample of individuals with no specific obesity-related expertise (n=230) and a sample of experts (n=200). Univariate and multivariate statistical analyses were used to investigate the scale's criterion validity. RESULTS: The ORK-10 scale has good internal consistency (Cronbach's alpha coefficient>0.7) and is acceptable for use in a UK adult population with an estimated reading age of 12-13 years. The scale demonstrated strong criterion validity, as those with educational or vocational expertise in the field of obesity achieved significantly higher scores than nonexperts (median 9.0 vs 4.0, Z=-17.364; P<0.001). This relationship was maintained after controlling for the potentially confounding factors of age and level of education. Nonexperts demonstrated low levels of knowledge regarding the health risks associated with obesity. CONCLUSIONS: The ORK-10 scale meets standard psychometric criteria for reliability and validity. This scale could be used to assess the effectiveness of health education interventions, to target the provision of health information and to investigate the interaction between knowledge and obesity-related behaviour.

Adolescent↗

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.

Activities of Daily Living↗

Comparison between continuous and discrete measurements of breathlessness during exercise in normal subjects using a visual analogue scale.

1. Visual analogue scaling of breathlessness made at discrete intervals during ventilatory stimulation tests can provide useful information about the intensity of this sensation. The aim of the present study was to investigate the use of continuous visual analogue scaling as a means of improving the temporal resolution of this measurement. 2. Six normal naive subjects scaled breathlessness using a visual analogue scale, during steady-state exercise. Further changes in this sensation were induced by either sustained hypercapnia or acute hypoxia; these responses were assessed either continuously or at discrete 30 s intervals and the two scaling methods were compared. 3. The continuous method of assessing breathlessness compared favourably with that of the more established discrete method, providing reproducible measurements in repeated tests equivalent in intensity to those obtained every 30 s. 4. Transient changes in the sensation of breathlessness produced by acute episodes of hypoxia were identified using the continuous scaling method but not with discrete scaling. 5. The continuous method of scaling breathlessness should aid the investigation of the neurophysiological basis of this sensation by allowing temporal relationships between changes in respiratory variables and the sensory consequences to be more carefully defined.

Adult↗

Direct magnitude estimation and interval scaling of stuttering severity.

The appropriateness of direct magnitude estimation and interval scaling for assessing stuttering severity was investigated by determining whether the continuum of the stutterers' judged severity was prothetic or metathetic. As operationally defined by Stevens, prothetic continua show a curvilinear relation between magnitude estimates and interval scale values of the same set of stimuli, whereas metathetic continua show a linear relation between these scale values. The stuttering severity of 20 stutterers was scaled by three groups of 15 listeners who used interval scaling, direct magnitude estimation with standard/modulus, and direct magnitude estimation without standard/modulus. The results indicated that the two sets of direct magnitude estimation scale values were related to the interval scale values in the curvilinear fashion that is typical of prothetic continua. These findings suggest that direct magnitude estimation is preferable to interval scaling for measuring stuttering severity.

Adult↗

Field trial of a haemoglobin colour scale: an effective tool to detect anaemia in preschool children.

The objective of this study was to evaluate the performance of the Haemoglobin Colour Scale, developed by Stott and Lewis, to diagnose anaemia in a primary health care setting where anaemia was prevalent and severe. Three measures of anaemia were compared in 535 preschool children: haemoglobin based on the Haemoglobin Colour Scale, clinical assessment in three sites (conjunctiva, palm and nail bed) and haemoglobin based on a digital haemoglobinometer (HemoCue method) taken as gold standard. A statistically significant correlation (r = 0.80, coefficient = 0.77 and Y intercept = 2.33) was obtained between the results of the Haemoglobin Colour Scale and the HemoCue. In more than 80% of cases, the difference between the colour scale readings and the results of the HemoCue was within 1 g/dl. Of 415 anaemic children (Hb < 11 g/dl by HemoCue), 85.2% were so identified by the Haemoglobin Colour Scale and 19.7% were classified anaemic by clinical pallor. Of 19 severely anaemic children (Hb < 7 g/dl by HemoCue), 73.6% were identified as severely anaemic and 100% were classified as anaemic by the colour scale, 61.1% were classified as anaemic using clinical pallor. We found the Haemoglobin Colour Scale to be a useful tool in identifying anaemic and severely anaemic children. Efficiencies in term of cost, accuracy and time make it an important resource in primary health care settings in developing countries. Further testing with other staff in other settings is recommended to determine the usefulness of large-scale distribution.

Anemia↗

The Canadian Triage and Acuity Scale: A Canadian perspective on emergency department triage.

The Canadian Triage and Acuity Scale has received widespread acceptance in Canada as a reliable and valid tool for emergency department triage. The importance of accurate triage becomes more apparent as emergency department volumes increase, and resources shrink. The need to ensure that those patients requiring more urgent care receive care first is the basis for all triage scales. Through the Canadian Triage and Acuity Scale National Working Group, the scale became the recommended triage tool for Canadian emergency departments. Work has been done on the interrater reliability of Canadian Triage and Acuity Scale among health care providers. There is a need to further assess the validity of the scale. This scale has now been applied in the out of hospital setting by paramedics and is being used in measurements of emergency physician workload. The future may see an electronic triage tool develop for emergency department use to reduce variability in its application. The Canadian Triage and Acuity Scale has become an integral component of Canadian emergency departments.

Canada↗

Pattern recognition of pelvic masses by gray-scale ultrasound imaging: the contribution of Doppler ultrasound.

OBJECTIVE: To determine the extent to which Doppler ultrasound examination contributes to a correct specific diagnosis of a pelvic mass when the preliminary diagnosis is based on subjective evaluation of the gray-scale ultrasound image (pattern recognition). METHODS: In 173 consecutive cases, women scheduled for surgery because of a pelvic mass judged clinically to be of adnexal origin underwent preoperative gray-scale and color Doppler ultrasound examination. On the basis of subjective evaluation of the gray-scale ultrasound image, the ultrasound examiner classified each tumor as probably benign or malignant. If possible, a specific diagnosis was made, e.g. 'endometriosis' or 'dermoid cyst'. The confidence with which the diagnosis was made was rated subjectively on a visual analog scale. The diagnosis based on gray-scale imaging was re-evaluated after color Doppler examination, the diagnostic confidence after Doppler examination also being rated on a visual analog scale. 'Malignancy' was not considered a specific diagnosis. RESULTS: Pattern recognition of the gray-scale ultrasound image resulted in no unequivocal specific diagnosis in 51% (88/173) of cases, a correct specific diagnosis in 42% (72/173) and an incorrect specific diagnosis in 7% (13/173). Doppler examination added to a correct specific diagnosis in only 5% (8/173) of cases, either by changing an incorrect specific diagnosis to a (more) correct one (five tumors), or by increasing the confidence with which a correct specific diagnosis was made (three tumors). Doppler examination was misleading in one tumor. CONCLUSION: By using pattern recognition of the gray-scale ultrasound image, a correct specific diagnosis can be made in almost half of adnexal tumors scheduled for surgery. Subjective assessment of the color content of the tumor scan contributed little to the specific diagnosis of pelvic tumors.

Adolescent↗

The applicability of the Antonovsky Sense of Coherence Scale to a group of Pentecostalists.

A methodological issue concerning the Antonovsky of Sense of Coherence (SOC) scale was raised in an earlier study questioning the applicability of the scale in different populations, and among these the Pentecostalists. The question was raised when a group of Pentecostalists had had difficulties in filling in another scale intended to measure the SOC. Therefore, the aim of this study was to test the applicability of the 29-item Antonovsky SOC scale in a group of people (n = 37) belonging to a church of the Pentecostal Movement and to compare the results with those of a randomized group (n = 145) from a general population. The Pentecostalists filled in the scale with no obvious difficulties. No significant differences were found between the Pentecostal group and the group of a general population regarding the total SOC scale scores (mean 152, SD 16 and mean 151, SD 18, respectively). The applicability difficulties found in the earlier study, however using an other SOC scale, could not be confirmed in the present study. To conclude, the Antonovsky SOC scale has so far not shown to have applicability weakness.

Adult↗

The development of the DEGR(R): A scale to assess pain in young children with cancer.

The Gustave Roussy Child Pain Scale (Douleur Enfant Gustave Roussy, DEGR(R)Scale) is a scale for grading prolonged pain in children aged 2-6 years with cancer. The scale comprised six behaviours specific to pain items, five psychomotor inertia items, and four anxiety items, with a total score ranging from 0 to 60. This work was designed to confirm the scale structure and to study its construct validity and convergent validity.Our work was composed of two parts. In the first part of the study, 152 children with progressive cancer were scored by two nurses using the DEGR(R)scale, in a cross-sectional design. And in the second part, 53 of these 152 children were video-recorded. The tapes were assessed both by a panel of four pain specialists using a 0 to 7 Likert scale and by a nurse using DEGR(R)scale.As for the 152 children, the mean of the total scores derived from the DEGR(R)is 20.2 (SD = 6.2). Both the degree of agreement between the nurses (the weighted kappa coefficient) and the internal consistency of the scale (Cronbach alpha coefficient = 0.90) were high, providing evidence of good reliability. Multivariate factor analyses showed a first factor of intensity of pain (51% of the total variance) and a second factor (14% of the total variance) which distinguishes the psychomotor inertia items from the items concerning voluntary expression of pain. Also, the results showed that psychomotor inertia items contribute to both factors and that it is an important sign of prolonged pain. Construct validity was strengthened by the absence of correlation between DEGR(R)scores and variables not related to pain, including fever, neutropenia and anaemia (indicative of poor medical condition) and the absence of parents' visits (indicative of psychological distress).Concerning the 53 video-recorded children, the nurses' DEGR(R)ratings were strongly correlated with the specialists panel scores indicating a fairly good case for convergent validity. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Journal Article↗

Reliability, validity, and sensitivity to change of the Cochin hand functional disability scale in hand osteoarthritis.

OBJECTIVE: To assess the reliability, validity and sensitivity to change of the Cochin hand functional scale in hand osteoarthritis (OA). BACKGROUND: The Cochin hand functional disability scale has been validated in rheumatoid arthritis. DESIGN: Patients with hand OA according to Altman's criteria were included. Impairment outcome measures (VAS of pain, hand score of tenderness, clinical hand score of impairment, Kallman's radiographic scale), functional disability measures [Cochin scale, Revel's functional index (RFI), Dreiser's functional index (DFI)] and patients' perceived handicap (VAS) were recorded twice, at baseline and at a 6-month follow-up visit. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. Sensitivity to change was assessed using the effect size (ES) and the standardized response mean (SRM), and the non-parametric Spearman rank correlation coefficient (r) was used to assess the correlation between quantitative variable changes and patient's overall opinion. RESULTS: 89 patients (8 males, mean age 63 years) were included. Interobserver reliability was excellent (ICC=0.96). The Bland and Altman method showed no systematic trend. Correlations of the Cochin scale score with RFI (r=0.86), DFI (r=0.87), VAS of handicap (r=0.67), VAS of pain (r=0.54), tenderness (r=0.51), clinical impairment (r=0.32), and Kallman's radiographic scale (r=0.13) indicated a good construct validity. Factor analysis extracted four main factors, accounting for 65% of the total variance. 51 patients were evaluated at the 6-month visit. The Cochin scale score had worsened with SRM and ES values of -0.26 and -0.17 respectively. Changes in the score had one of the highest correlation (r=0.47) with the patient's overall opinion. CONCLUSION: The Cochin hand functional disability scale which was first developed to assess the rheumatoid hand can be used to evaluate functional disability in hand OA.

Adult↗

Reliability and validity of the compliance belief scales among patients with heart failure.

BACKGROUND: Lack of medication and dietary compliance leads to troublesome symptoms and hospitalization in patients with heart failure. Compliance behaviors are influenced by beliefs about the behavior. OBJECTIVE: The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale (BMCS) and the Beliefs about Dietary Compliance Scale (BDCS) among patients with heart failure. THEORETICAL FRAMEWORK: This study's theoretical framework is the Health Belief Model. METHODS: A convenience sample of 234 patients with heart failure completed the BMCS and the BDCS. Patients completed the scales at baseline by face-to-face interviews and at 8 and 52 weeks after baseline by telephone interview. RESULTS: Construct validity of the scales was supported by confirmatory factor analysis. Both the BMCS and the BDCS had benefits and barriers scales with clear factor loadings. The internal consistency reliability estimates of the scales ranged from.63 to.88, with the BMCS having some estimates lower than.70. The test-retest reliability estimates ranged from.07 to.57. The intraclass correlation coefficient estimates were higher between the 8-week and 52-week scores for all scales. Possible reasons for the varying estimates are discussed. CONCLUSIONS: The BMCS and the BDCS have documented reliability and validity. Future work should be directed at evaluating the responsiveness of the scales to changing patient conditions and testing interventions to improve medication and dietary compliance through changing beliefs.

Adult↗

Discrimination of complex patterns: orientation information is integrated across spatial scale; spatial-frequency and contrast information are not.

Real-world objects are complex, containing information at multiple orientations and spatial scales. It is well established that at initial cortical stages of processing, local information about an image is separately represented at multiple spatial scales. However, it is not yet established how these early representations are later integrated across scale to signal useful information about complex stimulus features, such as edges and textures. In the studies reported here, we investigate the scale-integration processes involved in distinguishing among complex patterns. We use a concurrent-response paradigm in which observers simultaneously judge two components of compound gratings that differ widely in spatial frequency. In different experiments, each component takes one of two slightly different values along the dimensions of spatial frequency, contrast, or orientation. Using analyses developed within the framework of a multivariate extension of signal-detection theory, we ask how information about the frequency, contrast, or orientation of the components is or is not integrated across the two grating components. Our techniques permit us to isolate and identify interactions due to excitatory or inhibitory processes from effects due to noise, and to separately assess any attentional limitations that might occur in processing. Results indicate that orientation information is fully integrated across spatial scales within a limited orientation band and that decisions are based entirely on the summed information. Information about spatial frequency and contrast is not summed over spatial scale; cross-scale results show sensory independence. However, our results suggest that observers cannot simultaneously use information about frequency or contrast when it is presented at different spatial scales. Our results provide direct evidence for the existence of a higher-level summing circuit tailored to signal information about orientation. The properties of this mechanism differ substantially from edge-detector mechanisms proposed by Marr and others.

Female↗

Diffusion and scaling during early embryonic pattern formation.

Development of spatial patterns in multicellular organisms depends on gradients in the concentration of signaling molecules that control gene expression. In the Drosophila embryo, Bicoid (Bcd) morphogen controls cell fate along 70% of the anteroposterior axis but is translated from mRNA localized at the anterior pole. Gradients of Bcd and other morphogens are thought to arise through diffusion, but this basic assumption has never been rigorously tested in living embryos. Furthermore, because diffusion sets a relationship between length and time scales, it is hard to see how patterns of gene expression established by diffusion would scale proportionately as egg size changes during evolution. Here, we show that the motion of inert molecules through the embryo is well described by the diffusion equation on the relevant length and time scales, and that effective diffusion constants are essentially the same in closely related dipteran species with embryos of very different size. Nonetheless, patterns of gene expression in these different species scale with egg length. We show that this scaling can be traced back to scaling of the Bcd gradient itself. Our results, together with constraints imposed by the time scales of development, suggest that the mechanism for scaling is a species-specific adaptation of the Bcd lifetime.

Animals↗

Identification of a 41 kDa protein embedded in the biosilica of scales and bristles isolated from Mallomonas splendens (Synurophyceae, Ochrophyta).

Cells of the photosynthetic protist Mallomonas splendens (Synurophyceae, Ochrophyta) are encased within a highly patterned wall or scale case that consists of silicified scales and bristles. In an effort to understand the mechanisms that unicellular protists utilize to produce elaborate, mineralized structures of great complexity and hierarchical structure, we identified and characterized a 41 kDa protein from purified scales/bristles isolated from M. splendens (SP41 for Scale Protein of 41 kDa). A cDNA encoding this protein was isolated and sequence analysis indicated that it is a novel protein. Polyclonal antibodies were generated against bacterially expressed SP41 and used to localize the protein throughout scale and bristle morphogenesis. Immunoelectron microscopy confirmed the biochemical data that SP41 is a component of mature scales and bristles, the protein localizing to silicified components of the purified extracellular matrix. During scale and bristle biogenesis within the cell, SP41 is deposited into a specialized Silica Deposition Vesicle (SDV) concomitant with silica deposition, a highly regulated event during scale and bristle formation. These results argue for SP41 playing a role in morphogenesis and/or silicification within the SDV during scale and bristle biogenesis.

Amino Acid Sequence↗

The hypnosis scales at their centenary: some fundamental issues still unresolved.

Current approaches to the measurement of hypnotic performance can be traced back to the 19th century. In part because of these early origins and in part because of the nature of hypnotic phenomena, the hypnosis scales are unique psychometric instruments. The classic hypnosis scales are based on the notion of a "performance ladder"; items are scored on a pass/fail basis and can be arranged in increasing order of difficulty. Some of the implications on this "performance ladder" approach are reviewed. The evidence for two-mechanism models of hypnotic performance is reviewed. It is argued that this kind of formulation is at least as plausible as one that argues that the hypnosis scales measure "one thing" or "mostly one thing." If it were the case that the hypnosis scales were tapping two different and distinct processes, the label "hypnotic susceptibility" could not be unambiguously applied to scores on the hypnosis scales. The hypnosis scales would appear well-suited to the investigation of underlying mechanisms, yet no consistent picture of the mechanisms underlying hypnotic performance on the scales has emerged thus far. No resolution is presented, but some of the reasons why such a resolution is so elusive are discussed. The future of hypnosis scales is discussed with respect to multidimensional assessment and alternatives to the "work sample" approach.

Humans↗

External validity of the new Devereux Adolescent Behavior Rating scales.

The discriminant and concurrent validity of the five new scales for the Devereux Adolescent Behavior Rating Scale (DAB) was explored using a heterogeneous sample of psychiatric and substance abuse patients. Consistent with predictions, the substance abuse patients scored higher on the Acting Out Behaviors (AOB) and Heterosexual Interests (HI) scales, and psychiatric patients scored higher on the Psychotic Behaviors scale. Gender differences also were found, including boys being rated higher on Acting Out Behaviors, and girls higher on Heterosexual Interests. The new DAB scales demonstrated sufficient concurrent validity using a thorough record review and a patient rating scale (the Child Behavior Checklist [CBCL]). The Neurotic/Dependent Behaviors scale (NDB) showed a consistent relationship with substance abuse and several other measures of more externalizing behaviors, in addition to the predicted relationships with anxious, tense, and dependent behaviors. The Withdrawn/Timid Behaviors scale (WTB) proved to be a purer measure of internalizing behaviors in both sexes.

Acting Out↗