There is little evidence for the measurement properties of instruments commonly used for women with pelvic girdle pain.
The aim of this study was to examine the internal consistency, test-retest reliability, and construct validity of instruments used for women with pelvic girdle pain.
This was a cross-sectional methodology study, including test-retest reliability assessment.
Women with pelvic girdle pain in pregnancy and after delivery participated in a postal survey that included the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODI), Disability Rating Index (DRI), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and 8-item version of the Medical
Study 36-Item Short-Form Health Survey questionnaire (SF-36). Test-retest reliability was assessed with a random subsample 1 week later. Internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity based on hypotheses was assessed by correlation analysis. Discriminant validity was assessed with the area under the receiver operating characteristic curve.
All participants responded to the main (N=87) and test-retest (n=42) surveys. Cronbach alpha values ranged from .88 to .94, and ICCs ranged from .78 to .94. The MDC at the individual level constituted about 7% to 14% of total scores for the 8-item version of the SF-36, ODI, and PGQ activity subscale; about 18% to 22% for the DRI, PGQ symptom subscale, and PCS; and about 25% for the FABQ. Hypotheses were mostly confirmed by correlations between the instruments. The PGQ was the only instrument that significantly discriminated participants who were pregnant from participants who were not pregnant as well as pain locations.
A comparison of responsiveness to change of the various instruments used in this study was not undertaken, but will be carried out in a future study.
Self-report instruments for assessing health showed good internal consistency, test-retest reliability, and construct validity for women with pelvic girdle pain. The PGQ was the only instrument with satisfactory discriminant validity, thus, it is recommended for evaluating symptoms and disability in patients with pelvic girdle pain.
To evaluate the reliability and validity of the improved version of the Patient Generated Index (PGI) in patients with low back pain.
The PGI was administered to 90 patients attending care in 1 of 6 institutions in Norway and evaluated for reliability and validity. The questionnaire was given out to 61 patients for re-test purposes.
The PGI was completed correctly by 80 (88.9%) patients and, of the 61 patients responding to the re-test, 50 (82.0%) completed both surveys correctly. PGI scores were approximately normally distributed, with a median of 40 (range 80), where 100 is the best possible quality of life. There were no floor or ceiling effects. The 5 most frequently listed areas affecting quality of life were pain, sleep, stiffness, socializing and housework. The test-retest intraclass correlation coefficient was 0.73. The smallest detectable changes for individual and group purposes were 32.8 and 4.6, respectively. The correlations between PGI scores and other instrument scores followed a priori hypotheses of low to moderate correlations.
The PGI has evidence for reliability and validity in Norwegian patients with low back pain at the group level and may be considered for application in intervention studies when a comprehensive evaluation of quality of life is important. However, the smallest detectable change, of approximately 30 points, may be considered too large for individual purposes in clinical applications.
Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and University of Oslo, Building 37B, Nydalen, Box 4956, 0424 Oslo, Norway. Kjersti.Storheim@oslo-universitetssykehus.no
The Core Outcome Measures Index (COMI) is a short multidimensional scale covering all domains recommended to be included as outcome measures for patients with low back pain (LBP). The purpose of the present study was to translate and cross-culturally adapt the COMI into Norwegian and to test clinimetric properties of the Norwegian COMI version in patients with non-specific LBP recruited from various clinical settings.
Ninety patients with non-specific LBP from primary care and hospital settings participated in the validation part and 61 also in the reproducibility part of the study (1 week apart). Acceptability, data quality, reproducibility and construct validity were investigated.
The questionnaire was well accepted and with little missing data and end effects. Reliability in terms of intraclass correlations (ICC) was satisfactory for the COMI index [0.89 (95 % CI 0.82-0.94)] and most single-core items. Agreement was acceptable for the COMI index [standard error of measurement (SEM(agreement)) 0.80, minimal detectable change (MDC(individual)) 2.21], but exceeded the minimal standard of acceptability in some of the individual core items. Construct validity was acceptable for the COMI index.
The Norwegian version of the COMI index shows acceptable clinimetric properties in our patient population, but some of the sub-items had shortcomings. Our study, however, support the usefulness of the COMI index as an applicable stand-alone global scale when a light respondent burden is advisable.
Cites: Spine (Phila Pa 1976). 2000 Dec 15;25(24):3100-311124724
Cites: Eur Spine J. 2012 Aug;21 Suppl 6:S737-4921409562
Cites: Spine (Phila Pa 1976). 2000 Dec 15;25(24):3125-911124728
Cites: Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-9111124735
Cites: Arch Phys Med Rehabil. 2000 Dec;81(12 Suppl 2):S15-2011128900
Cites: Phys Ther. 2002 Jan;82(1):8-2411784274
Cites: Behav Sci. 1974 Jan;19(1):1-154808738
Cites: Health Policy. 1990 Dec;16(3):199-20810109801
Cites: Spine (Phila Pa 1976). 1998 Sep 15;23(18):2003-139779535
Cites: Spine (Phila Pa 1976). 2004 Sep 1;29(17):1923-3015534418
Cites: Spine (Phila Pa 1976). 2005 Jan 1;30(1):130-4015626993
Cites: Eur Spine J. 2005 Dec;14(10):1014-2615937673
Cites: BMC Med Res Methodol. 2006;6:516504090
Cites: Spine (Phila Pa 1976). 2006 May 20;31(12):1372-9; discussion 138016721302
To compare the predictive ability of the Orebro Musculoskeletal Pain Questionnaire-a screening tool for psychosocial factors in patients with low back pain across 2 cultural settings (Norway and Australasia) and to establish whether the Orebro provides additional information about outcome than that provided by the baseline value of the prognostic outcome.
Prospective cohort studies with 12 month follow-up; 97 working patients were seeking primary care in Norway and 133 working individuals participated in a trial conducted in Australasia. A series of multiple regression analyses were conducted with pain and disability as outcomes, and the Orebro score and baseline values of the outcome as predictors.
The predictive ability of the Orebro was similar in Norway and Australasia in all the analyses except for disability at 12 months, in which the predictive ability was significantly stronger in Norway as compared to Australasia (P=0.011). The Orebro provided additional information about outcome than that provided by the baseline value of the prognostic outcome: for pain the R-square changes were from 2.4% to 4.0% with no statistically difference between the nationalities. For disability the R-square changes in the Australasian cohort ranged from 1.9% to 4.8% and in the Norwegian cohort from 4.5% to 6.5%.
The Orebro questionnaire had similar predictive ability in Norway and Australasia when pain was used as an outcome, whereas the Orebro tended to be a stronger predictor in Norway when disability was used as outcome.
Pain catastrophizing has been found to be an important predictor of disability and days lost from work in patients with low back pain. The most commonly used outcome measure to identify pain catastrophizing is the Pain Catastrophizing Scale (PCS). To enable the use of the PCS in clinical settings and research in Norwegian speaking patients, the PCS had to be translated. The purpose of this study was therefore to translate and cross-culturally adapt the PCS into Norwegian and to test internal consistency, construct validity and reproducibility of the PCS.
The PCS was translated before it was tested for psychometric properties. Patients with subacute or chronic non-specific low back pain aged 18?years or more were recruited from primary and secondary care. Validity of the PCS was assessed by evaluating data quality (missing, floor and ceiling effects), principal components analysis, internal consistency (Cronbach's alpha), and construct validity (Spearman's rho). Reproducibility analyses included standard error of measurement, minimum detectable change, limits of agreement, and intraclass correlation coefficients.
A total of 38 men and 52 women (n?=?90), with a mean (SD) age of 47.6 (11.7) years, were included for baseline testing. A subgroup of 61 patients was included for test-retest assessments. The Norwegian PCS was easy-to-comprehend. The principal components analysis supported a three-factor structure, internal consistency was satisfactory for the PCS total score (a 0.90) and the subscales rumination (a 0.83) and helplessness (a 0.86), but not for the subscale magnification (a 0.53). In total, 86% of the correlation analyses were in accordance with predefined hypothesis. The reliability analyses showed intraclass correlation coefficients of 0.74?-?0.87 for the PCS total score and subscales. The PCS total score (range 0-52 points) showed a standard error of measurement of 4.6 points and a 95% minimum detectable change estimate of 12.8 points.
The Norwegian PCS total score showed acceptable psychometric properties in terms of comprehensibility, consistency, construct validity, and reproducibility when applied to patients with subacute or chronic LBP from different clinical settings. Our study support the use of the PCS total score for clinical or research purposes identifying or evaluating pain catastrophizing.
To evaluate reliability, validity and responsiveness of the Fear-Avoidance Beliefs Questionnaire (FABQ) for use in Norwegian patients with low back pain.
A prospective cohort study with 2 groups.
The questionnaire was tested in 123 patients with acute low back pain and 50 patients with chronic low back pain.
A translation and cross-cultural adaptation was performed. Test-retest reliability was assessed in 28 patients with chronic low back pain. Responsiveness was assessed in acute low back pain.
Two factors for the FABQ were confirmed; fear-avoidance beliefs about work (FABQ-Work) and physical activity (FABQ-PA), accounting for 60% and 54% of the total variance in acute and chronic low back pain, respectively. For FABQ-Work and FABQ-PA internal consistency was 0.90 and 0.79, intra-class correlation coefficients 0.82 and 0.66, minimal detectable changes 12 and 9 points, and coefficients of variation were 16% and 23%. The FABQ correlated weakly to moderately with pain, disability, distress, and clinical variables. Standardized response means were low for FABQ-Work (0.32) and moderate (0.56) for FABQ-PA. Both FABQ subscales showed initially floor and/or ceiling effects.
The Norwegian FABQ version had acceptable factor structure, internal consistency, test-retest reliability and construct validity. The responsiveness of the FABQ-Work was low, and for the FABQ-PA moderate, in the acute sample.
To develop and test a new instrument for patient self-reported quality of osteoarthritis (OA) care, and to provide quality indicator (QI) pass rates in a Norwegian OA cohort.
The OsteoArthritis Quality Indicator (OA-QI) questionnaire was developed using published QIs, expert panels, and patient interviews. Self-reported data were collected from 359 persons in a Norwegian OA cohort, and test-retest reliability and validity were assessed. Separate QI pass rates and summary QI pass rates were calculated.
The 17-item questionnaire includes QIs related to patient education and information, regular provider assessments, referrals, and pharmacologic treatment. The patient self-reported questionnaire was completed with minimal respondent burden. Support for content validity was confirmed by 2 patient research partners and 2 expert panels. All 10 predefined hypotheses relating to construct validity were confirmed. Test-retest kappa coefficients ranged from 0.20-0.80 and the percentage of exact agreement ranged from 62-90%. The mean pass rate for individual QIs was 31% (range 5-49%). The median summary QI pass rate was 27% (interquartile range 12-50%), with lower summary pass rates for nonpharmacologic compared to pharmacologic treatments.
To our knowledge, this is the first instrument developed to measure patient-reported QI pass rates for OA care. This study indicates that the OA-QI questionnaire is acceptable to persons with OA, and its short format makes it suitable for population surveys. The low patient self-reported QI pass rates in this study suggest a potential for quality improvement in OA care.
In rehabilitation, treatment is individually tailored to each patient's goals. Individualized instruments allow patients to choose domains that they consider important, which may make them particularly appropriate as evaluative tools in this setting. We aimed to evaluate the psychometric properties of the Norwegian version of the patient generated index (PGI) in patients with rheumatic diseases participating in inpatient rehabilitation or self-management programmes.
Patients completed the PGI together with other outcome measures at arrival and 5 and 52 weeks after arrival. The PGI was assessed for data quality by completion rates, reliability by the intraclass correlation coefficient (ICC), agreement by standard error of measurement (SEM) and smallest detectable change (SDC). Construct validity was assessed by testing a priori hypotheses regarding correlation between PGI scores and other outcome measures. Responsiveness was assessed by an a priori hypothesis regarding the correlation of different change scores and standardized response means (SRMs).
A total of 145 patients participated and 118 (81%) completed the PGI correctly. The ICC was 0.87, SEM 7.25 and SDC 20.10. Ninety-three per cent of the hypotheses of correlation were confirmed in tests for construct validity. Responsiveness was confirmed in 53% and 71% of hypotheses tested at 5 and 52 weeks. SRMs were 0.2 and 0.4, respectively.
The results support the validity, reliability and responsiveness of the Norwegian version of the PGI in patients with rheumatic diseases and its application as an outcome measure in rehabilitation or self-management programmes. Further research is needed to improve completion rates for the PGI.