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1.  Validity of the SF-12 for Use in a Low-Income African American Community-Based Research Initiative (REACH 2010) 
Preventing Chronic Disease  2008;5(2):A44.
The objective of our study was to assess the psychometric properties of the Medical Outcomes Study's 12-Item Short Form Survey Instrument (SF-12) for use in a low-income African American community. The SF-12, a commonly used functional health status assessment, was developed based on responses of an ethnically homogeneous sample of whites. Our assessment addressed the appropriateness of the instrument for establishing baseline indicators for mental and physical health status as part of Nashville, Tennessee's, Racial and Ethnic Approaches to Community Health (REACH) 2010 initiative, a community-based participatory research study.
A cross-sectional random residential sample of 1721 African Americans responded to a telephone survey that included the SF-12 survey items and other indicators of mental and physical health status. The SF-12 was assessed by examining item-level characteristics, estimates of scale reliability (internal consistency), and construct validity.
Construct validity assessed by the method of extreme groups determined that SF-12 summary scores varied for individuals who differed in self-reported medical conditions. Convergent and discriminate validity assessed by multitrait analysis yielded satisfactory coefficients. Concurrent validity was also shown to be satisfactory, assessed by correlating SF-12 summary scores with independent measures of physical and mental health status.
The SF-12 appears to be a valid measure for assessing health status of low-income African Americans.
PMCID: PMC2396981  PMID: 18341779
2.  Development of the Computer-Adaptive Version of the Late-Life Function and Disability Instrument 
Having psychometrically strong disability measures that minimize response burden is important in assessing of older adults.
Using the original 48 items from the Late-Life Function and Disability Instrument and newly developed items, a 158-item Activity Limitation and a 62-item Participation Restriction item pool were developed. The item pools were administered to a convenience sample of 520 community-dwelling adults 60 years or older. Confirmatory factor analysis and item response theory were employed to identify content structure, calibrate items, and build the computer-adaptive testings (CATs). We evaluated real-data simulations of 10-item CAT subscales. We collected data from 102 older adults to validate the 10-item CATs against the Veteran’s Short Form-36 and assessed test–retest reliability in a subsample of 57 subjects.
Confirmatory factor analysis revealed a bifactor structure, and multi-dimensional item response theory was used to calibrate an overall Activity Limitation Scale (141 items) and an overall Participation Restriction Scale (55 items). Fit statistics were acceptable (Activity Limitation: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.03; Participation Restriction: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.05). Correlation of 10-item CATs with full item banks were substantial (Activity Limitation: r = .90; Participation Restriction: r = .95). Test–retest reliability estimates were high (Activity Limitation: r = .85; Participation Restriction r = .80). Strength and pattern of correlations with Veteran’s Short Form-36 subscales were as hypothesized. Each CAT, on average, took 3.56 minutes to administer.
The Late-Life Function and Disability Instrument CATs demonstrated strong reliability, validity, accuracy, and precision. The Late-Life Function and Disability Instrument CAT can achieve psychometrically sound disability assessment in older persons while reducing respondent burden. Further research is needed to assess their ability to measure change in older adults.
PMCID: PMC3670156  PMID: 22546960
Function; Disability; Computer-adaptive testing; Activity; Participation
3.  Influence of Sport Participation on Community Integration and Quality of Life: A Comparison Between Sport Participants and Non-Sport Participants With Spinal Cord Injury 
To determine whether community integration and/or quality of life (QoL) among people living with chronic spinal cord injury (SCI) are superior among sport participants vs non-sport participants.
Study Design:
Cross-sectional study.
Persons (n = 90) living in the community with SCI (ASIA Impairment Scale A–D), level C5 or below, > 15 years of age, ≥ 12 months postinjury, and requiring a wheelchair for > 1 hours/day were divided into 2 groups based on their self-reported sport participation at interview: sport participants (n = 45) and non-sport participants (n = 45).
Independent-sample t tests revealed that both Community Integration Questionnaire (CIQ) and Reintegration to Normal Living Index (RNL) total mean scores were higher among sport participants vs non-sport participants (P < 0.05). Significant correlation between CIQ and RNL total scores was found for all participants (Pearson correlation coefficients, P < 0.01). Logistic regression analysis revealed that the unadjusted odds ratio of a high CIQ mean score was 4.75 (95% CI 1.7, 13.5) among current sport participants. Similarly, the unadjusted odds ratio of a high RNL score was 7.00 (95% CI 2.3, 21.0) among current sport participants. Regression-adjusted odds ratios of high CIQ and high RNL scores were 1.36 (95% CI 0.09, 1.45) and 0.15 (95% CI 0.04, 0.55), respectively. The odds ratio for pre-SCI sport participation predicting post-SCI sport participation was 3.06 (95% CI 1.23, 7.65).
CIQ and QoL scores were higher among sport participants compared to non-sport participants. There was an association between mean CIQ and RNL scores for both groups. Sport participants were 4.75 and 7.00 times as likely to have high CIQ and QoL scores. Both groups had a similar likelihood of high CIQ and RNL scores after adjusting for important confounders. Individuals who participated in sports prior to SCI were more likely to participate in sports post-SCI.
PMCID: PMC2678282  PMID: 19569458
Spinal cord injuries; Tetraplegia; Paraplegia; Disability; Sport participation; Wheelchair sports; Community reintegration; Quality of life
4.  Validity and Reliability of MOS Short Form Health Survey (SF-36) for Use in India 
Health is defined as the state of complete physical, mental and social well-being than just the absence of disease or infirmity. In order to measure health in the community, a reliable and validated instrument is required.
To adapt and translate the Medical Outcomes Study Short-Form Health Survey (SF-36) for use in India, to study its validity and reliability and to explore its higher order factor structure.
Materials and Methods:
Face-to-face interviews were conducted in 184 adult subjects by two trained interviewers. Statistical analyses for establishing item-level validity, scale-level validity and reliability and tests of known group comparison were performed. The higher order factor structure was investigated using principal component analysis with varimax rotation.
The questionnaire was well understood by the respondents. Item-level validity was established using tests of item internal consistency, equality of item-scale correlations and item-discriminant validity. Tests of scale-level validity and reliability performed well as all the scales met the required internal consistency criteria. Tests of known group comparison discriminated well across groups differing in socio-demographic and clinical variables. The higher order factor structure was found to comprise of two factors, with factor loadings being similar to those observed in other Asian countries.
The item-and scale-level statistical analyses supported the validity and reliability of SF-36 for use in India.
PMCID: PMC3612292  PMID: 23559699
Health surveys; reliability; questionnaires; quality of life; translations; validity
5.  Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M) 
Physiotherapy Canada  2011;63(2):199-208.
Purpose: To further investigate the construct validity of the Community Balance and Mobility Scale (CB&M), developed for ambulatory individuals with traumatic brain injury (TBI).
Methods: A convenience sample of 35 patients with TBI (13 in-patients, 22 outpatients) was recruited. Analyses included a comparison of CB&M and Berg Balance Scale (BBS) admission and change scores and associations between the CB&M and measures of postural sway, gait, and dynamic stability; the Community Integration Questionnaire (CIQ); and the Activities-specific Balance Confidence (ABC) Scale.
Results: Mean admission scores on the BBS and the CB&M were 53.6/56 (SD=4.3) and 57.8/96 (SD=23.3) respectively. Significant correlations were demonstrated between the CB&M and spatiotemporal measures of gait, including walking velocity, step length, step width, and step time; measures of dynamic stability, including variability in step length and step time; and the ABC (p<0.05). Significant correlations between the CB&M and CIQ were revealed with a larger data set (n=47 outpatients) combined from previous phases of research.
Conclusions: In patients with TBI, the CB&M is less susceptible to a ceiling effect than the BBS. The construct validity of the CB&M was supported, demonstrating associations with laboratory measures of dynamic stability, measures of community integration, and balance confidence.
PMCID: PMC3076901  PMID: 22379260
balance; brain injuries; posture; mobility limitations; outcome assessment; équilibre; évaluation des résultats; limites à la mobilité; posture; traumatisme crânien
6.  Development and validation of a Greek language version of the Manchester Foot Pain and Disability Index 
The Manchester Foot Pain and Disability Index (MFPDI) is a 19 item questionnaire used to assess the severity and impact of foot pain. The aim of this study was to develop a Greek-language version of the MFPDI and to assess the instrument's psychometric properties.
The MFPDI was translated into Greek by three bilingual content experts and two bilingual language experts, and then back-translated into English to assess for equivalence. The final Greek version was administered, along with a questionnaire consisting medical history and the Medical Outcomes Study Short Form 36 (SF-36), to 104 Greek-speaking, community-dwelling people (64 female, 40 male), aged between 64 and 90 years (mean 73.00, SD 5.26) with disabling foot pain.
The Greek translation of the MFPDI was found to have high internal consistency (Cronbach's α= 0.89, and item-total correlation coefficients from 0.33 to 0.72). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern with appearance and activity restriction, which explained 60.8% of the variance, with 38.9% of the variance explained by the first construct (functional limitation). Six items demonstrated different factor loadings to the original English version.
The Greek-language version of the MFPDI appears to be a valid tool in assessing foot pain in Greek-speaking older people. The total MFPDI scores are comparable between the Greek and English version, however due to differences in the factor loadings of some items, between-language comparisons of MFPDI should be undertaken with some caution.
PMCID: PMC2430552  PMID: 18513444
7.  Validation of the German version of the Neck Disability Index (NDI) 
The Neck Disability Index (NDI) is the most commonly used outcome measure for neck pain. This study aimed to determine the psychometric properties of a German version of the NDI. Cross-cultural translation and psychometric testing of the NDI were performed.
The 10-item NDI was translated into German and administered to 558 patients with chronic unspecific neck pain (Mean age 49.9 ± 11.4 years, 76% female). The factor structure and reliability of the NDI were assessed using factor analysis, Cronbach’s alpha, split-half reliability (Spearman-Brown coefficient), and intra-class correlation (ICC2,1). To determine convergent validity, pain intensity (visual analog scale; VAS), pain on movement (VAS), and quality of life (Short Form 36 Health Survey Questionnaire; SF-36) were correlated with the NDI. Correlation with range of motion and sensitivity to change were also assessed in a subsample of 49 patients.
The mean NDI score was 32.75 ± 13.09. Factor analysis revealed a single factor that explained 39.8% of the variance. Cronbach’s alpha was 0.81; Spearman-Brown coefficient was 0.80; and intra-class correlation was 0.81 (95% confidence interval = 0.78, 0.83). Significant correlations were found for pain intensity (r = 0.22, p < 0.01), pain on movement (r = 0.39, p < 0.01), quality of life (r = -0.30 to -0.45, p < 0.01), and range of motion (r = -0.34, p = 0.02). Patients who reported global improvement of health after an exercise or yoga intervention showed a higher decrease on the NDI than patients who reported no global improvement (p < 0.01).
The German version of the NDI has a comparable factor structure as the original version, acceptable psychometric properties, and is sensitive to change after physical activity. Neck disability is associated with other measures of neck pain.
PMCID: PMC3999938  PMID: 24642209
Neck pain; Chronic pain; Disability; Neck disability index; Translation; German; Validity; Reliability; Factor structure; Sensitivity to change
8.  Differences in Activity Limitation Between 2 Low Back Pain Subgroups Based on the Movement System Impairment Model 
To examine if activity limitation differs between 2 low back pain (LBP) subgroups in the Movement System Impairment (MSI) model.
Cross-sectional observational study.
University medical center musculoskeletal analysis laboratory.
Convenience sample of 83 subjects with chronic LBP who were subgrouped as rotation (Rot) or rotation with extension (RotExt) according to the MSI model.
Not applicable.
Main Outcome Measurements
Subjects completed the modified Oswestry Low Back Pain Disability Questionnaire and the physical function subscale of the 36-Item Short-Form Health survey (SF-36 PFS) to assess activity limitation. Subjects also completed baseline measures related to demographics, LBP history, pain intensity, habitual activity level, general health status, and fear-avoidance behavior. Independent-samples t-tests, χ2 tests of independence, and 2-way analysis of variance tests were used to analyze the data.
Subjects in the Rot subgroup reported greater activity limitation on the modified Oswestry Questionnaire (P = .02) and SF-36 PFS (P = .03) than subjects in the RotExt subgroup. No other differences between LBP subgroups were significant (P > .05), except gender. More women (71%) than men (29%) were in the RotExt subgroup (P = .03). However, there was no main effect of gender and no interaction effect of gender and LBP subgroup on the modified Oswestry Questionnaire or the SF-36 PFS (P > .05).
These results support that the Rot and RotExt LBP subgroups based on the MSI model differ with regard to variables that index activity limitation, with the Rot subgroup reporting greater limitation on both activity limitation measures. These differences are not the result of differences in other baseline measures.
PMCID: PMC3628674  PMID: 21145523
9.  Prior Depression History and Deterioration of Physical Health in Community-Dwelling Older Adults – a Prospective Cohort Study 
Depression worsens outcomes of physical illness. However, it is unknown whether this negative effect persists after depressive symptoms remit in older adults. This study examined whether prior depression history predicts deterioration of physical health in community-dwelling older adults.
Prospective cohort study
Three urban communities in the United States
351 adults aged 60 or older – 145 with a history of major or non-major depression in full remission and 206 concurrent age- and gender-matched comparison subjects with no history of mental illness.
Participants were assessed at baseline, 6 weeks, 1 year and 2 years for physical health functioning (the Physical Component Summary of the 36-Item Short-Form Health Survey) and chronic medical burden (the Chronic Disease Score). Given the repeated nature of measurements, linear mixed model regression was performed.
Both physical functioning and chronic medical burden deteriorated more rapidly over time in the group with prior depression history compared to comparison subjects, and these changes were independent of the measures of mental health functioning, depressive symptoms and sleep quality. Similar results were observed when those who developed depressive episodes during follow-up were excluded.
A prior history of clinical depression is associated with a faster deterioration of physical health in community-dwelling older adults, which is not explained by current levels of depressive symptoms and mental health functioning, nor by recurrence of depressive episodes. Careful screening for a past history of depression may identify those older adults at greatest risk for physical declines and chronic medical burden.
PMCID: PMC2860010  PMID: 20220581
prior depression history; physical health; older adults
10.  Systematic investigation of gastrointestinal diseases in China (SILC): validation of survey methodology 
BMC Gastroenterology  2009;9:86.
Symptom-based surveys suggest that the prevalence of gastrointestinal diseases is lower in China than in Western countries. The aim of this study was to validate a methodology for the epidemiological investigation of gastrointestinal symptoms and endoscopic findings in China.
A randomized, stratified, multi-stage sampling methodology was used to select 18 000 adults aged 18-80 years from Shanghai, Beijing, Xi'an, Wuhan and Guangzhou. Participants from Shanghai were invited to provide blood samples and undergo upper gastrointestinal endoscopy. All participants completed Chinese versions of the Reflux Disease Questionnaire (RDQ) and the modified Rome II questionnaire; 20% were also invited to complete the 36-item Short Form Health Survey (SF-36) and Epworth Sleepiness Scale (ESS). The psychometric properties of the questionnaires were evaluated statistically.
The study was completed by 16 091 individuals (response rate: 89.4%), with 3219 (89.4% of those invited) completing the SF-36 and ESS. All 3153 participants in Shanghai provided blood samples and 1030 (32.7%) underwent endoscopy. Cronbach's alpha coefficients were 0.89, 0.89, 0.80 and 0.91, respectively, for the RDQ, modified Rome II questionnaire, ESS and SF-36, supporting internal consistency. Factor analysis supported construct validity of all questionnaire dimensions except SF-36 psychosocial dimensions.
This population-based study has great potential to characterize the relationship between gastrointestinal symptoms and endoscopic findings in China.
PMCID: PMC2788573  PMID: 19925662
11.  The 36-Item Short Form Health Survey: Reliability and Validity in Chinese Medical Students 
Objective: The 36-Item Short Form Health Survey (SF-36) is widely validated and popularly used in assessing the subjective quality of life (QOL) of patients and the general public. The aim of the study is to assess the psychometric properties of the 36-Item Short Form Health Survey (SF-36) in medical students in mainland of China.
Methods: The reliability and validity of the 36-Item Short Form Health Survey (SF-36) questionnaire were assessed by conducting a cross-sectional study of Chinese medical students in December 2011. All 1358 3rd year and 4th year medical students from 46 classes at China Medical University were investigated.
Results: The overall Cronbach's α coefficient of the SF-36 questionnaire was 0.791, while the respective Cronbach's α coefficients for each of the seven dimensions were > 0.70, except where the social function dimension was 0.631. Results showed that the SF-36 questionnaire was reliable and valid.
Conclusion: In general, this study provides evidence that the SF-36 questionnaire is suitable measures for assess the QOL of medical students in China.
PMCID: PMC3444972  PMID: 22991490
Medical student; Quality of life; The 36-item short form health survey (SF-36); Reliability; Validity.
12.  Development and Psychometric Evaluation of the Reasons for Living—Older Adults Scale: A Suicide Risk Assessment Inventory 
The Gerontologist  2009;49(6):736-745.
Purpose: The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale—Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide. Design and Methods: Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in one's life, and current mental status and physical functioning. Results: Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach's alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior. Implications: These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.
PMCID: PMC2782323  PMID: 19546114
Suicide; Reasons for living; Suicide risk; Resilience
13.  Construct domain analysis of patient health-related quality of life: physical and mental trajectory profiles following open versus endovascular repair of abdominal aortic aneurysm 
Many clinical trials comparing the outcomes of open surgical repair (OSR) versus endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) have been conducted, with varying results. Surprisingly, few outcomes studies have closely examined perceived physical and mental health-related quality of life (HRQOL) factors through a validated survey tool. The purpose of this prospective observational study was to describe the trajectory of HRQOL measures, from baseline to 1 year after surgery, in patients undergoing OSR or EVAR for AAA, and to explore for differences in physical and mental composite scores and their construct domains (subscales) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36®) tool.
Patients and methods
Over an 18-month period, a small sample of patients undergoing elective AAA repair in a community hospital setting were prospectively enrolled. Fifteen patients undergoing OSR and twenty patients undergoing EVAR were studied. Physical and mental HRQOL parameters were assessed using the SF-36.
No significant differences in demographic and clinical variables were found between the OSR and EVAR groups. In the multivariable linear models with repeated measures, both groups showed a significant decline in physical health composite scores 30 days after the surgical procedure (P < 0.01). However, although the OSR group showed a statistically significant decline in three of the four physical health domains, the EVAR group declined in only one physical health domain. Only the OSR group showed a significant decline in three of the four mental health domains at 30 days; however, the decline of these domains was not reflected in the group’s mental health composite scores. By 90 days after surgery, both groups were not significantly different from their baseline in physical or mental health composite scores, or in any of their respective physical health domains.
In this small sample of patients undergoing AAA repair, EVAR resulted in less physical and emotional decline than OSR in the early postoperative period. However, patients in both groups may return to near baseline status at 90 days.
PMCID: PMC3536356  PMID: 23300352
AAA; endovascular aneurysm repair (EVAR); open surgical repair (OSR); Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36®); health related quality of life (HRQ)
14.  Psychometric performance of the CAMPHOR and SF-36 in pulmonary hypertension 
The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) and the Medical Outcomes Study Short Form 36 (SF-36) are widely used to assess patient-reported outcome in individuals with pulmonary hypertension (PH). The aim of the study was to compare the psychometric properties of the two measures.
Participants were recruited from specialist PH centres in Australia and New Zealand. Participants completed the CAMPHOR and SF-36 at two time points two weeks apart. The SF-36 is a generic health status questionnaire consisting of 36 items split into 8 sections. The CAMPHOR is a PH-specific measure consisting of 3 scales; symptoms, activity limitations and needs-based QoL. The questionnaires were assessed for distributional properties (floor and ceiling effects), internal consistency (Cronbach's alpha), test-retest reliability and construct validity (scores by World Health Organisation functional classification).
The sample comprised 65 participants (mean (SD) age = 57.2 (14.5) years; n(%) male = 14 (21.5%)). Most of the patients were in WHO class 2 (27.7%) and 3 (61.5%). High ceiling effects were observed for the SF-36 bodily pain, social functioning and role emotional domains. Test-retest reliability was poor for six of the eight SF-36 domains, indicating high levels of random measurement error. Three of the SF-36 domains did not distinguish between WHO classes. In contrast, all CAMPHOR scales exhibited good distributional properties, test retest reliability and distinguished between WHO functional classes.
The CAMPHOR exhibited superior psychometric properties, compared with the SF-36, in the assessment of PH patient-reported outcome.
PMCID: PMC3751055  PMID: 23844640
15.  Correlation of Symptoms to Function in Older Adults with Comorbidity 
To (1) describe the relationship between symptom scores and mobility function measures, (2) assess whether symptom scores and disease scores are similarly associated with mobility function, and (3) identify clusters of symptoms that are most strongly associated with functional status in older adults
Secondary analysis of cross-sectional data from three cohorts
Academic medical center
195 community-dwelling subjects with poor flexibility or cardiorespiratory fitness (fitness cohort), 211 female retirement community residents with vertebral fractures (VF cohort), and 61 subjects with Parkinson's disease (PD cohort)
20-item self-reported symptom scale, 17-item self-reported disease scale, Short Form 36 (SF-36) Physical Functioning Scale, 5-item Nagi Disability scale, 10-meter walk time, supine to stand time
Symptom scores correlated with mobility function measures (Spearman correlation coefficients range from 0.222 to 0.509) at least as strongly as, if not more strongly than did disease scores. Symptom scores remained associated with functional outcomes after controlling for disease score and demographic variables. Adding symptom scores to models that contained disease scores significantly increased the association with functional outcomes. In the fitness cohort, muscle weakness was the most explanatory single symptom, associated with an average decrease of 17.8 points on the Physical Functioning Scale. A model that included only muscle weakness, pain, and shortness of breath accounted for 21.2% of the variability in the Physical Functioning Score.
Symptoms represent useful indicators of disability burden in older adults and are promising targets for interventions to improve function in complex patients.
PMCID: PMC2674624  PMID: 19392960
symptom; function; disability; comorbidity
16.  Reliability and Validity of the Korean Version of the Lifespan Sibling Relationship Scale 
Experimental Neurobiology  2013;22(4):330-336.
The sibling relationship and its potential impact on neurodevelopment and mental health are important areas of neuroscientific research. Validation of the tools assessing the quality of the sibling relationship would be the first essential step for conducting neurobiological and psychosocial studies related to the sibling relationship. However, to the best of our knowledge, no sibling relationship assessment tools have been empirically validated in Korean. We aimed to evaluate the psychometric properties of the Korean version of the Lifespan Sibling Relationship Scale (LSRS), which is one of the most commonly used self-report questionnaires to assess the quality of the sibling relationship. A total of 109 adults completed a series of self-report questionnaires including the LSRS, the mental health subscale of the Medical Outcomes Study-Short Form 36 version 2 (SF36v2), the Satisfaction with Life Scale (SLS), and the Marlowe-Crowne Social Desirability Scale (MC-SDS). The internal consistency, subscale intercorrelations, one-week test-retest reliability, convergent validity, divergent validity, and the construct validity were assessed. All six subscale scores and the total score of the LSRS demonstrated good internal consistency (Cronbach's α=0.85-0.94) and good test-retest reliability (intraclass correlation coefficient=0.77-0.92). Correlations of the LSRS with the SF36v2 mental health score (r=0.32, p=0.01) and with the SLS (r=0.27, p=0.04) supported the good convergent validity. The divergent validity was shown by the non-significant correlation of the LSRS with the MC-SDS (r=0.15, p=0.26). Two factors were extracted through factor analysis, which explained 78.63% of the total variance. The three Adult subscales loaded on the first factor and the three Child subscales loaded on the second factor. Results suggest that the Korean version of the LSRS is a reliable and valid tool for examining the sibling relationship.
PMCID: PMC3897695  PMID: 24465149
sibling relationships; validity; reliability; lifespan sibling relationship scale; psychometrics
17.  Measurement equivalence of the SF-36 in the canadian multicentre osteoporosis study 
Studies that compare health-related quality of life (HRQOL) and other patient-reported outcomes in different populations rest on the assumption that the measure has equivalent psychometric properties across groups. This study examined the measurement equivalence (ME) of the 36-item Medical Outcomes Study Short Form Survey (SF-36), a widely-used measure of HRQOL, by sex and race in a population-based Canadian sample.
SF-36 data were from the Canadian Multicentre Osteoporosis Study, a prospective cohort study that randomly sampled adult men and women from nine sites across Canada. Confirmatory factor analysis (CFA) techniques were used to test hypotheses about four forms of ME, which are based on equality of the factor loadings, variances, covariances, and intercepts. Analyses were conducted for Caucasian and non-Caucasian females (n = 6,539) and males (n = 2,884). CFA results revealed that a measurement model with physical and mental health factors provided a good fit to the data. All forms of ME were satisfied for the study groups.
The results suggest that sex and race do not influence the conceptualization of a general measure of HRQOL in the Canadian population.
PMCID: PMC3325165  PMID: 22414200
SF-36; Health-related quality of life; Psychometrics; Equivalence; Confirmatory factor analysis
18.  Psychometric properties of a questionnaire to assess exercise-related musculoskeletal injuries in older adults attending a community-based fitness facility 
BMJ Open  2012;2(6):e001777.
There currently exists no reliable or validated tool for the assessment of exercise-related injuries in older adults. The purpose was to develop and evaluate the psychometric properties of a questionnaire to measure exercise-related injury in older adults participating in supervised exercise programmes.
The study utilised a repeated survey design.
The study took place at one community-based older-adult exercise facility.
The questionnaire was administered to 110 community-dwelling older adults (45 men, mean age 75±8 years; 65 women, mean age 71±8 years). All participants completed the survey at both time points.
Outcome measures
Test–retest reliability of the self-administered written questionnaire was determined at two-time points. The questionnaire asked participants about their exercise-related injury incurred at the facility in the 12 months. Items included the mechanism, cause and site of injury. The minimum requirement for reliability (κ coefficient) was set at 0.80.
16% (n=18) reported having an injury. Test–retest reliability ranged from 0.76 to 1.00, with all but type of injury (0.76) having κ coefficients greater than 0.80. The lower extremities were the most common site of exercise-related injury. Overexertion movements were the most common cause of injury occurring during strength training exercises.
The present questionnaire assessing the 12-month recall in older adults is a reliable measure of exercise-related injuries and information gained indicates that older adults can safely participate in exercise activities.
PMCID: PMC3533033  PMID: 23180390
Epidemiology; Sports Medicine; Statistics & Research Methods
19.  Cross-sectional validation of the Aging Perceptions Questionnaire: a multidimensional instrument for assessing self-perceptions of aging 
BMC Geriatrics  2007;7:9.
Self-perceptions of aging have been implicated as independent predictors of functional disability and mortality in older adults. In spite of this, research on self-perceptions of aging is limited. One reason for this is the absence of adequate measures. Specifically, there is a need to develop a measure that is theoretically-derived, has good psychometric properties, and is multidimensional in nature. The present research seeks to address this need by adopting the Self-Regulation Model as a framework and using it to develop a comprehensive, multi-dimensional instrument for assessing self-perceptions of aging. This study describes the validation of this newly-developed instrument, the Aging Perceptions Questionnaire (APQ).
Participants were 2,033 randomly selected community-dwelling older (+65 yrs) Irish adults who completed the APQ alongside measures of physical and psychological health. The APQ assesses self-perceptions of aging along eight distinct domains or subscales; seven of these examine views about own aging, these are: timeline chronic, timeline cyclical, consequences positive, consequences negative, control positive, control negative, and emotional representations; the eighth domain is the identity domain and this examines the experience of health-related changes.
Mokken scale analysis showed that the majority of items within the views about aging subscales were strongly scalable. Confirmatory factor analysis also indicated that the model provided a good fit for the data. Overall, subscales had good internal reliabilities. Hierarchical linear regression was conducted to investigate the independent contribution of APQ subscales to physical and psychological health and in doing so determine the construct validity of the APQ. Results showed that self-perceptions of aging were independently related to physical and psychological health. Mediation testing also supported a role for self-perceptions of aging as partial mediators in the relationship between indices of physical functioning and physical and psychological health outcomes.
Findings support the complex and multifaceted nature of the aging experience. The good internal reliability and construct validity of the subscales suggests that the APQ is a promising instrument that can enable a theoretically informed, multidimensional assessment of self-perceptions of aging. The potential role of self-perceptions of aging in facilitating physical and psychological health in later life is also highlighted.
PMCID: PMC1868732  PMID: 17462094
20.  Relationship of Body Mass Index in Young Adulthood and Health-Related Quality of Life Two Decades Later: The Coronary Artery Risk Development in Young Adults (CARDIA) Study 
International journal of obesity (2005)  2010;35(1):10.1038/ijo.2010.120.
The expanding overweight and obesity epidemic notwithstanding, little is known about their long-term effect on health-related quality of life (HRQoL). The main objective of this study was to investigate whether overweight (body mass index [BMI] 25–<30 kg/m2) and obese (BMI ≥ 30 kg/m2) young adults have poorer HRQoL 20 years later.
The authors studied 3014 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal, community-dwelling, biracial cohort from four cities. BMI was measured at baseline and 20 years later. HRQoL was assessed via the physical component summary (PCS) and the mental component summary (MCS) scores of the Medical Outcomes Study 12-Item Short Form Health Survey at year 20. Higher PCS or MCS scores indicate better HRQoL.
Mean year 20 PCS score was 52.2 for normal weight participants at baseline, 50.3 for overweight, and 46.4 for obese (P-trend <0.001). This relation persisted after adjustment for baseline demographics, general health, and physical and behavioral risk factors and after further adjustment for 20-year changes in risk factors. No association was observed for MCS scores (P-trend 0.43).
Overweight and obesity in early adulthood are adversely associated with self-reported physical HRQoL, but not mental HRQoL 20 years later.
PMCID: PMC3875360  PMID: 20548305
21.  In search of parsimony: reliability and validity of the Functional Performance Inventory-Short Form 
The 65-item Functional Performance Inventory (FPI), developed to quantify functional performance in patients with chronic obstructive pulmonary disease (COPD), has been shown to be reliable and valid. The purpose of this study was to create a shorter version of the FPI while preserving the integrity and psychometric properties of the original.
Patients and methods:
Secondary analyses were performed on qualitative and quantitative data used to develop and validate the FPI long form. Seventeen men and women with COPD participated in the qualitative work, while 154 took part in the mail survey; 54 completed 2-week reproducibility assessment, and 40 relatives contributed validation data. Following a systematic process of item reduction, performance properties of the 32-item short form (FPI-SF) were examined.
The FPI-SF was internally consistent (total scale α = 0.93; subscales: 0.76–0.89) and reproducible (r = 0.88; subscales: 0.69–0.86). Validity was maintained, with significant (P < 0.001) correlations between the FPI-SF and the Functional Status Questionnaire (activities of daily living, r = 0.71; instrumental activities of daily living, r = 0.73), Duke Activity Status Index (r = 0.65), Bronchitis-Emphysema Symptom Checklist (r = −0.61), Basic Need Satisfaction Inventory (r = 0.61) and Cantril’s Ladder of Life Satisfaction (r = 0.63), and Katz Adjustment Scale for Relatives (socially expected activities, r = 0.51; free-time activities, r = −0.49, P < 0.01). The FPI-SF differentiated patients with an FEVl% predicted greater than and less than 50% (t = 4.26, P < 0.001), and those with severe and moderate levels of perceived severity and activity limitation (t = 9.91, P < 0.001).
Results suggest the FPI-SF is a viable alternative to the FPI for situations in which a shorter instrument is desired. Further assessment of the instrument’s performance properties in new samples of patients with COPD is warranted.
PMCID: PMC3008327  PMID: 21191436
functional status; health outcomes; activities of daily living; COPD; patient-reported outcomes; chronic pulmonary disease; health-related quality of life
22.  Reliability and Validity of PROMIS Cognitive Abilities and Cognitive Concerns Scales Among People with Multiple Sclerosis 
Background: Cognitive impairment is among the most debilitating outcomes of multiple sclerosis (MS). Although several neuropsychological tests and self-report cognitive measures have been used to assess cognitive impairment, they may not be sensitive to change over time, or may not be feasible to administer in a clinical setting. The purpose of this study was to assess the reliability and validity of the 8-item PROMIS Cognitive Abilities and Cognitive Concerns Scales in a large community-based sample of people with MS. The PROMIS Cognitive Abilities and Cognitive Concerns Scales derive from the National Institutes of Health–funded Patient Reported Outcomes Measurement Information System (PROMIS), an item repository that capitalizes on recent psychometric advances to produce short, psychometrically sound health measures.
Methods: Mailed survey data were collected from 322 individuals recruited from two National Multiple Sclerosis Society chapters in a southwestern state.
Results: Both cognitive scales demonstrated high internal consistency reliability and were moderately correlated with self-reported depressive symptoms, self-efficacy, barriers to health promotion, health, and functional status (all correlation coefficients >0.35). In hierarchical regression analysis, the PROMIS Cognitive Concerns score added significant unique variance to the prediction of MS Incapacity Status after controlling for self-reported depressive symptoms, exercise, spiritual growth, and global health. Those who were unemployed owing to their disabilities had significantly lower PROMIS Cognitive Abilities scores and higher Cognitive Concerns scores than those who were working or those who were retired or not working for other reasons.
Conclusions: The PROMIS Cognitive Abilities and Cognitive Concerns Scales are short, psychometrically sound measures that assess an important dimension of functioning and health for people with MS.
PMCID: PMC3967698  PMID: 24688349
23.  The Role of Social Support and Coping Strategies on Mental Health of a Group of Iranian Disabled War Veterans 
Iranian Journal of Psychiatry  2010;5(3):102-107.
The purpose of this study was to examine the role of social support on the mental health of disabled war veterans alongside the role of physical disability and deployment type. The second aim of the study was to examine the relationship between coping strategies and mental health.
85 disabled Iranian war veterans participated in this study. All of the participants were asked to complete the Medical Outcomes Study (MOS),Social Support Survey, Impact of Event-Revised Scale (IES-R), Hospital Anxiety and Depression Scale (HADS), The Short Form (SF-36) Health Survey Questionnaire, and Brief COPE Scale.
The results showed that social support had a significant contribution on the mental health of the participants above and beyond the physical disability and deployment type. The physical disability also predicted the mental health of veterans, but deployment type did not have any significant contribution on mental health of the participants. The findings also showed that those veterans who used constructive coping strategies had better mental health status.
The findings suggest that after more than twenty years of war, social support still plays an important role in the life of Iranian disabled war veterans.
PMCID: PMC3430500  PMID: 22952501
Iran; Mental health; Psychological adaptation; Social Support; Veterans
24.  Development of a Danish Language Version of the Manchester Foot Pain and Disability Index: Reproducibility and Construct Validity Testing 
Pain Research and Treatment  2013;2013:284903.
Introduction. The Manchester Foot Pain and Disability Index (MFPDI) is a 19-item questionnaire for the assessment of disability caused by foot pain. The aim was to develop a Danish language version of the MFPDI (MFPDI-DK) and evaluate its reproducibility and construct validity. Methods. A Danish version was created, following a forward-backward translation procedure. A sample of 84 adult patients with foot pain was recruited. Participants completed two copies of the MFPDI-DK within a 24- to 48-hour interval, along with the Medical Outcomes Study Short Form 36 (SF-36), and a pain Visual Analog Scale (VAS). Reproducibility was assessed using the intraclass correlation coefficient (ICC) and 95% limits of agreement (Bland-Altman plot). Construct validity was evaluated with Pearson's Rho, using a priori hypothesized correlations with SF-36 subscales and VASmean. Results. The MFPDI-DK showed very good reliability with an ICC of 0.92 (0.88–0.95). The 95% limits of agreement ranged from −6.03 to 6.03 points. Construct validity was supported by moderate to very strong correlations with the SF-36 physical subscales and VASmean. Conclusion. The MFPDI-DK appears to be a valid and reproducible instrument in evaluating foot-pain-related disability in Danish adult patients in cross-sectional samples. Further research is needed to test the responsiveness of the MFPDI-DK.
PMCID: PMC3606795  PMID: 23533748
25.  Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale 
Physiotherapy Canada  2011;63(1):115-125.
Purpose: This cross-sectional study explores the psychometric properties and dimensionality of the Fullerton Advanced Balance (FAB) Scale, a multi-item balance test for higher-functioning older adults.
Methods: Participants (n=480) were community-dwelling adults able to ambulate independently. Data gathering consisted of survey and balance performance assessment. Psychometric properties were assessed using Rasch analysis.
Results: Mean age of participants was 76.4 (SD=7.1) years. Mean FAB Scale scores were 24.7/40 (SD=7.5). Analyses for scale dimensionality showed that 9 of the 10 items fit a unidimensional measure of balance. Item 10 (Reactive Postural Control) did not fit the model. The reliability of the scale to separate persons was 0.81 out of 1.00; the reliability of the scale to separate items in terms of their difficulty was 0.99 out of 1.00. Cronbach's alpha for a 10-item model was 0.805. Items of differing difficulties formed a useful ordinal hierarchy for scaling patterns of expected balance ability scoring for a normative population.
Conclusion: The FAB Scale appears to be a reliable and valid tool to assess balance function in higher-functioning older adults. The test was found to discriminate among participants of varying balance abilities. Further exploration of concurrent validity of Rasch-generated expected item scoring patterns should be undertaken to determine the test's diagnostic and prescriptive utility.
PMCID: PMC3024205  PMID: 22210989
aged; balance; fall risk assessment tool; falls; psychometrics; FAB Scale; aînés; chutes; équilibre; outil d'évaluation du risque de chute; psychométrie

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