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Alcohol use disorder (AUD) is recognized as a chronic relapsing disorder. Alcohol Relapse Risk Scale (ARRS), a multidimensionally self-rating scale, was developed initially by the Japanese to assess the risk of alcohol reuse. The study aimed to validate the reliability and factor structure of the Chinese version of the ARRS (C-ARRS) for patients with AUD. A total of 218 patients diagnosed with AUD according to DSM-5 were recruited for self-administering C-ARRS. We assessed the internal consistency of C-ARRS using Cronbach's α coefficients and examined the factor structure through confirmatory factor analysis (CFA). Additionally, we investigated the concurrent validity by correlating C-ARRS with the Visual Analog Scale of Alcohol Craving (VAS), Penn Alcohol Craving Score (PACS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. CFA demonstrated inadequate data fit for the original 32-item C-ARRS, prompting the development of a revised 27-item version consisting of 6 subscales with satisfactory model fit estimates. The 27-item C-ARRS exhibited favorable internal consistency, with Cronbach's α ranging from 0.611 to 0.798, along with adequate factor loadings. The 27-item C-ARRS scores displayed significant correlations with the scores of VAS, PACS, BDI and BAI (p <.001). Our results indicated favorable reliability and factor structure of the 27-item C-ARRS. The significant correlation between the 27-item C-ARRS and clinical measures (such as depression, anxiety, and craving) demonstrates satisfactory concurrent validity. These observations collectively support the feasibility of using 27-item C-ARRS to assess the risk of alcohol relapse in patients with AUD. • AUD is a prevalent psychiatric disorder characterized by a high rate of relapse. • No tools are available in Chinese to assess the relapse risk in patients with AUD. • We validated the 32-item Chinese version of Alcohol Relapse Risk Scale (CARRS). • The modified 27-item C-ARRS version exhibits satisfactory reliability and validity. • C-ARRS could provide information on relapse risk and facilitate early treatment. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the test-retest reliability of the L test under single and dual-task conditions in women with fibromyalgia. To analyze the concurrent validity of the L test and Timed Up and Go test (TUG) and the relationship between the L test and the impact of the disease. A cross-sectional study with 22 women with fibromyalgia. The Intraclass Correlation Coefficient (ICC) 3,1 evaluated the reliability. The concurrent validity was established between the L test and the TUG. The Pearson product-moment correlation assessed the correlation between the L test and the impact of the disease. Results revealed an ICC of 0.95 (0.876–0.979) in the single condition with the stopwatch and 0.95 (0.872–0.978) with the Chronopic. In the dual-task condition 0.93 (0.832–0.971) with the stopwatch and 0.94 (0.854–0.975) with the Chronopic. The L test and the TUG showed significant relationships with a stopwatch in the single (test-r = 0.839; retest-r = 0.897) and the dual-task conditions (test-r = 0.793; retest-r = 0.882). These findings were also found with the Chronopic in the single (test-r = 0.876; retest-r = 0.901) and the dual-task conditions (test-r = 0.872; retest-r = 0.897). Significant relationships were found between the L test and the impact of the disease with a stopwatch in the single (test-r = 0.502; retest-r = 0.647) and the dual-task conditions (test-r = 0.428; retest-r = 0.571). And with the Chronopic in the single (test-r = 0.528; retest-r = 0.663) and the dual-task conditions (test-r = 0.482; retest-r = 0.608). L test is a reliable tool under single and dual-task conditions in women with fibromyalgia. This test is a valid method when compared with the TUG, and it is related to the impact of the disease. [ABSTRACT FROM AUTHOR]

Validate the Preschool Nutrition Education Practices Survey. Iterative approach combining design-based research and Standards for Educational and Psychological Testing. Los Angeles, CA and Philadelphia, PA Early Care and Education (ECE) classrooms. Expert panel members (n = 7); ECE teachers: interviews (n = 8), pilot survey (n = 31), and final survey (n = 136). Early care and education nutrition education practices used in the classroom either during class time or mealtime. Qualitative content analysis was implemented for content, response process, and consequences of testing validity evidence. Rasch rating scale analysis was conducted for the response process and internal structure validity and reliability evidence. Qualitative field-testing produced strong content, response process, and consequences of testing validity evidence to inform survey modifications. Quantitative field-testing generated a psychometrically sound, well-targeted 12-item survey on a 4-point frequency scale with excellent item and person reliability (0.97 and 0.93 respectively) and separation (5.36 and 3.77 respectively); good Rasch Principal Components Analysis findings (60.3%); and productive item fit statistics (0.50–1.50 logits). Robust validity (content, response process, consequences of testing, internal structure) and reliability evidence were demonstrated for using the Preschool Nutrition Education Practices Survey to assess ECE teachers' use of nutrition education practices. Future research is needed to examine its relationship to other variables, such as nutrition teaching efficacy, and to determine its ability to detect change in ECE nutrition education practices over time and across groups. [ABSTRACT FROM AUTHOR]

The study was a methodological conducted to evaluate the validity and reliability of the Turkish version of the Diabetes Caregiver Activity and Support Scale (D-CASS). This study was included on 272 individuals who cared for patients diagnosed with type 2 diabetes at least one year ago. Language, content, internal criterion, construct-concept validity were used to test the validity of the scale, and cronbach alpha, item-scale correlation, and test-retest were used to test the reliability. The CVI was 0.95. The study was conducted with 272(60.3% female, 39.7% male) caregivers of individuals with type 2 diabetes. The study was found four week test-retest reliability with r = 0.70, p < 0001. The factor loadings of the scale items are between 0.77 and 0.95. The single factor obtained explains 75% of the total variance. The scale was found to have a high degree of reliability (Cronbach alpha=0.95). The activities and supportive behaviours scale of caregivers of individuals with type 2 diabetes(D-CASS) is a valid and reliable measurement tool that can be used for the Turkish population. • There were responsibilities of caregivers in the management of diabetes, which is a chronic disease. • It was determined that which activity the caregivers had difficulty or did easily in this process. • Issues that caregivers find difficult in further training should be included in the trainings. [ABSTRACT FROM AUTHOR]

People with stroke often have asymmetric motor impairment. Investigating asymmetries in, and dynamic properties of, centre of pressure movement during quiet standing can inform how balance is controlled. What are the test-retest reliabilities of unconventional measures of quiet standing balance control in people with chronic stroke? Twenty people with chronic stroke (>6 months post-stroke), who were able to stand for at least 30 s without support, were recruited. Participants completed two 30-second quiet standing trials in a standardized position. Unconventional measures of quiet standing balance control included: symmetry of variability in centre of pressure displacement and velocity, between-limb synchronization, and sample entropy. Root mean square of centre of pressure displacement and velocity in the antero-posterior and medio-lateral directions were also calculated. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability, and Bland-Altman plots were created to examine proportional biases. ICC 3,2 were between 0.79 and 0.95 for all variables, indicating 'good' to 'excellent' reliability (>0.75). However, ICC 3,1 for symmetry indices and between-limb synchronization were < 0.75. Bland-Altman plots revealed possible proportional biases for root mean square of medio-lateral centre of pressure displacement and velocity and between-limb synchronization, with larger between-trial differences for participants with worse values. These findings suggest that centre of pressure measures extracted from a single 30-second quiet standing trial may have sufficient reliability for some research studies in chronic stroke. However, for clinical applications, the average of at least two trials may be required. • We determined test-retest reliability of 'unconventional' quiet standing balance measures. • Symmetry indices and between-limb synchronization had moderate reliability. • Sample entropy had good-to-excellent reliability for a single 30 s trial. • The mean of 2–6 trials should be used for clinical decision making (ICC>0.95). [ABSTRACT FROM AUTHOR]

• DPP for diagnosing leptospirosis was evaluated in reference laboratories in Brasil. • The test was less sensitive than specific. • The highest accuracy occurred between 7 and 14 days after symptom onset. • Accuracy measures were similar between the laboratories. • Predictive values indicated the best situations to utilize DPP in health services. Leptospirosis is a zoonotic disease with significant global impact and a challenging diagnosis. The utilization of adequately validated rapid tests is relevant for the opportune identification of the disease and for reduction in fatality rates. The present study analyzes the accuracy and reliability of the Dual Path Platform (DPP) assay -produced in Brazil by the Oswaldo Cruz Foundation (Fiocruz)- for diagnosing leptospirosis. Firstly, a serological panel was constructed in the Brazilian Reference Laboratory for Leptospirosis using samples routinely handled by reference laboratories of six Brazilian states. It consisted of 150 positive (according to MAT and IgM-ELISA) and 250 negative samples for leptospirosis. Subsequently, the panel samples were distributed to the reference laboratories for the performance of DPP assays in triplicate. Different measures were used in the assessment of diagnostic quality. Predictive values were estimated for different pre-test probability settings. Sensitivities varied between 67.33 % and 74.00 % and specificities between 93.20 % and 98.40 % in the states, and there were adequate agreements between them. Accuracies were lower for the samples of patients with less than 7 days of symptoms. In contexts of prevalence values up to around 25 %, positive and negative predictive values were around 90 %. However, in situations of high pre-test probabilities, NPVs were low. This study improves understanding of the use of DPP in diagnosing leptospirosis, particularly its application in healthcare settings. As long as the time of symptoms onset and clinical and epidemiological contexts are adequately considered for the interpretation of results, DPP is a valid option to be used in the leptospirosis diagnostic routine. [ABSTRACT FROM AUTHOR]

This study was conducted to translate the ELPO risk assessment scale for the development of pressure injuries due to surgical positioning to Turkish and to test its validity and reliability in the Turkish Population. The data were collected using the patient identification form, the risk assessment scale for the prevention of injuries due to surgical positioning, and the Braden Scale. This scale consisted of a total of seven items, each of which contained five sub-items. It is rated between 1 and 5 in the Likert type. The total score of the scale ranges between 7 and 35. The risk of developing pressure injuries increases in patients as the score increases. A total of 184 patients were included in the study sample. The mean age of the group was 55.96 ± 17.90, and the content validity index was 0.944. The sensitivity of the test was 60%, the specificity was 66%, and the accuracy was 66%. There was a negative, weak, statistically significant correlation between the total scores of the risk assessment scale for the prevention of injuries due to surgical positioning and the Braden scale. The mean total score of the scale was 18.45 ± 2.96 (12–26) and 35.9% (n = 66) of the group were at high risk. The ELPO, which includes the risks specific to patients during surgery, can be used as an assessment scale for the development of pressure injury due to surgical positioning for Turkish population. • Pressure injuries that occur in patients undergoing surgery is one of the important problems experienced in the healthcare services. • The protective measures to be taken as a result of systematic evaluations in patients undergoing surgery provide a great opportunity to prevent pressure injuries that may develop in the post-op period. • In general, although there is a risk assessment tool for pressure injuries in the literature, there are very limited numbers of scales that evaluate the risk of pressure injuries, especially in patients undergoing surgery. • The ELPO risk assessment scale will provide both evidence and support for nurses to systematically assess surgical patients at risk of developing of pressure injuries due to surgical positioning and to take protective measures. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the validity and reliability of a customized smartphone application (CSA) for postural sway (PS) assessment. This validity and reliability study evaluated static balance by measuring PS in 29 healthy volunteers (15 women, 14 men, mean age 28 ± 5.11). Assessments included synchronized data collection using 3 systems: the CSA, a force plate, and the clinical modified balance error scoring system (mBESS). The experimental procedure included three 40-seconds long repetitions in 3 positions. Outcome measures included pathway and 95% ellipse area. Statistical analysis compared the developed application to both the force plate and the mBESS to test its validation and analyzed repeatability of the 3 experimental measurements. Good to strong correlations were found between the CSA and the force plate in double and tandem stance (pathway r = 0.81-0.91), and moderate to high reliability was found for the CSA (0.66-0.75) and for the force plate (0.69-0.77) pathway measurements. The similarity in reliability results of the 2 devices and the high correlation both support the validity of the CSA. Furthermore, a high correlation was demonstrated between the CSA and the mBESS (r = 0.80), higher than the force plate and the mBESS. The developed CSA was found valid and reliable in healthy young adults, and further research is needed to recommend it for clinical balance assessments. The CSA could therefore be considered for PS assessment in the clinical field. [ABSTRACT FROM AUTHOR]

In health care, quality-of-life surveys and questionnaires related to care are becoming increasingly important as a measure of its quality. There is currently no Spanish version of the Unité Rhumatologique des Affections de la Main (URAM) scale, which makes it suitable for hand pathology. The purposes of this study are to develop a Spanish version of the URAM and perform a transcultural adaptation of it, analyzing the result for reliability, validity, and sensitivity to changes. The questionnaire was evaluated for patients with Dupuytren's disease and Carpal Tunnel Syndrome. The cohort study subjects were interviewed at three points in time (baseline, three days after intervention, and one month after), administering the QuickDASH, URAM, and SF-12 (CF12 = physical component, CM12 = mental component) questionnaires at baseline and after intervention; and only the URAM at 3 days. Content validity was evaluated using Cronbach's α. The distribution of the factorial loads of the items and the pattern of the answers were checked. Responsiveness was evaluated by the size of the effect and the reliable rate of change. Convergent and divergent validity was performed using Spearman's r between the different questionnaires. The study was conducted with 106 patients. The mean baseline scores were: URAM = 14.8, QuickDASH = 41.6, CF12 = 39.3 and CM12 = 49.4. Ceiling or floor effects were not observed in the Spanish URAM. The Cronbach α = 0.853 explains 49.6% of the variance. The study had a high reproducibility (intraclass correlation coefficient (ICC) = 0.939). Size effect, measured as differences in scores, was moderate for URAM (-0.69) and QuickDASH (-0.51); and low for CF12 and CM12. The correlation of URAM with QuickDASH was high (r = 0.716), and moderate with DD and CTS. The Spanish version of the URAM is a valid and reliable tool for use in assessing hand pathology. [ABSTRACT FROM AUTHOR]

To develop a preliminary subjective evaluation scale for assessing the built environments of China's Hygienic City Initiative and to evaluate its reliability and validity. The initial items of the scale were determined based on a review of policy documents and consultations with experts. The final items of the scale were confirmed through individual interviews with residents combined with the discretetrend method, critical ratio method, correlation coefficient method, and factor analysis method. Then, the dimensions of the scale were determined using exploratory factor analysis (EFA). The Cronbach's α coefficient, split-half reliability coefficient, and confirmatory factor analysis (CFA) were used to assess the reliability and validity of the scale. A scale containing five dimensions with 22 items was established, including urban lifestyle, governance, basic functions, environmental sanitation, and amenities. The Cronbach's α coefficient of the scale was 0.876, and the split-half reliability coefficient was 0.796. The CFA results indicate that each inspection level was within the standard limit. The preliminarily subjective evaluation scale for assessing the built environments of China's Hygienic City Initiative demonstrates a high level of reliability and validity. Additional empirical studies should be carried out to further verify the value of the scale in terms of practical application. [ABSTRACT FROM AUTHOR]

To determine the validity and reliability of a nutrition knowledge questionnaire for adolescents. An adult questionnaire was administered to 4 high school student convenience samples with and without known prior nutrition education. Questionnaire refinement was determined by item-total correlation, item discrimination, and item difficulty. Mean percentage of correct answers was calculated, and the group difference was assessed using an independent samples t test. A post hoc regression analyzed the association between mean percentage of correct answers and group while controlling for school. The questionnaire, with 1 question eliminated, had good internal consistency reliability (Cronbach α = 0.83). The nutrition education group (n = 174) demonstrated significantly (P < 0.0001) higher mean percentage of correct answers compared with the no nutrition education group (n = 136). The association between mean percentage of correct answers and the group remained with school controlled. Results suggest that the questionnaire is valid and reliable for measuring nutrition knowledge in high school–aged adolescents. [ABSTRACT FROM AUTHOR]

• The Chinese IDBS has a highly reliable and stable structure. • The Chinese IDBS supports the four-factor model. • The Chinese IDBS showed significant relationship with drivers' behavior. • Agreeableness and conscientiousness influenced impulsive driving behavior. Impulsivity plays an important role in aberrant driving behavior and crash involvement. The purpose of this study was to evaluate the reliability and validity of the Impulsive Driver Behavior Scale (IDBS, Bıçaksız & Özkan, 2016a) with a Chinese sample. Two hundred and ninety-nine drivers completed the Chinese version of the Impulsive Driver Behavior Scale, the Driver Behavior Questionnaire, the Big Five Inventory and some social-demographic and traffic violation items. A confirmatory factor analysis indicated that a four-factor solution with 20 items yielded a better fit to the data than other solutions. The reduced IDBS showed good reliability and a stable structure. Drivers' functional impulsivity was positively correlated with positive driver behavior and some ordinary violations. Meanwhile, the other three dimensions of dysfunctional impulsivity showed negative correlations with positive driver behavior and positive associations with aberrant driving behavior and penalty points and fines. Impulsive driver behavior is also associated with agreeableness and conscientiousness. These results provide evidence supporting the IDBS as a reliable and valuable instrument for measuring driving impulsivity in the Chinese traffic environment. [ABSTRACT FROM AUTHOR]

Understanding and assessing mood are pivotal in psychological and psychiatric research, yet existing scales often exhibit limitations such as focusing on singular dimensions of mood and introducing comparative bias through Likert scales. To address these issues, the Chen-HAgiwara Mood Test (CHAMT), a novel three-item scale, was developed. Grounded in the valence-arousal two-dimensional theory of affect, CHAMT offers a comprehensive assessment, focusing on three integral mood components: pleasure, relaxation, and vigor. This study evaluates the reliability, validity, and applicability of CHAMT in capturing mood variations post diverse experimental interventions. The results indicate that CHAMT exhibits high internal consistency and notable item-total correlations, underscoring its reliability. It demonstrated excellent same-day test-retest reliability, with variations observed on different days, implying a potential influence of temporal factors on mood assessments. The notable correlations between CHAMT's components and established external criteria such as positive affect, depression, and state anxiety substantiate its validity in assessing diverse mood dimensions. The examination of different interventions revealed a discernable impact on specific mood components, aligning with theoretical expectations, and showcasing the nuanced interplay between interventions and mood dimensions. The findings suggest that CHAMT holds substantial promise in refining mood assessments in psychological and psychiatric research, due to its brevity, multifaceted approach, and alignment with established theoretical frameworks. • Introduced CHAMT: a three-item mood scale rooted in valence-arousal theory. • CHAMT overcomes biases and limitations of traditional mood scales. • Demonstrated CHAMT's high consistency and same-day test-retest reliability. • CHAMT showcases robust validity with correlations to external mood criteria. • Unveiled nuanced interplay between interventions and mood dimensions with CHAMT. [ABSTRACT FROM AUTHOR]

Background: Currently, there are 4 EQ-5D-5L scoring algorithms available for the United Kingdom that can be used to derive a utility score.Objectives: To perform a psychometric validation of the EQ-5D utility score in patients with metastatic Merkel cell carcinoma (mMCC) and to compare 4 EQ-5D-5L value sets currently available for the United Kingdom.Methods: Data collected in the phase 2 trial JAVELIN Merkel 200 were analyzed, in which 88 patients with mMCC were treated with avelumab. Utility scores were calculated using the EQ-5D-5L valuation set by Devlin et al and 3 further algorithms that are based on EQ-5D-3L valuations. Criterion validity was assessed by Pearson correlations between utility and other HRQoL scales. Responsiveness was assessed by correlating change in utility scores with change in HRQoL scales and percentage change in tumor size. Effect sizes for change from baseline in utility were calculated in subgroups of patients with improving and deteriorating health based on clinically relevant changes in various external anchors.Results: Devlin utilities were up to 0.10 points higher than utilities calculated from EQ-5D-3L valuations. Large correlations (0.45-0.72; P < .01) between utility and the EuroQol Visual Analogue Scale and FACT-G total, physical, and functional scores were found for all 4 algorithms. Large correlations between these measures were also found for change from baseline scores. In patients with health improvements, effect sizes were larger for the 3 EQ-5D-3L-based algorithms, whereas the Devlin utilities had larger effect sizes for health deteriorations, probably because of different levels of baseline utility.Conclusions: The English National Institute for Health and Care Excellence currently recommends use of the 3L valuation sets. Our analyses show that all 4 scoring algorithms have good and similar psychometric properties in patients with mMCC. [ABSTRACT FROM AUTHOR]

Objective: To investigate the reliability and validity of the Chinese version of VR-CoDES.Methods: The VR-CoDES was translated into Chinese, and a focus group was held to discuss its cultural adaptation. Video consultations between 75 fourth-year medical students and 2 standardized patients (SPs) were coded by two raters with the Chinese VR-CoDES. Inter-rater reliability was tested by using ICC. To obtain validity, the SPs reviewed the video consultations to confirm the cues and concerns.Results: ICC was 0.79. Specificity and sensitivity were 0.99 and 0.96 respectively. The SPs expressed considerably more cues (mean = 7.00) than concerns (mean = 0.32). Half of the responses of medical students were explicit reducing space. Focus group participants raised some cultural considerations, and some interactions were difficult to code due to cultural differences.Conclusion: The Chinese VR-CoDES obtained good reliability and validity. Due to differences in the expression of emotions and other differences such as different medical systems between China and Western countries, the Chinese VR-CoDES needs further cultural adaptation.Practice Implication: More consultations in real clinical settings need to be gathered to further support the Chinese VR-CoDES both on validation and cultural adaptation. [ABSTRACT FROM AUTHOR]

Highlights • Firstly tested Traffic Climate Scale (TCS) and Positive Driver Behaviours Scale among 887 drivers in China. • The Chinese TCS has a highly reliable and stable three-factor structure. • Measures of convergent validity support validity of the Chinese TCS. • Showed the links between traffic safety climate, driver behaviours and traffic accidents involvement. Abstract Traffic Climate Scale (TCS) and Positive Driver Behaviours Scale (PDBS) are new measurement tools. The study aims to translate the TCS and PDBS into Chinese and to assess their factor structures in a large sample of licensed motor vehicle drivers in China. A further aim is to investigate the effects of TCS factors on drivers' behaviours and traffic accidents involvement. Data were collected using an online survey. Participants were 887 fully licensed motor vehicle drivers, including 531 males and 356 females who completed a Chinese translated questionnaire including the TCS, PDBS, Driver Behaviour Questionnaire (DBQ), items related to drivers' driving records and demographic characteristics. The result of the exploratory factor analysis revealed clear three-factor solution ('Functionality', 'External affective demand' and 'Internal requirement') of TCS with high item loadings and acceptable internal consistency coefficients. The convergent validity of the Chinese TCS was supported by its relationship with driver behaviour factors (violations, errors, lapses and positive behaviours), the traffic accidents involvement and demographic characteristics. The results further show that the external affective demand consistently and positively relate to aberrant behaviours and negatively relate to positive behaviours with indirect positive significant effects on accidents involvement. Functionality is concurrently and negatively related to aberrant behaviours and positively related to positive behaviours with no effects on accidents involvement. The internal requirement is negatively related to aberrant behaviours but, positively related to positive behaviours with positive significant direct effects on accidents involvement. [ABSTRACT FROM AUTHOR]

In this study, it was aimed to develop a valid and reliable measurement instrument to measure sleep quality in coronary care patients. This is a methodological study that was carried out with 201 patients at the coronary care unit of a university hospital. The validity and reliability of the scale were tested using exploratory and confirmatory factor analyses, Cronbach's alpha analysis, and Pearson's correlation analysis. The scale's Cronbach's alpha coefficient was found to be 0.816. There were significant positive relationships between the overall scale and its dimensions. The Pearson's correlation analysis showed a significant negative relationship between the Sleep Quality Scale for Coronary Care Patients and the Richards-Campbell Sleep Questionnaire. The Sleep Quality Scale for Coronary Care Patients was determined to be a valid and reliable measurement instrument for assessing the sleep quality of patients who are receiving care in coronary care units. The scale that was developed in this study can be applied to coronary care patients because it is easy to implement and specific to intensive care settings. This way, the sleep quality levels of patients can be assessed quickly, and nursing interventions for potential problems can be defined. Hence, the emergence of sleep-related health problems can be prevented. Although RCSQ is the most commonly used scale to evaluate the sleep quality of patients treated in the intensive care unit, SQ-CC is thought to be more inclusive in considering noise-, environment-, and patient-related subjective factors. The evaluation of environmental factors can also provide objective data for improvements to be made to eliminate these factors in clinics. Furthermore, the use of this scale in national and international scientific studies where the sleep quality of coronary care patients is evaluated will contribute to not only our colleagues but also the relevant scientific field. [ABSTRACT FROM AUTHOR]

Patients with Duchenne Muscular Dystrophy (DMD) have gait disorders. Therefore, specific gait assessment tools are needed. The aim of this study was to develop a gait assessment instrument for DMD patients (DMD-GAS), and investigate its validity and reliability. The scale was developed considering the expert opinions which included 10 physiotherapists who had experience in the management of patients with DMD, and the Content Validity Index (CVI) was calculated. The final version of the DMD-GAS that was agreed upon the experts consisted of 10 items, and each item scored between 0 and 2. The intra-rater reliability was established by the video analysis of children with a 1-month interval and inter-rater reliability was determined by the scores of 3 physiotherapists. The study included 56 patients with DMD. The criterion validity was determined by investigating the relationship between the total score of the DMD-GAS and Motor Function Measure (MFM), 6 Minute Walk Test (6MWT), and the data obtained from GAITRite. The CVI of the DMD-GAS was 0.90 (p < 0.05). The construct validity and internal consistency of the DMD-GAS were excellent as well as the intra- and inter-rater reliability (>0.90). Moderate-to-very strong correlations were found between the total score of the DMD-GAS and the MFM-total score (r = 0.78), 6MWT (r = 0.71), gait speed (r = 0.50), stride length (r = 0.56), and base of support (r = −0.70) (p < 0.01). The results indicated that DMD-GAS was a reliable and valid instrument to determine gait characteristics of the patients with DMD in clinical settings. NCT05244395. • This study presents a new scale that can assess the kinetic properties of each part of the body during walking and the spatio-temporal characteristics of gait in a disease-specific manner. • DMD-GAS was a reliable, valid and practical assessment instrument for gait deviations. • DMD-GAS promises a practical assessment of gait deviations of children with DMD. [ABSTRACT FROM AUTHOR]

Highlights • The newly adopted Chinese version of the DSI represents a useful tool to measure driving skill. • The two components (perceptual-motor skills and safety skills) of driving skills have cross-cultural stability. • Personality traits were significant predictors of driving skill. Abstract Most road accidents are caused by human factors alone or in combination with other factors. Deficits in driving skill are a human factor that contributes to accidents. It is important to focus on driving skills to reduce traffic accidents and enhance safe driving. In this study, we adopted a Chinese version of the Driver Skill Inventory (DSI) and explored its correlation with driving behaviors, sociodemographic factors and personality. A total of 295 licensed drivers voluntarily completed a survey that covered the DSI, the Driver Behavior Questionnaire, the Positive Driver Behavior Scale, self-reported traffic accidents, penalty points and fines, the Big Five Inventory, and sociodemographic parameters. First, the results of principal axis analysis on the DSI yielded two clear factors: perceptual-motor skills and safety skills. Second, both perceptual-motor skills and safety skills were positively correlated with positive behaviors. Safety skills were negatively correlated with all aberrant driving behaviors (e.g., aggressive violations, ordinary violations, errors, and lapses), whereas perceptual-motor skills were negatively correlated with errors and lapses. Third, with regard to penalties, safety skills were negatively associated with penalty fines and points received within the past year, whereas perceptual-motor skills showed no such correlation. Fourth, with regard to sociodemographic parameters, perceptual-motor skills were positively correlated with years of holding a driving license, weekly driving distance and annual driving distance. Men reported higher perceptual-motor skills than women, whereas safety skills were unrelated to gender. Fifth, structural equation modeling was conducted to test the effects of personality traits on driving skill. The results showed that conscientiousness, neuroticism and openness to experience were significant predictors of perceptual-motor skills, whereas agreeableness and conscientiousness were significant predictors of safety skills. Overall, based on these results, the Chinese version of the DSI has acceptable internal consistency and a stable structure; thus, it represents a useful tool to measure driving skill. Moreover, the measurement of personality traits, which are important individual factors closely linked to driving skill, can aid in the education of professional drivers or to inform preventative and educational activities that focus on personality traits in addition to knowledge. [ABSTRACT FROM AUTHOR]

Background: The SF-12v2 has been validated in general population and other conditions but the evidence is limited in Americans with cancer.Objective: To assess reliability and validity of SF-12v2 among adults with self-reported cancer using the Medical Expenditure Panel Survey (MEPS).Methods: Self-reported cancer participants (SCPs) were identified from 2003 MEPS. SF-12v2 was administered as part of self-administered questionnaires. Physical (PCS12) and mental (MCS12) component scores of SF-12v2 were evaluated for reliability (internal consistency, test-retest) and validity (convergent, discriminant, predictive, concurrent).Results: 420 SCPs were identified with average age of 59.3 years (SE = 0.9). 10.7% had multiple cancers (>1) and 52% had at least one other chronic condition (OCC). Average PCS12 and MCS12 were 45.09 (SE = 0.5) and 50.75 (SE = 0.5). PCS12 and MCS12 demonstrated high internal consistency (αPCS12 = 0.89; αMCS12 = 0.88), acceptable test-retest reliability (ICCPCS12 = 0.82; ICCMCS12 = 0.73), strongly correlated with most of the expected EQ-5D domains (r = 0.51-0.71), and demonstrated strong convergent validity on perceived health (r = 0.61) and perceived mental health (r = 0.52). PCS12 and MCS12 were able to discriminate between groups with and without physical/cognitive limitations. Only PCS12 was negatively correlated with number of OCCs.Conclusion: The SF-12v2 is a reliable and valid instrument to quantify health-related quality of life among adults with self-reported cancer. [ABSTRACT FROM AUTHOR]

Communication adjustment from patients' perspective is paramount to ensure optimization of voice rehabilitation post laryngectomy. Very few specific self-rating tools exist with the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) having the most evidence regarding validity, reliability and clinical utility. This study aimed to translate and validate a Bahasa Malaysia version of SECEL (mSECEL) using a validated framework of transcultural adaptation. This cross-sectional study was conducted in the Otorhinolaryngology, Department of Universiti Kebangsaan Malaysia Medical Centre from February 2019 to May 2020. The mSECEL was produced following a rigorous forward and backward translation. Eighty-three laryngectomees (78 male, five female) using various methods of alaryngeal communication (47 voice prosthesis, 29 electrolarynx, three esophageal speech and four pen and paper), completed the mSECEL and mVHI-10 before head and neck and flexible laryngoscopic examinations. The mSECEL was repeated in 2 weeks via telephone interview or clinic visit. Its reliability was assessed using intraclass correlation. The Pearson product-moment correlation test was used to analyze correlation between the mSECEL and mVHI-10. The mSECEL questionnaire showed strong internal consistency with the Cronbach alpha of >0.90 for total score, Environmental and Attitude subscale. The test-retest reliability for total mSECEL score was high with the intraclass correlation of 0.97. There was a highly significant positive correlation between the mSECEL total score and mVHI-10 (P < 0.001). Items in the General subscale showed poorer internal consistency with Cronbach alpha ranging 0.55-0.46 and poor correlation with mVHI-10. The Bahasa Malaysia version of the SECEL measure is a valid and reliable instrument to evaluate communication perception after laryngectomy. Future studies should consider subscale validation and further abbreviation of its items to make this measure clinically relevant. [ABSTRACT FROM AUTHOR]

This is a mixed design study planned to determine the views of women, midwives, and physicians about the ideal birth unit and to develop a to develop a valid and reliable measurement tool for postpartum women's evaluation of the effect of birth units in terms of physical, emotional, and social aspects on their satisfaction with the birth environment. The exploratory sequential design, which is accepted as a mixed design, was used in the study. In the qualitative phase of the study, a content analysis was conducted by interviewing a total of 20 participants including 5 pregnant women, 5 postpartum women, 5 midwives and 5 obstetricians. In the quantitative phase, the Draft Birth Unit Satisfaction Assessment scale, which was developed in line with the data obtained as a result of the qualitative study, a literature review, and expert opinions, was used to evaluate postpartum women's (n = 435) satisfaction with the birth environment. Content validity, exploratory factor analysis, and confirmatory factor analysis were used for the validity analyses of the scale, and item analysis, internal consistency, and time-dependent invariance were evaluated for reliability. In the qualitative phase of the study, the themes were grouped under 5 categories (physical features of the hospital, features of the birth room, privacy, aesthetics and support) according to the qualitative data on the factors that showed participants' views on the ideal birth unit. In the quantitative stage, the Birth Unit Satisfaction Assessment Scale, which consisted of 30 items and 5 sub-dimensions (communication and care, physical characteristics of the birth room, comfort, opportunities supporting birth, and decoration and aesthetics), was developed. In conclusion, it was determined that the scale developed in this study was a valid and reliable measurement tool that could be used to evaluate postpartum women's satisfaction with the birth environment. [ABSTRACT FROM AUTHOR]

Objective impaired maternal bonding is a risk factor for problems with infant well-being and development. The investigation of perinatal variables related to disorders of the mother–infant relationship as well as the administration of reliable and valid screening tools to new mothers in the postpartum can help identify early signs of a disturbed mother–child relationship. The Postpartum Bonding Questionnaire (PBQ) has been shown to be a valid screening instrument, but its dimensional structure is still controversial. An analysis of the literature demonstrated the need for research into the perinatal correlates of the quality of mother-newborn bonding as measured by the PBQ, and for information about the reliability and validity of the Italian version of the questionnaire. Aim to (a) carry out preliminary analysis of the psychometric properties of an Italian version of the PBQ and (b) explore how mother–infant disturbances are related to relevant perinatal psychological variables. Design the research design consisted of a prenatal and a postnatal phase. Setting prenatal education classes delivered in public and private institutions. Participants 123 pregnant Italian women were recruited from prenatal education classes. Measurements in the prenatal period participants completed a questionnaire measuring maternal-fetal attachment; at the postnatal assessment (3 months postpartum) participants completed the Italian PBQ together with measures of mother–infant attachment, the couple's adjustment and maternal psychological well-being. Exploratory factor analysis was used to investigate the factor structure of the PBQ. Internal consistencies were evaluated using Cronbach's alpha. Nomological validity was assessed via Pearson correlations. Findings a three-factor model provided the most meaningful representation of the PBQ data, with one factor reflecting annoyance and anger towards the infant, another reflecting detachment and rejection and the third reflecting anxiety about infant care. Internal consistencies were good. Impaired mother-infant bonding was negatively correlated with prenatal and postnatal mother–infant attachment and couple adjustment, as well as being positively correlated with maternal depressive symptoms. Key conclusions and implications for practice the Italian PBQ is a reliable, valid screening instrument and can be used for research, including transcultural comparisons in perinatal psychiatry. It can also be used clinically to detect signs of a disordered mother–child relationship. Knowledge of the variables generally associated with mother-infant bonding problems combined with data from postpartum administration of the PBQ could be used in midwifery to develop preventive programmes based on the specific needs of new mothers. [ABSTRACT FROM AUTHOR]

Objective: The Checklist Individual Strength (CIS) measures four dimensions of fatigue: Fatigue severity, concentration problems, reduced motivation and activity. On the fatigue severity subscale, a cut-off score of 35 is used. This study 1) investigated the psychometric qualities of the CIS; 2) validated the cut-off score for severe fatigue and 3) provided norms.Methods: Representatives of the Dutch general population (n=2288) completed the CIS. The factor structure was investigated using an exploratory factor analysis. Internal consistency and test-retest reliability were determined. Concurrent validity was assessed in two additional samples by correlating the CIS with other fatigue scales (Chalder Fatigue Questionnaire, MOS Short form-36 Vitality subscale, EORTC QLQ-C30 fatigue subscale). To validate the fatigue severity cut-off score, a Receiver Operating Characteristics analysis was performed with patients referred to a chronic fatigue treatment centre (n=5243) and a healthy group (n=1906). Norm scores for CIS subscales were calculated for the general population, patients with chronic fatigue syndrome (CFS; n=1407) and eight groups with other medical conditions (n=1411).Results: The original four-factor structure of the CIS was replicated. Internal consistency (α=0.84-0.95) and test-retest reliability (r=0.74-0.86) of the subscales were high. Correlations with other fatigue scales were moderate to high. The 35 points cut-off score for severe fatigue is appropriate, but, given the 17% false positive rate, should be adjusted to 40 for research in CFS.Conclusion: The CIS is a valid and reliable tool for the assessment of fatigue, with a validated cut-off score for severe fatigue that can be used in clinical practice. [ABSTRACT FROM AUTHOR]

The current study aims to provide psychometric analyses of a shortened version of the Comprehensive Autistic Trait Inventory (CATI) from three different samples administered to 4910 Chinese populations (56.864 % females, mean age 19.857 ± 4.083) aged 14–56. The factor structure of CATI in Chinese was examined by confirmatory factor analysis and exploratory structural equation modeling, and a 24-item Chinese version short form of CATI (CATI-SF-C) was developed. The validity (structure validity, convergent validity, and discriminant validity) and reliability (internal consistency and test-retest reliability) were evaluated, and the predictive ability for classifying autism was examined (Youden's Index = 0.690). According to these findings, the CATI-SF-C is a reliable and valid autistic traits assessment tool for the general population. • The first short form of the Chinese version of CATI which based on the DSM-5. • The large sample included three different samples of the general Chinese population. • Good measurement invariance across gender and sample groups. [ABSTRACT FROM AUTHOR]

• It is not clear whether contemporary safety methods work as intended when used by healthcare practitioners. • We assessed the criterion-referenced validity of Net-HARMS and AcciMap. • 67 healthcare practitioners applied both methods on two occasions. • Net-HARMS achieved poor levels of validity, whereas AcciMap achieved high levels. • Further work is required to support the use of state-of-the-art safety science methods in practice. In healthcare practice, state-of-the-art safety science methods are overlooked in favour of established methods. Bridging this 'research-practice' gap is critical to support safe, high-quality healthcare; however, it is not clear whether contemporary methods work as intended when used by practitioners. This study aimed to assess the criterion-referenced validity of systems thinking-based risk assessment (Net-HARMS) and accident analysis methods (AcciMap). Sixty-seven healthcare practitioners from Queensland, Australia, received training in each method and used Net-HARMS to identify risks associated with patient medication administration tasks and AcciMap to analyse an adverse medication administration event. Validity was assessed by comparing participants' analyses to 'gold standard' expert analyses. Net-HARMS achieved poor levels of validity for both task and emergent risk identification. AcciMap achieved high levels of validity for the placement of contributory factors at the correct healthcare system level but only moderate levels when identifying relationships between contributory factors. The findings highlight the need for further work to support the use of state-of-the-art safety science methods in practice. This includes the provision of education in systems thinking, methods training programs, the development of further support materials, and modification of the methods to improve their usability. [ABSTRACT FROM AUTHOR]

To assess the reliability and validity of the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) in patients with upper extremity (UE) musculoskeletal diseases in Taiwan. An expert panel was organized to evaluate the validity of QuickDASH. In addition, patients with UE, including carpal tunnel syndrome (CTS), confirmed by nerve conduction velocity or sonography were recruited to evaluate its reliability and validity. We recruited participants at the two largest medical centers and one clinic in Tainan, Taiwan. We recruited participants 20 to 65 years of age and divided them into three groups: patients with CTS (CTS group), patients with UE musculoskeletal diseases who were under rehabilitation (rehabilitation group), and the general population (general group). Not applicable. In addition to the expert panel, we evaluated the validity of QuickDASH through administering DASH questionnaire, grip strength measurement, Semmes-Weinstein monofilament sensory test, and Purdue pegboard test to every participant. The retest reliability was assessed one week apart. There are 15 participants in the CTS group, 22 in the rehabilitation group, and 30 in the general group. The mean score for QuickDASH questionnaire in the CTS group, rehabilitation group, and general group were 29.70, 21.59, and 1.97, respectively (p value < 0.01). The 95% confidence interval CI of the difference between two groups was 0.00∼18.18 between the CTS group and the rehabilitation group, 22.73∼31.82 between the CTS group and the general group, and 11.36∼18.18 between the rehabilitation group and the general group. The intra-class correlation coefficient was 0.91, which indicated excellent test-retest reliability. A strong correlation between the scores of QuickDASH and DASH questionnaires was observed. QuickDASH appeared to be reliable and valid for the use in patients with UE musculoskeletal diseases in Taiwan. The research didn't have any interest in conflict to bias the presentation and the funder had no role in any stage of the study. [ABSTRACT FROM AUTHOR]

Summary Background Situation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios. Objectives To develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT). Design Instrument development and validation. Settings A faculty of nursing of a French–Canadian university. Participants 15 critical care experts and 234 bachelor-level nursing students from a critical care course. Methods The queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey. Results The instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation. Conclusions This instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios. [ABSTRACT FROM AUTHOR]

The use of evidence-based practices in education has been gaining a lot of attention in recent years. Researchers often use meta-analyses to identify evidence-based practices. To conduct meta-analyses of studies employing single-subject experimental research (SSER) designs for the purpose of identifying evidence base for a practice, a necessary step is to obtain raw data from published graphs. One method for obtaining raw data from published SSER graphs is the use of computer programs specifically designed to extract data from graphs. Purpose of the present study was to examine the reliability and validity of three data extraction programs, Ungraph, GraphClick, and DigitizeIt, using 60 graphs obtained from 15 SSER studies focused on a practice. Three coders extracted data from the graphs using the three programs. Values extracted by each coder were compared to (a) each other (reliability) and (b) values reported in the original articles in which the graphs were obtained from (validity). Results showed that raw data from SSER graphs can be obtained reliably using all three data extraction programs and values obtained using the three programs are highly valid. These results suggest that researchers can use data extracted using these programs with a high level of confidences while conducting meta-analyses of studies employing SSER designs. Authors make recommendations for improving the accuracy of data extraction using the three programs. [ABSTRACT FROM AUTHOR]

Objective: The objective was to evaluate the psychometric properties of the Rheumatoid Arthritis-Work Instability Scale (RA-WIS) in a clinical trial setting.Methods: Secondary analyses were conducted using data from a 56-week, randomized controlled trial of patients with early rheumatoid arthritis (RA). Patient-reported outcome measures included the RA-WIS, the Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life Questionnaire, and the Global Assessment of Disease Activity and Pain, data for which were collected at baseline and at weeks 12, 16, 24, and 56. Data were analyzed for reliability, validity, and responsiveness.Results: Among 148 patients whose data were analyzed, more than half were women (56.1%) with a mean age of 46.8 years. On average, patients experienced RA symptoms for 8.7 months; the mean 28-Joint Disease Activity Score (DAS28) was 5.9, and the mean HAQ - Disability Index was 1.3. The RA-WIS demonstrated excellent internal consistency and test-retest reliability (α = 0.89 and intraclass correlation coefficient = 0.91, respectively). At baseline and week 24, moderate to strong correlations were seen between RA-WIS total scores and the HAQ, the Global Assessment of Disease Activity, and the Pain Rheumatoid Arthritis Quality of Life Questionnaire, ranging from 0.47 to 0.81 (all P < 0.0001). Mean RA-WIS total scores and work disability risk levels discriminated between clinical severity scores on the DAS28, the HAQ - Disability Index, and the Physician Global Assessment of Disease Activity (all P < 0.05). Mean baseline to week 24 RA-WIS total change scores were significantly different among American College of Rheumatology responder groups (P ≤ 0.0001) and between DAS28 remission status groups (P < 0.001).Conclusions: These findings provide evidence supporting the reliability, validity, and responsiveness of the RA-WIS for evaluating work disability in patients with RA in a clinical trial setting. [ABSTRACT FROM AUTHOR]

Background: although obstetrical interventions are used commonly in Turkey, there is no standardized evidence-based assessment tool to evaluate maternity care outcomes. The Optimality Index-US (OI-US) is an evidence-based tool that was developed for the purpose of measuring aggregate perinatal care processes and outcomes against an optimal or best possible standard. This index has been validated and used in Netherlands, USA and UK until now. Objective: the objective of this study was to adapt the OI-US to assess maternity care outcomes in Turkey. Design: translation and back translation were used to develop the Optimality Index-Turkey (OI-TR) version. To evaluate the content validity of the OI-TR, an expert panel group (n = 10) reviewed the items and evidence-based quality of the OI-TR for application in Turkey. Following the content validity process, the OI-TR was used to assess 150 healthy and 150 high-risk pregnant women who gave birth at a high volume, urban maternity hospital in Turkey. The scores between the two groups were compared to assess the discriminant validity of the OI-TR. The percentage of agreement between two raters and the Kappa statistic were calculated to evaluate the reliability. Findings: content validity was established for the OI-TR by an expert group. Discriminant validity was confirmed by comparing the OI scores of healthy pregnant women (mean OI score = 77.65%) and those of high-risk pregnant women (mean OI score = 78.60%). The percentage of agreement between the two raters was 96.19, and inter-rater agreement was provided for each item in the OI-TR. Conclusion: OI-TR is a valid and reliable tool that can be used to assess maternity care outcomes in Turkey. The results of this study indicate that although the risk statuses of the women differed, the type of care they received was essentially the same, as measured by the OI-TR. Care was not individualised based on risk and for a majority of items was inconsistent with evidence based practice, which is not optimal. Implications for practice: use of the OI-TR will help to provide a standardized way to assess maternity care process and outcomes of maternity care in Turkey which can inform future research aimed at improving maternity care outcomes. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinimetric properties of maximal aerobic and anaerobic fitness measurement protocols in adults with cerebral palsy (CP).Data Sources: A systematic search through March 2015 of databases PubMed, Embase, SPORTDiscus and PsycINFO was performed with medical subject heading terms for 'cerebral palsy' combined with search terms adults or adolescents and multiple text words for fitness and exercise tests that yielded 864 articles.Study Selection: Abstracts were screened by two reviewers to identify use of maximal fitness measurements in adolescents (14-18yrs) or adults (>18yrs) with CP of all abilities. Ninety-four articles were reviewed. No studies of adolescent (14-18yrs) qualified. Eight articles reported clinimetric properties for adults with CP who walk or propel a wheelchair independently. Five articles reported on aerobic capacity, one reported on anaerobic capacity and two reported on both.Data Extraction: Methodological quality of the studies was rated using portions of the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. Quality of the measurement protocols was evaluated based on statistical strength of the clinimetrics. Synthesis of the overall evidence was based on the Cochrane review group guidelines which combine methodological quality and statistical strength.Data Synthesis: Eight articles reported on 4 aerobic and 1 anaerobic protocols. Overall synthesis revealed that for ambulatory adults with CP there is (i) moderate evidence for good reliability and good construct validity of maximal aerobic and anaerobic cycle tests, (ii) moderate evidence for good criterion validity of sub-maximal aerobic cycle tests, and (iii) strong evidence for poor criterion validity of the six-minute walk test as a maximal aerobic test. And for adults who propel a wheelchair there is limited evidence of good reliability for maximal aerobic wheelchair ergometer tests.Conclusions: Limited quality research exists on the clinimetric properties of aerobic and anaerobic capacity measures for adults with CP who have independent mobility. Quality aerobic and anaerobic measures for adults with more severe mobility impairments are absent. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to assess interrater and intrarater reliability and validity for single inclinometry (SI) and dual inclinometry (DI) assessment of cervical lateral flexion (CLF) range of motion and compare reliability in a practicing physical therapist (PT) and student PTs (SPTs). Methods Twenty-four subjects performed right and left CLF while SI, DI, and 3-dimensional kinematics were concurrently recorded. Subjects were reassessed by 2 SPTs and 1 PT using both SI and DI. Each subject was measured twice per rater in round-robin fashion. Results There were significant positive relationships between DI and motion capture for both right ( r = 0.841; P < .01) and left lateral flexion ( r = 0.838; P < .01). Single inclinometry also had a significant correlation with motion capture for right ( r = 0.927, P < .01) and left ( r = 0.834, P < .01) lateral flexion. Interrater reliability was good for both SI and DI methods. For SI, intraclass correlation coefficient (ICC) (3,1) was 0.905 and 0.870 for right and left CLF, respectively. For DI, ICC(3,1) was 0.803 and 0.757 for right and left CLF, respectively. Intrarater reliability was good for both methods. Average SI values were ICC(2,1) of 0.928 and 0.897 for right and left CLF, respectively. Average DI values were ICC(2,1) of 0.882 and 0.851 for left and right, respectively. Although not significant, the PT had slightly higher reliability in all measures (range, 0.881-0.935) compared to the SPTs (range, 0.880-0.925). Conclusions Both SI and DI are acceptable for clinical use and both are reliable measurement methods for CLF between raters and for repeated measures. There are minimal differences in reliability between a PT with experience and SPTs with minimal experience. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the psychometric properties and the factorial structure of the Driving Anger Expression Inventory (DAX) in a Chinese sample. We also explored the relationships among driving anger expression, general anger expression, and driving outcomes. Three hundred and fifty-eight drivers completed the Chinese version of the DAX, the Anger Expression Scale (AX), the Dula Dangerous Driving Index (DDDI) and a questionnaire about several types of traffic violations. A confirmatory factor analysis of the Chinese DAX yielded a four-factor solution with 20 items. This solution showed the best goodness of fit of the data and acceptable reliability. The validity of the revised DAX was also verified. The aggressive expression forms were positively correlated with dangerous driving behaviors. Using the vehicle to express anger was associated with fines. The aggressive forms were also positively correlated with general anger expression-out and negatively correlated with general anger control. The adaptive expression of anger was positively correlated with anger control but negatively correlated with dangerous driving behaviors, penalty points and fines. Furthermore, young drivers (<30 years old) reported more personal and physical aggressive expressions of anger than other drivers. Gender differences were only found in some age groups. Thus, the revised DAX was confirmed to be a reliable and valuable instrument to measure forms of driving anger expression in traffic environments in China. [ABSTRACT FROM AUTHOR]

Driver inattention is a significant cause of motor vehicle collisions and incidents. The purpose of this study was to translate the Attention-Related Driving Error Scale (ARDES) into Chinese and to verify its reliability and validity. A total of 317 drivers completed the Chinese version of the ARDES, the Dula Dangerous Driving Index (DDDI), the Attention-Related Cognitive Errors Scale (ARCES) and the Mindful Attention Awareness Scale (MAAS) questionnaires. Specific sociodemographic variables and traffic violations were also measured. Psychometric results confirm that the ARDES-China has adequate psychometric properties (Cronbach’s alpha = 0.88) to be a useful tool for evaluating proneness to attentional errors in the Chinese driving population. First, ARDES-China scores were positively correlated with both DDDI scores and number of accidents in the prior year; in addition, ARDES-China scores were a significant predictor of dangerous driving behavior as measured by DDDI. Second, we found that ARDES-China scores were strongly correlated with ARCES scores and negatively correlated with MAAS scores. Finally, different demographic groups exhibited significant differences in ARDES scores; in particular, ARDES scores varied with years of driving experience. [ABSTRACT FROM AUTHOR]

Objectives: Case-mix adjustment is difficult for stroke outcome studies using administrative data. However, relevant prescription, laboratory, procedure, and service claims might be surrogates for stroke severity. This study proposes a method for developing a stroke severity index (SSI) by using administrative data. Study Design and Setting: We identified 3,577 patients with acute ischemic stroke from a hospital-based registry and analyzed claims data with plenty of features. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). We used two data mining methods and conventional multiple linear regression (MLR) to develop prediction models, comparing the model performance according to the Pearson correlation coefficient between the SSI and the NIHSS. We validated these models in four independent cohorts by using hospital-based registry data linked to a nationwide administrative database. Results: We identified seven predictive features and developed three models. The k-nearest neighbor model (correlation coefficient, 0.743; 95% confidence interval: 0.737, 0.749) performed slightly better than the MLR model (0.742; 0.736, 0.747), followed by the regression tree model (0.737; 0.731, 0.742). In the validation cohorts, the correlation coefficients were between 0.677 and 0.725 for all three models. Conclusion: The claims-based SSI enables adjusting for disease severity in stroke studies using administrative data. [ABSTRACT FROM AUTHOR]

Objectives To validate the Fullerton Advanced Balance (FAB) Scale for patients with idiopathic Parkinson disease (PD); and to compare the FAB Scale with the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Berg Balance Scale (BBS). Design Observational study to assess concurrent validity, test-retest, and interrater reliability of the FAB Scale in patients with PD and to compare the distribution of the scale with the Mini-BESTest and BBS. Setting University hospital in an urban community. Participants Patients with idiopathic PD (N=85; Hoehn and Yahr stages 1–4). Interventions Not applicable. Main Outcome Measures FAB Scale, Mini-BESTest, BBS, timed Up and Go test, Unified Parkinson's Disease Rating Scale, and visual analog scale. Results Interrater (3 raters) and test-retest (3±1d) reliability were high for all scales (ICCs≥.95). The FAB Scale was highly correlated with the Mini-BESTest (Spearman ρ=.87) and timed Up and Go test item of the Mini-BESTest (Spearman ρ=.83). In contrast with the BBS, the FAB Scale and Mini-BESTest have only minimal ceiling effects. The FAB Scale demonstrated the most symmetric distribution when compared with the Mini-BESTest and BBS (skewness: FAB scale: −.54; Mini-BESTest: −1.07; BBS: −2.14). Conclusions The FAB Scale is a valid and reliable tool to assess postural control in patients with PD. No ceiling effect was noted for the FAB Scale. Although the items of the FAB Scale are more detailed when compared with the Mini-BESTest, interrater and test-retest reliability were excellent. The scale is a promising tool to detect small changes of the postural control system in individuals with PD. [ABSTRACT FROM AUTHOR]

Objective To assess the responsiveness of one generic questionnaire, Medical Outcomes Study Short Form-36 (SF-36), and one region-specific outcome measure, Lower Extremity Functional Scale (LEFS), in patients with traumatic injuries of lower extremities. Design A prospective and observational study of patients after traumatic injuries of lower extremities. Assessments were performed at baseline and 3 months later. Setting In-patients and out-patients in two university hospitals in Taiwan. Participants A convenience sample of 109 subjects were evaluated and 94 (86%) were followed. Interventions Not applicable. Main Outcome Measure(s): Assessments of responsiveness with distribution-based approach (effect size, standardized response mean [SRM], minimal detectable change) and anchor-based approach (receiver's operating curve analysis, ROC analysis). Results LEFS and physical component score (PCS) of SF-36 were all responsive to global improvement, with fair-to-good accuracy in discriminating between participants with and without improvement. The area under curve gained by ROC analysis for LEFS and SF-36 PCS was similar (0.65 vs. 0.70, p = 0.26). Conclusions Our findings revealed comparable responsiveness of LEFS and PCS of SF-36 in a sample of subjects with traumatic injuries of lower limbs. Either type of functional measure would be suitable for use in clinical trials where improvement in function was an endpoint of interest. [ABSTRACT FROM AUTHOR]

Background/Purpose The disability eligibility determination system is based on the International Classification of Functioning, Disability and Health (ICF) framework in Taiwan. The Functioning Disability Evaluation Scale (FUNDES) has been developed since 2007 for assessing the status of an individual's activities and participation in the disability eligibility system. The purpose of this study was to examine the reliability and validity of the FUNDES-Adult Version (FUNDES-Adult). Methods During 2011–2012, a total of 5736 adults with disabilities (aged 58.4 ± 18.2 years) were randomly recruited for a national population-based study. These adults were assessed in person by certified professionals in the authorized hospitals. Domains 1–6 of the FUNDES-Adult addressing the performance and capability dimensions are modified from the World Health Organization Disability Assessment Schedule 2.0–36-item version, and Domain 7 (Environmental attribute) and capability and capacity dimensions of Domain 8 (Motor action) are designed based on the ICF coding system. Results The internal consistency was excellent (Cronbach's α ≥ 0.9). An exploratory factor analysis yielded a five-factor FUNDES structure with a variance of 76.1% and 76.9% and factor loadings of 0.56–0.94 and 0.55–0.94 for the performance and capability dimensions, respectively. The factor loadings for the second-order confirmatory factor analysis for the performance and capability dimensions were from 0.81 to 0.89. In Domains 1–6 and 8, the ceiling effects were from 9% to 36%, and the floor effects were from 5% to 45%. Conclusion FUNDES-Adult has acceptable reliability and validity and can be used to measure activities and participation for people with disabilities. [ABSTRACT FROM AUTHOR]

Background Nocturia is a chronic, fluctuating disease that disrupts sleep and has a wide-ranging impact on quality of life. Valid tools to measure the patient-reported impact of nocturia are essential for evaluating the value of treatment, but the available tools are suboptimal. Objectives This study reports the development and validation of the Nocturia Impact Diary—an augmented form of the Nocturia Quality of Life questionnaire designed to be completed in conjunction with the widely used 3-day voiding diary. Methods The process comprised three steps: Step 1: Development of a concept pool using the Nocturia Quality of Life questionnaire and data from relevant studies; Step 2: Content validity study; Step 3: Psychometric testing of construct validity, reliability, and sensitivity of the diary in a randomized, placebo-controlled study in patients with nocturia. Results Step 1: Fourteen items and 4 domains were included in the first draft of the diary. Step 2: Twenty-three patients with nocturia participated in the cognitive debriefing study. Items were adjusted accordingly, and the content validity was high. Step 3: Fifty-six patients were randomized to desmopressin orally disintegrating tablet or placebo. The diary demonstrated high construct validity, with good sensitivity and a good fit to Rasch model, as well as high internal consistency, discriminatory ability, and acceptable sensitivity to change. Results indicated that the diary was unidimensional. Conclusions The Nocturia Impact Diary is a convenient, validated patient-reported outcome measure. It should be used in conjunction with a voiding diary to capture the real-life consequences of nocturia and its treatment. [ABSTRACT FROM AUTHOR]

The Activities specific Balance Confidence (ABC) is a questionnaire which was developed to assess falls-associated self-efficacy. The aim of this study was to evaluate reliability and validity of the German abbreviated 6-item version of the ABC scores in community-dwelling older people. The study sample included 384 subjects (age 71.1 ± 9.7). In order to determine the psychometric properties, reliability and validity were assessed through administration of the German adaptation of the ABC-D16 to participants twice, 10 days apart, and comparison of the ABC-D16 and the ABC-D6 with functional measures of balance and mobility (one-leg stance; 10 m walk; TUG; Fullerton Advanced Balance Scale (FAB)), physical activity (Physical Activity Scale for the Elderly (PASE)), physical fitness (30 s arm curl, 30 s chair stand, 6 min walk), cognition (Trail-Making-Test (TMT)), falls status, and quality of life (SF36). Factor analyses suggested a 1-factor solution for the ABC-D6 scale (explained variance 79.8%). Internal consistency (.95) and test-retest reliability (.98) for the ABC-D6 scores were excellent. Scores on the ABC-D6 were significantly lower than on the ABC-D16, but ABC-D16 and ABC-D6 scores were highly correlated (.94). There was an increasing difference in the ABC-scores between men and women with increasing age. Fallers reported lower balance confidence than non-fallers. The ABC-D6 score significantly correlated with functional measures of balance and mobility, physical activity, physical fitness, cognition, and quality of life (-.698 < r < .720). It was found that the ABC-D6 is a reliable and valid instrument to asses falls-associated self-efficacy and may be used in future research projects and clinical trials. [ABSTRACT FROM AUTHOR]

Background Previous studies, which relied on hypothetical cases and chart reviews, have questioned the inter-rater reliability of the ASA physical status (ASA-PS) scale. We therefore conducted a retrospective cohort study to evaluate its inter-rater reliability and validity in clinical practice. Methods The cohort included all adult patients (≥18 yr) who underwent elective non-cardiac surgery at a quaternary-care teaching institution in Toronto, Ontario, Canada, from March 2010 to December 2011. We assessed inter-rater reliability by comparing ASA-PS scores assigned at the preoperative assessment clinic vs the operating theatre. We also assessed the validity of the ASA-PS scale by measuring its association with patients' preoperative characteristics and postoperative outcomes. Results The cohort included 10 864 patients, of whom 5.5% were classified as ASA I, 42.0% as ASA II, 46.7% as ASA III, and 5.8% as ASA IV. The ASA-PS score had moderate inter-rater reliability (κ 0.61), with 67.0% of patients (n=7279) being assigned to the same ASA-PS class in the clinic and operating theatre, and 98.6% (n=10 712) of paired assessments being within one class of each other. The ASA-PS scale was correlated with patients' age (Spearman's ρ, 0.23), Charlson comorbidity index (ρ=0.24), revised cardiac risk index (ρ=0.40), and hospital length of stay (ρ=0.16). It had moderate ability to predict in-hospital mortality (receiver-operating characteristic curve area 0.69) and cardiac complications (receiver-operating characteristic curve area 0.70). Conclusions Consistent with its inherent subjectivity, the ASA-PS scale has moderate inter-rater reliability in clinical practice. It also demonstrates validity as a marker of patients' preoperative health status. [ABSTRACT FROM AUTHOR]

Objectives In order to quantify the effects of physical activity such as walking on chronic disease, accurate measurement of physical activity is needed. The objective of this study was to determine the validity and reliability of a new activity monitor, the Fitbit One, in a population of healthy adults. Design Cross-sectional study. Methods Thirty healthy adults ambulated at 5 different speeds (0.90, 1.12, 1.33, 1.54, 1.78 m/s) on a treadmill while wearing three Fitbit One activity monitors (two on the hips and one in the pocket). The order of each speed condition was randomized. Fitbit One step count output was compared to observer counts and distance output was compared to the calibrated treadmill output. Two-way repeated measures ANOVA, concordance correlation coefficients, and Bland and Altman plots were used to assess validity and intra-class correlation coefficients (ICC) were used to assess reliability. Results No significant differences were noted between Fitbit One step count outputs and observer counts, and concordance was substantial (0.97-1.00). Inter-device reliability of the step count was high for all walking speeds (ICC ≥ 0.95). Percent relative error was less than 1.3%. The distance output of the Fitbit One activity monitors was significantly different from the criterion values for each monitor at all speeds (P < 0.001) and exhibited poor concordance (0.0-0.05). Inter-device reliability was excellent for all treadmill speeds (ICC ≥ 0.90). Percent relative error was high (up to 39.6%). Conclusions The Fitbit One activity monitors are valid and reliable devices for measuring step counts in healthy young adults. The distance output of the monitors is inaccurate and should be noted with caution. [ABSTRACT FROM AUTHOR]

Objective To systematically review the psychometric evidence on the 2-minute walk test (2MWT). Data Sources Electronic searches of databases including MEDLINE, CINAHL, Academic Search Premier, SPORTDiscus, PsycINFO, EMBASE, the Cochrane Library, and DARE were done until February 2014 using a combination of subject headings and free texts. Study Selection Studies were included if psychometric properties of the 2MWT were (1) evaluated; (2) written as full reports; and (3) published in English language peer-reviewed journals. Data Extraction A modified consensus-based standard for the selection of health measurement instruments checklist was used to rate the methodological quality of the included studies. A quality assessment for statistical outcomes was used to assess the measurement properties of the 2MWT. Data Synthesis Best-evidence synthesis was collated from 25 studies of 14 patient groups. Only 1 study was found that examined the 2MWT in the pediatric population. The testing procedures of the 2MWT varied across the included studies. Reliability, validity (construct and criterion), and responsiveness of the 2MWT also varied across different patient groups. Moderate to strong evidence was found for reliability, convergent validity, discriminative validity, and responsiveness of the 2MWT in frail elderly patients. Moderate to strong evidence for reliability, convergent validity, and responsiveness was found in adults with lower limb amputations. Moderate to strong evidence for validity (convergent and discriminative) was found in adults who received rehabilitation after hip fractures or cardiac surgery. Limited evidence for the psychometric properties of the 2MWT was found in other population groups because of methodological flaws. Conclusions There is inadequate breadth and depth of psychometric evidence of the 2MWT for clinical and research purposes—specifically, minimal clinically important changes and responsiveness. More good-quality studies are needed, especially in the pediatric population. Consensus on standardized testing procedures of the 2MWT is also required. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Burn Specific Health Scale (BSHS) is designed to measure burn-specific, health-related quality of life (HRQoL). The aim of the present study was to evaluate the reliability and validity of the Chinese version of the abbreviated BSHS (BSHS-A). Methods: The English version of the BSHS-A was translated into Chinese using a standardised procedure. The participants were 457 patients classified into three severity groups (mild, moderate and severe). All patients completed the Chinese BSHS-A questionnaire, the Short Form-36 (SF-36) and the EuroQol 5-Dimensions (EQ-5D). To evaluate clinical utility of the BSHS-A, we used Cronbach's alpha (internal consistency), intraclass correlation coefficients (ICCs; test–retest reliability) and construct validity (using the SF-36 and EQ-5D). Results: Cronbach's alpha for all subscales was >0.80, demonstrating high internal consistency of the BSHS-A (Chinese version). The ICC was >0.70 for each patient group. Strong correlations were observed between the BSHS-A and SF-36 and EQ-5D scales. Neither floor nor ceiling effects were found. Conclusion: The present study demonstrated that the BSHS-A (Chinese version) has good psychometric properties, showing suitable internal consistency and test–retest reliability. The BSHS-A may, thus, be useful for assessing HRQoL in Chinese burn victims. However, adaptations may be required to reduce its length. [Copyright &y& Elsevier]

Background: There are several questionnaires available to assess quality of life in breast cancer, however the choice of the best questionnaire often does not take into account the adequacy of these questionnaires’ measurement properties. Objective: To test the measurement properties of two generic quality of life questionnaires and one quality of life questionnaire specific for women with breast cancer. Method: We assessed 106 women after surgery for breast cancer. The assessment included application of the SF-36, WHOQOL-bref, and FACT-B+4 questionnaires as well as the Global Perceived Effect and Pain Numerical Rating scales. The participants were interviewed on three occasions to investigate internal consistency, floor and ceiling effects, construct validity, reproducibility, and responsiveness. Results: Most of the instruments’ domains showed adequate internal consistency (Cronbach’s alpha varying from 0.66 to 0.91). Reliability varied from poor to substantial (ICC2,1 between 0.39 and 0.87) and agreement varied from negative to very good. The SF-36 presented doubtful agreement and showed floor and ceiling effects in three domains. The domains of the generic questionnaires presented moderate to good correlation with the FACT-B+4 (Pearson varying from 0.31 to 0.69). The internal responsiveness varied from small to large (ES varying from –0.26 to 0.98) and external responsiveness was found in only some of the instruments’ domains. Conclusions: Most of the measurement properties tested for the WHOQOL-bref and FACT-B+4 were adequate as was their ability to assess quality of life in women with breast cancer. The SF-36 showed inadequacy in agreement and floor and ceiling effects and should not be used in women with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Hope has received attention as a central component of recovery from mental illness; however, most instruments measuring hope were developed outside the mental health field. To measure the effects of mental health programs on hope in people with schizophrenia, a specialized scale is needed. Objective: This study examined the psychometric properties of the newly developed 9-item Schizophrenia Hope Scale (SHS-9) designed to measure hope in individuals with schizophrenia. Design: A descriptive survey design. Setting: Participants were recruited from three psychiatric hospitals and two community mental health centers in South Korea. Participants: A total of 347 individuals over age 18 with a DSM-IV diagnosis of schizophrenia, schizoaffective, or schizophrenia spectrum disorders (competent to provide written informed consent) participated in this study; 149 (94 men, 55 women) completed a preliminary scale consisting of 40 revised items, and 198 (110 men, 88 women) completed the second scale of 17 items. Methods: Scale items were first selected from extensive literature reviews and a qualitative study on hope in people with schizophrenia; the validity and reliability of a preliminary scale was then evaluated by an expert panel and exploratory factor analysis. The remaining 9 items forming the Schizophrenia Hope Scale (SHS-9) were evaluated through confirmatory factor analysis. Results: The SHS-9 demonstrates promising psychometric integrity. The internal consistency alpha coefficient was 0.92 with a score range of 0-18 and a mean total score of 12.06 (SD = 4.96), with higher scores indicating higher levels of hope. Convergent validity was established by correlating the SHS-9 to the State-Trait Hope Inventory, r = 0.61 (p < 0.01). Divergent validity with the Beck Hopelessness Scale was also established, r = 0.55 (p < 0.01). Exploratory and confirmatory factor analysis resulted in a 1-factor solution, with the essential meaning of hope accounting for 61.77% of the total item variance. Conclusion: As hope has been shown to facilitate recovery from mental illness, the accurate assessment of hope provided by the short, easy-to-use Schizophrenia Hope Scale (SHS-9) may aid clinicians in improving the quality of life of individuals with schizophrenia. [ABSTRACT FROM AUTHOR]

Abstract: Background: Practitioners traditionally use observation to classify the position of patients' anatomical landmarks. This information may contribute to diagnosis and patient management. Objectives: To calculate a) Inter-rater reliability of categorising the sagittal plane position of four anatomical landmarks (lateral femoral epicondyle, greater trochanter, mastoid process and acromion) on side-view photographs (with landmarks highlighted and not-highlighted) of anonymised subjects; b) Intra-rater reliability; c) Individual landmark inter-rater reliability; d) Validity against a ‘gold standard’ photograph. Design: Online inter- and intra-rater reliability study. Subjects: Photographed subjects: convenience sample of asymptomatic students; raters: randomly selected UK registered osteopaths. Methods: 40 photographs of 30 subjects were used, a priori clinically acceptable reliability was ≥0.4. Inter-rater arm: 20 photographs without landmark highlights plus 10 with highlights; Intra-rater arm: 10 duplicate photographs (non-highlighted landmarks). Validity arm: highlighted landmark scores versus ‘gold standard’ photographs with vertical line. Research ethics approval obtained. Raters: Osteopaths (n = 48) categorised landmark position relative to imagined vertical-line; Gwet's Agreement Coefficient 1 (AC1) calculated and chance-corrected coefficient benchmarked against Landis and Koch's scale; Validity calculation used Kendall's tau-B. Results: Inter-rater reliability was 'fair' (AC1 = 0.342; 95% confidence interval (CI) = 0.279–0.404) for non-highlighted landmarks and 'moderate' (AC1 = 0.700; 95% CI = 0.596–0.805) for highlighted landmarks. Intra-rater reliability was 'fair' (AC1 = 0.522); range was ‘poor’ (AC1 = 0.160) to ‘substantial’ (AC1 = 0.896). No differences were found between individual landmarks. Validity was ‘low’ (T B = 0.327; p = 0.104). Conclusion: Both inter- and intra-rater reliability was ‘fair’ but below clinically acceptable levels, validity was ‘low’. Together these results challenge the clinical practice of using observation to categorise anterio-posterior landmark position. [Copyright &y& Elsevier]

Highlights: [•] The Chinese Dula Dangerous Driving Index (DDDI) has a highly reliable and stable structure. [•] The Chinese version of the DDDI supports the four-factor model. [•] Measures of convergent and criterion validity demonstrate that the Chinese DDDI is valid. [•] Young drivers showed more risky driving behaviors than older drivers, and drivers with more experience (via driving years) may exhibit significantly riskier driving behaviors than less experienced drivers. [•] The Chinese DDDI can be used to develop training courses and interventions for professional drivers in China. [ABSTRACT FROM AUTHOR]

Abstract: Background: Social cognitive theory describes a process in which behavior can be disengaged from moral self control through eight different mechanisms. These mechanisms were used for the development of a new scale for measuring moral disengagement (Moral Disengagement Inventory, or MDI) in pharmacists. Objectives: The objectives of this study were to assess the reliability and validation of a scale to measure pharmacists' moral disengagement toward patients who exhibit behaviors directly or indirectly leading to their disease condition, such as an asthmatic patient who smokes or a non-compliant asthmatic patient. Methods: A self-administered survey called the Moral Disengagement Instrument (MDI) was developed for this study. Once the MDI was designed, the items were evaluated for content validity, readability and face validity. The reliability of the developed measures was assessed. The convergent and discriminant validity of the moral disengagement constructs were tested using confirmatory factor analysis. Results: The reliability coefficient for the MDI for the asthmatic smoker was 0.814 and reliability coefficient for the MDI for the non-compliant asthmatic patient was 0.782. Evidence supporting validity of the MDI was provided in a confirmatory factor analysis. Conclusions: The Moral Disengagement Instrument (MDI), developed as a tool for measuring pharmacists' disengagement beliefs for a smoker asthmatic patient and a non-compliant asthmatic patient, was found to be reliable and valid. [Copyright &y& Elsevier]