Validación de cuestionarios para la medición de variables en salud: conceptos fundamentales / Validation of questionnaires for the measurement of health variables: Fundamental concepts

Dentro de la práctica clínica, así como en la salud poblacional, es habitual utilizar cuestionarios que permiten evaluar condiciones o variables que no son directamente observables. No obstante, la construcción y validación de estos instrumentos o cuestionarios suele ser poco conocida. El objetivo de esta revisión narrativa es sintetizar de manera general el proceso de construcción y validación de estos cuestionarios, para así tener una mejor comprensión de este proceso, de los aspectos que se evalúan y de la mejor forma de utilizarlos. La validación de cuestionarios corresponde a un proceso de análisis de este, cuya finalidad es medir una variable latente o constructo, así como sus dimensiones, las que no pueden ser observadas directamente. Una variable latente puede ser inferida a través de un conjunto de atributos específicos que forman parte de ella, como los ítems de un cuestionario y que sí son observables. En este artículo se abordan de manera teórica los conceptos fundamentales de validación de cuestionarios o test, variables latentes o constructos, estudio de la confiabilidad y de la validez, así como los factores que afectan a estas dos últimas características, a través de una revisión narrativa. En el texto, se presentan ejemplos sobre estos conceptos.

In clinical practice and population health, it is common to use questionnaires to assess conditions or variables that are not directly observable. However, the construction and validation of these instruments or questionnaires are often poorly understood. This narrative review aims to summarize in a general way the process of construction and validation of these questionnaires in order to have a better understanding of this process, the aspects that are evaluated, and the best way to use them. The validation of questionnaires corresponds to a process of analysis of the questionnaire, aiming to measure a latent variable and its dimensions, which cannot be observed directly. A latent variable can be inferred through a set of specific attributes that are part of it, such as the items of a questionnaire, which are observable. Through a narrative review, this article addresses the fundamental concepts of questionnaire or test validation, latent variables or constructs, reliability and validity studies, and the factors that theoretically affect the latter two characteristics. Examples of these concepts are presented in the text.

Prevalencia de lactancia materna en el sector público de salud de Argentina, según la Encuesta Nacional de Lactancia Materna, 2017 / Prevalence of breastfeeding in the public health sector of Argentina according to the National Survey on Breastfeeding of 2017

Introducción. La lactancia materna (LM) reduce el riesgo de morbimortalidad en niños, además, provee ventajas medioambientales y económicas. El monitoreo de su práctica es indispensable para las políticas públicas. Objetivos. Los objetivos de este trabajo fueron estimar la prevalencia de LM en la población que demanda al sector público, comparar la prevalencia con datos del 2015 y evaluar variables de interés asociadas. Población y métodos. Estudio transversal observacional. Mediante un cuestionario estructurado, se relevó información de ingestión y datos sociodemográficos de lactantes <6 meses (n = 15 322) y de entre 12 y 15 meses (n = 3243) que concurrieron en forma espontánea a efectores del sector público entre agosto y septiembre de 2017. Resultados. La prevalencia de LM exclusiva (LME) en <6 meses fue del 53,5 % (intervalo de confianza del 95 % [IC95%]: 52,7-54,3); al cuarto y sexto mes, del 51,5 % (IC95%: 49,7-53,4) y del 41,7 % (IC95%: 39,8-43,5) respectivamente. La prevalencia de LME al cuarto y al sexto mes aumentaron en relación con el 2015 (p <0,001). La prevalencia de LM en niños de 12 a 15 meses fue del 77,8 % (IC95%: 76,4-79,3). Las siguientes variables se asociaron en forma independiente con menor frecuencia de LME (en <6 meses) y LM: mayor edad del niño, menor nivel educativo materno, parto por cesárea, bajo peso al nacer, puesta al pecho después de la primera hora y separación de la díada madre-hijo/a ≥4 horas diarias. Conclusiones. La LME al sexto mes y la LM continuada muestran cierta mejora, pero aún la proporción de lactantes amamantados no logra alcanzar niveles deseables.

Introduction. Breastfeeding reduces the risk for morbidity and mortality in children and also provides environmental and financial advantages. Breastfeeding monitoring is critical for public policies. Objectives. The objectives of this study were to estimate the prevalence of breastfeeding in the population seeking care in the public sector, compare this prevalence to data from 2015, and assess associated outcome measures. Population and methods. Cross-sectional, observational study. A structured questionnaire was used to collect intake and sociodemographic data from infants aged < 6 months (n = 15 322) and 12-15 months (n = 3243) who sought care from public sector health care providers spontaneously between August and September 2017. Results. The prevalence of exclusive breastfeeding among infants < 6 months was 53.5% (95% confidence interval [CI]: 52.7-54.3); and at 4 and 6 months, 51.5% (95% CI: 49.7-53.4) and 41.7% (95% CI: 39.8-43.5), respectively. The prevalence of exclusive breastfeeding at 4 and 6 months increased compared to 2015 (p < 0.001). The prevalence of breastfeeding among infants aged 12-15 months was 77.8% (95% CI: 76.4-79.3). The following variables were independently associated with a lower frequency of exclusive breastfeeding (< 6 months old) and breastfeeding: older age, lower level of maternal education, delivery via C-section, low birth weight, initial breastfeeding after the first hour, and separation of the mother-child dyad ≥ 4 hours a day. Conclusions. Exclusive breastfeeding at 6 months and continued breastfeeding showed certain improvement, but the rate of breastfed infants is still below desirable levels.

Cross-cultural adaptation of a questionnaire assessing the child and parents' expectations of orthodontic treatment in Brazil

ABSTRACT Introduction: The Sayers and Newton questionnaire was developed in England to assess the child's and parent's expectations about orthodontic treatment. Objective: The aim of this study was to carry out the cross-cultural adaptation of the questionnaire for the Brazilian Portuguese language, to test its reliability, and to compare patients' and their parents' expectations of orthodontic treatment. Methods: After translation and cross-cultural adaptation, the questionnaire was applied to 98 patients (12-14 years), who had been referred for treatment, and their caregivers. The internal consistency of the instrument was assessed by Cronbach's Alpha Coefficient and the test-retest reliability, by Intraclass Correlation Coefficient (ICC). Results: Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.75. Test-retest reliability revealed satisfactory reproducibility (ICC = 0.85). The results showed some significant differences between the expectations of the patients and their caregivers (p < 0.05). There were no significant gender differences (p > 0.05). Conclusions: The process of cross-cultural adaptation of the Sayers and Newton questionnaire for the Brazilian Portuguese was concluded. This study demonstrated that this instrument is reliable and applicable to assess the child's and parent's expectations about orthodontic treatment in Brazil, and it has acceptable psychometric properties.

RESUMO Introdução: O questionário de Sayers e Newton foi desenvolvido na Inglaterra para avaliar as expectativas dos pacientes e de seus responsáveis quanto ao tratamento ortodôntico. Objetivo: O objetivo do presente estudo foi realizar a adaptação transcultural do questionário para a língua portuguesa do Brasil, testar sua confiabilidade e comparar as expectativas de pacientes e responsáveis em relação ao tratamento ortodôntico. Métodos: Após tradução e adaptação transcultural, o questionário foi aplicado a 98 pacientes (12-14 anos), encaminhados ao departamento de Ortodontia da PUC-MINAS para tratamento e de seus responsáveis. A consistência interna do instrumento foi avaliada pelo coeficiente alfa de Cronbach, e a confiabilidade teste-reteste, pelo coeficiente de correlação intraclasse (ICC). Resultados: A confiabilidade interna foi confirmada pelo coeficiente alfa de Cronbach de 0,75. A confiabilidade teste-reteste revelou reprodutibilidade satisfatória (ICC = 0,85). Os resultados mostraram algumas diferenças significativas entre as expectativas dos pacientes e de seus responsáveis (p < 0,05). Não houve diferenças significativas quanto ao sexo (p > 0,05). Conclusões: Foi concluído o processo de adaptação transcultural do questionário de Sayers e Newton para o português brasileiro. Esse estudo demonstrou que esse instrumento é confiável e aplicável para avaliar as expectativas dos pacientes e dos pais sobre o tratamento ortodôntico no Brasil e possui propriedades psicométricas aceitáveis.

Uso do Self-Reporting Questionnaire (SRQ-20) para identificação de grupo clínico e predição de risco de suicídio / The use of Self-Reporting Questionnaire (SRQ-20) for Clinical Group Identification and Suicide Risk Prediction / Uso del Self-Reporting Questionnaire (SRQ-20) para la Identificación del Grupo Clínico y la Predicción del Riesgo de Suicídio

O Self-Reporting Questionnaire (SRQ-20) é uma escala de rastreio utilizada em serviços de atenção básica para avaliar indicadores de transtornos mentais comuns (TMC). O objetivo deste trabalho foi investigar evidências de validade clínica do SRQ-20, comparando participantes clínicos e não clínicos e verificando sua capacidade em diferenciar grupos com transtornos psiquiátricos específicos, como também em predizer risco de suicídio. Participaram do estudo 161 pessoas, 60% sendo de amostra clínica. Foram realizadas análises descritivas, correlações, ANOVAs, análises de regressão logística e curvas ROC. Os resultados apontaram grande tamanho de efeito na capacidade do instrumento em diferenciar grupo clínico e não clínico. Pacientes com transtornos de humor ou de ansiedade não diferiram dos psicóticos em relação à quantidade de sintomas apresentados. Transtornos de personalidade apresentaram escores significativamente maiores que os demais grupos. O SRQ-20 mostrou-se também bom preditor do risco de suicídio. A escala demonstrou ser uma ferramenta útil, principalmente na avaliação breve de TMC e possíveis sinais de risco.

The Self-Reporting Questionnaire (SRQ-20) is a screening scale frequently used in basic care to assess indicators of common mental disorders (CMD). The objective of this study was to investigate evidence of clinical validity of the SRQ-20, comparing clinical and non-clinical participants, and verifying its capacity to differentiate groups with specific psychiatric disorders, as well as to predict suicide risk. The study had 161 participants, of which 60% composed a clinical sample. Descriptive analyzes, correlations, ANOVAs, logistic regression analysis and ROC curves were performed. Results showed a large effect size to SRQ-20 in differentiate clinical and nonclinical groups. Patients with mood or anxiety disorders did not differ from psychotics in relation to the number of common mental symptoms presented. Personality disorders presented significantly higher scores than other groups. SRQ-20 was also a good predictor of suicide risk. The scale has been shown to be a useful clinical tool, especially in brief evaluation of CMD and possible signs of risk.

El Self-Reporting Questionnaire (SRQ-20) es una escala de seguimiento utilizada en servicios de salud para evaluar indicadores de trastornos mentales comunes (TMC). El objetivo de este trabajo fue investigar evidencias de validez clínica del SRQ-20, comparando participantes clínicos y no clínicos y verificando su capacidad en diferenciar grupos con trastornos psiquiátricos específicos, como también en predecir riesgo de suicidio. Participaron del estudio 161 personas, 60% siendo de muestra clínica. Se realizaron análisis descriptivos, correlaciones, ANOVAs, análisis de regresión logística y curvas ROC. Los resultados apuntaron gran tamaño de efecto en la capacidad del instrumento en diferenciar grupo clínico y no clínico. Los pacientes con trastornos de humor o de ansiedad no diferían de los psicóticos en relación a la cantidad de síntomas mentales comunes presentados. Los trastornos de personalidad presentaron escores significativamente mayores que los demás grupos. El SRQ-20 se mostró también buen predictor del riesgo de suicidio. La escala demostró ser una herramienta útil, principalmente en la evaluación breve de TMC y posibles señales de riesgo.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study

ABSTRACT BACKGROUND: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty. OBJECTIVE: To determine whether foot pain can influence a greater degree of frailty. DESIGN AND SETTING: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain. METHODS: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). RESULTS: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS. CONCLUSIONS: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Internet and decision-making regarding health among pregnant woman: cross-cultural adaptation of a questionnaire for use in Brazil / A Internet e tomada de decisões sobre saúde entre gestantes: uma adaptação transcultural de um questionário para uso no Brasil / Internet y toma de decisiones respecto a la salud entre mujeres embarazadas: adaptación transcultural de un cuestionario para su uso en Brasil

The aim of this study was to translate and cross-culturally adapt the Women's Use of the Internet in Pregnancy Questionnaire (WUIPQ) to Brazilian Portuguese and analyze the psychometric properties of the Preparation for Decision Making Scale (PDMS). This study consisted of the following steps: translation, synthesis, back-translation, evaluation by the author of the original questionnaire, review by the panel of experts, and pretest of the WUIPQ. For such, Brazilian pregnant women and mothers who were members of Facebook groups participated in the study. We measured test-retest reliability as well as internal consistency and performed confirmatory factor analysis (CFA) of the B-PDMS. In the pretest, 88.14% of the participants considered the items of the B-WUIPQ to be clear and pertinent, and 84.09% rated the sequence and organization of the questionnaire as excellent/good. The intraclass correlation coefficient and Cronbach's alpha coefficient for the B-PDMS were 0.850 (95%CI: 0.791-0.899) and 0.91, respectively. CFA revealed factor loadings higher than 0.70 for most items, with a comparative fit index of 0.989, Tucker-Lewis index of 0.984, and root mean square error of approximation of 0.08 (95%CI: 0.06-0.09). The B-WUIPQ presented cross-cultural adapted, and the B-PDMS demonstrated satisfactory psychometric proprieties to Brazilian pregnant women.

O estudo teve como objetivos, traduzir e realizar a adaptação transcultural do Women's Use of the Internet in Pregnancy Questionnaire (WUIPQ) para português do Brasil e analisar as propriedades psicométricas da Preparation for Decision Making Scale (PDMS). O estudo consistiu nas seguintes etapas: tradução, síntese, retrotradução, avaliação pelo autor do questionário original, revisão pelo painel de especialistas e pré-teste do WUIPQ. Gestantes e mães brasileiras que pertenciam a grupos de Facebook participaram no estudo. Medimos a confiabilidade teste-reteste e a consistência interna e realizamos análise fatorial confirmatória (AFC) do B-PDMS. No pré-teste, 88,14% das participantes consideraram os itens do B-WUIPQ claros e pertinentes, e 84,09% avaliaram a sequência e organização do questionário como excelentes ou boas. Os coeficientes de correlação intraclasse e alfa de Cronbach para o B-PDMS foram 0,850 (IC95%: 0,791-0,899) e 0,91, respectivamente. A AFC revelou cargas fatoriais acima de 0,70 para a maioria dos itens, com um índice de ajuste comparativo de 0,989, índice de Tucker-Lewis de 0,984 e raiz da média dos quadrados dos erros de aproximação de 0,08 (IC95%: 0,06-0,09). O B-WUIPQ apresentou boa adaptação transcultural, e o B-PDMS demonstrou propriedades satisfatórias para gestantes brasileiras.

El objetivo de este estudio fue traducir y adaptar transculturalmente el Women's Use of the Internet in Pregnancy Questionnaire (WUIPQ) al portugués de Brasil y analizar las propiedades psicométricas de la Preparation for Decision Making Scale (PDMS). Este estudio consistió en los siguientes pasos: traducción, síntesis, traducción inversa, evaluación por parte del autor del cuestionario original, revisión de un panel de expertos, y pretest del WUIPQ. Para ello, mujeres embarazadas brasileñas, y madres que eran miembros de grupos de Facebook, participaron en el estudio. Se midió la fiabilidad del test-retest y la consistencia interna, y se realizó un análisis factorial confirmatorio (AFC) de la B-PDMS. En los pretest, 88,14% de las participantes consideraron los ítems del B-WUIPQ claros y pertinentes, y un 84,09% calificaron la secuencia y organización del cuestionario como excelente/buena. El coeficiente de correlación intraclase y el coeficiente alfa de Cronbach para la B-PDMS fueron 0,850 (IC95%: 0,791-0,899) y 0,91, respectivamente. El AFC reveló cargas factoriales superiores a 0,70 para la mayoría de los ítems, con un índice de ajuste comparativo de 0,989, índice de Tucker-Lewis de 0,984 y raíz de la media de los cuadrados de los errores de aproximación de 0,08 (IC95%: 0,06-0,09). El B-WUIPQ demostró estar transculturalmente adaptado, y la B-PDMS mostró propiedades psicométricas satisfactorias para las mujeres brasileñas embarazadas.

Clinical Efficacy of Allergen-Specific Immunotherapy from Patient and Physician Perspectives

PURPOSE: Allergen-specific immunotherapy (AIT) is the only curative treatment for allergic diseases, but a few allergic patients receive AIT. In this multicenter cross-sectional study, we aimed to explore patient and physician perspectives on AIT through a questionnaire survey. MATERIALS AND METHODS: Allergic patients who received subcutaneous immunotherapy for at least 1 year were asked to answer a questionnaire developed by an expert panel of allergen and immunotherapy workgroup in Korea. RESULTS: A total of 267 patients (adults, 60.3%) with allergic rhinitis (91.4%), asthma (42.7%), or atopic dermatitis (20.2%) from referred hospitals completed the survey. Among patients and physicians, respectively, the overall rates of satisfaction with AIT for allergic rhinitis were 86.4% and 83.3% (kappa agreement=0.234, p<0.001), and those for asthma were 85.3% and 72.9% (kappa agreement=0.373, p<0.001). Moreover, pediatric asthmatic patients reported a significantly higher satisfaction rate than adult asthmatic patients after AIT (p=0.040). Symptom severity (p<0.001, respectively) and drug use for allergic rhinitis and asthma decreased after AIT. However, there was no significant difference in satisfaction rates between children and adults in allergic rhinitis (p=0.736). Interestingly, 35.7% and 35% of allergic rhinitis and asthma patients, respectively, reported experiencing improvement in their symptoms within 6 months of starting AIT. CONCLUSION: In this study evaluating the perspectives of patients and physicians on AIT, the majority of patients were satisfied with the efficacy and safety of AIT, but not its cost. AIT should be recommended for AR and allergic patients.

Life quality evaluation using "time trade off" method for rheumatoid hands / Avaliando qualidade de vida do paciente com artrite nas mãos pelo método "time trade off"

ABSTRACT Objective: Rheumatoid arthritis is a prevalent disease in the population (range 0.5% to 1%) and involves both orthopedic and rheumatologic treatment. The Time Trade-Off (TTO) technique, which determines the number of years the patient or the professional would be allowed before a successful procedure in terms of life expectancy and value of the procedure, has been gaining ground in clinical protocols. From this standpoint, we sought to compare evaluations provided by the patients, orthopedists, and rheumatologists in determining the TTO and to correlate their responses with the clinical repercussions using previously established scores such as the Brief Michigan Hand Questionnaire and the Disease Activity Score-28 (DAS-28). Methods: A prospective study was conducted that involved 37 patients with rheumatoid arthritis, orthopedists, and rheumatologists. The TTO questionnaire was administered by an independent evaluator for evaluation using the DAS-28 and the Brief Michigan Hand Questionnaire. Results: The descriptive analysis revealed similar medians between the orthopedists, rheumatologists, and patients for single assessments. However, there was a weak correlation between the results from the patient and rheumatologist, the patient and Brief Michigan Questionnaire, and those of the orthopedic surgeon and the DAS-28. Conclusion: Similar median values demonstrated equivalent TTO among the orthopedist, rheumatologist, and patient. However, given the weak correlations between the scores, it was not possible to substitute results using a single evaluation scale. Level of Evidence II, Prognostic Studies.

RESUMO Objetivo: Artrite reumatoide é uma doença prevalente na população (0,5% a 1%), envolvendo tratamento tanto ortopédico, quanto reumatológico. A técnica do "Time Trade Off", que determina a quantidade de anos que o paciente ou o profissional daria para ter sucesso absoluto em determinado procedimento, vem ganhando espaço nos protocolos modernos. Diante disto, comparamos a avaliação dada pelo paciente, pelo ortopedista e pelo reumatologista usando "Time Trade Off" e correlacionamos com repercussão clínica e escores já estabelecidos: Brief Michigan Questionnaire (Anexo I) e Disease Activity Score-28 (DAS-28) (Anexo II). Métodos: Estudo prospectivo com 37 pacientes diagnosticados com artrite reumatoide, que foram submetidos ao questionário "Time Trade Off" pelo ortopedista, pelo reumatologista e por um avaliador independente, e avaliação através do DAS-28 e do Brief Michigan. Resultados: Através da análise descritiva, notou-se medianas semelhantes entre ortopedista, reumatologista e paciente. Entretanto, evidenciou-se correlação fraca entre paciente e reumatologista, paciente e o Brief Michigan; e ortopedista e o DAS-28. Conclusão: Valores de mediana semelhantes demonstram "Time Trade Off" equivalentes entre ortopedista, reumatologista e paciente. Mas, diante das correlações fracas entre os escores, não foi possível substituí-los por uma escala única de avaliação. Nível de Evidência II, Estudo Prognóstico.

Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective / 간호학회지

PURPOSE: This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery. METHODS: The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients. RESULTS: The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p < .001). The internal consistency reliability was acceptable (Cronbach's alpha =.96). CONCLUSION: This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Validation of the Korean version of visual analogue scale for irritable bowel syndrome questionnaire for assessment of defecation pattern changes

PURPOSE: Patients often complain of change of defecation pattern and it is necessary to quantify their symptoms. To quantify symptoms, use of questionnaire is ideal, so we adopted a simple and easily writable visual analogue scale for irritable bowel syndrome questionnaire (VAS-IBS). The aim of this study was to develop and validate the Korean version of VAS-IBS questionnaire (Korean VAS-IBS) that can adequately reflect the defecation pattern. METHODS: This study translated English VAS-IBS into Korean using the forward-and-back translation method. Korean VAS-IBS was performed on 30 patients, who visited the outpatient clinic and had no possibility of special defecation pattern. Detailed past medical history and Bristol stool chart was added to the questionnaire. The survey was conducted twice, and the median interval between the 2 surveys was 10 days (8–11 days). Cronbach α for internal consistency reliability and intraclass correlation coefficients for test-retest reliability were analyzed. RESULTS: Korean VAS-IBS achieved acceptable homogeneity with a Cronbach α coefficient of 0.66–0.79 showing adequate internal consistency reliability. In addition, intraclass correlation coefficients showed significant test-retest reliability with 0.46–0.80 except for the question assessing the “perception of psychological wellbeing.” CONCLUSION: The Korean VAS-IBS is a valid and reliable questionnaire for the measurement of the symptoms of defecation pattern changes.

Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries

STUDY DESIGN: Prospective observational study. PURPOSE: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. OVERVIEW OF LITERATURE: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. METHODS: In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. RESULTS: According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05). CONCLUSIONS: A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

Validation of the Online version of the Previous Day Food Questionnaire for schoolchildren / Validação da versão Online do Questionário Alimentar do Dia Anterior para Escolares

ABSTRACT Objective To evaluate the validity of the web-based version of the Previous Day Food Questionnaire Online for schoolchildren from the 2nd to 5th grades of elementary school. Methods Participants were 312 schoolchildren aged 7 to 12 years of a public school from the city of Florianópolis, Santa Catarina, Brazil. Validity was assessed by sensitivity, specificity, as well as by agreement rates (match, omission, and intrusion rates) of food items reported by children on the Previous Day Food Questionnaire Online, using direct observation of foods/beverages eaten during school meals (mid-morning snack or afternoon snack) on the previous day as the reference. Multivariate multinomial logistic regression analysis was used to evaluate the influence of participants' characteristics on omission and intrusion rates. Results The results showed adequate sensitivity (67.7%) and specificity (95.2%). There were low omission and intrusion rates of 22.8% and 29.5%, respectively when all food items were analyzed. Pizza/hamburger showed the highest omission rate, whereas milk and milk products showed the highest intrusion rate. The participants who attended school in the afternoon shift presented a higher probability of intrusion compared to their peers who attended school in the morning. Conclusion The Previous Day Food Questionnaire Online possessed satisfactory validity for the assessment of food intake at the group level in schoolchildren from the 2nd to 5th grades of public school.

RESUMO Objetivo Avaliar a validade da versão baseada na Internet do Questionário Alimentar do Dia Anterior (Online) para escolares do segundo ao quinto ano do ensino fundamental. Métodos Participaram do estudo 312 escolares de 7 a 12 anos de uma escola pública de Florianópolis, Santa Catarina. A validade foi testada pela sensibilidade, especificidade e taxas de concordância (acertos, omissões e intrusões) dos itens alimentares relatados no Questionário Alimentar do Dia Anterior Online, usando a observação direta dos alimentos consumidos no lanche escolar do dia anterior como padrão de referência. Análise de regressão logística multivariada multinomial foi conduzida para avaliar a influência de fatores relacionados aos participantes nas taxas de omissão e intrusão. Resultados Os resultados apontaram adequada sensibilidade (67,7%) e especificidade expressiva (95,2%). As taxas de omissão e de intrusão foram baixas, 22,8% e 29,5%, respectivamente, quando considerados todos os itens alimentares. O item pizza/hambúrguer exibiu a maior taxa de omissão, enquanto os laticínios apresentaram a maior taxa de intrusão. Escolares que frequentavam a escola no turno vespertino apresentaram maior probabilidade de intrusões de itens alimentares comparados aos escolares do turno matutino. Conclusão O Questionário Alimentar do Dia Anterior Online apresentou validade satisfatória para a análise do consumo alimentar em nível de grupo de escolares do segundo ao quinto ano de escola pública.

The Methods for Foot Function Index and Foot and Ankle Outcome Score Measurement: A Comparison between Paper-and-Pencil Method and Electronic Method / 대한족부족관절학회지

PURPOSE: The patient-reported outcome measure (PROM) is used to quantify the subjective state of patients before and after the treatment. The electronic method was recently developed and used for the completion of PROM, in addition to the conventional paper and pencil method. This study identified whether the results of Foot Function Index (FFI) and Foot and Ankle Outcome Score (FAOS) using the paper and pencil method was different from those using the electronic method. MATERIALS AND METHODS: Between May 2016 and August 2016, 42 patients who were admitted to the Seoul Foot and Ankle Center two days before surgery were included for evaluation. The mean age was 46 years (range, 21~72 years). There were 29 males and 13 females. To use the electronic method, the PADAS software (PADAS, Seoul, Korea) was implemented using a touch pad. The primary trial of FFI and FAOS was performed using either the paper-and-pencil method or the electronic method. At 24 hours after the primary test, a secondary trial of FFI and FAOS was performed using the other method. Then, we identified the reliability of FFI and FAOS between the two methods by calculating the intraclass coefficient. RESULTS: Twenty-two patients underwent the first trial using the paper-and-pencil method, and 20 patients underwent the first trial using the electronic method. Of the 42 patients, 8 patients were excluded from this study and only 34 patients were included in this study. The reliability of FFI was excellent with an intraclass coefficient of 0.957, and the reliability of FAOS was also excellent with an intraclass coefficient of 0.840. CONCLUSION: The paper-and-pencil method and the electronic method have the same result for the completion of FFI and FAOS in this study. Therefore, it is commonly considered that the completion of FFI and FAOS using the electronic method can be applied in practice.

Visual Outcomes, Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens

PURPOSE: To evaluate visual outcomes following implantation of a trifocal diffractive intraocular lens (IOL) and to analyze their correlation with patient satisfaction and ease of performing daily tasks. METHODS: This was a prospective study enrolling 100 eyes of 50 patients undergoing cataract surgery with implantation of trifocal IOL AT LISA tri 839MP. Visual and refractive outcomes were evaluated during a 3-month follow-up. Postoperatively, a questionnaire was used to evaluate patient satisfaction with regard to surgical outcome, spectacle independence, perception of photic phenomena, and ease of performing some vision-related activities. RESULTS: A total of 91%, 87%, and 79% of eyes achieved a monocular uncorrected distance, near, and intermediate visual acuity of 0.1 logarithm of the minimum angle of resolution or better, respectively. After the surgery, 96% of the patients could perform their daily activities without problems. The mean spectacle independence scores for reading, doing computer work, and for distance were 10.33 ± 12.47, 5.71 ± 11.90, and 3.92 ± 9.77, respectively (scale: 0 = no spectacles needed; 40 = spectacles always needed). No correlation was found between spectacle independence and visual outcome (-0.101 ≤ r ≤ 0.244, p ≥ 0.087). Mean scores (0 = no symptoms; 40 = strong symptoms) for glare at night, ghost images, and halos were 15.15 ± 12.02, 4.49 ± 7.92, and 13.34 ± 10.82, respectively. No correlation was found between photic phenomena and visual outcome (-0.199 ≤ r ≤ 0.209, p ≥ 0.150). A total of 80% of patients reported satisfaction with the surgery outcome, and 86% would recommend the surgery to friends and family. CONCLUSIONS: Implantation of the AT LISA tri 839MP IOL after cataract surgery provides effective visual restoration associated with a minimal level of photic phenomena, a positive impact on the performance of vision-related daily activities, and a high level of postoperative patient satisfaction.