Validation of the Italian Version of the Dizziness Handicap Inventory, the Situational Vertigo Questionnaire, and the Activity-Specific Balance Confidence Scale for Peripheral and Central Vestibular Symptoms.

Neurophysiological measurements of the vestibular function for diagnosis and follow-up evaluations provide an objective assessment, which, unfortunately, does not necessarily correlate with the patients' self-feeling. The literature provides many questionnaires to assess the outcome of rehabilitation programs for disequilibrium, but only for the Dizziness Handicap Inventory (DHI) is an Italian translation available, validated on a small group of patients suffering from a peripheral acute vertigo. We translated and validated the reliability and validity of the DHI, the Situational Vertigo Questionnaire (SVQ), and the Activities-Specific Balance Confidence Scale (ABC) in 316 Italian patients complaining of dizziness due either to a peripheral or to a central vestibular deficit, or in whom vestibular signs were undetectable by means of instrumental testing or clinical evaluation. Cronbach's coefficient alpha, the homogeneity index, and test-retest reproducibility, confirmed reliability of the Italian version of the three questionnaires. Validity was confirmed by correlation test between questionnaire scores. Correlations with clinical variables suggested that they can be used as a complementary tool for the assessment of vestibular symptoms. In conclusion, the Italian versions of DHI, SVQ, and ABC are reliable and valid questionnaires for assessing the impact of dizziness on the quality of life of Italian patients with peripheral or central vestibular deficit.

Patient-reported outcomes measure for children born preterm: validation of the SOLE VLBWI Questionnaire, a new quality of life self-assessment tool.

AIM: This study was conducted to develop and validate a new self-report questionnaire for measuring quality of life (QoL), at school age, in children with a very low birthweight (VLBW). METHOD: Through a focus group approach, children were involved directly in defining the questionnaire items, which were presented as illustrations rather than written questions. This preliminary validation of the questionnaire was conducted in 152 participants with VLBW (aged 7-11y) randomly selected from the five participating Italian centres. The questionnaire was completed by children and parents separately; data on children's demographic and medical history, and intellectual, adaptive, and behavioural functioning were collected using standardized scales. All the children also completed the Paediatric Quality of Life Inventory (PedsQL), another Italian-language measure of QoL in children. RESULTS: Our questionnaire was readily accepted and understood, and quick to complete. The Cronbach's alpha value showed it to be a reliable instrument. The child-compiled version correlated well with the PedsQL, whereas no correlations emerged with the other scales used, IQ, or degree of impairment. Conversely, these variables correlated significantly with the parent-compiled version. Children's and parents' answers were divergent on practically all the items. INTERPRETATION: The results confirm the validity of the new instrument and highlight a poor overlap between parents' and children's perspectives.

Validation of the Besta Neurological Institute rating scale for myasthenia gravis.

INTRODUCTION: We validated the scale for myasthenia gravis (MG) developed at the Neurological Institute Foundation of Milan (INCB-MG scale). METHODS: A total of 174 patients were evaluated with the INCB-MG and compared with the MG Composite (MGC) as the gold standard. Dimensionality, reliability, and validity of the INCB-MG scale were studied by principal component factor analysis, Cronbach alpha, and Pearson correlation coefficients; interobserver reliability was calculated by the weighted Cohen K coefficient. RESULTS: Generalized and bulbar INCB-MG subscales were unidimensional with excellent consistency; the INCB-MG and MGC scales were strongly correlated. Fatigability assessment was correlated with the INCB-MG generalized, bulbar, and respiratory subscales. CONCLUSIONS: The INCB-MG scale is a reliable tool to assess MG and is strongly correlated with the MGC. The INCB-MG scale is a valid tool for every day practice and should be further investigated for its application in clinical trials.

A new self-report quality of life questionnaire for children with neuromuscular disorders: presentation of the instrument, rationale for its development, and some preliminary results.

Improvement of quality of life in neuromuscular disorders is a primary objective, both in management of affected children and in the context of therapeutic trials. Quality of life is a subjective concept and it is crucial to gather information directly from patients. We created the SOLE Questionnaire for NMDs, a new instrument designed to investigate quality of life in children with neuromuscular disorders, and tested it in a study population of 78 patients and in 81 healthy children aged 5 to 13 years. The SOLE Questionnaire, characterized by a visual and neutral approach, was well received, practical, rapid to administer, and able to discriminate between patients and controls. We also confirmed the presence of disagreement about children's quality of life between children and their parents. We suggest that our new approach could help to improve understanding of quality of life in children with neuromuscular disorders.

Duloxetine is effective in treating depression in multiple sclerosis patients: an open-label multicenter study.

OBJECTIVES: Duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, was evaluated for its therapeutic efficacy, safety, and tolerability in the treatment of depression in patients with multiple sclerosis (MS). Lifetime depression prevalence approaches 50% in MS patients. The aim of the study was to assess the safety and efficacy of duloxetine for treatment of depression in MS patients. METHODS: An open-label study evaluated the efficacy of 12 weeks of duloxetine administration (maximal dose = 60 mg/d) in MS patients with clinical depression. The Beck scale score variation after 4 (T1) and 12 (T2) weeks of treatment was used for the primary outcome measurement, whereas secondary outcome was measured using the Modified Fatigue Impact Scale. Safety was evaluated by recording treatment-related adverse events, monitoring vital signs, and recording frequency and reasons for interruption or discontinuation of treatment. RESULTS: Seventy-five patients were enrolled in the study. Sixty-three patients completed the study by continuing duloxetine treatment for 12 weeks (T2). Twelve subjects dropped out of the study because of adverse effects or noncompliance. Nausea was the most common adverse event reported. A significant reduction in the Beck Depression Inventory and Modified Fatigue Impact Scale scores, after both 4 and 12 weeks of therapy, was observed. CONCLUSIONS: The results suggest that duloxetine is well tolerated, safe, and effective in reducing depression and fatigue in MS patients.

Cross-cultural validation of a short form of the Oral Health Impact Profile for temporomandibular disorders.

OBJECTIVES: We set out to develop and validate an Italian version of the Oral Health Impact Profile Questionnaire (OHIP) that is appropriate for use in temporomandibular disorders (TMD). METHODS: At first, we had the questionnaire translated from English into Italian by three bilingual individuals whose mother tongue was Italian and thus had three different versions of the questionnaire. These were translated back into English by a native English speaker and the version closest to the original English OHIP was selected. The validation of a questionnaire generally involves the study of the psychometric properties of the instrument: its validity and reliability. Before studying these properties, we assessed the factorial structure of the questionnaire. RESULTS: The number of eigenvalues >1, computed by exploratory factor analysis, was seven. The percentage of cumulative variability explained by a model with six dimensions is 66, whereas that explained by a model with seven dimensions is 70. Therefore, considering that the increment of explained variability due to the seventh dimension is low (3.68%) and that the seventh eigenvalue is very close to 1, we considered a six-factor model capable of explaining the factorial structure of the data. Content analysis suggested eliminating the item 'Felt Self-conscious', as most of the subjects did not understand its meaning. Spearman correlation coefficients showed an association between the scores of all the different subscales and the variable for pain. All the coefficients were significantly different from 0 (P < 0.05). Cronbach's alpha value, always >0.70, showed quite a good reliability for each of the six subscales. CONCLUSIONS: These results reveal a reasonable degree of cross-cultural consistency between the two versions of the OHIP, and thus indicate that our Italian version is valid.

Asthma-like symptoms assessment through ECRHS screening questionnaire scoring.

The definition of asthma has always been a matter of discussion. The European Community Respiratory Health Survey (ECRHS) is a multinational survey designed to compare the prevalence of asthma in subjects aged 20 to 44 years throughout European countries. In each center a representative sample completed a self-administered screening questionnaire composed of nine dichotomous items. We propose a method for constructing a score for the ECRHS screening questionnaire and we validate the method with reference to the clinical diagnosis available for the Italian centers. Clinical diagnosis was made by a group of medical experts after examining the responses to a standardized clinical interview, respiratory function tests, and allergy tests. Before constructing a summary score, the number of latent factors/dimensions explaining correlations among the observed items was recognized. We identified only one factor/dimension underlying the screening questionnaire, so a summary score was determined by the Homogeneity Analysis by Alternating Least Square (HOMALS). Using best Receiver Operating Characteristic (ROC) threshold the diagnostic test of the score had sensitivity and specificity of 75.1 and 80.1%, respectively. The method of scoring is easily reproducible, and has the advantage of optimizing information recoded by the questionnaire.