The Ultrashort Mental Health Screening Tool Is a Valid and Reliable Measure With Added Value to Support Decision-making.
Mental health influences symptoms, outcomes, and decision-making in musculoskeletal healthcare. Implementing measures of mental health in clinical practice can be challenging. An ultrashort screening tool for mental health with a low burden is currently unavailable but could be used as a conversation starter, expectation management tool, or decision support tool.
(1) Which items of the Pain Catastrophizing Scale (PCS), Patient Health Questionnaire (PHQ-4), and Brief Illness Perception Questionnaire (B-IPQ) are the most discriminative and yield a high correlation with the total scores of these questionnaires? (2) What is the construct validity and added clinical value (explained variance for pain and hand function) of an ultrashort four-item mental health screening tool? (3) What is the test-retest reliability of the screening tool? (4) What is the response time for the ultrashort screening tool?
This was a prospective cohort study. Data collection was part of usual care at Xpert Clinics, the Netherlands, but prospective measurements were added to this study. Between September 2017 and January 2022, we included 19,156 patients with hand and wrist conditions. We subdivided these into four samples: a test set to select the screener items (n = 18,034), a validation set to determine whether the selected items were solid (n = 1017), a sample to determine the added clinical value (explained variance for pain and hand function, n = 13,061), and a sample to assess the test-retest reliability (n = 105). Patients were eligible for either sample if they completed all relevant measurements of interest for that particular sample. To create an ultrashort screening tool that is valid, reliable, and has added value, we began by picking the most discriminatory items (that is, the items that were most influential for determining the total score) from the PCS, PHQ-4, and B-IPQ using chi-square automated interaction detection (a machine-learning algorithm). To assess construct validity (how well our screening tool assesses the constructs of interest), we correlated these items with the associated sum score of the full questionnaire in the test and validation sets. We compared the explained variance of linear models for pain and function using the screening tool items or the original sum scores of the PCS, PHQ-4, and B-IPQ to further assess the screening tool's construct validity and added value. We evaluated test-retest reliability by calculating weighted kappas, ICCs, and the standard error of measurement.
We identified four items and used these in the screening tool. The screening tool items were highly correlated with the PCS (Pearson coefficient = 0.82; p < 0.001), PHQ-4 (0.87; p < 0.001), and B-IPQ (0.85; p < 0.001) sum scores, indicating high construct validity. The full questionnaires explained only slightly more variance in pain and function (10% to 22%) than the screening tool did (9% to 17%), again indicating high construct validity and much added clinical value of the screening tool. Test-retest reliability was high for the PCS (ICC 0.75, weighted kappa 0.75) and B-IPQ (ICC 0.70 to 0.75, standard error of measurement 1.3 to 1.4) items and moderate for the PHQ-4 item (ICC 0.54, weighted kappa 0.54). The median response time was 43 seconds, against more than 4 minutes for the full questionnaires.
Our ultrashort, valid, and reliable screening tool for pain catastrophizing, psychologic distress, and illness perception can be used before clinician consultation and may serve as a conversation starter, an expectation management tool, or a decision support tool. The clinical utility of the screening tool is that it can indicate that further testing is warranted, guide a clinician when considering a consultation with a mental health specialist, or support a clinician in choosing between more invasive and less invasive treatments. Future studies could investigate how the tool can be used optimally and whether using the screening tool affects daily clinic decisions.
Level II, diagnostic study.
Wouters RM
,de Ridder WA
,Slijper HP
,Vermeulen GM
,Hovius SER
,Selles RW
,Hand-Wrist Study Group
,van der Oest MJW
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Psychometric evaluation of the Danish version of the Pain Self-Efficacy Questionnaire in patients with subacute and chronic low back pain.
The Pain Self-Efficacy Questionnaire (PSEQ) is a widely used patient-reported outcome measure designed to assess the level of pain self-efficacy in patients with low back pain (LBP). Although the PSEQ has been translated into Danish, its measurement properties remain unknown in patients with subacute and chronic LBP in Danish outpatient clinics. The aim of this study was to investigate the construct validity, internal consistency, test-retest reliability, and measurement error of the Danish version of the PSEQ in a group of Danish patients with subacute and chronic LBP in a hospital outpatient setting.
Patients with LBP referred to two Danish outpatient clinics were recruited for this study. Two days after the consultation, the participants were emailed a link to a survey that included the following outcome measures: the PSEQ, the Oswestry Disability Index, the Numeric Pain Rating Scale, and the Tampa Scale of Kinesiophobia. Five days after completion of the survey, a new survey that included the PSEQ was sent to the participants.
In total, 109 participants were included for the analysis of construct validity and internal consistency, with 94 participants included for the analysis of test-retest reliability and measurement error. Construct validity was found to be high and internal consistency was acceptable, with Cronbach's alpha = 0.93 (95% confidence interval [CI] = 0.91-0.93). Test-retest reliability was found to be good, with an intraclass correlation coefficient (ICC2.1) of 0.89 (95% CI = 0.82-0.92). The standard error of measurement was calculated to be 4.52 and the smallest detectable change was 12.5 points.
The Danish version of the PSEQ showed acceptable measurement properties in terms of construct validity, internal consistency, and test-retest reliability in a group of patients with subacute and chronic LBP. However, further studies are needed to investigate other aspects of the measurement properties.
Errebo M
,Oxfeldt M
,Tegner H
,Christensen J
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Validity and reliability of the revised scale of avoidance and struggle behaviours in stuttering (r-SASBS).
Secondary behaviours, which encompass reactions developed due to an individual's fear and stress about stuttering, have the potential to exacerbate the condition. Therefore, self-evaluation of secondary behaviours is significant in the multidimensional approach for people who stutter (PWS).
To determine the validity and reliability of the Revised Scale of Avoidance and Struggle Behaviours in Stuttering (r-SASBS).
The results of the item analysis and content validity of the Scale of Avoidance and Struggle Behaviours in Stuttering (SASBS), whose pilot study was completed, were reviewed and the number of items was reduced from 30 to 16. The r-SASBS was administered to 440 participants (PWS = 365; people who did not stutter = 75). The content, construct, discriminant validity, internal consistency and test-retest reliability of the r-SASBS were analysed.
Content validity was analysed quantitatively based on expert opinions and was found to be high. The r-SASBS had two factors based on exploratory factor analysis. The number of items was reduced to 14 using confirmatory factor analysis. With discriminant validity, it was found that the r-SASBS could distinguish between the groups. The internal consistency and reliability of the test-retest scores were found to be high.
These findings indicated that the r-SASBS is a reliable and valid scale for the self-evaluation of secondary behaviours in PWS. Thus, it can be used by speech-language pathologists for the multidimensional assessment of stuttering. The validity and reliability of the r-SASBS should be investigated in school-aged children who stutter.
What is already known on this subject Assessment of secondary behaviours in stuttering can be performed using objective and subjective tools. In this regard, a preliminary study was conducted to evaluate these behaviours, using the SASBS, which was developed based on interviews with PWS and a literature review. This study established the content and structural validity of the assessment and found it to have high internal consistency. What this study adds to the existing knowledge Although secondary behaviour assessments need to be comprehensive, it can be time-consuming in busy clinical settings. Owing to the importance of self-reported secondary behaviours in the assessment of stuttering and the reliability of information obtained from the client, there is a need for scales that can be administered quickly to assess the impact of secondary behaviours in PWS. This study examines the validity and reliability of the r-SASBS. What are the practical and clinical implications of this work? The SASBS was reviewed in this study and the number of items was reduced. The r-SASBS was administered to 440 participants. The validity of the r-SASBS was determined based on its content, discriminant, and construct validity. The reliability of the r-SASBS was determined using internal consistency and test-retest reliability. The results indicate that the r-SASBS is a reliable and valid tool for self-evaluating secondary behaviours in PWS. This could be a valuable measure of secondary behaviours in stuttering, which could improve treatment outcomes.
Hancer H
,Tokgoz-Yilmaz S
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