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Assessment of musculoskeletal symptoms and their impacts in the adolescent population: adaptation and validation of a questionnaire.

ABSTRACT: BACKGROUND: Valid and reliable instruments measuring musculoskeletal symptoms prevalence and their impacts in the adolescent population are scarce. The Extended Nordic Musculoskeletal Questionnaire (NMQ-E) is a reliable instrument that measures the prevalence, severity and impact of musculoskeletal symptoms. The purpose of this study was: (1) to develop a musculoskeletal symptom screening tool for younger populations derived from the NMQ-E and NMQ French versions and (2) to assess the validity and reliability of the adapted version of the instrument. METHODS: Based on the results of a translated (French) and adapted NMQ-E administered to 61 adolescents, a final 27-item dichotomous questionnaire was developed. The questionnaire measured the 6-month prevalence of musculoskeletal symptoms and the impact of these symptoms on school attendance as well as on sports and leisure activity participation. Among the adolescents who agreed to participate, thirty-nine (mean age: 13.7?±?1.8) formed the reliability cohort and thirty-four (mean age: 14.2?±?2.3) formed the criterion validity cohort. Reliability was measured by test-retest with a mean time interval of 28 hours. Criterion validity was assessed by comparing the answers to the questionnaires to the participants' clinical records. Statistical tests used were proportions of observed agreement (Po) and the Cohen kappa statistic (k). RESULTS: The mean Po for the test-retest was 0.92 for the 6-month symptom prevalence items, 0.99 for the impact of symptoms on school items and 0.96 for the impact on sports and leisure activities items. Kappa values for the reliability assessment ranged between 0.57 and 1.00 for the 27 dichotomous variables. The criterion validity kappa obtained for the agreement between participants' clinical records and questionnaires was k =?0.76. CONCLUSIONS: Kappa values for the reliability and the criterion validity are of moderate to perfect agreement beyond chance, indicating that there are only minor variations between tests, and good agreement between questionnaire items and clinical records. These results indicate that the adapted version of the NMQ-E is an appropriate self-administered musculoskeletal symptom screening tool for the adolescent population. Items related to the impacts of symptoms would benefit from additional validation using school and sport attendance records.

SUBMITTER: Legault EP

PROVIDER: S-EPMC4107588 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Project description:Background and objectiveChronic insomnia has major consequences for daytime functioning, yet no fully validated patient-reported outcome instrument for once-daily assessments is available to measure these consequences. This study describes the development and psychometric evaluation of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ).MethodsThe Daytime Insomnia Symptom Scale (DISS), an existing 20-item instrument for assessing daytime functioning, was modified to give an 18-item version of the IDSIQ (IDSIQ-18) based on iterative qualitative interviews with 54 subjects with insomnia and expert input. The construct validity and other psychometric properties of the IDSIQ-18 were analyzed based on an interventional study (NCT03056053) in which subjects with insomnia received zolpidem (5 or 10 mg) daily for 2 weeks and an observational study among subjects with no diagnosis of insomnia (good sleepers). Participants in both studies completed the IDSIQ-18 daily for 2 weeks. Exit interviews were conducted with a sample of subjects who completed the interventional study to elicit concepts defining the experience of insomnia, to assess understanding of the response scales, and to determine meaningful change thresholds. Exploratory factor analysis and Rasch analysis were conducted to further assess the structure and latent model for the scoring of the final IDSIQ instrument. Further psychometric evaluation of the final IDSIQ was then conducted.ResultsSubjects in both the interventional study (N = 114) and observational study (N = 103) were predominantly female (65% for subjects with insomnia and 60% for good sleepers). Mean age was 51 years for subjects with insomnia and 45 years for good sleepers. Subjects in the exit interviews (N = 41) demonstrated a good understanding of the IDSIQ-18 response scales. Day 1 mean scores were higher (worse) in subjects with insomnia compared with good sleepers. Based on inter-item correlation, exploratory factor, and Rasch analyses and review of the qualitative data, four items were removed. This yielded the final IDSIQ, with 14 items comprising three domains: Alert/Cognition, Mood, and Sleepiness. The domain structure was determined in a confirmatory factor analysis. Evidence of internal consistency reliability was strong: day 1 Cronbach's alpha was 0.917 for IDSIQ total score and 0.806-0.918 for the domains. Test-retest reliability, assessed for subjects with insomnia with no change on the Patient Global Assessment of Disease Severity scale between day 1 and day 8, was also good (intra-class correlation coefficient 0.856-0.911). Meaningful change thresholds derived for this sample using anchor-based approaches were 20 for IDSIQ total score, 9 for the Alert/Cognition domain, 4 for the Mood domain, and 4 for the Sleepiness domain.ConclusionsThese studies, which closely followed Food and Drug Administration Guidance for Industry on patient-reported outcome measures, support use of the IDSIQ as a fit-for-purpose measure for deriving valid and reliable endpoints in insomnia clinical research trials and real-world studies.

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Assessment of musculoskeletal symptoms and their impacts in the adolescent population: adaptation and validation of a questionnaire.

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