Şehim Kutlay

Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis

The objective of this study is to test the reliability and validity of WHODAS-II (Turkish version) for the assessment of disability in patients with osteoarthritis. This study is designed as follows: the internal construct validity of WHODAS-II in patients with knee osteoarthritis was assessed by Rasch analysis, and external construct validity by association with the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) and the Nottingham Health Profile (NHP); reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and test–retest ICC. Our study presents the results of 225 outpatients assessed with mean age 58.4 years (SD 11.1) of whom 80.9% were female. Cronbach’s α, ICC, and test–retest ICC values for the six subscales of WHODAS-II varied between 0.71 and 0.94, 0.71 and 0.94, and 0.87 and 0.97, respectively. Rasch analysis of WHODAS-II indicated that after adjustment for local dependency, satisfactory fit was achieved. Two separate ‘activities’ and ‘participation’ components could also be identified. External construct validity of the scale was confirmed with expected correlations with WOMAC and NHP. This study concludes that WHODAS-II provides a reliable and valid health status instrument for measuring disability and components of ‘activities’ and ‘participation’ in patients with osteoarthritis. Thus, it provides the opportunity to model the consequences of disease according to the International Classification of Functioning, Disability and Health framework.

Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey.

The Functional Independence Measure for Children (WeeFIM) instrument has recently been adapted and validated for non‐disabled children in Turkey. The aim of this study was to validate the instrument in children with cerebral palsy (CP). One hundred and thirty‐four children with CP were assessed using the WeeFIM. Reliability was tested by internal consistency, intraclass and interrater correlation coefficients (ICCs), internal construct validity by Rasch analysis, and external construct validity by correlation with the Denver II Development Test (Denver II). Mean age of the participants (70 females, 64 males) was 4y 6mo (SD 3y 8mo, range 6mo–16y). CP type was: diplegia in 37.3%, hemiplegia in 20.2%, quadriplegia in 8.2%, ‘baby at risk’ (i.e. infants who show neuromotor delay but cannot be classified in a CP type) in 29.9%, and other in 4.5%. Reliability of the WeeFIM was excellent with high Cronbach’s alpha and ICC values ranging between 0.91 and 0.98 for the motor and cognitive scales. After collapsing response categories, both motor and cognitive scales met Rasch model expectations. Unidimensionality of the motor scale was confirmed after adjustment for local dependency of items. There was no substantive differential item functioning and strict unidimensionality for both scales was shown by analysis of the residuals. External construct validity was supported by expected high correlations with developmental ages determined by the social, fine motor function, language, and gross motor function domains of the Denver II. We conclude that the WeeFIM is a reliable and valid instrument for evaluating the functional status of Turkish children with CP.

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke

Purpose: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. Methods: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM™). Results: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed “activities” and “participation” components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach’s α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM™. Conclusions: WHODAS-II provides a reliable and valid instrument for measuring disability and components of “activities” and “participation” in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs. Implications for Rehabilitation The impact of stroke on patients’ functioning in terms of activities and participation is important in the postacute and long-term rehabilitation phase. The World Health Organization Disability Assessment Schedule (WHODAS-II) was developed specifically to measure activities and participation. Psychometric properties of the WHODAS-II in stroke have received some attention recently, mostly using classical approaches. This study has tested the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis and it has been found that WHODAS-II provides a reliable and valid instrument for measuring functioning and components of “activities” and “participation” in stroke survivors.

Construct validity and reliability of the rivermead behavioural memory test in the Turkish population

Primary objective: To adapt the Rivermead Behavioural Memory Test (RBMT) for the Turkish adult population and to test its reliability and validity among acquired brain injury patients. Research design: Descriptive study of RMBTs normative scores, reliability and validity. Methods and procedures: One hundred and seventy-one acquired brain injury patients undergoing inpatient rehabilitation in a university hospital and 266 normal adults were assessed by RBMT. Reliability was tested by internal consistency and person separation index (PSI), internal construct validity by Rasch analysis and external construct validity by associations with physical and cognitive disability. Results: Reliability was good with Cronbachs α = 0.84 and PSI = 0.85 at admission. Fit to the Rasch model showed one item (faces) to deviate from model expectation. After its removal, internal construct validity was confirmed (mean item fit = −0.394, SD = 0.796; mean person fit = −0.228, SD = 0.681). External construct validity was supported by expected correlations. Conclusion: The original 12-item version of RBMT adapted for use in acquired brain injury in Turkey has been shown to lack internal construct validity. An 11-item version (without ‘faces’) gives a valid unidimensional summed score and can be transformed to a linear metric for use in studies where change scores are required.

Cerebral infarct due to meningovascular neurobrucellosis: a case report.

Brucellosis is a common and multisystemic zoonotic infectious disease. Central nervous system involvement is rarely seen in brucellosis, with an incidence of 0.5-25%. The aim of this report is to underline the importance of brucellosis, which is an endemic infection in our country, during the diagnostic evaluation of stroke.

The interval scaling properties of the London Handicap Scale: an example from the adaptation of the scale for use in Turkey

Objectives: To adapt the London Handicap Scale into the Turkish language, and to investigate the scaling properties of this version in a sample of people who have experienced a stroke. Design: After the translation process, the internal construct validity was tested by Rasch analysis and the reliability by internal consistency and intraclass correlation coefficient. The interval scaling properties were assessed by contrasting the raw and weighted London Handicap Scale scores with the Rasch latent estimates. Setting: An outpatient rehabilitation unit of a university hospital. Subjects: One hundred and eighty-eight community-dwelling post-stroke patients (mean age 63 (SD 12) years, 54% male) were assessed by the Turkish version of the London Handicap Scale. Results: After adjustment for local dependency, the data showed good fit to Rasch model expectations with a mean item fit −0.240 (SD 1.868), person fit −0.403 (SD 0.893) and chi-square interaction 8.55 (df 10, P = 0.575). The reliability was good with a Cronbach’s α and intraclass correlation coefficient of 0.845. Analysis of the scaling properties showed that either the raw London Handicap Scale score or its weighted score were non-linear with respect to the Rasch latent estimate. Conclusions: The London Handicap Scale is a valid and reliable scale for use in stroke in Turkey. Its unweighted raw scores and weighted scores are equivalent and ordinal, but a linear transformation is possible through Rasch analysis.

Adaptation of the osteoarthritis-specific quality of life scale (the OAQoL) for use in Germany, Hungary, Italy, Spain and Turkey

The Osteoarthritis Quality of Life scale (OAQoL) is specific to individuals with osteoarthritis. The present study describes the adaptation of the OAQoL for use in the following five European languages: German, Hungarian, Italian, Spanish and Turkish. The study involved three stages in each language; translation, cognitive debriefing (face and content validity) and validation. The validation stage assessed internal consistency (Cronbach’s alpha), reproducibility (test–retest reliability using Spearman’s rank correlations), convergent and divergent validity (correlations with the Health Assessment Questionnaire, The Western Ontario and McMaster Universities Index of osteoarthritis and Nottingham Health Profile) and known group validity. The OAQoL was successfully translated into the target languages with minimal problems. Cognitive debriefing interviewees found the measures easy to complete and identified few problems with content. Internal consistency ranged from 0.94 to 0.97 and test–retest reliability (reproducibility) from 0.87 to 0.98. These values indicate that the new language versions produce very low levels of measurement error. Median OAQoL scores were higher for patients reporting a current flare of osteoarthritis in all countries. Scores were also related, as expected, to perceived severity of osteoarthritis. The OAQoL was successfully adapted for use in Germany, Hungary, Italy, Spain and Turkey. The addition of these new language versions will prove valuable to multinational clinical trials and to clinical practice in the respective countries.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study

Objectives This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

Integrating patient reported outcome measures and computerized adaptive test estimates on the same common metric: an example from the assessment of activities in rheumatoid arthritis

This study aimed to explore the potential of an inclusive and fully integrated measurement system for the Activities component of the International Classification of Functioning, Disability and Health (ICF), incorporating four classical scales, including the Health Assessment Questionnaire (HAQ), and a Computerized Adaptive Testing (CAT).

Reliability, Construct Validity and Measurement Potential of the International Classification of Functioning, Disability and Health Comprehensive Core Set for Chronic Widespread Pain

Abstract Objectives: To investigate the reliability and construct validity of the International Classification of Functioning, Disability and Health [ICF] Comprehensive Core Set for Chronic Widespread Pain [CWP] in order to test its possible use as a measuring tool for functioning. Methods: Patient participants with CWP were assessed by the ICF Comprehensive Core Set for CWP, the Short Form-36 Health Survey [SF-36] and the Fibromyalgia Impact Questionnaire [FIQ]. The internal construct validity of the “Body Functions” [BF], “Activity” [A], “Participation” [P] and “Environmental Factors” [EF] domains were tested by Rasch analysis; the reliability by internal consistency and the Person Separation Index; and external construct validity by association with the SF-36 and FIQ. Results: One hundred patients with fibromyalgia syndrome [FMS] were recruited for this study in Ankara, Turkey. Most were literate in Turkish and were able to complete the SF-36 and FIQ unassisted but some were illiterate, so the instruments were read to them by an investigator. In each scale, items showing disordered thresholds were rescored, testlets were created to overcome local dependency problems, and items mismatched to the Rasch model were deleted. Then the internal construct validity of the BF, A, P and EF scales were good, indicating a single underlying construct for each scale. The scales were free of differential item functioning. Reliabilities of the scales were adequate [Cronbach’s alphas 0.78–0.86, Person Separation Index’s 0.68–0.82]. The BF, A and P showed moderate correlations with the SF-36 and FIQ, whereas the EF scale had statistically significant but weak correlation only with SF-36 Social Functioning. Conclusion: Since the four scales derived from BF, A, P and EF components of the ICF core set for CWP were shown to be reliable and valid through Rasch analysis and classical psychometric methods, these might be used as clinical assessment tools.