An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire

BACKGROUND: Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL) measure, the deep venous thrombosis quality of life questionnaire (DVTQOL), for patients with recent exposition and treatment of proximal deep venous thrombosis. METHODS: A total of 121 consecutive outpatients (50 % males; mean age 61.2 ± 14 years) treated with warfarin (Waran(®)) for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. RESULTS: Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising); limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93). The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. CONCLUSIONS: The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored

Psychometric validation of the German translation of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in patients with reflux disease

BACKGROUND: Symptoms of heartburn has an impact on health-related quality of life (HRQL). When a questionnaire is translated into a new language, a linguistic validation is necessary but not sufficient unless the psychometric characteristics have been verified. The aim is to document the psychometric characteristics of the German translation of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire. METHODS: 142 patients with symptoms of heartburn (Age: M = 47.5, ± 14.6; Males = 44.4%) completed the German translation of GSRS, the QOLRAD, the Short-Form-36 (SF-36) and the Hospital Anxiety and Depression (HAD) scale. RESULTS: The internal consistency reliability of GSRS ranged from 0.53–0.91 and of QOLRAD from 0.90–0.94, respectively. The test-retest reliability of GSRS ranged from 0.49–0.73 and of QOLRAD from 0.70–0.84. The relevant domains of the GSRS and QOLRAD domain scores significantly correlated. GSRS domains of Abdominal Pain and Constipation correlated (negatively) with most of the domains of the SF-36. The relevant QOLRAD domains significantly correlated with all SF-36 domains. CONCLUSIONS: The psychometric characteristics of the German translation of GSRS and QOLRAD were found to be good, with satisfactory reliability and validity. The reliability of the GSRS Abdominal Pain domain was moderate

Reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in dyspepsia: A six-country study

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Interpersonal Skills in the Dentist-Patient Relationship

The concept of interpersonal skills and its relevance in the dentist-patient relationship wasinvestigated. In Study I, general dentists responding to a mailed questionnaire reported thatthe ideal characteristics of a good dentist can be divided into three categories: 1)interpersonal skills; 2) clinical skills; and 3) other skills. The relative importance of anumber of listed attributes in dentistry were: contact with patients, communication skills,empathy, manual skills and theoretical knowledge, in that order.In Studies II and III, dentists specialized in the treatment of dental phobia wereinterviewed. The analysis of the transcribed interviews was influenced by the principles ofGrounded Theory. In Study II, characteristics of the patient-centered dental consultation wereidentified, including categories of 'Holistic perception and understanding of the patient';'The dentist's positive outlook on people'; and 'The dentist's positive view of patientcontact'. In study III, the following categories described the dynamics of interpersonalprocesses in the dentist-patient encounter: 'Relatedness, based on affective resonance andconcordant roles'; 'The dental phobic patient's emotions'; 'The patient's verbal and nonverbalcues'; 'The dentist's role as a clinician: professional interpersonal skills'; and 'Thedentist's role as a fellow-being: general interpersonal skills'. The results of studies II andIII have a theoretical implication and are supported by previous models of patient-centeredmedicine and the dynamics of the doctor-patient consultation. In Study IV the factor structure of the Swedish version of the Getz's Dental Beliefs Surveywas investigated based on a dental phobic patient population. An exploratory factor analysis(EFA) indicated two solutions: a one-factor (scree plot) solution 'Communication'; and athree-factor (eigenvalues) solution: 'Communication', 'Trust', and 'Fear of NegativeInformation'. A confirmatory factor analysis (CFA), however, suggested a five-factor solution:'Communication', 'Trust', 'Fear of Negative Information', 'Lack of Control' and 'SocialInteraction Distress in Dental Treatment (SIDDT)'. Neither the EFA nor the CFA confirmed thefour-factor structure suggested by the constructors of the DBS. Moreover, the items includedin the dimensions were also partly different from the original version of the DBS. The resultsfrom the two factor analyses indicated that the factor structure of the DBS is ambiguous.Finally, it was concluded that the DBS measures a complex phenomenon with the help of only afew items. The results from the four studies contribute to a better understanding of the concept ofinterpersonal skills in dentistry from the perspective of the dentist, and indirectly of thepatient. Concepts and categories that were identified in Studies I, II and III were inaccordance with the contents of the items and the labels of the DBS factors, investigated inStudy IV. The significance of dentists' interpersonal skills when treating patients,particularly with dental phobia, was confirmed both quantitatively and qualitatively. Key words: Interpersonal skills, dentist-patient relationship, dental phobia, patient-centereddentistry, Grounded Theory, qualitative method, exploratory and confirmatory factor analysis,Dental Beliefs Survey Correspondence to: Károly R. Kulich, Department of Psychology, Göteborg University,Box 500, 405 30 Göteborg, Sweden. E-mail: [email protected] ISSN 1101-718X, ISRN GU/PSYK/AVH 73 SE, ISBN 91-628-4043-

Psychometric validation of the Afrikaans translation of two patient-reported outcomes instruments for reflux disease

Objectives: To verify the validity and reliability of two Afrikaans patient-reported outcomes instruments, a disease-specific and a health-related quality of life instrument in patients with reflux disease. Design: Psychometric validation study. Setting: South African, major referral gastroenterology clinic. Subjects: Consecutive patients with predominant symptoms of heartburn. Outcome measures: Patients completed the Afrikaans versions of the Gastrointestinal Symptom Rating Scale (GSRS), the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) and the Short Form Health-36 (SF-36). The frequency and severity of heartburn during the previous 7 days were recorded. Results: 125 patients (aged of 46.0 ±12.3 years, 74.4% female, 87% mixed race) completed the assessments. Most patients (62%) had severe symptoms and half (54%) had symptoms on more than 5 days in the previous week. Patients were most bothered by symptoms of reflux (mean GSRS score of 4.9), indigestion (4.0) and abdominal pain (4.0). These symptoms caused patients problems with food and drink (mean QOLRAD score of 3.5), emotional distress (3.6), impaired vitality (3.7) and sleep disturbance (3.8). The internal consistency of the GSRS symptom clusters was between 0.65 and 0.86 and, for QOLRAD dimensions, it was in the range 0.82 0.94. Test-retest reliability was 0.620.75 (GSRS) and 0.710.82 (QOLRAD). Relevant domains of GSRS and QOLRAD were significantly correlated. GSRS domains of abdominal pain and indigestion, and relevant QOLRAD domains, showed negative correlation with related SF-36 domains. Conclusions: The Afrikaans translations of GSRS and QOLRAD are valid and reliable instruments for use in clinical trials for the assessment of reflux symptoms and their impact on South African patients' healthrelated quality of life. South African Gastroenterology Review Vol. 4(1) 2006: 5-