The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults.

Background: Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients. Purpose: To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension. Patients and methods: A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18 years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups. Results: The participants had a mean age of 56.6 years (SD = 10.7 years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001). Conclusion: The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.

Psychometric validation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP).

Introduction: Reliable and valid instruments are needed to measure the impact of mental health services and programs on the journeys of recovery of service users. The aim of this study was to explore the psychometric properties of the cross-culturally adapted 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Methods: One hundred and ten participants from three locations in Spain (Málaga, Barcelona and Madrid), who were users of primary and specialized mental health services, were interviewed from October 2021 to June 2022. Results: The internal consistency obtained was excellent: ω =.93 and α =.92. Temporal reliability using intraclass correlation coefficients was moderate (ICC=.684, p <.000). Regarding convergent validity, the QPR-15-SP had a moderate correlation with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (ρ =-.500, p <.000), a Visual Numeric Recovery Scale (VNRS) (ρ =.591, p <.000), and the Stages of Recovery Instrument (STORI) (r =.566, p <.000). Correlations between advanced stages of recovery and higher QPR-15-SP scores were found (Moratorium: ρ =-.579, p <.000; Awareness: ρ =-.130, p =.189; Preparation: r =-.043, P=.665; Rebuilding: r =.460, p <.000; Growth: ρ =.697, p <.000). In terms of divergent validity, the QPR-15-SP had low correlation with the DUKE-UNC Functional Social Support Scale (ρ =.273, p <.005). The confirmatory factor analysis of the 1-factor structure obtained reasonable goodness of fit indexes. Discussion: The QPR-15-SP has acceptable psychometric properties, providing support for measuring recovery in Spain and allowing international comparison research.

Test-Retest reliability and preliminary reliable change estimates for Sway Balance tests administered remotely in community-dwelling adults.

Objective: Impaired balance and postural stability can occur with advanced age, following traumatic brain injury, in association with neurological disorders and diseases, and as the result of acute or chronic orthopedic problems. The remote assessment of balance and postural stability could be of value in clinical practice and research. We examined the test-retest reliability and reliable change estimates for Sway Balance Mobile Application tests (Sway Medical, Tulsa OK, USA) administered remotely from the participant's home. Method: Primarily young, healthy community-dwelling adults completed Sway Balance Mobile Application tests remotely on their personal mobile devices once per week for three consecutive weeks while being supervised with a video-based virtual connection. Sway Balance tests include five stances (i.e., feet together, tandem right foot forward, tandem left foot forward, single leg right foot, single leg left foot), which are averaged to compute a Sway Balance composite score from 0 to 100, with higher scores indicating better postural stability. We examined test-retest reliability (measured with intraclass correlation coefficients, ICCs) and preliminary reliable change estimates for 70%, 80%, and 90% confidence intervals. Results: Participants included 55 healthy adults (ages = 26.7 ± 9.9 years, interquartile range = 20-30, range = 18-58; 38 [69%] women). Test-retest reliability for the Sway Balance composite score across three weeks was.88. Test-retest reliability for individual stances ranged from 62 to 83 (all ps < 0.001). At the 80% confidence interval, preliminary reliable changes estimates were 9 points for the Sway Balance composite score. Conclusions: For a remote administration, test-retest reliability was moderate-to-good for all Sway Balance stances, as well as for the Sway Balance composite score. Reliable change estimates may allow clinicians to determine whether an improvement or decline in performance is greater than the expected improvement or decline due to measurement error in young adults.

Parkinson's Disease Medication Adherence Scale: Conceptualization, Scale Development, and Clinimetric Testing Plan.

Background: Medication adherence is a crucial component in the management of patients with chronic diseases needing a long-term pharmacotherapy. Parkinson's disease (PD) is a chronic, degenerative disease with complex drug treatment that poses challenging barriers to patient adherence. The adoption of best practices of scale development can contribute to generate solid concepts and, in the long run, a more stable knowledge base on the underlying constructs of medication adherence in PD measured by the items of the first scale to be created for this purpose. Purpose: To present the development process and clinimetric testing plan of the Parkinson's Disease Medication Adherence Scale (PD-MAS). Method: We adopted a hybrid approach plan based on the United States Food and Drug Administration and Benson and Clark Guide that will create a patient-reported outcome instrument. We presented an overview of consecutive and interrelated steps, containing a concise description of each one. International research centers from Brazil and United States were initially involved in the planning and implementation of the methodological steps of this study. Results: We developed a four-phase multimethod approach for the conceptualization and the clinimetric testing plan of the PD-MAS. First, we describe the development process of the conceptual framework of the PD-MAS underpinning the scale construct; second, we formalized the development process of the first version of the PD-MAS from the generation of item pools to the content validation and pre-testing; third, we established the steps for the first pilot testing and revision; fourth, we describe the steps plan for the first pilot testing and revision, to finally describe its clinimetric testing plan and validation. Conclusion: The overview presentation of the development phases and the clinimetric testing plan of the PD-MAS demonstrate the feasibility of creating an instrument to measure the multidimensional and multifactorial components of the medication adherence process in people with PD.

Validity, reliability and responsiveness of the Body Image Quality of Life Inventory in patients treated for infective endocarditis.

RATIONALE AND OBJECTIVES: Suffering through infective endocarditis (IE) can drastically alter a person's physical appearance, and body image-related concerns have been reported by patients. The extent and severity of the phenomenon has not previously been explored, as no quantitative measure has been validated in this patient population. The purpose of this study was thus to assess the validity, reliability and responsiveness of the Danish Body Image Quality of Life Inventory (BIQLI-DA) on patients treated for IE. METHODS: We evaluated the psychometric properties of the BIQLI-DA on data obtained in the CopenHeart IE trial, which is a randomised clinical trial evaluating the effects of comprehensive cardiac rehabilitation for patients treated for IE. We administered the BIQLI-DA as part of data collection at baseline and 6 months. We examined the psychometric properties through correlations to other measures, including body mass index, Medical Outcome Short Form 36 and Hospital Anxiety and Depression Scale. In addition, we examined internal consistency on item and scale level and performed anova group-by-time interaction to test for responsiveness. RESULTS AND STUDY LIMITATION: Participants were seventy patients with a mean age of 58 years and of which 83% were men. Results indicated convergent construct validity by confirming hypothesised associations to potentially related constructs. The BIQLI-DA was found to be highly internally consistent with a Cronbach's alpha of 0.96. Instrument responsiveness was indicated by a significant group-by-time interaction. Support for the validity of the BIQLI-DA might have been strengthened by a larger sample with more women. A more optimal design for testing responsiveness would possibly have allowed for clearer conclusions. CONCLUSIONS: The BIQLI-DA may be applicable in healthcare research as it seems to be valid, reliable and responsive; however, evidence should be strengthened through further exploration of instrument performance, particularly regarding responsiveness.

Instrument translation and initial psychometric evaluation of the Danish Body Image Quality of Life Inventory.

RATIONALE AND OBJECTIVES: Negative body perception has been reported in a number of patient populations. No instrument in Danish for measuring body image-related concerns has been available. Without such an instrument, understanding of the phenomenon in Danish-speaking populations is limited. The purpose of the study was thus to translate and validate a Danish version of the Body Image Quality of Life Inventory (BIQLI), in order to obtain a valid instrument applicable for healthcare research. METHODS: The study consisted of two phases: (i) instrument adaptation, including forward and back translation, expert committee comparisons and cognitive interviewing, and (ii) empirical testing of the Danish version (BIQLI-DA) with subsequent psychometric evaluation. Hypothesised correlations to other measures, including body mass index (BMI), Medical Outcome Short Form-8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 and Symptom Check List-90-Revised (SCL-90-R® ) were tested. In addition, exploratory factor structure analysis (EFA) and internal consistency on item and scale level were performed. RESULTS AND STUDY LIMITATIONS: The adapted instrument was found to be semantically sound, yet concerns about face validity did arise through cognitive interviews. Danish college students (n = 189, 65 men, Mage = 21.1 years) participated in the piloting of the BIQLI-DA. Convergent construct validity was demonstrated through associations to related constructs. Exploratory factor analysis revealed a potential subscale structure. Finally, results showed a high internal consistency (Cronbach's alpha = 0.92). Support for the validity of the BIQLI-DA might have been strengthened by repeating cognitive interviews after layout alterations, by piloting the instrument on a larger sample. CONCLUSIONS: This study demonstrated tentative support for the validity of the Danish Body Image Quality of Life (BIQLI-DA) and found the measure to be reliable in terms of internal consistency. Further exploration of response processes and construct validity is needed.