[Translated article] 4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis.

BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

Development and validation of a Spanish version of the Obstetric Quality of Recovery-10 item score (ObsQoR-10-Spanish).

Background: Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure. Methods: ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-speaking patients undergoing elective Caesarean or vaginal delivery. Patients <38 weeks, undergoing an intrapartum Caesarean delivery, intrauterine death, or maternal admission to the intensive care unit (ICU) were excluded. Validity was assessed by evaluating (i) convergent validity-correlation with 24-h EuroQoL and global health visual analogue scale (GHVAS) scores (0-100); (ii) discriminant validity-difference in ObsQoR-10-Spanish score for patients with GHVAS scores >70 vs <70; (iii) hypothesis testing-correlation of ObsQoR score with maternal and neonatal factors; and (iv) cross-cultural validity assessed using differential item functioning analysis. Reliability was assessed by evaluating: (i) internal consistency; (ii) split-half reliability and (iii) test-retest reliability; and (iv) floor and ceiling effects. Results: One hundred patients were approached, recruited, and completed surveys. Validity: (i) convergent validity: the ObsQoR 24-h score correlated moderately with the 24-h EuroQoL (r=-0.632) and GHVAS scores (r=0.590); (ii) discriminant validity: the ObsQoR-10-Spanish 24-h scores were higher in women who delivered vaginally compared to via Caesarean delivery, (mean [standard deviation] scores were 89 [9] vs 81 [12]; P<0.001). The 24-h ObsQoR-Spanish scores were lower in patients experiencing a poor vs a good recovery (mean [standard deviation] scores were 76 [12.3] vs 87.1 [10.6]; P=0.001); (iii) hypothesis testing: the ObsQoR-10 score correlated negatively with age (r=-0.207) and positively with 5-min (r=0.204) and 10-min (r=0.243) Apgar scores. Remaining correlations were not significant; and (iv) differential item functioning analysis suggested no potential bias among the 10 items. Reliability: (i) internal consistency was good (Cronbach alpha=0.763); (ii) split-half reliability was good (Spearman-Brown prophesy reliability estimate of 0.866); (iii) test-retest reliability was excellent with an intra-class correlation coefficient of 0.90; and (iv) floor and ceiling effects: six patients scored a maximum total ObsQoR-10 score. Conclusions: The ObsQoR-10-Spanish patient-reported outcome measure is valid, reliable, and clinically feasible, and should be considered for use in Spanish-speaking women to assess quality of inpatient postpartum recovery.

4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis. / 4 Domain Sports PROM en español: adaptación transcultural en la población chilena y análisis de confiabilidad.

BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

Patient Health Questionnaire-9: A clinimetric analysis.

OBJECTIVE: The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles. METHODS: An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility. RESULTS: Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger's coefficient of 0.49 was found, indicating an acceptable level of scalability. CONCLUSION: The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed.

The Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) is reliable and valid for chronic stroke survivors.

BACKGROUND: Stroke is the leading cause of disability worldwide. Assessing stroke's impact on patients' daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population. OBJECTIVES: This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke. METHODS: Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity. RESULTS: The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76-0.91) except for the "getting along" domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale. CONCLUSIONS: The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals.

The Brazilian version of the High-Activity Arthroplasty Score: cross-cultural adaptation

ABSTRACT BACKGROUND: The High Activity Arthroplasty Score (HAAS) is a self-administered questionnaire, developed in British English, that reliably and validly measures the levels of sports activities in patients following hip and knee arthroplasty surgery. OBJECTIVE: To cross-culturally adapt the HAAS to Brazilian Portuguese language. DESIGN AND SETTING: A cross-sectional study was conducted at a public university hospital in Brazil. METHODS: The Brazilian version of the HAAS was created through a six-step process: translation, synthesis, committee review, pretesting, back-translation, and submission to developers. The translation step was conducted by two independent bilingual translators, both native speakers of Brazilian Portuguese. The back-translation was performed by an independent translator, a native speaker of British English. To ensure the questionnaire's comprehensibility, 46 volunteers (51% men; average age 34-63) participated in the pre-testing step. RESULTS: The cross-cultural adaptation process necessitated modifications to certain terms and expressions to achieve cultural equivalence with the original HAAS. CONCLUSION: The HAAS has been translated from English into Brazilian Portuguese and culturally adapted for Brazil. The validation process for HAAS-Brazil is currently underway.

Patient Health Questionnaire-9: a clinimetric analysis

Objective: The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles. Methods: An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility. Results: Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger's coefficient of 0.49 was found, indicating an acceptable level of scalability. Conclusion: The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed.

Cross-cultural adaptation and validation of the KOOS, JR questionnaire for assessing knee osteoarthritis in Spanish-speaking patients.

PURPOSE: The present study aims to translate, adapt and validate a Spanish version of the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), including a reliability and validity analysis in patients with knee osteoarthritis (OA). METHODS: This study conducted a prospective validation study following the six stages of the "Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures". Psychometric testing was conducted in patients with knee osteoarthritis. Subjects answered the Spanish KOOS, JR (S-KOOS, JR) and a validated Spanish Oxford Knee Score (S-OKS). Retest was conducted at 10 days. Acceptability, floor and ceiling effect, internal consistency (Cronbach's α), reproducibility (mixed-effect model coefficient [MEMC]) and construct validity (Spearman's correlation; p = 0.05) were assessed. RESULTS: Forty-one patients (mean age: 65.6 ± 5.39; 48.8% female) participated in the study. All patients (100%) answered both scores during the first assessment and 38 (92.7%) during the second assessment. All patient-reported outcomes measures were answered completely (100%). The S-KOOS, JR resulted in 100% acceptability when answered. There were no ceiling or floor effects detected. The Cronbach's α for the S-KOOS, JR was 0.927 and its MEMC was 0.852 (CI 95% 0.636-1.078). The Spearman's correlation between the S-KOOS, JR and the S-OKS was 0.711 (CI 0.345-0.608; p < 0.001) and 0.870 (CI 0.444-0.651; p < 0.001) for the first and second assessments, respectively. CONCLUSION: The S-KOOS, JR has very high internal consistency and reproducibility, with a high correlation with the S-OKS; it is a reliable and valid instrument for characterising Spanish-speaking patients suffering from knee OA. LEVEL OF EVIDENCE: IV.

Cross-cultural adaptation and evaluation of the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S).

OBJECTIVE: To cross-culturally adapt and evaluate the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S) in Chilean runners with a running-related injury. DESIGN: Cross-cultural adaptation and validation study, following the Consensus-based Standards for selecting health Measurement Instruments (COSMIN) recommendations. SETTING: Outpatient sports medicine clinic and running clubs. PARTICIPANTS: UWRI was forward and backward translated, and culturally adapted. Thirty-one runners participated in the content validity of the UWRI-S; and fifty-seven in the assessment of psychometric properties. MAIN OUTCOME MEASURES: Runners seeking care from a physiotherapist completed the UWRI-S (baseline and after 48-72 h for reliability), Lower Extremity Functional Scale (LEFS), Patient Specific Functional Scale (PSFS), Global Rating of Change scale (GROC), and Numeric Pain Rating Scale (NPRS). RESULTS: Suggestions about accuracy of wording and understanding of items were incorporated. UWRI-S showed a positive moderate correlation with LEFS (r = 0.6; p < 0.05), positive fair with GROC (r = 0.5, p < 0.05), negative fair with NPRS (r = -0.4; p < 0.05) and no correlation with PSFS (r = 0.3; p = 0.1). UWRI-S demonstrated acceptable internal consistency (α = 0.87) and test-retest reliability (ICC = 0.87). CONCLUSION: UWRI-S is a valid and reliable measure to evaluate running ability of Chilean runners during recovery from a running-related injury.

Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies.

OBJECTIVE: Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. METHODS: Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. RESULTS: The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. CONCLUSION: The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance.

Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese).

BACKGROUND: We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties. METHODS: After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24 h (±6 h) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese. RESULTS: One hundred thirteen enrolled women completed the surveys at 24 h and 29 women at 25 h (100% response rate). VALIDITY: (i) convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r = -0.587) and GHVAS score (r = 0.568) at 24 h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p < 0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r = 0.191; p = 0.043). (iv) Cross-cultural validity: differential item functioning analysis suggested bias in 2 items. Reliability: (i) internal consistency was good (Cronbach's alpha = 0.82 and inter-item correlation = 0.31). (ii) Split-half reliability was very good (Spearman-Brown Prophesy Reliability Estimate = 0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient = 0.87). (iv) Floor and ceiling effects: < 5% women scored either 0 or 100 (lowest and highest scores, respectively). CONCLUSION: ObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.

Cough Severity Index in Brazilian Portuguese: Translation and Cross-Cultural Adaptation.

OBJECTIVE: To translate and cross-culturally adapt the Cough Severity Index to Brazilian Portuguese. MATERIAL AND METHODS: This is a study with observational, cross-sectional, and analytical design. The procedure for translation and cross-cultural adaptation followed the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust and was performed in five stages: translation, synthesis, back translation, committee review, and pretesting. The sample for the pretest consisted of 34 participants with refractory chronic cough, 11 males and 23 females, with an average age of 48 years and 1 month. RESULTS: The title of the questionnaire, the answer options, and seven of the ten questions were agreed upon by three judges, the remaining three questions were retranslated by a fourth judge. After back-translation and committee review, editing of question five was necessary. The option "never" was more frequently selected for four questions and the option "always" for six questions. There was a significantly higher proportion of other response categories of the instrument compared to the response category "not applicable." CONCLUSION: This study resulted in the elaboration of a translated and cross-culturally adapted version of the Cough Severity Index in Brazilian Portuguese.

Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies

Abstract Objective Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. Methods Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. Results The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. Conclusion The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance.

Socioeconomic status impacts postoperative productivity loss and health utility changes in refractory chronic rhinosinusitis.

BACKGROUND: Social determinants of health can have a substantial impact on treatment outcomes. Prior study has shown that socioeconomic status influences the likelihood of improvement in quality-of-life (QOL) following endoscopic sinus surgery (ESS). However, the impact of socioeconomic factors on changes in productivity loss and health utility after ESS remains unknown. METHODS: Adult patients (≥18 years of age) with chronic rhinosinusitis (CRS) who underwent ESS were prospectively enrolled into a multi-institutional cohort study. Productivity losses were calculated using the human capital approach and monetized using U.S. government-estimated wage rates. Health utility values (HUVs) were derived from the Medical Outcomes Study Short-Form-12 survey using University of Sheffield algorithms. Independent socioeconomic factors of interest included: age, gender, ethnicity, insurance status, educational attainment, and household income categorized via the Thompson-Hickey model. RESULTS: A total of 229 patients met inclusion criteria, and 163 (71%) provided postoperative follow-up. All subjects reported significant, within-subject improvement in both mean monetized productivity loss (p < 0.001) and HUV postoperatively (p < 0.001). Using paired sample statistics, patients with lowest income (≤$25,000/year) and with Medicare insurance did not report significant improvement in productivity loss (p ≥ 0.112) or HUV (p ≥ 0.081), although sample size limitations may have contributed to this finding. Patients in higher income tiers ($25,001 to $100,000/year and $100,001+/year) and those with employer-provided/private health insurance reported significant postoperative improvements in productivity loss and HUV (all p ≤ 0.003). CONCLUSION: Socioeconomic factors, including income and insurance provision, may impact improvements in productivity loss and HUV following ESS. Further research to validate these findings, ascertain mechanisms behind these results, and improve these outcomes is warranted.

Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling.

BACKGROUND: Hypertension is the most prevalent risk factor for cardiovascular disease globally. Roughly one-third of the adult population has hypertension. However, most people diagnosed with hypertension do not benefit from blood pressure control with pharmacologic interventions: they are overdiagnosed and overtreated and might experience negative psychosocial consequences of being labelled. These consequences are relevant outcomes that need to be assessed and validly measured to identify all benefits and harms related to interventions designed to prevent cardiovascular disease. OBJECTIVES: To develop a pool of items with high content validity for a draft version of a condition-specific questionnaire to measure the psychosocial consequences of being labelled with mild hypertension. METHODS: We selected relevant items from existing Consequences of Screening (COS) questionnaires. These items belonged to two groups: COS core items and potential condition-specific items. All items were originally in Danish and were translated into Brazilian Portuguese using the dual-panel method. Individual and group interviews were conducted with people with mild hypertension and low risk for cardiovascular disease, and were designed to test the translated items for face and content validity and were also used to generate new relevant items. Structured individual interviews were conducted to categorise all the items into domains. RESULTS: The Brazilian Portuguese dual-panel translation of both groups of items was found to be relevant for adults diagnosed with hypertension. We generated 52 new items to achieve high content validity. The result was a set of 132 items divided into 22 domains in 2 parts. Part I was directed at the general population, whereas part II was directed only at people diagnosed with hypertension and it consisted of 38 items in 8 domains. Twelve items remained as single items. High content validity was achieved with the pool of 132 items divided into 22 domains in 2 parts. DISCUSSION: High content validity was achieved for a condition-specific questionnaire measuring the psychosocial consequences of being labelled with mild hypertension. This instrument encompassed 132 items divided into 22 domains in 2 parts. Thereby, a draft of the Consequneces of Hypertension questionnaire (COH) was developed. The psychometric properties of this questionnaire will be discussed in a diferent paper.

Cross-cultural Adaptation and Measurement Properties of the Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire.

Background Achilles tendon disorders are very common among athletes. It is important to measure symptoms and functional limitations objectively related to Achilles tendinopathy using outcome measures that have been validated in the language of the target population. Objectives To perform a cross-cultural adaptation and to evaluate the measurement properties of the Brazilian version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Methods This clinical measurement study adapted the VISA-A questionnaire to Brazilian Portuguese (VISA-A-Br). The adapted questionnaire was then tested on 2 occasions within an interval of 5 to 14 days. This study evaluated the following measurement properties: internal consistency, test-retest reliability, measurement error, construct validity, and ceiling and floor effects. Results The VISA-A-Br showed good internal consistency (Cronbach α = .79; after excluding 1 item at a time, Cronbach α = .73-.84), good test-retest reliability (intraclass correlation coefficient model 2,1 = 0.84; 95% confidence interval: 0.71, 0.91), an acceptable measurement error (standard error of measurement, 3.25 points; smallest detectable change, 9.02 points), good construct validity (Spearman correlation coefficients for the Lower Extremity Functional Scale, 0.73; the Foot and Ankle Outcome Score pain subscale, 0.66; other symptoms subscale, 0.48; function in daily living subscale, 0.59; function in sport and recreation subscale, 0.67; and foot and ankle- related quality of life subscale, 0.70), and no ceiling and floor effects. Conclusion The clinical measurement properties of the VISA-A-Br are equivalent to those of the original version, and the instrument has been validated and confirmed as reliable to measure pain and function among the Brazilian population with Achilles tendinopathy. This adaptation of the questionnaire may be used in clinical and scientific settings. J Orthop Sports Phys Ther 2018;48(7):567-573. Epub 24 Apr 2018. doi:10.2519/jospt.2018.7897.

Preoperative Lund-Mackay computed tomography score is associated with preoperative symptom severity and predicts quality-of-life outcome trajectories after sinus surgery.

BACKGROUND: Disagreement exists about the relationship between Lund-Mackay CT scores (LMCTS) and quality-of-life outcome (QoL) measures. We investigated whether preoperative LMCTS are associated with preoperative QoL, and whether LMCTS is predictive of postoperative QoL outcomes in chronic rhinosinusitis (CRS) patients. METHODS: Adult patients with medically recalcitrant CRS (n = 665) were enrolled in a prospective, observational cohort study. Preoperative LMCTS and pre- and postoperative self-reported QoL outcomes (22-item Sino-Nasal Outcomes Test [SNOT-22]) were collected and evaluated over 12 months. Five hundred sixty-eight patients met the inclusion criteria. Longitudinal linear mixed-effects modeling was used to investigate the effect of LMCTS on QoL after functional endoscopic sinus surgery (FESS). RESULTS: Preoperative LMCTS were significantly associated with preoperative SNOT-22 scores (p < 0.01) and postoperative SNOT-22 scores (p < 0.001), driven by Extranasal and Rhinologic subdomains of the QoL questionaire. Patients in the lowest preoperative LMCTS quartile had the lowest mean change in SNOT-22 scores at 12 months (16.8 points; 95% confidence interval [CI], 12.2-21.3). Patients in the second and third lowest preoperative LMCTS quartiles had mean changes at 12 months of 21.1 points (95% CI, 16.7-25.4) and 23.1 points (95% CI, 18.3-27.9). Patients in the highest preoperative LMCTS quartile had the greatest improvement in SNOT-22 scores after FESS (29.9 points; 95% CI, 24.9-34.8). The difference in QoL change at 12 months between the highest and lowest preoperative LMCTS quartiles was 13.1 points (95% CI, 6.0-20.2; p < 0.001). CONCLUSION: Our study demonstrates that preoperative LMCTS correlate with preoperative extranasal and rhinologic symptom severity and that the LMCTS is an indicator of postsurgical QoL outcomes for medically recalcitrant chronic rhinosinusitis patients in a large tertiary otolaryngology setting.

Comparative effectiveness of allergy testing method in driving immunotherapy outcomes.

BACKGROUND: Skin-prick testing (SPT), in vitro testing (IVT), and intradermal-dilutional testing (IDT) are methods to detect patient sensitivities to specific allergens and direct immunotherapy dosing. We used objective and subjective measures of improvement to compare outcomes based on test method. METHODS: Patients underwent 1 of 3 protocols: SPT, screening SPT followed by IDT, or IVT. We used institution billing data to do a cost analysis of these tests. The time to maintenance (TTM) therapy was analyzed and patients were stratified into high and low reactors. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was used to quantify symptoms pre-maintenance and post-maintenance. RESULTS: Of 177 patients (SPT, n = 40; IVT, n = 91; IDT, n = 46), 115 (SPT, n = 35; IVT, n = 39; IDT, n = 41) were high reactors. Out of 90 patients (SPT, n = 17; IVT, n = 37; IDT, n = 36) reaching maintenance, 58 were high reactors (SPT, n = 15; IVT, n = 12; IDT, n = 31). Overall, SPT, IVT, and IDT median TTM were 542, 329, and 578.5 days, respectively. IDT TTM was shorter compared to IVT overall and in high reactors (hazard ratio [HR] = 1.91, p = 0.02; HR = 2.12, p = 0.03), but was not significant compared to SPT high reactors (p = 0.33). The IDT cost was $62.66, translating to an incremental cost-effectiveness ratio of $0.23 per day of shortened TTM. Median RQLQ change for the SPT, IVT, and IDT groups was 6.5, 1, and 1.5, respectively, but was not significant (p = 0.60). CONCLUSION: IDT reached maintenance immunotherapy quicker than IVT but there was no difference compared to SPT. TTM did not correlate with improvements in patient symptoms between testing methods. This study represents a novel comparison of outcomes based on initial allergy testing method.