Cross-cultural validation into Portuguese of a questionnaire to assess computer vision syndrome in workers exposed to digital devices / Validação intercultural em português de um questionário para avaliar a síndrome visual do computador em trabalhadores expostos a dispositivos digitais

ABSTRACT Purpose: As digital devices are increasingly used at work, valid and reliable tools are needed to assess their effect on visual health. This study aimed to translate, cross-culturally adapt, and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Portuguese. Methods: A 5-phase process was followed: direct translation, synthesis of translation, back-translation, consolidation by an expert committee, and pretest. To run the pretest, a cross-sectional pilot study was conducted with 26 participants who completed the prefinal Portuguese version of the CVS-Q© and were asked about difficulties, comprehensibility, and suggestions to improve the questionnaire. To evaluate the reliability and validity of the Portuguese version of the CVS-Q©, a cross-sectional validation study was performed in a different sample (280 workers). Results: In the pretest, 96.2% had no difficulty in completing it, and 84.0% valued it as clear and understandable. CVS-Q© in Portuguese (Questionário da Síndrome Visual do Computador, CVS-Q PT©) was then obtained. Validation revealed the scale's good internal consistency (Cronbach's alpha=0.793), good temporal stability (intraclass correlation coefficient=0.847; 95% CI 0.764-0.902, kappa=0.839), adequate sensitivity and specificity (78.5% and 70.7%, respectively), good discriminant capacity (area under the curve=0.832; 95% CI 0.784-0.879), and adequate convergent validity with the ocular surface disease index (Spearman correlation coefficient=0.728, p<0.001). The factor analysis provided a single factor accounting for 37.7% of the explained common variance. A worker who scored ≥7 points would have computer vision syndrome. Conclusions: CVS-Q PT© can be considered an intuitive and easy-to-understand tool with good psychometric properties to measure computer vision syndrome in Portuguese workers exposed to digital devices. This questionnaire will assist in making decisions on preventive measures, interventions, and treatment and comparing exposed populations in different Portuguese-speaking countries.

RESUMO Objetivos: À medida que a utilização de equipamentos digitais no emprego aumenta, a avaliação do seu efeito na saúde visual necessita de ferramentas válidas e robustas. Este estudo teve como objetivo traduzir, adaptar culturalmente e validar para português o Questionário da Síndrome Visual do Computador (CVS-Q©). Métodos: O procedimento foi realizado em 5 fases: tradução direta, síntese da tradução, tradução inversa, consolidação por um painel de especialistas, e pré-teste. Para fazer o pré-teste foi realizado um estudo piloto transversal aplicado a uma amostra de 26 participantes que completaram a versão pré-final da versão portuguesa do CVS-Q©, questionando por dificuldades, compreensão e sugestões de melhoria do questionário. Para avaliar a confiança e validade da versão portuguesa do CVS-Q© foi realizado um estudo transversal de validação em uma amostra diferente (280 funcionários). Resultados: No préteste, 96.2% dos participantes não apresentaram dificuldades no preenchimento do questionário, enquanto 84.0% indicaram que era claro e compreensível. Obteve-se, então, o CVS-Q© em português (Questionário da Síndrome Visual do Computador, CVS-Q PT©). A sua validação revelou uma boa consistência interna da sua escala (Cronbach's alpha=0.793), boa estabilidade tem poral (coeficiente de correlação interclasse=0.847; 95% CI 0.764-0.902, kappa=0.839), sensibilidades e especificidades adequadas (78.5% e 70.7%, respetivamente), boa capacidade de discriminação (área abaixo da curva=0.832; 95% CI 0.784-0.879), e uma adequada validade da convergência com o índice de doença da superfície ocular (ocular surface disease index - OSDI; coeficiente de correlação de Spearman=0.728, p<0.001). A análise fatorial revelou um único fator responsável por explicar a variância comum em 37.7%. Um funcionário com uma pontuação ≥7 pontos sofria de síndrome visual do computador. Conclusão: O CVS-Q PT© pode ser considerada uma ferramenta intuitiva, de fácil interpretação e com boas pro priedades psicométricas para avaliar a síndrome visual do computador em funcionários portugueses expostos a ecrãs digitais. Este questionário facilitará as decisões sobre medidas preventivas, intervenções e tratamento, e a comparação entre as populações expostas em diferentes países de língua portuguesa.

Cross-cultural validation into Portuguese of a questionnaire to assess computer vision syndrome in workers exposed to digital devices.

PURPOSE: As digital devices are increasingly used at work, valid and reliable tools are needed to assess their effect on visual health. This study aimed to translate, cross-culturally adapt, and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Portuguese. METHODS: A 5-phase process was followed: direct translation, synthesis of translation, back-translation, consolidation by an expert committee, and pretest. To run the pretest, a cross-sectional pilot study was conducted with 26 participants who completed the prefinal Portuguese version of the CVS-Q© and were asked about difficulties, comprehensibility, and suggestions to improve the questionnaire. To evaluate the reliability and validity of the Portuguese version of the CVS-Q©, a cross-sectional validation study was performed in a different sample (280 workers). RESULTS: In the pretest, 96.2% had no difficulty in completing it, and 84.0% valued it as clear and understandable. CVS-Q© in Portuguese (Questionário da Síndrome Visual do Computador, CVS-Q PT©) was then obtained. Validation revealed the scale's good internal consistency (Cronbach's alpha=0.793), good temporal stability (intraclass correlation coefficient=0.847; 95% CI 0.764-0.902, kappa=0.839), adequate sensitivity and specificity (78.5% and 70.7%, respectively), good discriminant capacity (area under the curve=0.832; 95% CI 0.784-0.879), and adequate convergent validity with the ocular surface disease index (Spearman correlation coefficient=0.728, p<0.001). The factor analysis provided a single factor accounting for 37.7% of the explained common variance. A worker who scored ≥7 points would have computer vision syndrome. CONCLUSIONS: CVS-Q PT© can be considered an intuitive and easy-to-understand tool with good psychometric properties to measure computer vision syndrome in Portuguese workers exposed to digital devices. This questionnaire will assist in making decisions on preventive measures, interventions, and treatment and comparing exposed populations in different Portuguese-speaking countries.

The Chinese version of the Computer Vision Syndrome Questionnaire: translation and cross-cultural adaptation.

BACKGROUND: The Spanish version of the Computer Vision Syndrome Questionnaire (CVS-Q©) is a validated instrument, with good psychometric properties, to measure Computer Vision Syndrome (CVS) in workers using Video Display Terminals (VDTs). To date, there are no known valid instruments in Chinese for the assessment of CVS despite the high exposure to VDTs at work that this population presents. For this, the purpose of this study is to translate and cross-culturally adapt the CVS-Q© into Chinese. METHODS: A study with five consecutive stages: direct translation, synthesis of translations, back translation, consolidation by a committee of experts, and pre-test. During the pre-test, a cross-sectional pilot study was conducted on VDT users (n = 44) who completed the Chinese version of the questionnaire plus an ad hoc post-test to assess the comprehensibility of the scale and to verify aspects of its applicability and feasibility. Data concerning sociodemographic information, general and ocular health, use of optical correction and varying exposure to VDTs was also collected. RESULTS: The entire sample considered the Chinese version of the CVS-Q© simple, clear, and easy to understand and 95.5% also found it easy to complete. 88.7% considered that the scale did not need any improvement. The final version of the Chinese scale to measure CVS was obtained (the CVS-Q CN©). The mean age of participants was 31.3 ± 9.8 years, 47.6% were women, and 57.1% used VDTs to work for more than 8 h/day. CONCLUSIONS: The CVS-Q CN© can be considered an easy tool to assess CVS in workers exposed to digital devices in China. This version would facilitate research, its use in clinical practice, and the prevention of occupational hazards in the workplace.

Prevalence and risk factors of computer vision syndrome-assessed in office workers by a validated questionnaire.

Background: Computer vision syndrome (CVS) is a common occupational health problem, but its clinical definition, prevalence and risk factors are not well defined. In general, non-validated diagnostic instruments have been used to assess its prevalence. For this reason, the aim of this study is to estimate the prevalence and potential risk factors for CVS using a validated questionnaire. Methods: A cross-sectional study (n = 238) was carried out in Italian office workers using digital devices. All participants responded to an anamnesis, a digital exposure questionnaire, and the validated Italian version of the Computer Vision Syndrome Questionnaire. A battery of 3 ocular surface and tear ophthalmic tests (break-up time, BUT), Schirmer II and corneal staining) was performed. Results: The mean age (±SD) was 45.55 (11.02) years, 64.3% were female. 71.4% wore glasses to work, whose design was monofocal (for distance) in 47.6%, monofocal (for near) in 26.5%, general progressive in 16.5% and occupational progressive in 8.8% of cases. 35.7% used digital devices >6 hours/day in the workplace. The prevalence of CVS was 67.2%. In the multivariate model, female sex (aOR: 3.17; 95% CI [1.75-5.73]), the use of digital devices >6 hours/day at workplace (aOR: 2.07; 95% CI [1.09-3.95]) and the use of optical correction at work (aOR: 2.69; 95% CI [1.43-5.08]) significantly increased the odds of CVS. Association was observed between presenting CVS and having abnormal BUT (χ2 = 0.017). Conclusions: The prevalence of CVS in Italian office workers, especially among females, was high. Intensive use of digital devices at work (>6 hours/day) and the use of optical correction at work significantly increased the odds of CVS. There is an association between poor tear stability and CVS. Further research is needed on the influence of wearing optical correction on CVS. The use of a validated questionnaire in health surveillance of digital workers is strongly recommended.

Validation of a scale to assess adherence to oral chemotherapy based on the experiences of patients and healthcare professionals (EXPAD-ANEO).

Background: Lack of adherence to Oral antineoplastic agents (OAAs) treatment has important clinical, social and economic consequences. Objective: To develop and validate a novel instrument for assessing adherence to OAAs, based on the reported experiences of people with cancer in relation to their treatment and the opinions of the healthcare professionals who care for them. Methods: We performed a multicenter validation study of a scale designed to assess adherence to OAAs. First, a steering committee developed the items for an initial scale, based on the results of a qualitative study that evaluated patients' and professionals' experiences with this treatment. We then assessed the validity and reliability of the initial scale in a sample of 268 outpatients with cancer who received their OAAs from four Spanish hospitals. Results: The mean age of the sample of 268 outpatients was 64.1 (standard deviation [SD] 12.4) years, and 47% of participants were women. With the results of this analysis, we developed the EXPAD-ANEO scale, which has 2 factors, one for beliefs and expectations and another for behavior. Both factors explain 52% of the explained common variance. Good reliability was obtained, with a McDonald's omega of 0.7 for the first factor and 0.6 for the second factor. The fit indices were optimal (Root Mean Square Error of Approximation = 0.02, Comparative Fit Index = 0.99, Tucker Lexis Index = 0.99 and Standardized Root Mean Squared Residual = 0.03), which verifies the appropriateness of the items to the model. We measured EXPAD-ANEO criterion validity against pill count, obtaining a specificity of 80%. We measured convergent validity with the Morisky-Green test and found a significant association (p < 0.001). We measured divergent validity with questions on health literacy from the 16-item European Health Literacy Survey and found no correlation (p = 0.153). Conclusion: EXPAD-ANEO is the first validated instrument for evaluating patients' experiences with and adherence to OAAs, providing valuable information that can help health professionals to establish individual strategies or collective programs for improving therapeutic results and reducing healthcare costs.

What Are the Dry Eye Questionnaires Available in the Scientific Literature Used for? A Scoping Review.

PURPOSE: Dry eye disease (DED) is a frequent chronic ophthalmic condition. Its diagnosis includes tests and patient reported outcomes (PRO) questionnaires. Although many PRO dry eye questionnaires (PRO-DEQs) are available, they differ greatly from each other and not all have been validated. The purpose of this study was to retrieve the PRO-DEQs present in the scientific literature by performing a descriptive analysis of them and identifying those with known validity and reliability characteristics and to perform a descriptive analysis of the geographic area, year of publication, and characteristics of the target population of the clinical studies that have used validated PRO-DEQs. DESIGN: Scoping review of the literature. METHODS: Searches were conducted in PubMed to retrieve PRO-DEQs published up to July 2018 and written in English, French, Italian or Spanish. RESULTS: One thousand six hundred two records were identified and 973 were included in the final analysis. Of these, 56 provided information on the design and validation of PRO-DEQs and 49 PRO-DEQs were identified. Twenty-two PRO-DEQs were validated (17 original and 5 modified) and 27 had no associated design, validity, and reliability studies. Most of the validated PRO-DEQs were designed in English, the number of items varies from 1 to 57, the dimensions are generally not specified, and they are self-administered. The greatest use of validated PRO-DEQs in clinical studies has been in Asia since 2010, with the Ocular Surface Disease Index being the most used. These questionnaires have been used mostly in adults, retired professionals, and people with visual diseases to diagnose DED. CONCLUSIONS: This study aims to encourage the use of validated PRO-DEQs to guarantee the quality of the results obtained and the comparability and replicability among studies.

CVS-Q teen©: síndrome visual informático en adolescentes y su relación con libros de texto digitales / CVS-Q teen©: computer vision syndrome in adolescents and its relationship with digital textbooks

Objetivo: Analizar la prevalencia y la evolución del síndrome visual informático en estudiantes de secundaria y bachillerato mediante el CVS-Q© adaptado y validado para adolescentes, según empleen libros en papel o en soporte digital.Método: Se adaptará el CVS-Q© mediante un pilotaje en adolescentes y un grupo nominal compuesto por especialistas en salud visual, profesorado y padres/madres. Se evaluarán la calidad y la aplicabilidad de la versión resultante (CVS-Q teen©) y se realizará un estudio de validación con pruebas visuales, retest y análisis psicométrico. Posteriormente, se realizará un estudio prospectivo longitudinal con cuatro medidas repetidas en adolescentes de dos institutos de San Juan de Alicante (uno ha sustituido libros por tabletas). Se medirá el síndrome visual informático mediante el CVS-Q teen© con tres seguimientos. Se analizará la prevalencia de síndrome visual informático según factores sociodemográficos, visuales y de uso de dispositivos digitales. Se realizarán modelos de regresión logística con efecto aleatorio por estudiante y tiempo de uso. (AU)

Objective: To analyse the prevalence and progression of computer vision syndrome in secondary and high school students with the CVS-Q© adapted and validated for adolescents, depending on whether they use textbooks or digital books.Method: The CVS-Q© will be adapted by a pilot study in adolescents and a nominal group of visual health specialists, teachers and parents. The resulting version (CVS-Q teen©) will be tested to confirm its quality and applicability and a validation study will be done with visual tests, retest and psychometric analysis. Subsequently, a prospective longitudinal study with four repeated measures will be carried out in adolescents from two secondary schools of San Juan de Alicante (one has replaced textbooks by tablets). Computer vision syndrome will be measured by the CVS-Q teen© with three follow-ups. The prevalence of computer vision syndrome will be analysed according to sociodemographic, visual and digital device use variables. Logistic regression models will be performed, with random effect by student and time of use. (AU)

[CVS-Q teen©: computer vision syndrome in adolescents and its relationship with digital textbooks]. / CVS-Q teen©: síndrome visual informático en adolescentes y su relación con libros de texto digitales.

OBJECTIVE: To analyse the prevalence and progression of computer vision syndrome in secondary and high school students with the CVS-Q© adapted and validated for adolescents, depending on whether they use textbooks or digital books. METHOD: The CVS-Q© will be adapted by a pilot study in adolescents and a nominal group of visual health specialists, teachers and parents. The resulting version (CVS-Q teen©) will be tested to confirm its quality and applicability and a validation study will be done with visual tests, retest and psychometric analysis. Subsequently, a prospective longitudinal study with four repeated measures will be carried out in adolescents from two secondary schools of San Juan de Alicante (one has replaced textbooks by tablets). Computer vision syndrome will be measured by the CVS-Q teen© with three follow-ups. The prevalence of computer vision syndrome will be analysed according to sociodemographic, visual and digital device use variables. Logistic regression models will be performed, with random effect by student and time of use.

Translation, cross-cultural adaptation and validation of the Computer Vision Syndrome Questionnaire into Persian (CVS-Q FA©).

PURPOSE: To translate, cross-culturally adapt and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Persian. METHODS: This study was carried out in 2 phases: (1) the CVS-Q© was translated and cross-culturally adapted into Persian and (2) the validity and reliability of CVS-Q FA© were assessed in a cross-sectional validation study. An expert committee composed of 15 optometrists evaluated content validity (item-level (I-CVI) and scale-level (S-CVI) content validity index were calculated). A pretest was performed (n = 20 participants) to verify the comprehensibility of the questionnaire. A total of 102 computer users completed the final questionnaire. Criterion validity and diagnostic performance of the CVS-Q FA© were assessed by calculating sensitivity, specificity and receiver characteristic operator curve. Cronbach's alpha was calculated for the assessment of internal consistency and 46 participants refilled the questionnaire for the second time and the interclass correlation coefficient (ICC) and Cohen's kappa (κ) were evaluated for test-retest reliability. RESULTS: The translation and cross-cultural adaptation process was performed successfully according to accepted scientific recommendations without any major difficulties. The I-CVI was above 0.80 for all items (symptoms) except item 15 (feeling that sight is worsening) and the S-CVI was 0.92. The CVS-Q FA© showed good sensitivity (81.1%) and acceptable specificity (69.2%). Also, it achieved good internal consistency (Cronbach's alpha = 0.80) and test-retest reliability (ICC = 0.81 and κ = 0.65). CONCLUSION: The CVS-Q FA© was successfully translated, cross-culturally adapted, and validated into Persian. This study provides a valid and reliable tool for the assessment of computer vision syndrome among the Iranian working population.

Rasch-Validated Italian Scale for Diagnosing Digital Eye Strain: The Computer Vision Syndrome Questionnaire IT©.

The use of digital devices affects eye health; this can influence the performance of workers. To assess this impact, validated patient-reported outcome questionnaires are needed. The purpose of this study was to validate the psychometric properties of the Italian version of the Computer Vision Syndrome Questionnaire (CVS-Q©) using Rasch analysis. Two hundred and forty-one Italian workers completed an ad hoc questionnaire on anamnesis and exposure to digital devices, and the Italian version of the CVS-Q©. Subsequently, a battery involving three clinical ocular surface and tear tests was performed. The reliability and validity of the scale was assessed using the Andrich Rating Scale Model, and the prevalence of computer vision syndrome (CVS) was calculated. A good fit of both items and persons to the predictions of the Rasch model was observed, with acceptable reliability, unidimensionality, and no or minimal severe differences as a function of gender or age; moreover, good test-retest repeatability, adequate values of sensitivity, reliability, and area under the curve, and adequate construct validity based on clinical tests were obtained. Workers with a questionnaire score ≥ 7 were found to present with CVS. The prevalence of CVS was 76.6%. The CVS-Q IT© is a valid and reliable scale to assess CVS in Italian workers who use digital devices.

Revisión sistemática y metaanálisis sobre la relación entre la productividad laboral y la enfermedad de ojo seco en pacientes con ojo seco no relacionado con Sjögren y con el Síndrome de Sjögren / Work productivity among Sjögren's Syndrome and non-Sjögren's dry eye patients: a systematic review and meta-analysis

Este trabajo es un comentario del artículo: Sivakumar GK, Patel J, Malvankar-Mehta MS, Mather R. Work productivity among Sjögren’s Syndrome and non-Sjögren’s dry eye pa-tients: a systematic review and meta-analysis. Eye (Lond). 2021; Online ahead of print. doi: 10.1038/s41433-020-01282-3. (AU)

AbstractThis text is a commentary on the article: Sivakumar GK, Patel J, Malvankar-Mehta MS, Ma-ther R. Work productivity among Sjögren’s Syndrome and non-Sjögren’s dry eye patients: a systematic review and meta-analysis. Eye (Lond). 2021; Online ahead of print. doi: 10.1038/s41433-020-01282-3 (AU)

Computer vision syndrome prevalence according to individual and video display terminal exposure characteristics in Spanish university students.

AIM: To estimate the prevalence of computer vision syndrome (CVS) in university students and its relationship with sociodemographic and optical correction factors and exposure to video display terminal (VDT). METHODS: This cross-sectional study included 244 Spanish university students who responded to an anamnesis, a VDT exposure questionnaire and the Computer Vision Syndrome Questionnaire (CVS-Q© ). A descriptive analysis was performed and the prevalence of CVS was calculated. Logistic regression models were used to measure the association between CVS and the variables studied. RESULTS: The mean age was 20.7 years (SD = 2.1), 57% were women, 78.3% used VDTs ≥ 2 hours/day to study. The prevalence of CVS was 76.6%, and the most frequent symptoms were headache and itching. In the crude analysis, being a woman, using glasses daily and to study, and a longer VDT use to study and in total were associated with a higher prevalence of CVS; while in the older group, the prevalence was lower. In the multivariate model, VDT use to study was associated with a greater probability of CVS (aOR: 3.43; 95%CI: 1.03-11.42), and being between 22 and 29 years was associated with a lower probability of it (aOR: 0.36; 95%CI: 0.15-0.89). CONCLUSION: CVS has a high prevalence amongst Spanish university students. The most affected are the younger ones and those who use VDTs for longer hours to study. It is essential to continue investigating the influence of the type of tasks conducted with VDTs on CVS and thus to establish the preventive measures to reduce this syndrome.

Differences in Eye Health, Access to Eye Care Specialists and Use of Lenses among Immigrant and Native-Born Workers in Spain.

Latin American immigrants make up 49% of the total immigrant population in Spain, yet little is known about their eye health. The aim of this study is to determine if there are differences in self-perceived eye health, access to eye care specialists, and use of lenses between a sample of Latin American immigrant workers from Colombia and Ecuador, and native-born workers in Spain. We used data from the PELFI cohort (Project for Longitudinal Studies of Immigrant Families). The sample consisted of 179 immigrant workers born in Colombia or Ecuador, and 83 Spanish-born workers. The outcome variables were self-perceived eye health, access to eye specialists, and use of lenses. A descriptive analysis of the sample was carried out, and the prevalence of the three outcome variables in immigrants and natives was calculated and adjusted for explanatory variables. Random effects logistic regression models examined eye health outcomes by workers' country of birth. Immigrants are less likely to report poor self-perceived eye health than native-born (ORc 0.46; CI 95%, 0.22-0.96). Furthermore, they have less access to specialists (ORc 2.61; CI 95%, 1.32-5.15) and a higher probability of needing lenses but not having them (ORc 14.14; CI 95%, 1.77-112.69). This latter variable remained statistically significant after adjusting for covariates (ORa 34.05; CI 95%, 1.59-729.04). Latin American immigrants may not value the use of lenses, despite eye care specialists indicating that they need them. Eye health education is required to recognize the importance of using lenses according to their visual needs.

Translation and cultural adaptation of the Computer Vision Syndrome Questionnaire (CVS-Q) into Italian.

BACKGROUND: The original Spanish version of the Computer Vision Syndrome Questionnaire (CVS-Q©) is a validated instrument with good psychometric properties to measure the Computer Visual Syndrome (CVS) in workers exposed to video display terminals (VDT). The Italian version would facilitate research and its use in clinical practice the prevention of occupational hazards. OBJECTIVE: To culturally translate and adapt the CVS-Q© into Italian. METHODS: Study with 5 consecutive stages: Direct translation, Synthesis of translations, Retro-translation, Consolidation by a committee of experts and Pre-test. During the Pre-test, a cross-sectional pilot study was conducted on users of VDT (n=40) who completed the Italian version of the questionnaire. Socio-demographic information and exposure assessment to VDT was also collected, as well as on the difficulty to fill in the CVS-Q©. RESULTS: The final version into Italian of the CVS-Q© was obtained. The totality of the sample considered that it didn't present difficulty in its completion and 90% confirmed that no improvement was needed; so that the 15% required to make changes was not reached. The mean age of participants was of 35.80±16.28 (20-65 years), 57.5% were women and 67.5% used VDT at work. A prevalence of CVS of 62.5% was observed. CONCLUSION: The CVS-Q© can be considered a tool easy to understand and manage for measuring the CVS in the population exposed to VDT in Italy.