Construct validity and test-retest reliability of the Fatigue Severity Scale in people with chronic neck pain

Exploring the psychometric properties of the fatigue severity scale: results from a systematic review and reliability meta-analysis

INTRODUCTION

Fatigue is a multifactorial phenomenon that affects individuals across several conditions. Fatigue Severity Scale (FSS) is a widely used questionnaire to measure perceived fatigue. This systematic review aims to identify the psychometric properties of FSS across different populations where it has been validated.

METHODS

The study selection process was conducted from April 2024 to January 2025. The databases used to identify included studies were MEDLINE (via PubMed), SCOPUS, Web of Science, and CINAHL (via EBSCO). The risk of bias was evaluated using the COSMIN checklist. For the meta-analysis, studies reporting the internal consistency of the scale were analyzed.

RESULTS

At the end of the selection process, 59 articles were included in the review; the sample sizes ranged from 20 to 2017 participants, and the mean age spanned from 21,86 to 68,1 years.

CONCLUSION

The FSS is a valid and reliable instrument for fatigue assessment. It would be desirable to investigate heterogeneity; it would be beneficial to investigate responsiveness and to explore the settings in which it is used. Another advise would be to calculate cutoff in healthy subjects to better understand fatigue symptoms and the differences in perception between populations.

REGISTRATION

: PROSPERO (CRD42025635211).

KOJI AWARENESS, a self-rating whole-body movement assessment system, has intersession reliability and comparability to external examiner rating

KOJI AWARENESS is a newly developed self-rating whole-body movement assessment system that includes 11 domains and 22 tests. The primary aim of this study was to investigate the intersession reliability of KOJI AWARENESS, and the secondary aim was to determine whether a fixed bias existed between self-rating and external examiner rating. Fifty university students rated their movement ability in two separate sessions; an external examiner also rated the students' movement ability. Participants were blinded to their scores at the first session as well as the external examiner's rating scores. The primary analysis included examining the intersession reliability of the total score with intraclass correlation coefficients (ICCs). ICC values were interpreted as follows: insufficient, < .7 and sufficient, ≥ .7. To achieve the secondary aim, Bland-Altman analysis was performed. ICC for the intersession reliability was .86 with a 95% confidence interval (CI) of .77 to .92 and a minimum detectable change (MDC) of 5.15. Bland-Altman analysis revealed fixed bias as the 95% CIs of the mean difference between the two different rating scores (-3.49 to -2.43 and -3.94 to -2.98 in the first and second sessions, respectively) did not include 0 in the data of each session. However, no proportional bias was identified because no statistically significant Pearson's correlation (P > .05) was noted between the means of the two methods and the mean difference between the two different methods in each session. This study identified that KOJI AWARENESS has sufficient intersession reliability among relatively young and healthy participants. External examiner rating tended to have lower total scores than self-rating; however, the bias was below the MDC and seemed not to be clinically significant.

Whole-Body Photobiomodulation Therapy for Fibromyalgia: A Feasibility Trial

Effective treatment for fibromyalgia (FM) is lacking and further treatment options are needed. Photobiomodulation therapy (PBMT) represents one potential treatment option. Whilst favourable findings have been reported using localised PBMT, no investigations have established the value of whole-body PBMT for the complete set of symptom domains in FM. A single-arm feasibility study was conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. A non-probability sampling method was used to access individuals with FM. The primary outcome measure was identified as the Revised Fibromyalgia Impact Questionnaire (FIQR). Forty-nine participants were screened and twenty-one trial participants entered the trial. Nineteen participants completed the intervention (18 whole-body PBMT sessions over approximately six weeks). Descriptive statistics and qualitative analysis was undertaken to represent feasibility outcomes. Acceptability of the trial device and processes were established. Outcome measures towards efficacy data were guided by core and peripheral OMERACT (outcomes measures in rheumatological clinical trials) domains, utilising a combination of participant-reported and performance-based outcome measures. Data for the embedded qualitative component of the trial were captured by participant-reported experience measures and audio-recorded semi-structured interviews. Positive changes were observed for FM-specific quality of life, pain, tenderness, stiffness, fatigue, sleep disturbance, anxiety, depression and cognitive impairment. Patient global assessment revealed improvements at 6 weeks, with continued effect at 24 weeks. FM-specific quality of life at 24 weeks remained improved compared with baseline scores. The findings provided evidence to support a full-scale trial and showed promise regarding potential efficacy of this novel non-invasive treatment in an FM population.

Whole-body photobiomodulation therapy for chronic pain: a protocol for a feasibility trial

INTRODUCTION

Chronic pain conditions are a leading cause of disease and disability. They are associated with symptoms such as fatigue, sleep and mood disturbances. Minimal evidence is available to support effective treatments and alternatives treatment approaches are called for. Photobiomodulation therapy has been highlighted as one promising option. A whole-body therapy device (NovoTHOR) has recently been developed with a number of potential advantages for people with chronic pain. Research is needed to consider the feasibility of this device.

METHODS AND ANALYSIS

A single-centre single-armed (no placebo group) feasibility study with an embedded qualitative component will be conducted. The intervention will comprise 18 treatments over 6 weeks, with 6-month follow-up, in the whole-body photobiomodulation device. A non-probability sample of 20 adult participants with a clinician diagnosis of chronic axial pain, polyarthralgia, myofascial pain or widespread pain will be recruited (self-referral and clinician referral). Outcome measures will focus on acceptability of trial processes with a view to guiding a definitive randomised controlled trial. Analyses will use descriptive statistics for quantitative aspects. The qualitative element will be assessed by means of a participant-reported experience questionnaire postintervention and semistructured audio-recorded interviews at three stages; preintervention, midintervention and postintervention. The latter will be transcribed verbatim and a reflexive thematic analysis will be used to identify emerging themes. Exploratory outcomes (participant-reported and performance-based measures) will be analysed according to data distribution.

ETHICS AND DISSEMINATION

The study has received ethical approval from the Leicester Central Research and Ethics Committee. Findings will be disseminated via local chronic pain groups, public register update, submission for presentation at scientific meetings and open-access peer-reviewed journals, and via academic social networks.

TRIAL REGISTRATION NUMBER

NCT05069363.

No effect of resveratrol on fatty acid oxidation or exercise capacity in patients with fatty acid oxidation disorders: A randomized clinical cross-over trial

The objective was to investigate whether resveratrol (RSV) can improve exercise capacity in patients with fatty acid oxidation (FAO) disorders. The study was a randomized, double-blind, cross-over trial. Nine patients with very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency or carnitine palmitoyl transferase (CPT) II deficiency were randomized to receive either 8 weeks of 1000 mg day^-1 RSV or placebo (P) followed by a 4-weeks wash-out period and subsequently 8 weeks of the opposite treatment. Primary outcome measures were heart rate and FAO as measured via stable isotope technique during constant workload exercise. Secondary outcome measures included fat and glucose metabolism; perceived exertion; as well as subjective measures of energy expenditure, fatigue, and daily function. Eight participants completed the trial. Heart rate did not differ at the end of exercise after treatment with RSV vs placebo (P = .063). Rate of oxidation of palmitate at end of exercise was not different with 1.5 ± 0.8 (RSV) vs 1.3 ± 0.6 (P) μmol kg^-1  min^-1 (P = .109). Secondary outcomes did not change except for increased plasma glycerol and decreased plasma glucose levels at the end of exercise after treatment with RSV vs placebo. A daily dose of 1000 mg resveratrol does not improve exercise capacity or FAO during exercise in patients with CPTII or VLCAD deficiencies.

The chronic disease helplessness survey: developing and validating a better measure of helplessness for chronic conditions

Supplemental Digital Content is Available in the Text.

Introduction:

Learned helplessness develops with prolonged exposure to uncontrollable stressors and is therefore germane to individuals living with pain or other poorly controlled chronic diseases. This study has developed a helplessness scale for chronic conditions distinct from previous scales that blur the conceptualization of control constructs. Extant measures commonly examine controllability, not the three pillars of helplessness identified by Maier and Seligman (1976): cognitive, emotional, and motivational/motor deficits.

Methods:

Individuals who self-report a chronic pain condition (N = 350) responded to a Chronic Disease Helplessness Survey (CDHS) constructed to capture cognitive, motivational/motor, and emotion deficits. Exploratory factor analysis (EFA; N = 200) and confirmatory factor analysis (CFA; N = 150) were performed. The CDHS was assessed for convergent and discriminant validity.

Results:

A three-factor solution corresponding to cognitive, emotional, and motivational/motor factors was identified by EFA. The solution exhibited sufficient model fit and each factor had a high degree of internal consistency. The CDHS was significantly associated with greater pain intensity and interference, PCS helplessness, lower perceived pain control, and lower general self-efficacy. Individuals with diabetes generally experience greater control strategies over daily symptoms (e.g., diet, oral medications, and insulin) than patients with chronic pain and in this study displayed significantly lower CDHS scores compared to individuals with chronic pain, demonstrating discriminant validity.

Conclusions:

This study provides preliminary evidence that the three-factor CDHS is a psychometrically sound measure of helplessness in individuals with chronic pain.

Content validity and reliability of the modified Japanese version of the Healthcare Providers Patient-Activation Scale: self-reported adherence to patient-centered physical therapy scale

BACKGROUND

Modifications to the Healthcare Providers Patient-Activation Scale (HP-PAS), which evaluates attitudes toward the importance of using a patient-centered approach (PCA), are required.

PURPOSE

Content validity and reliabilities of a scale developed from the HP-PAS to evaluate self-reported adherence to patient-centered physical therapy were preliminarily investigated.

METHODS

A total of 86 Japanese physical therapists completed the validity assessments in an anonymous survey. Among them, 53 completed the reliability assessments in a named survey. The HP-PAS was modified to mark the most suitable frequency for each item, creating an 11-point scale. For the validity assessments, the participants assigned each item to a therapist-centered approach or PCA using a 5-point scale. Content validity was considered when the proportion of scores 4 and 5 ("possibly" or "definitely" a PCA) with respect to the total number of scores was > 50%. Ceiling and flooring effects were considered when the response proportions of scores of 10 and 0, respectively, on an 11-point scale were > 20%. Items with an intraclass correlation coefficient (ICC) < 0.4 in the test-retest reliability from the item list were excluded.

RESULTS

Of the 20 items, 6 were excluded, developing a 14-item self-reported adherence to a patient-centered physical therapy scale (SAPCPTS), which exhibited good internal consistency (Cronbach's α = 0.95, 95% confident intervals [CIs] = 0.93-0.96) and test-retest reliability (ICC = 0.84, 95% CIs = 0.75-0.91).

CONCLUSION

This study identified that the 14-item SAPCPTS demonstrated preliminary evidence of content validity and reliability.

Rasch Analysis of Self-Reported Adherence to Patient-Centered Physical Therapy Scale among Japanese Physical Therapists: Cross-Sectional Study

This study primarily aimed to develop a shorter version of the self-reported adherence to patient-centered physical therapy (s-SAPCPTS) by using Rasch analysis and secondarily aimed to preliminarily investigate the relationship between the s-SAPCPTS scores and demographics (i.e., age, sex, final academic degree (non-postgraduate degrees or postgraduate degrees), and practice environment). In an online anonymous survey, 110 Japanese physical therapists completed the self-reported adherence to patient-centered physical therapy and provided data on their demographics. Through the Rasch analysis, items were excluded in a stepwise manner, until certain pre-established criteria of the unidimensionality were satisfied. Subsequently, a conversion table for the Rasch score was developed. Furthermore, multiple regression analysis was conducted by using the independent variables age, sex, and final academic degree. Using the Kruskal-Wallis test, we compared the Rasch s-SAPCPTS scores among four practice environments. Consequently, the seven-item s-SAPCPTS was developed by excluding seven items through the Rasch analysis. Postgraduate degree was a statistically significant contributing factor for Rasch s-SAPCPTS scores (p = 0.038, β = 0.20). The Kruskal-Wallis test demonstrated statistically significant differences in the Rasch s-SAPCPTS scores among the four practice environments (p = 0.006). In conclusion, the seven-item s-SAPCPTS was developed with the preliminary evidence of construct validity. It was also found that the final academic degree and practice environment could be the contributing factors of s-SAPCPTS scores.

No effect of resveratrol in patients with mitochondrial myopathy: A cross-over randomized controlled trial

Mitochondrial myopathies (MM) are caused by mutations that typically affect genes involved in oxidative phosphorylation. Main symptoms are exercise intolerance and fatigue. Currently, there is no specific treatment for MM. Resveratrol (RSV) is a nutritional supplement that in preclinical studies has been shown to stimulate mitochondrial function. We hypothesized that RSV could improve exercise capacity in patients with MM. The study design was randomized, double-blind, cross-over and placebo-controlled. Eleven patients with genetically verified MM were randomized to receive either 1000 mg/day RSV or placebo (P) for 8 weeks followed by a 4-week washout and then the opposite treatment. Primary outcomes were changes in heart rate (HR) during submaximal cycling exercise and peak oxygen utilization (VO₂ max) during maximal exercise. Secondary outcomes included reduction in perceived exertion, changes in lactate concentrations, self-rated function (SF-36) and fatigue scores (FSS), activities of electron transport chain complexes I and IV in mononuclear cells and mitochondrial biomarkers in muscle tissue among others. There were no significant differences in primary and secondary outcomes between treatments. Mean HR changes were -0.3 ± 4.3 (RSV) vs 1.8 ± 5.0 bpm (P), P = .241. Mean VO₂ max changes were 0.7 ± 1.4 (RSV) vs -0.2 ± 2.3 mL/min/kg (P), P = .203. The study provides evidence that 1000 mg RSV daily is ineffective in improving exercise capacity in adults with MM. These findings indicate that previous in vitro studies suggesting a therapeutic potential for RSV in MM, do not translate into clinically meaningful effects in vivo.

Cross-cultural Adaptation of the Health Sciences Evidence-based Practice Questionnaire into Japanese and Its Test-Retest Reliability in Undergraduate Students

OBJECTIVES

The Health Sciences Evidence-Based Practice (HS-EBP) questionnaire was recently developed for measuring five constructs of evidence-based clinical practice among Spanish health professionals by applying content and construct validity investigation. The current study aims to undertake a cross-cultural adaptation of the HS-EBP into Japanese and to investigate the internal consistency and test-retest reliability of the Japanese HS-EBP among undergraduate students of nursing and physical and occupational therapies.

METHODS

Cross-cultural adaptation was undertaken by following Beaton's five-step process. Subsequently, the Japanese HS-EBP test-retest reliability was assessed with a 2-week interval. Participants were recruited from among third and fourth grade undergraduate students of nursing and physical and occupational therapies with clinical training experience.

RESULTS

Pilot testing included 30 participants (11 nursing students, 11 physical therapy students, 8 occupational therapy students). Consequently, we developed the Japanese HS-EBP to be understandable for undergraduate students of nursing and physical and occupational therapies. Data from 52 participants who completed test-retest reliability questionnaires demonstrated adequate test-retest reliability in the total scores of Domains 1, 3, 4, and 5 [intraclass correlation coefficients were (ICC)=0.74, 0.70, 0.75, and 0.74, respectively]; the exception was Domain 2, which had an ICC of 0.66. Internal consistency (Cronbach's α) was adequate for Domains 1-5, for which α was 0.87, 0.94, 0.86, 0.93, and 0.95, respectively.

CONCLUSIONS

This study developed the Japanese version of HS-EBP and provided preliminary evidence of adequate internal consistency and test-retest reliability in most domains for undergraduate students of nursing and physical and occupational therapies.

Development and validity assessment of a Japanese version of the Exercise Adherence Rating Scale in participants with musculoskeletal disorders

BACKGROUND

Exercise adherence is important for achieving a long-term effect from musculoskeletal management. The Exercise Adherence Rating Scale (EARS), which was developed in 2017 as a patient reported outcome measure to assess exercise adherence in those with chronic low back pain in the UK, has demonstrated acceptable validity and reliability and is a robust measure of exercise adherence. This study aimed to undertake cross-cultural adaptation of the EARS into Japanese and investigate its structural validity in participants with musculoskeletal disorders.

METHODS

The current study was composed of two phases, where a provisional Japanese version of the EARS was developed employing an international guideline for cross-cultural adaptation (Phase A), and structural validity was then evaluated using the Rasch analysis (Phase B). Participants with musculoskeletal disorders who have individualized home exercises prescribed by a physical therapist were recruited.

RESULTS

In Phase A, the pilot testing was conducted twice because the initial testing detected some uncertainty revealed in comments from 17 participants (5 males and 12 females, 18-79 years of age) about which activities and exercises were supposed to be included. We therefore modified the draft by identifying a person who prescribed/recommended activities and exercises as per the Working Alliance Inventory. The second pilot testing using this draft recruited 30 participants (6 males and 24 females, 18-79 years of age), who provided no further comments, demonstrating the Japanese version of the EARS (EARS-J) had been successfully developed. In Phase B, data from 200 participants who completed the EARS-J (63 males and 127 females, mean ± SD of age = 53.6 ± 17.0) were analyzed using the Andrich's Rating Scale Model. Rasch statics indicated unidimensionality of the six items of the EARS-J. The Cronbach α was 0.77. Substantial ceiling effect (21.0%) was observed, with no floor effect (0.5%).

CONCLUSIONS

A Japanese version of the EARS has been developed, which demonstrated acceptable structural validity with the evidence of unidimensionality in the Rasch analysis in Japanese people with musculoskeletal disorders who were prescribed individualized home exercises. However, there was a substantial ceiling effect and further studies are required to comprehensively establish validity and reliability of the EARS-J.

Greater Severity and Functional Impact of Post-traumatic Headache in Veterans With Comorbid Neck Pain Following Traumatic Brain Injury

BACKGROUND

Post-traumatic headache (PTH) is a commonly experienced symptom after mild traumatic brain injury (mTBI). Blast injury- or blunt injury-related mechanisms for mTBI in veterans can also affect musculoskeletal structures in the neck, resulting in comorbid neck pain (NP). However, it is unknown whether the presence of comorbid NP may be associated with a different pattern of headache symptoms, physical functioning, or emotional functioning compared to those without comorbid NP. The purpose of this study is to examine the role of comorbid NP in veterans with mTBI and PTH.

DESIGN AND METHODS

This was a cross-sectional investigation of an existing dataset that included 33 veterans who met inclusion criteria for PTH after mTBI. Standardized measures of headache severity and frequency, insomnia, fatigue, mood disorders, and physical and emotional role function were compared between groups with and without comorbid NP.

RESULTS

The majority of participants with PTH reported comorbid NP (n = 22/33, 67%). Those with comorbid NP experienced more headache symptoms that were severe or incapacitating, as compared to mild or moderate for those without NP (φ = 0.343, P = .049); however, no differences in headache frequency (φ = 0.231, P = .231) or duration (φ = 0.129, P = .712) were observed. Participants with comorbid NP also reported greater insomnia (d = 1.16, P = .003) and fatigue (d = 0.868, P = .040) as well as lower physical functioning (d = 0.802, P = .036) and greater bodily pain (d = 0.762, P = .012). There were no differences in anxiety, depression, mental health, emotional role limitations, vitality, or social functioning between those with and without comorbid NP (d ≤ 0.656, P ≥ .079).

CONCLUSIONS

A majority of veterans with mTBI and PTH in our sample reported comorbid NP that was associated with greater headache symptom severity and physical limitations, but not with mood or emotional limitations. Preliminary findings from this small convenience sample indicate that routine assessment of comorbid NP and associated physical limitations should be considered in veterans with mTBI and PTH.

Cross-cultural adaptation of the Healthcare Provider-Patient Activation Scale to Japanese

[Purpose] This study aimed to investigate a cross-cultural adaptation of the 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). [Participants and Methods] We followed a guideline for cross-cultural adaptation that recommended using two forward and backward translations. In pilot testing, participants were Japanese physical therapists who provided comments about expression readability. Two authors independently categorized each comment as either "unable to understand" or "suggestion to enhance clarity", after which Cohen κ and % agreement were used to assess agreement. We then assessed the flooring and ceiling effects, internal consistency, and Spearman ρ between the factor scores of the patient-activation-approach and non-patient-activation-approach. [Results] A total of 58 Japanese physical therapists participated in the pilot test. The agreement on comments was κ=0.44 and 86.5%. We identified the flooring and ceiling effects for most items. In addition, the internal consistency was acceptable for each factor; however, the Spearman ρ between the patient-activation-approach and non-patient-activation-approach factor scores was positive when it should have been negative. [Conclusion] We developed a Japanese version of the HP-PAS which will serve as a foundation for future studies to establish a measurement method for the magnitude of patient activation in the physical therapist population.

Effects of Manual Therapy on Fatigue, Pain, and Psychological Aspects in Women with Fibromyalgia

Fibromyalgia is a condition characterised by chronic widespread muscle pain and fatigue, sleep disturbances, cognitive disorders, and mood disturbance. The purpose of this study was to determine the effectiveness of a manual therapy technique performed with moderate digital pressure in women with fibromyalgia (n = 24). In this randomised, controlled trial, the participants were randomly assigned to the experimental group or placebo group. The experimental group was assisted with manual therapy sessions based on connective tissue massage, whereas the placebo group was "treated" with ultrasound sessions performed without conductive gel and with the machine turned off as the placebo. Fatigue severity scale (FSS), visual analogical scale (VAS), Pittsburgh sleep quality index (PSQI), and profile of mood states (POMS-29) were completed before and after the intervention. In the experimental group (manual therapy), significant results were obtained on a VAS scale, referring to the neck pain in patients with fibromyalgia (p < 0.001). Correlations showed a relationship between fatigue and sleep variables (R = 0.411; p = 0.046) and pain variables with the POMS anger-hostility subscale (R = 0.436; p = 0.033). Although the size of the sample could be a limitation, the study concluded that the application of manual therapy in fibromyalgia patients performed with moderate pressure for 15 min on the posterior cervical musculature decreased the perception of pain, muscle fatigue, and the state of tension-anxiety.

Psychometric properties of fatigue severity scale in Chinese systemic lupus erythematosus patients

BACKGROUND

Fatigue is the most common symptom in Systemic Lupus Erythematosus (SLE) patients. Many fatigue instruments have been used in SLE, with Fatigue Severity Scale (FSS) mostly adopted. However, fatigue instruments haven't been tested in the Chinese SLE population. The aim of our study was to test the psychometric properties of FSS in Chinese SLE patients.

METHODS

A cross-sectional study was conducted. 201 patients diagnosed with SLE were enrolled in the study with convenience sampling. Fatigue score, depression score and vitality subscale score of SF-36 were collected. Floor and ceiling effects were tested. Factor analysis was conducted. Reliability and validity of FSS were also tested.

RESULTS

Floor (4.50%) and ceiling (4.00%) effects were minimal. One factor was extracted, explaining 61.80% of total variance. When item1 and item 2 were deleted, one factor explained 69.54% of variance, and Cronbach's Alpha increased from 0.92 to 0.93. Intraclass correlation coefficient (ICC) was 0.94. Fatigue correlated with both depression (r = 0.52, P < 0.01) and vitality (r = - 0.55, P < 0.01), indicating acceptable construct validity for original FSS. When item 1 and 2 were removed, the correlation coefficient between 7-item FSS and vitality increased (r = - 0.58, P < 0.01), while correlation coefficient between 7-item FSS and depression remained the same (r = 0.52, P < 0.01). Known-groups validity was verified by that patients with depression showed higher fatigue score both for 9-item (Z = -5.56, P < 0.001) and 7-item FSS (Z = -5.70, P < 0.001).

CONCLUSIONS

9-item FSS is a reliable instrument and can be used to assess fatigue problem in Chinese SLE patients, and 7-item FSS also demonstrated good psychometric properties in the same participants.

Reporting on the level of validity and reliability of questionnaires measuring Katakori severity: A systematic review

Objectives:

Katakori is a Japanese term for non-specific symptoms including discomfort or dull pain caused by muscle stiffness around the neck through the shoulders and is one of the most frequently reported symptoms in Japan. However, there has been no standardized patient-reported outcome measure to evaluate Katakori severity. This study aimed to investigate the reporting level on validity and reliability of patient-reported outcome measures of Katakori severity.

Method:

A systematic search in ICHUSHI, MEDLINE, EMBASE and PubMed was undertaken from inception to April 2017 without language limitations. Two authors independently undertook screening by inspecting the title and abstract. Inclusion criteria were as follows: (1) participants with Katakori symptoms, (2) reporting reliability or validity of questionnaire evaluating Katakori severity and (3) published journal articles. Studies that either of the authors retained through the screening process were inspected with full text by the two authors independently to examine eligibility of the study. Any disagreement on eligibility after full-text inspection was resolved by discussion between them. Methodological quality was rated with the COnsensus-based Standards for the selection of health Measurement INstruments checklist. Subsequently, the evidence level of each measurement property was assessed for each questionnaire. The two authors extracted data independently. Any disagreement was resolved by discussion between them.

Results:

Five questionnaires were identified in five studies. The Shoulder Pain and Disability Index and Scale for Measuring Felt Shoulder Stiffness had the highest level of methodological quality. However, excellent measurement properties were found in only two out of nine criteria. Furthermore, in particular, content validity was not investigated in any measure.

Conclusion:

There is preliminary evidence for the reliability and validity of the Shoulder Pain and Disability Index and Scale for Measuring Felt Shoulder Stiffness; however, much further research is required. Identifying or developing a patient-reported outcome measure with content validity would be a future research agenda.

A Japanese version of the Patient Attitudes and Beliefs Scale for patients with musculoskeletal disorders

Background: The Patient Attitudes and Beliefs Scale (PABS) is a self-reporting questionnaire with 12 items on a 5-point Likert scale for patient's attitude towards shared decision making but its adaptation into Japanese has not been undertaken. Objectives: To develop a Japanese version of the PABS (PABS-J) through translation into Japanese and evaluation of an appropriate scoring system and unidimensionality using Rasch analysis and test-retest reliability. Design: This study included a cross-cultural validation step and investigations of questionnaire validity and reliability. Method: One-hundred-ten patients with musculoskeletal disorders referred to physiotherapy completed the Japanese draft of the PABS before the initial session of physiotherapy. Seventy-five of the 110 participants completed the PABS twice, on a separate day. Items that violated pre-determined criteria of unidimensionality and test-retest reliability (Quadratic-weighted κ ≦ 0.4) were removed. Further, the 110 participants identified one of the four stages of readiness towards shared decision making and correlation with the score of the PABS-J was preliminarily investigated as concurrent validity. Results/Findings: Rasch analysis confirmed unidimensionality of six items and appropriateness of a 3-point scale. Moderate test-retest reliability of the PABS-J was detected (Intra-class correlation coefficient = 0.70). A statistically significant and positive but weak correlation between the PABS-J scores and the four stages of readiness towards shared decision making was detected (ρ = 0.20, P = 0.03). Conclusions: The current study demonstrated partial validity and reliability of the PABS-J with six items and 3-point scale. This questionnaire will be a foundation for further investigations attitude towards shared decision making.

Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome

We investigated central fatigue in 50 patients with chronic fatigue syndrome (CFS) and 50 matched healthy controls (HC). Resting state EEG was collected from 19 scalp locations during a 3 min, eyes-closed condition. Current densities were localized using exact low-resolution electromagnetic tomography (eLORETA). The Multidimensional Fatigue Inventory (MFI-20) and the Fatigue Severity Scale (FSS) were administered to all participants. Independent t-tests and linear regression analyses were used to evaluate group differences in current densities, followed by statistical non-parametric mapping (SnPM) correction procedures. Significant differences were found in the delta (1-3 Hz) and beta-2 (19-21 Hz) frequency bands. Delta sources were found predominately in the frontal lobe, while beta-2 sources were found in the medial and superior parietal lobe. Left-lateralized, frontal delta sources were associated with a clinical reduction in motivation. The implications of abnormal cortical sources in patients with CFS are discussed.

Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain

Synopsis There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms. However, there are other possible causes for these symptoms, and secondary adaptive changes should also be considered in differential diagnosis. Understanding the nature of these symptoms and differential diagnosis of their potential origin is important for rehabilitation. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits. Once adequately assessed, appropriate tailored management should be implemented. Research to further assist differential diagnosis and to understand the most important contributing factors associated with abnormal cervical afferent input and subsequent disturbances to the sensorimotor control system, as well as the most efficacious management of such symptoms and impairments, is important for the future. J Orthop Sports Phys Ther 2017;47(7):492-502. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7052.

Measurement of fatigue: Comparison of the reliability and validity of single-item and short measures to a comprehensive measure

BACKGROUND

Evidence is needed on the clinicometric properties of single-item or short measures as alternatives to comprehensive measures.

OBJECTIVES

We examined whether two single-item fatigue measures (i.e., Likert scale, numeric rating scale) or a short fatigue measure were comparable to a comprehensive measure in reliability (i.e., internal consistency and test-retest reliability) and validity (i.e., convergent, concurrent, and predictive validity) in Korean young adults.

METHODS

For this quantitative study, we selected the Functional Assessment of Chronic Illness Therapy-Fatigue for the comprehensive measure and the Profile of Mood States-Brief, Fatigue subscale for the short measure; and constructed two single-item measures. A total of 368 students from four nursing colleges in South Korea participated. We used Cronbach's alpha and item-total correlation for internal consistency reliability and intraclass correlation coefficient for test-retest reliability. We assessed Pearson's correlation with a comprehensive measure for convergent validity, with perceived stress level and sleep quality for concurrent validity and the receiver operating characteristic curve for predictive validity.

RESULTS

The short measure was comparable to the comprehensive measure in internal consistency reliability (Cronbach's alpha=0.81 vs. 0.88); test-retest reliability (intraclass correlation coefficient=0.66 vs. 0.61); convergent validity (r with comprehensive measure=0.79); concurrent validity (r with perceived stress=0.55, r with sleep quality=0.39) and predictive validity (area under curve=0.88). Single-item measures were not comparable to the comprehensive measure.

CONCLUSIONS

A short fatigue measure exhibited similar levels of reliability and validity to the comprehensive measure in Korean young adults.

Fatigue in patients with spinal muscular atrophy type II and congenital myopathies: evaluation of the fatigue severity scale

PURPOSE

The aim of this study was to evaluate whether the fatigue severity scale (FSS) is an appropriate instrument to assess fatigue in patients with spinal muscular atrophy type II (SMA II) and congenital myopathies (CM).

METHODS

FSS and visual analog scale (VAS) were administered to 33 SMA II- and 72 CM patients. The psychometric properties of the FSS were evaluated by means of classical test theories for each of the disease groups. If abnormal fatigue was present in the disease group, the construct of fatigue was evaluated by means of focus group interviews.

RESULTS

Fatigue was rare in SMA II patients, but very frequent in patients with CM. The cut-off score designating abnormal fatigue (FSS score ≥ 4) was exceeded by 10% of the SMA II patients in contrast to 76% of the CM patients, of whom 52% suffered from severe fatigue (FSS score ≥ 5). Focus group interviews demonstrated that fatigue had an adverse effect on motor function, level of energy, social relations, and identity, four themes that could be captured by the FSS. The FSS and VAS were strongly correlated in SMA II patients, but only moderately in CM patients. The psychometric properties indicated that the original FSS with nine items measures more than one construct of fatigue, eliminating the first two items improved scale properties.

CONCLUSION

This study demonstrates that fatigue is characteristic in patients with CM, but not in patients with SMA II, in whom fatigue does not seem to impact daily life. While fatigue in CM and SMA II can be captured by FSS, omitting the first two items of the scale will improve its properties and content validity, along with comprehension of the scale itself.