MetaDTA is an online, interactive application for Meta-analysis of diagnostic test accuracy studies, which calls on the lme4 and shiny packages in R software to perform the statistical analyses and create an interactive user interface. The application does not require any knowledge of statistics and programming, nor does it require any specialized software to be installed, making it easy to use for users with no specialized statistical knowledge. In this paper, we will focus on the quantification of diagnostic test accuracy, visualisation of results and interactive functions of the MetaDTA platform, and introduce users to the specific operation of the application with examples, aiming to help relevant researchers to complete Meta-analysis of diagnostic accuracy studies, plot summary receiver operating characteristic (SROC) curves, draw the results of the evaluation of the quality of the included studies, and carry out sensitivity analysis.
Health literacy is closely associated with health status, most domestic studies tend to use multidimensional and multi-item tools for assessing health literacy, lacking simple and effective assessment methods.
To simplify health literacy scale and conduct psychometric test within the Chinese population.
Adults aged 18 years and above were selected from the "China Family Health Index Survey (2021) " for this investigation. Based on inclusion and exclusion criteria, a total of 7 449 participants were selected and randomly divided into two sample sets, including 3 680 cases in sample set 1 and 3 769 cases in sample set 2. The general information questionnaire, Short-form Health Literacy Questionnaire (HLS-SF12), Perception Social Support Scale (PSSS), and Family Health Scale Short-form (FHS-SF) were administered to the respondents. Classical test theory (CTT) and the Mokken model in item response theory (IRT) were used to screen the original items, and validation analyses such as reliability and validity of the simplified scales were also conducted.
A 9-item version (HLS-SF9) and a 4-item version (HLS-SF4) were simplified by using CTT and the Mokken model, respectively. Both the HLS-SF9 and the HLS-SF4 had no ceiling effect or floor effect, and the Cronbach's α coefficients for both were 0.913 and 0.842, with split-half reliabilities of 0.871 and 0.815, respectively. The exploratory factor analysis of HLS-SF4 revealed one common factor, accounting for 67.813% of the cumulative variance, with factor loadings exceeding 0.81 for each item. The confirmatory factor analysis of HLS-SF9 showed that χ2/df was 10.844, goodness of fit index (GFI) was 0.985, adjusted goodness of fit index (AGFI) was 0.971, normative fit index (NFI) was 0.986, comparative fit index (CFI) was 0.987, and root mean squared error of approximation (RMSEA) was 0.051. The correlation analysis demonstrated positive correlation of HLS-SF9 and HLS-SF4 with PSSS (r=0.367, 0.292, P<0.001), as well as FHS-SF (r=0.340, 0.237, P<0.001), respectively. The intraclass correlation coefficients (ICC) (95%CI) for the criterion validity of HLS-SF9 against HLS-SF12 was 0.989 (0.988-0.999), while for HLS-SF4 against HLS-SF12 was 0.892 (0.886-0.899) .
The simplified health literacy scales have good reliability and validity, which are reliable and effective tools for assessing the health literacy of the Chinese population. Researchers can choose the scale according to the needs of research precision (HLS-SF9) or assessment time (HLS-SF4) .
Scale assessment for irritable bowel syndrome (IBS) has been widely implemented in clinical practice, how to choose an appropriate assessment tool is very important. In view of this, we used literature research methodology to search patient-reported outcomes and disease-specific health-related quality of life instruments for IBS, summarized their main contents and psychometric properties, then put forward recommendations on the selection of the instruments. A total of 37 commonly used instruments for IBS were retrieved, which have proven to have good reliability, validity and responsiveness, and can be better applied in clinical practice. We suggest medical professionals and researchers choose an assessment instrument for IBS according to the purpose and content of their research.
Gastrointestinal symptoms as a common clinical evaluation index require a universal evaluation tool, and the Gastrointestinal Symptom Rating Scale (GSRS) has been widely applicated in domestic studies. However, the versions used are not standardized Chinese versions and their measurement performance has not been reported yet.
To explore the measurement performance of the Chinese version of the GSRS, in order to provide an objective basis for expanding the application of the scale.
From October 2021 to March 2022, patients with irritable bowel syndrome (IBS), chronic enteritis and chronic gastritis who attended outpatient clinics of splenogastroenterology or gastroenterology in 45 hospitals (community health service centers), including Jilin Provincial People's Hospital and Beijing Changping District Urban Community Health Service Center, etc. The Chinese version of GSRS was used to evaluate the gastrointestinal symptoms of the included patients on treatment days 0, 3, 7 and 14. Reliability and validity analyses were conducted on the Chinese version of GSRS, and the paired Wilcoxon signed rank sum test was applied to compare the changes in the scores of patients before and after treatment. Additionally, effect size (ES), standardized response mean (SRM), and score change rate (CR) were used to assess the responsiveness of the scales.
A total of 554 patients were included and followed up, including 127 patients (22.93%) with IBS, 244 (44.04%) patientswith chronic enteritis and 183 (33.03%) patients with chronic gastritis. The Cronbach's alpha coefficient for the Chinese version of GSRS was 0.896, the Guttman Split-half coefficient was 0.920, the Spearman-Brown coefficient was 0.926, the intraclass correlation coefficient (ICC) for the two retest results was 0.589, and the Spearman correlation coefficient was 0.662. The content validity index for each item ranged from 0.78 to 1.00. The content validity index (CVI) for the scale-level universal agreement was 0.73, and the average CVI was 0.96. Exploratory factor analysis extracted a total of three common factors with eigenvalues>1, and the rate of cumulative variance contribution is 60.721%.The validation factor analysis demonstrated that the data samples did not fit the initial model M0 well, and each fit index of model M1 is within the acceptable range after correction according to the modification indicator hints in the acceptable range: χ2/df<3.000, root mean square error of approximation (RMSEA) <0.800, and each fit index >0.900. The total Chinese version of GSRS scores of patients after 14 d of treatment are lower than the total Chinese version of GSRS scores before treatment (P<0.001), with ES=1.03, SRM=1.01, and CR=74.32%.
The Chinese version of GSRS has a high level of measurement performance with good reliability and responsiveness, which is suitable for measuring a general population with gastrointestinal symptoms and evaluating the treatment effectiveness of them.
In the field of physical activity and health research, a key issue is to measure and evaluate the physical activity level of different groups by using scientific methods. As a classic scale for measuring physical activity, Harvard Alumni Health Study Physical Activity Questionnaire (HAHS-PAQ) has been verified in many countries and different groups. However, there is still no report of the reliability and validity of this scale in Chinese college students.
To develop a Chinese version of the HAHS-PAQ (HAHS-PAQ-C) and to test its reliability and validity among Chinese college students.
The HAHS-PAQ-C was developed using the Brislin's approach. Then from December 2017 to April 2018, freshmen from Tsinghua University were recruited to attend a survey for testing the scale, among whom 116 and 166 cases completed the reliability and validity study, respectively. Spearman rank correlation analysis was used to test the test-retest reliability of the HAHS-PAQ-C and its criterion validity with ActiGraph wGT3X-BT accelerometer as the criterion. The Bland-Altman plot was adopted to evaluate the consistency of two physical activity measurements of HAHS-PAQ-C and ActiGraph wGT3X-BT accelerometer.
The correlation coefficients of total energy consumption, walking, climbing stairs and sports or leisure entertainment measured every other week with 2 repetitions by HAHS-PAQ-C were 0.504, 0.570, 0.711 and 0.429, respectively (P<0.05). Meanwhile, the correlation coefficients of total weekly energy consumption, medium- and high-intensity energy consumption and walking measured by HAHS-PAQ-C and ActiGraph wGT3X-BT accelerometer were 0.441, 0.258 and 0.312, respectively (P<0.05). The result of Bland-Altman plot revealed that the average value of the mean of total energy consumption measured by HAHS-PAQ-C and ActiGraph wGT3X-BT accelerometer was 1 778.78, of which 94.6% (157/166) points were within the 95%CI.
The cross-validation of the HAHS-PAQ-C in Chinese college students has proven it has good reliability and validity, and is feasible to be popularized, which could be used as a physical activity measurement tool for Chinese college students, and will provide assistance to Chinese college students to take exercise and interventions appropriately.
Functional assessment is a foundation for rehabilitation treatment, which contributes to the development of the rehabilitation program and the improvement of rehabilitation outcomes. However, there are only few assessment scales with unvaried domains for upper extremity function after stroke.
To develop the Chinese version of Upper Extremity Performance Test (TEMPA) and to explore its reliability and validity in stroke patients.
We translated and revised the English version of TEMPA to a Chinese version according to the Brislin's translation procedures of forward-translation, back-translation, review, cultural adaptation and a pre-test. Then from August 2021 to January 2022, the Chinese version of TEMPA, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Simple Test for Evaluating Hand Function (STEF) were used to evaluate the upper limb function of 40 patients with stroke recruited from Department of Rehabilitation, Tangshan Workers' Hospital. One week after the first evaluation, the Chinese version of TEMPA (TEMPA-C) was used to evaluate their upper limb function again. The test intra-rater reliability and inter-rater reliability of each dimension of the TEMPA-C were tested by intraclass correlation coefficient (ICC). The internal consistency reliability of TEMPA-C was tested by Cronbach's α. The total score of each dimension and item score of TEMPA-C and the scores of FMA-UE and STEF were analyzed by Pearson correlation analysis to test criterion validity of TEMPA.
The ICC for the intra-rater reliability and the inter-rater reliability of the TEMPA-C functional rating total score was 0.992, and 0.982, respectively. The ICC for the intra-rater reliability and the inter-rater reliability of the TEMPA-C task analysis total score was 0.998 and 0.999, respectively. The Cronbach's α of the TEMPA-C functional rating dimension was 0.858. The score for performing each of the 9 tasks of the TEMPA-C execution speed dimension was negatively correlated with the score of the affected side of STEF, and the correlation coefficient ranged from -0.785 to -0.460. The total score of the TEMPA-C functional rating dimension was positively correlated with the scores of FMA-UE, FMA-UE wrist-hand part and the affected side of STEF, so was the total score of the TEMPA-C task analysis dimension, and the correlation coefficients were all above 0.7.
The TEMPA-C was highly reliable and valid, and could be used in measuring the function of upper extremity in patients with stroke.
As a simple, rapid and effective research method, test-negative design (TND) has been widely used to support the evaluation of post-marketing effectiveness of vaccines and efficacies of interventions in healthcare institutions, showing a magnificent prospect of application. With the emergence of new derivative types such as real-time TND and cluster-randomized TND, TND has also been gradually applied to the exploration of disease risk factors and effectiveness evaluation of interventions. However, there are still few related research reports in China. We introduced the basic principles, methods and essentials of implementation, newly derivative types such as real-time TND and cluster-randomized TND, advantages and limitations of TND, as well as its applications in assessing post-marketing effectiveness for vaccines and efficacies of interventions, providing a theoretical and practical basis for researchers in China to carry out relevant research.
The program of screening for stroke in high-risk populations is being carried out vigorously in Chinese communities, the implementation effectiveness of which is closely associated with residents' intention to use the program. However, there is no reliable scale for measuring high-risk residents' intention to use stroke screening.
To develop a scale for measuring high-risk people's intention to use stroke screening, and to assess its reliability and validity, providing a reliable tool for assessing high-risk residents' intention to use stroke screening.
The Theory of Planned Behavior, literature review, field survey and brainstorming were used to develop the item pool of the scale. Then the items were used to form an initial version of High-risk People's Intention to Use Stroke Screening Scale (three domains covering 28 items) after being revised in accordance with the assessment results of two rounds of expert survey with five experts (four stroke researchers and one with a good command of developing a scale) from July to August 2021. After that, the reliability and validity of the initial version of the scale was tested in August to September 2021 with a convenience sample of community residents from Hubei's Xiangyang, Wuhan, Jingmen, and Guangdong's Guangzhou, Huizhou, Shenzhen.
Altogether, 535 residents attended the survey for testing the reliability and validity of the initial version of the scale, and 524 of them (98%) returned responsive questionnaires. The final revised version consists of four domains (positive attitude, negative attitude, subjective norms, perceived behavioral control) with 25 items. The Cronbach's α of the scale was 0.904. And its ICC for test-retest reliability was 0.810. The content validity index of each item (I-CVI) ranged from 0.80 to 1.00. The scale-level CVI/universal agreement (S-CVI/UA) and average scale-level CVI (S-CVI/Ave) were 0.93 and 0.99, respectively. By exploratory factor analysis, four common factors were extracted, and they explained 61.945% of the total variance. The loading for each factor was 0.482-0.828. Confirmatory factor analysis showed that the scale's fit indices were: χ2=361.040, df=267, χ2/df=1.352, RMSEA=0.038, GFI=0.897, CFI=0.958, AGFI=0.875, IFI=0.959, TLI=0.953, NFI=0.859.
The scale has proven to be highly reliable and valid, which could be used as a tool for measuring high-risk community-dwelling residents' intention to use stroke screening.
