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BackgroundThe original version of the Childhood Health Assessment Questionnaire (CHAQ30orig) suffers from a ceiling effect and hence has reduced clinical validity. The purpose of this study was to evaluate the effect of adding eight more demanding items (CHAQ38) and a new categorical response option (CATII) on discriminant validity and score distribution in a European patient sample.MethodsEighty-nine children with Juvenile Idiopathic arthritis (JIA) and 22 healthy controls, aged 7-16 years, were recruited from eight centres across Europe. Eight new CHAQ items and scoring option were translated back and forth for the countries in which they were not already present. Demographic, clinical, and CHAQ data were collected on-site. Subsequently, five different scoring methods were applied, i.e. the original method (CHAQ30orig) and four alternatives. These alternatives consisted of the mean item scores for the 30 and 38-question versions with either the original (CATI), or the new categorical response option (CATII). The five versions were tested for their ability to distinguish between patients and controls. Furthermore score distributions were evaluated and visualized by box and whisker plots.ResultsTwo CHAQ revisions with the new response option showed poor discriminative ability, whereas one revised version (CHAQ38CATI) had comparable discriminative ability comparable to the original CHAQ. A profound ceiling effect was observed in the original scoring method of the CHAQ (27%). The addition of eight more demanding items and application of a plain mean item score reduced this significantly to 14% (χ2 = 4.21; p < 0.05).ConclusionsRevising the CHAQ by adding eight more demanding items and applying a plain mean item scoring (CHAQ38CATI) maintained discriminant ability and reduced the ceiling effect in a European patient sample. The new categorical response option (CATII) seemed promising, but was less able to distinguish children with JIA from healthy controls and had less favourable distribution characteristics. The CHAQ38CATI is advocated for future use in mildly affected JIA patients.

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Adding core stabilisation exercises to traditional arm rehabilitation for patients with traumatic arm injury reduces compensatory movement patterns. Trends towards better functional outcomes in the stabilisation group are worth testing in a large-scale trial.

ÖzetKanıtlar YBÜ'de hastaların entübasyon ve sedasyon gibi çeşitli nedenlerle iletişim kuramama problemlerinin yatışları süresince hoş olmayan duygular, stres ve kötü deneyimler yaşamalarına sebep olduğunu belirtmektedir. Ağrı, yalnızlık duygusu, izolasyon, iletişim yetersizliği, uyku bozukluğu, korku ve kabuslar bunlar arasında sayılabilir. Bu olumsuz deneyimler arasında ağrı, önemli bir "stresör" olarak yoğun bakım hastalarının karşısına çıkmaktadır. Ağrı değerlendirmesinde en güvenilir kaynak hastanın kendisidir. Ancak ağrılarını entübasyon ve sedasyon nedeniyle sözel olarak ifade edemeyen yoğun bakım hastaları çeşitli davranışsal ve fizyolojik belirtilerle ağrılarını ifade etmektedirler. Bu nedenle yoğun bakımlarda ağrıya davranışsal ve davranışsalfizyolojik yanıtın değerlendirildiği özel tanılama araçlarının kullanılması önemlidir. Yoğun bakım hemşireleri bakım temelli ekip üyeleri olmaları sebebiyle hasta ile en çok vakit geçiren ve onları yakından izleyen sağlık profesyonelleri oldukları için ağrının değerlendirilmesi ve yönetiminde anahtar rol oynamaktadır. AbstractEvidence suggests that patients with communication inability problems for various reasons, such as intubation and sedation, cause unpleasant, stress and bad experiences during their time in intensive care unit. Pain, loneliness, isolation, communication inability, sleep disturbance, fear and nightmares can be counted. Among these negative experiences, pain is encountering intensive care patients as an important "stressor". The most reliable source of pain assessment is the patient itself. However, intensive care patients who cannot express their pain verbally due to intubation and sedation express their pain with various behavioral and physiological indications. For this reason, it is important to use special diagnostic tools that assess behavioral and behavioralphysiological responses to pain in intensive care. Intensive care nurses play a key role in the evaluation and management of pain because they are health care professionals who spend most of their time with patients and closely monitor them because they are maintenance-based team members.

BackgroundRegarding to determine pain-related anxiety of patients in clinical trials, there are sufficient number of tools in the literature (1). On the other hand there is a lack of internationally accepted measures which adapted in Turkish population to assess pain-related anxiety.ObjectivesThe aim of this study was to translate the short version of the Pain Anxiety Symptom Scale (PASS-20) into Turkish, assess its test-retest reliability and validate the use of PASS-20 among patients.Methods47 patients with different rheumatic diseases (ankylosing spondylitis, rheumatoid arthritis…) aged between 21-71 years (mean 47.91±48.00 years) participated in this study. Translation/re trans-lation of the English version of the PASS-20 was done blindly and independently by four different individuals and adapted by a team. After the translation, 34 patients was performed Turkish PASS-20 with an interval of a week for the test/retest reliability. And also, all patients were asked to fill Tampa Kinesiophobia Scale (TKS) (2)and Beck Anxiety Scale (BAS) (3)for validation.ResultsThere was no difference between test and retest results (p>0.05). The test-retest reliability was found to be 0.864 (95% CI=0.706-0.937). Cronbach's alpha was 0.864. Construct validity, tested by determining the correlation between the Turkish PASS-20 and the Turkish adaptation of the TKS (r=0.554, p<0.01), and BAS (r=0.545, p<0.01).ConclusionsTest-retest reliability of the Turkish version of the PASS-20 was found to be good in our study and it was seen that this scale could be used in clinics for patients with rheumatic diseases. This study is considered as a preliminary report in terms of validation of the PASS-20 because of the lack of participated patients number. However, pre-results indicates that PASS-20 scale is usefull for rheumatic patients with pain in Turkey.ReferencesMcCracken LM, Dhingra L. A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain research & management: the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur. 2002;7(1):45-50.Tunca Yılmaz Ö, Yakut Y, Uygur F, Uluğ N. Tampa Kinezyofobi Ölçeği'nin Türkçe versiyonu ve test-tekrar test güvenirliği Fizyoter Rehabil 2011;22(1):44-9.Ulusoy M, Sahin NH, Erkmen H. Turkish Version of the Beck Anxiety Inventory: Psychometric Properties. Journal of Cognitive Psychotherapy. 1998;12(2):163.Disclosure of InterestNone declared

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