Validation of the Italian version of the Client Satisfaction with Device module of the Orthotics and Prosthetics Users' Survey

doi:10.1016/j.dhjo.2014.04.002

Disability and Health Journal

Volume 7, Issue 4, October 2014, Pages 442-447

https://doi.org/10.1016/j.dhjo.2014.04.002 Get rights and content

Abstract

Background

Information on patient satisfaction with orthosis (PSwO) is crucial for verifying and enhancing orthotic quality, for clinical decision making, and for improving patient's quality of life.

Objective

To perform the translation and cross-cultural adaptation into Italian of the recently revised version of the Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey, and then analyze its psychometric properties using factor and Rasch analyses.

Methods

We translated and cross-culturally adapted the revised CSD into Italian (CDS-It) and assessed it in a convenience sample of orthotic-user patients with orthopedic, neurological and rheumatic conditions (N = 178; 56% men; median age, 62 years). Exploratory factor analysis and Rasch analysis (rating scale model) were used to investigate, respectively, dimensionality and metric properties of the scale.

Results

Factor analysis confirmed the substantial unidimensionality of the CSD-It. The rating scale fulfilled the category functioning criteria. All items fitted the Rasch model except #2 (“The weight of my device is manageable”) that overfitted the model, and #4 (“It is easy to put on my device”) that was underfitting in six stroke patients (i.e. not systematically). The targeting of item difficulty to person ability was out of range. The person separation reliability was 0.70 and Cronbach's alpha 0.73. The residual correlation between items #7 and #8 showed a borderline local dependency.

Conclusions

This study confirms the validity of the CSD-It, and provides a useful starting point for further refinement of this outcome measure.

Section snippets

Subjects

A convenience sample of patients was consecutively recruited between November 2011 and November 2012 at the Salvatore Maugeri Foundation, Unit of Occupational Rehabilitation and Ergonomics, Veruno (NO), Italy (Table 1). Inclusion criteria were: age 18 years or older, and current use of an orthosis in the context of rehabilitation for neurological, orthopedic or rheumatic diseases. Exclusion criteria were: problems with reading and understanding the Italian language and any diagnosed cognitive

Factor analysis

Horn's PA revealed one factor with empirical variance exceeding those from the random data (Table 2). EFA for the 1-factor model showed all items as loading > 0.40 to the factor. The factor explained 45% of the variance.

Rasch Analysis

After verifying the unidimensionality of CSD-It, the 8 items underwent RA. The rating scale fulfilled the category functioning criteria.

As shown in Table 3, six out of the 8 items fitted (infit and outfit MnSq between 0.80 and 1.2) the underlying construct (PSwO) that the

Discussion

The role of outcome measures in improving clinical decision-making heavily relies on the metric quality of these tools. First, this study showed the internal construct validity of the Italian cross-cultural translation/adaptation of the recently revised 8-item CSD. In addition it confirmed, in a large sample of rehabilitation subjects with a variety of diseases and orthoses, other main metric characteristics of the tool for assessing satisfaction with device. On the other hand, our results

Conclusion

In summary, the psychometric properties of CSD-It are in line with previous analyses on the English² and Swedish versions of the tool,⁶ and the present study extends the validity evidence of CSD for assessing PSwO, in a large range of diseases and orthoses. However, our results confirm some limitations of the CSD (in terms of reliability, targeting, and dimensionality) that should be addressed in future research, e.g. inserting additional items with appropriate difficulty and slightly modifying

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Cited by (22)

Measuring Satisfaction With Upper Limb Prostheses: Orthotics and Prosthetics User Survey Revision That Includes Issues of Concern to Women
2022, Archives of Physical Medicine and Rehabilitation
To (1) modify the Orthotics and Prosthetics User Survey (OPUS) Client Satisfaction with Device (CSD) instrument to incorporate issues of concern to women and (2) evaluate measure's structural and concurrent validity and reliability in persons with upper limb amputation (ULA).
Cross-sectional survey study with retest after 2 weeks. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Rasch analyses were used to select items and examine differential item functioning, range of coverage, and person and item reliability. Test-retest reliability was evaluated with intraclass correlation coefficients. Pearson correlations were used to estimate associations with other prosthesis satisfaction measures.
Telephone administered survey.
Convenience sample of 468 participants in the US (N=468; 19.9% women) with ULA, including a 50-person retest subsample (4% female).
Not applicable.
Modified OPUS CSD.
EFA suggested 3 subscales: Comfort, Appearance, and Utility. CFA found acceptable model fit. After dropping items with poor fit and high pairwise correlations in Rasch partial credit models, CFA model fit indices were acceptable (comparative fit index=0.959, Tucker-Lewis Index=0.954, root mean square error of approximation=0.082). Rasch person reliability was 0.62 (Utility), 0.77 (Appearance), and 0.82 (Comfort). Cronbach α was 0.81, 87, and 0.71 for Comfort and Appearance, and Utility subscales, respectively. Correlations between the modified CSD, the original CSD, and the Trinity Amputation and Prosthesis Experience Satisfaction Scale were 0.54-0.94.
We identified 3 subscales: Comfort (6 items), Appearance (8 items), and Utility (4 items) with 7 new items identified as important to women. The subscales demonstrate evidence of sound concurrent structural and test-retest reliability and concurrent validity. The Appearance and Comfort subscales have good reliability for group-level use in clinical and research applications, whereas the Utility subscale had poor to fair person reliability but excellent item reliability.
Cross-cultural adaptation and Rasch validation of the Slovene version of the Orthotics and Prosthetics Users’ Survey (OPUS)Client Satisfaction with Device (CSD)in upper-limb prosthesis users
2019, Annals of Physical and Rehabilitation Medicine
Citation Excerpt :
the 2 statistically discernible ability “strata” provide a clear distinction between satisfied and unsatisfied persons (but do not permit a more fine-grained assessment of satisfaction levels). In addition, the somewhat weak reliability levels found in present and previous papers [6–9,12] (and their correlation with precision/accuracy in measuring change) indicate that both sensitivity to change and responsiveness of the CSD, although not yet examined, will tend to be poor [18]. Moreover, our results confirmed some points that warrant discussion.
To validate the Slovene version of the Orthotics and Prosthetics Users’ Survey (OPUS) 8-item Client Satisfaction with Device (CSD) questionnaire in upper-limb prosthesis users and to further verify measurement properties of this tool with Rasch analysis.
Participants consisted of a convenience sample of 76 adults (54 men) using a prosthesis after unilateral upper-limb amputation who consecutively attended a follow-up visit at our centre.
After translation and cross-cultural adaptation of the CSD into the Slovene language, we evaluated functioning of the rating scale categories, item fit (internal construct validity), reliability indices and dimensionality, as well as convergent and discriminant construct validity of the questionnaire.
Rasch analysis indicated that: (1) functioning of the 4 response options was acceptable; (2) all items fitted the measured construct [information-weighted (infit) and outlier-sensitive (outfit) mean-square statistics 0.60 to 1.40]; (3) person separation reliability was 0.62 (and Cronbach α = 0.76), item separation reliability was 0.83; (4) on principal component analysis (PCA) on the standardised residuals, the CSD showed borderline but acceptable unidimensionality and no local item dependency. Moreover, as expected, the CSD score showed good correlation with the QUEST 2.0 score (r_s = 0.57) and little to fair correlation with the OPUS Upper Extremity Functional Status score (r_s = 0.21).
The metric properties of the Slovene version of CSD agree with previous studies. The present study confirms the validity of CSD for measuring patient satisfaction with an upper-limb device, enhances the confidence in this tool for assessing upper-limb prosthesis users, and contributes to further refining the technical quality of this measure.
A simple orthosis solves a problem in a patient with a dystonic finger after stroke
2017, Journal of Hand Therapy
The Persian version of satisfaction assessment module of Orthotics and Prosthetics Users' Survey
2016, Disability and Health Journal
Citation Excerpt :
Moreover, the OPUS has items to assess satisfaction from device aesthesis and patient–therapist interaction that were neglected in QUEST.5 The original OPUS is in English and it has been translated to Swedish, Italian, and Arabic languages with acceptable psychometric properties.13–15 The OPUS is a comprehensive self-reported questionnaire with five separate modules to measure functional status, satisfaction, and quality of life in patients who received devices and services from P&O facilities.
Orthotics and Prosthetics User's Survey (OPUS) was developed to measure patient satisfaction in Prosthetic and Orthotic (P&O) field.
To translate the satisfaction assessment module of OPUS (OPUS-SM) into Persian language (Persian OPUS-SM) and investigate its psychometric properties.
For cross-cultural adaptation of the OPUS-SM, the guideline suggested by the World Health Organization was recruited. A sample of 116 Persian-speaking people who received P&O devices and services, participated in this study. During the first session, participants filled out the Persian OPUS-SM and the Visual Analog Scale (VAS) regarding their satisfaction from delivered devices and services. Drawing from the above sample of 116 participants, 41 participants retook the Persian OPUS-SM 5–7 days after their first time. The results of the first and second administration sessions were analyzed to assess internal consistency, test-retest reliability, item-subscale correlation, minimal detectable change, floor and ceiling effects, criterion validity, and dimensionality of the Persian OPUS-SM.
The Cronbach's alphas of the Persian OPUS-SM were 0.71 and 0.89 for device and service satisfaction subscales, respectively. The intraclass correlation coefficients were 0.76 and 0.90 for device and service satisfaction subscales, respectively. The SEM and MDC for device satisfaction were 6.21 and ±17.21, respectively. The SEM and MDC for service satisfaction were 2.25 and ±6.22, respectively. There was a strong correlation between VAS and satisfaction subscales of the Persian OPUS-SM. Dimensionality assessment revealed that Persian OPUS-SM is a unidimensional measure.
The adapted and translated Persian OPUS-SM is a reliable and validated measure.
Cross-Cultural Validity and Differential Item Functioning of the Orthotics and Prosthetics Users' Survey with Swedish and United States Users of Lower-Limb Prosthesis
2015, Archives of Physical Medicine and Rehabilitation
To investigate the cross-cultural validity of the Orthotics and Prosthetics Users' Survey (OPUS), to evaluate differential item functioning (DIF) related to country, sex, age, amputation level, and amputated side (unilateral, bilateral), and to determine known-group validity of the OPUS.
Survey.
Outpatient clinics.
The sample (N=321) consisted of Swedish (n=195) and U.S. (n=126) adults using lower-limb prostheses.
Not applicable.
Four OPUS modules were used: lower extremity functional status, client satisfaction with device (CSD), client satisfaction with services (CSS), and health-related quality of life. Rasch analysis was used to calculate measures for persons and items.
The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of CSD and CSS needed adjustments, and the unidimensionality of CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for 2 out of 6 comparisons.
This study supports the validity of OPUS measure comparisons between Sweden and the United States and between subgroups with different demographic characteristics. Some of the country-related DIF may reflect the different health care financing systems. The findings demonstrate that the OPUS can discriminate between certain patient groups. The results also challenge some of our preconceptions about persons with bilateral amputation, indicating that we might know these persons less well than we think.
Translation and validation of the Malay version of modified orthotics and prosthetics users' survey
2024, Prosthetics and Orthotics International

View all citing articles on Scopus

: Statements of funding/conflicts of interest: The authors state that we did not received any financial support or will have other benefits from commercial sources for the work reported on in the manuscript, that there are not any other direct or indirect financial interests that any of the authors may have, which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work. This disclosure includes, but is not limited to, grants or funding, employment, affiliations, patents (in preparation, filed, or granted), inventions, honoraria, consultancies, royalties, stock options/ownership, or expert testimony.

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Research PaperValidation of the Italian version of the Client Satisfaction with Device module of the Orthotics and Prosthetics Users' Survey

Abstract

Background

Objective

Methods

Results

Conclusions

Section snippets

Subjects

Factor analysis

Rasch Analysis

Discussion

Conclusion

Orthotics

Development and measurement properties of the Orthotics and Prosthetics Users' Survey (OPUS): a comprehensive set of clinical outcome instruments

Prosthet Orthot Int

Upper Limb Prosthetic Outcome Measures (ULPOM): a working group and their findings

J Prosthet Orthot

Assessing satisfaction with orthotic devices and services: a systematic literature review

J Prosthet Orthot

Validity evidence for a modified version of the Orthotics and Prosthetics Users' Survey

Disabil Rehabil Assist Technol

Translation and linguistic validation of the Swedish version of Orthotics and Prosthetics Users' Survey

Prosthet Orthot Int

Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey

Prosthet Orthot Int

Guidelines for the process of cross-cultural adaptation of self-report measures

Spine

A rationale and test for the number of factors in factor analysis

Psychometrika

FACTOR: a computer program to fit the exploratory factor analysis model

Behav Res Methods

Relation of sample size to the stability of component patterns

Psychol Bull

Research Paper
Validation of the Italian version of the Client Satisfaction with Device module of the Orthotics and Prosthetics Users' Survey