Nurse Media Journal of Nursing e-ISSN: 2406-8799, p-ISSN: 2087-7811 https://medianers.
:269-287.
August 2022 https://doi.
org/10.
14710/nmjn.
REVIEW
An Evaluation of Psychometric Properties of Needs Assessment Instruments in Patients with Coronary Artery Disease Undergoing Cardiac Rehabilitation Programs: A Systematic Review Kourosh Zarea1.
Eesa Mohammadi2.
Johanne Alteren3.
Neda Sayadi1 1Nursing Department.
Nursing Care Research Centre in Chronic Disease.
Ahvaz Jundishapur University of Medical Sciences.
Ahvaz.
Iran 2Department of Nursing.
Faculty of Medical Sciences.
Tarbiat Modares University.
Tehran.
Iran 3Faculty of Health Sciences and Social Care.
Molde University College.
Molde.
Norway Article Info Abstract Article History:
Received: 1 January 2022 Revised: 10 August 2022 Accepted: 18 August 2022 Online: 31 August 2022 Keywords:
Cardiovascular rehabilitation.
coronary artery disease.
COSMIN
instrument needs Corresponding Author:
Neda Sayadi Nursing Department.
Nursing Care Research Centre in Chronic Disease.
Ahvaz Jundishapur University of Medical Sciences.
Ahvaz.
Iran.
Email:
sayadi_neda@yahoo.
Background: Coronary Artery Disease (CAD) is the foremost reason of illnesses and death in the world.
Assessment of the needs is a priority in these patients.
However, there is a paucity of tools for the evaluation of needs, with the controversy surrounding their validity.
Purpose: This review aimed to evaluate the psychometric properties of tools used to assess needs of patients with CAD undergoing cardiac rehabilitation (CR) plans.
Methods: An online literature search combined with manual search was carried out on 11 databases to identify relevant articles.
The terms used in the search were:
cardiac rehabilitation AND coronary artery disease, cardiac rehabilitation AND acute coronary syndrome, and questionnaires OR need assessment OR tool OR Articles from 1989 to 2021 were selected using some inclusion criteria and no validation studies were excluded.
The quality of the questionnaires was evaluated by researchers using consensus-based standards for the selection of health status measurement instruments (COSMIN) list.
Data analysis had been done by calculating overall methodological quality scores per study on a measurement property using COSMIN checklist.
A methodological quality score per box was obtained by taking the lowest rating of any item in a box (Aoworse score countsA.
Results: Of 653 articles, 15 papers were involved in the study.
Six studies reported cross-cultural validity, nine studies for criterion validity, and none reported measurement error, hypothesis testing, and responsiveness.
There is no vigorous and valid single scale for the measurement of needs in CAD patients.
Overall, the CADE-Q questionnaire was good and a patient self-assessment tool for cardiac rehabilitation was poor based on psychometric properties.
Conclusions: The findings of this study disclosed that even though it has been more than 32 years, from 1989 to 2021, of the development in need assessment instruments, each instrument has as a minimum of one AupoorAy psychometric property according to the COSMIN checklist.
So, it is recommended for the next studies to design and develop instruments with better psychometric validities for clinical environment.
How to cite: Zarea.
Mohammadi.
Alteren.
, & Sayadi.
An evaluation of psychometric properties of needs assessment instruments in patients with coronary artery disease undergoing cardiac rehabilitation programs:
A systematic review.
Nurse Media Journal of Nursing, 12.
, 269-287.
https://doi.
org/10.
14710/nmjn.
Introduction Cardiovascular illness is the principal reason for death in the world (Vasan et al.
, 2.
Patients with Coronary Artery Disease (CAD) are at high risk of recurring cardiovascular events.
In spite of the progress in pharmacological and invasive cure approaches, risk factors remain independent forecasters of cardiac death in patients with CAD (De Bacquer et al.
, 2.
Consequently, secondary prevention constitutes a crucial part of the current care of patients by cardiovascular illness.
The expression AuCardiac RehabilitationAy (CR) refers to coordinated complex interventions planned to enhance a cardiac patientAos physical, mental, and social performance, as well as steadying, reducing, or even reversing the development of the causal atherosclerotic progressions, thus decreasing morbidity and mortality (Anderson et al.
, 2.
CR or secondary prevention plans deliver a critical and cost-effective situation to bring applicable preventive care (Balady et al.
, 2.
Because of the low quality of life in patients with Copyright A 2022.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 270 CAD particularly in patients undergoing surgery (Fayyazi et al.
, 2.
, a participation in CR and education programs has been established to be related to an enhanced lifestyle and an improved diagnosis after an acute coronary occasion (Perk et al.
, 2012.
Ahyana et al.
, 2.
These programs are aimed at reducing risk factors and maintaining individuals in ideal physical, psychological, social, and functional conditions (Dibben et al.
, 2.
The main activities pursued in a CR program include education, a recommendation for lifestyle modification, risk factor management, psychosocial assistance, secondary prevention, and lasting management plans (Fawcett & Desanto-Madeya, 2.
CR contains four main phases that are phase I .
he acute phas.
, phase II .
he sub-acute phas.
, phase i .
he intensive outpatient therapy phas.
, and phase IV .
he self-governing continuing conditioning phas.
The first phase of nursing care in all phases of CR is to recognize patientsAo needs.
The result of the research by Mohammadi et al.
showed that the care needs of the patients with CAD in phase I CR including physical, psychological, social, and spiritual care needs.
Physical care needs included aspects such as providing patients with information regarding the characteristics of CAD, sexual and physical activities after hospital discharge, post-discharge dietary regimen, medications, physical exercise, smoking cessation, wound care, self-care during physical activity, follow-up medical visits, and CAD signs and symptoms.
Psychological care needs were mainly related to stress and anxiety management and depression prevention.
Social care needs covered aspects such as social relationships after getting discharged from hospital and returning to work and other social activities (Mohammadi et al.
, 2.
In particular, the educational supportive role of nurses by Orem in the process of CR has been expressed and the focus of the nurse in this section is to accurately identify the social, emotional, and physical needs of patients and give appropriate training to them since providing these programs is beyond their ability due to the limited time available to nurses.
Having a valid and reliable assessment tool in a clinical setting to assess the needs of the patient and his family can compensate the time limit of nurses and increase the effectiveness of the rehabilitation program (Naghdi et al.
, 2.
Despite the advantages of CR and the major activities carried out in this regard, there is a paucity of tools for the evaluation of needs, with the controversy surrounding their validity which means that sometimes the author did not implement or did not completely report the psychometric properties of the tools (Fawcett & Desanto-Madeya, 2.
Indeed, one of the critical issues today in studies of this field is the selection of appropriate and relevant assessment tools (Naghdi et al.
, 2.
In addition, before the selection of a tool, it is vitally important that psychometric properties be evaluated based on appropriate criteria (Mokkink.
Terwee.
Knol et al.
, 2.
The consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist, a tool for evaluating the methodological quality of studies on the measurement properties of health status questionnaires, has been developed as the tool of choice in recent years (Mokkink.
Terwee.
Knol et al.
, 2.
Utilizing the COSMIN checklist makes it likely to disapprovingly assess and evaluate the quality of these studies (Menezes Costa et al.
This checklist can be used in systematic review studies to examine the features of the scale with the same purpose.
Tool choice must be according to high-quality studies, and the COSMIN checklist can be used as a guide for developing tools and reporting features of instrumental scales in studies (Mokkink.
Terwee.
Knol et al.
, 2.
Nonetheless, although the assessment, planning, and implementation of effective interventions in the CR domain call for precise measurement, and evaluation of CR needs appropriate tools, no systematic review on CR questionnaires to date delivers an explained appraisal on the methodological quality of the studies.
Therefore, the objective of present review is to recognize scales that investigate needs in patients with CAD undergoing CR and evaluate the psychometric properties of the instruments.
Methods 1 Research design This study is a systematic review of studies that assessed the psychometric properties of needs in patients with CAD undergoing CR programs.
Also, this review was done in 2021 and in accordance with the Favoured Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) strategies.
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NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 271 Identification 2 Search methods An online literature search was carried out by two research members (NS & KZ) on MagIran.
IranMedex (Indexing articles published in Iranian biomedical journal.
ISC (Islamic World Science Citatio.
SID (Scientific Information Database Ae a Persian databas.
PubMed.
MEDLINE.
CINAHL .
ia EBSCO).
Scopus.
Wiley.
EMBASE .
ia OVID), and Web of Science to identify relevant articles.
The terms used in the search were: cardiac rehabilitation AND coronary artery disease, cardiac rehabilitation AND acute coronary syndrome, and questionnaires OR need assessment OR tool OR scale.
The words were applied as keywords or free-text words in all databases except for PubMed, in which Mesh terms were used.
The search was supplemented with a separate search for the recognized questionnaires in addition to the authors of these The titles of the related references were searched, and the full texts of the articles meeting the inclusion criteria were studied (Figure .
Evidences recognized via Database search .
Included Eligibility Screening Documents after duplicates eliminated .
Screening titles and abstracts .
Articles removed due to unrelated to the purpose of the research .
Full-text articles assessed For eligibility .
= .
Removal of articles due to lack of necessary criteria .
Articles submitted to the final review stage .
Figure 1.
PRISMA flowchart 3 Inclusion and exclusion criteria Articles were included in this study if they were: full-text .
riginal article.
, published in English or Persian, published in peer-review journals, and concerned with the development or assessment of the measurement properties of an original form of a need assessment in CR programs questionnaire.
Abstracts without full articles, review/systematic review articles, and conference articles were excluded from the study.
As per Terwee et al.
standards, publications counted as editorials and case reports were also omitted.
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NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 272 4 Screening of articles Two investigators (NS & KZ) individually assessed titles and abstracts of the recognized records for possible inclusion in the study and evaluated full texts for eligibility by applying the inclusion and exclusion criteria.
As can be seen from Figure 1, after screening the titles and abstracts, 554 articles were removed as they were unrelated to the researchAos purpose.
The investigators selected the full-text articles based on the inclusion and exclusion criteria, leaving 15 articles for final review.
The investigators determined differences regarding inclusion and exclusion criteria by discussion until they reached an agreement.
If agreement could not be reached, the last decision was made by third and fourth investigators (EM & JA).
5 Data extraction Data were extracted from included articles by two research members (NS & KZ) into Table 1 (See Appendix .
This was carried out in order to summarize the need assessment scales and narrative findings of psychometric characteristics of the scales derived from the included studies.
6 Quality appraisal The methodological quality of articles was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist by NS & KZ.
When agreement could not be reached between two investigators, the last decision was made by the third and fourth investigators (EM & JA).
The COSMIN checklist has newly been improved and available by Mokkink.
Terwee.
Patrick et al.
The COSMIN list is according to a global Delphi study contributed by 57 experts.
Delphi technique considered the most appropriate method to develop a checklist on the methodological quality of studies on measurement properties.
Within this Delphi study, the authors have had many interesting discussions, and reached consensus on a number of important issues about the assessment of measurement properties.
Therefore, this checklist has been verified to have a suitable inter-rater agreement and reliability (Mokkink.
Terwee.
Knol et al.
The COSMIN checklist involves twelve boxes.
Nine of these boxes denote methodological standards for studies on measurement properties: A) internal consistency.
B) reliability.
C) measurement error.
D) content validity.
E) structural validity.
F) hypotheses testing.
G) crosscultural validity.
H) criterion validity.
I) responsiveness.
Box J) contains two standards for the interpretability of patient-reported outcomes.
Besides, the COSMIN checklist delivers assessment criteria for articles that use the Item-Response-Theory (IRT bo.
and generalizability of the results (Generalizability bo.
Each of the boxes A) to I) and the IRT box consists of several items regarding design necessities and statistical analyses.
The scoring system of COSMIN checklist indicated in Table 2-7 (See Appendix .
The items can be scored on a four-point rating scale representing options for poor, fair, good, or excellent The overall score of the quality of each psychometric property is defined as the lowest score of any item within the box, following the Auworst score countsAy method.
For example, for a reliability study, if one item in the box AoReliabilityAo is scored poor, the methodological quality of that reliability study is esteemed as poor.
At the COSMIN website .
, the authors indicate that the checklist mainly emphasizes standards for studies that examine psychometric properties of Health-Related Patient-Reported Outcomes (HR-PRO.
(Mokkink.
Terwee.
Patrick et al.
, 2.
The quality appraisal of the involved articles is presented in Table 8.
7 Data analysis As this study investigated the psychometric properties of the scales from the articles, the data analysis had also been done by using COSMIN checklist (Table .
After all studies were assessed their psychometric components using nine boxes .
ox A-I) in the COSMIN checklist, the authors (NS & KZ) analyzed the data according to overall quality of the scales and each box of the COSMIN Results 1 Study characteristics As presented in the PRISMA flow chart (Figure .
, 653 articles were found in the first search.
Afterward omitting doubled and irrelevant studies, 15 studies remained.
The search identified 7 Copyright A 2022.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 273 different questionnaires relating to need assessment in patients with CAD undergoing the CR Table 8.
COSMIN quality assessment COSMIN BOXES First author .
BOX A INTERNAL De Melo Ghisi Good et al.
De Melo Ghisi.
Good Oh et al.
Marofi et al.
Good De Melo Ghisi Good et al.
Chen et al.
Good Santos et al.
Poor De Melo Ghisi Poor et al.
De Melo Ghisi Good et al.
De Melo Ghisi Good & Oh .
De Melo Ghisi.
Poor Grace et al.
De Melo Ghisi Poor et al.
Sayadi et al.
Good Van EngenPoor Verheul et al.
Smith et al.
Poor Phelan et al.
Poor Note.
NR: not reported BOX B
Reliability BOX C
Measurement BOX D Content
BOX E
Structural BOX F
Hypothesis BOX G
Crosscultural BOX H
Criterion
BOX I
Responsiveness Poor Good Poor Good Good Poor Poor Good Good Poor Good Poor Poor Good Good Poor Poor Poor Good Poor Poor Poor Poor Poor Good Good Poor Poor Good Good Poor Poor Poor Poor Poor Poor Good Poor Poor Good Poor Poor Poor Poor Poor Poor These questionnaire consisted of: .
A patient self-assessment tool for cardiac rehabilitation, .
the cardiac rehabilitation needs assessment tool (CRNAT), .
the information needs in cardiac rehabilitation (INCR) tool, .
the coronary artery disease education questionnaire (CADE-Q), .
the second version of the coronary artery disease education questionnaire (CADEQ II), .
short version of the coronary artery disease education questionnaire (CADE-Q SV), .
care needs questionnaire in phase 1 cardiac rehabilitation for patients with coronary artery disease (CNCR-Q).
The rest of the articles .
of included studies showed the cross-cultural validation of these questionnaires in other countries and one study was an algorithm about need assessment for the patient in CR.
Involved studies were available from the year 1989 to 2021.
All studies were peer-review original articles.
Majority of the studies .
were showed in the Canada (De Melo Ghisi et al.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi.
Grace et al.
, 2013.
De Melo Ghisi & Oh, 2021.
Melo Ghisi.
Oh et al.
, 2.
followed by Iran .
(Marofi et al.
, 2020.
Sayadi et al.
, 2.
Brazil .
(De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
, 2018.
De Melo Ghisi et al.
, 2014 Santos et , 2.
China .
(Chen et al.
Australia .
(Smith et al.
, 2.
Netherlands .
(Van Engen-Verheul et al.
, 2.
and USA .
(Phelan et al.
, 1.
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NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 274 2 Quality evaluation of the studies The results showed that the concept of need was investigated in all studies.
Overall the CADEQ questionnaire was good based on psychometric properties.
Respecting to the study design, seven articles were cross-cultural assessment studies (Chen et al.
, 2018.
De Melo Ghisi et , 2014.
De Melo Ghisi et al.
, 2018.
De Melo Ghisi & Oh, 2021.
De Melo Ghisi.
Oh et al.
, 2013.
Marofi et al.
, 2020.
Santos et al.
, 2.
and others were studied about design and psychometric properties of questionnaires (De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2016.
De Melo Ghisi.
Grace et al.
, 2013.
Phelan et al.
, 1989.
Sayadi et al.
, 2021.
Smith et al.
Van Engen-Verheul et al.
, 2.
The number of tool items and factors of involved studies were different.
The maximum item number was 60 (De Melo Ghisi.
Grace et al.
, 2.
, the minimum number of dimensions were three (Marofi et al.
, 2.
and the maximum number was 11 dimensions in one study (Phelan et , 1.
Internal consistency was directed with estimating CronbachAos alpha and Kuder- Richardson20 test.
Intra-Class Corelation (ICC) and SpearmanAos rank correlation coefficient were used for stability in reliability.
Educational level, family income.
CR duration, and time of diagnosis were used as a criterion for criterion validity.
Majority of studies had construct validity.
factor analysis .
(De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
De Melo Ghisi & Oh, 2021.
De Melo Ghisi.
Oh et al.
, 2013.
Sayadi et al.
, 2.
, confirmatory factor analysis .
(Chen et al.
, 2.
, and exploratory and confirmatory factor analysis .
(Marofi et al.
, 2.
while other studies did not report it.
Other psychometric characteristics of involved studies are reviewed in Table 1.
The results of the COSMIN quality assessment of 15 involved articles are provided in Table 8.
None of these articles had AuExcellentAy quality in all psychometric properties.
3 BOX A Ae Internal consistency Internal consistency is the extent to which items in a .
scale are intercorrelated, so assessing the equal construct (Terwee et al.
, 2.
In twelve studies, internal consistency calculated based on Cronbach alpha or Kuder-Richardson-20, (Chen et al.
, 2018.
De Melo Ghisi et al.
, 2014.
De Melo Ghisi et al.
, 2016.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2010.
Melo Ghisi et al.
, 2018.
De Melo Ghisi.
Grace et al.
, 2013.
De Melo Ghisi & Oh, 2021.
De Melo Ghisi.
Oh et al.
, 2013.
Marofi et al.
, 2020.
Santos et al.
, 2019.
Sayadi et al.
, 2.
The COSMIN checklist scores for four studies were AupoorAy because they did not calculate the factor analysis also the author did not reference to other studies (De Melo Ghisi et al.
, 2014.
De Melo Ghisi et al.
De Melo Ghisi.
Grace et al.
, 2013.
Santos et al.
, 2.
and eight studies were evaluated as AuGoodAy because percentage of missing items were not explained.
(Chen et al.
, 2018.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
, 2018.
De Melo Ghisi & Oh, 2021.
Melo Ghisi.
Oh et al.
, 2013.
Marofi et al.
, 2020.
Sayadi et al.
, 2.
Three studies had not calculated internal consistency so the COSMIN score were "poor" (Phelan et al.
, 1989.
Smith et , 2015.
Van Engen-Verheul et al.
, 2.
4 BOX B Ae Reliability Reliability is the degree to which patients can be discriminated from each other, despite measurement errors .
elative measurement erro.
(Terwee et al.
, 2.
Ten studies had not calculated reliability so the COSMIN score was AupoorAy (Chen et al.
, 2018.
De Melo Ghisi et al.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2014.
De Melo Ghisi & Oh, 2021.
De Melo Ghisi.
Oh et al.
, 2013.
Phelan et al.
, 1989.
Sayadi et al.
, 2021.
Smith et al.
, 2015.
Van EngenVerheul et al.
, 2.
The rest studies described reliability criteria and were estimated as Aupoor,Ay because all of them used only one measurement (De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
De Melo Ghisi.
Grace et al.
, 2013.
Santos et al.
, 2.
5 BOX C Ae Measurement error The systematic and random error of a score that is not attributed to true variations in the construct is measured as measurement error.
Measurement errors of all studies were not stated.
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, 2022, 275 6 BOX D Ae Content validity The content validity is described as Authe extent to which the domain of interest is comprehensively sampled by the items in the questionnaireAy.
Content validity of all studies were AuexcellentAy because the content of questionnaire was evaluated by expert panels.
7 BOX E Ae Structural validity According to the COSMIN checklist, structural validity is the degree to which the scores of scales are a sufficient indication of the dimensionality of the construct.
In this regard, seven articles did not describe factor analysis and were appraised as Aupoor.
Ay( De Melo Ghisi et al.
, 2016.
De Melo Ghisi.
Grace et al.
, 2013.
Santos et al.
, 2019.
De Melo Ghisi et al.
, 2014.
Smith et al.
, 2015.
Van Engen-Verheul et al.
, 2012.
Phelan et al.
, 1.
and eight studies were evaluated exploratory or confirmatory factor analysis but proportion of missing items NOT defined, so COSMIN score were AugoodAy(Chen et al.
, 2018.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
, 2018.
De Melo Ghisi.
Oh et al.
, 2013.
De Melo Ghisi.
Oh et al.
, 2013.
Marofi et al.
Sayadi et al.
, 2.
8 BOX F Ae Hypothesis testing Hypothesis testing of all studies were not reported.
9 BOX G Ae Cross cultural In this study, seven questionnaires were used.
Cross-cultural adaptation was performed only for four questionnaires (De Melo Ghisi et al.
, 2010.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et , 2016.
De Melo Ghisi.
Grace et al.
, 2.
Cross-cultural adaptation of INCR was done to the Portuguese language (De Melo Ghisi et al.
, 2.
Cross-cultural adaptation of CADE-Q were done to Persian and English language (De Melo Ghisi.
Oh et al.
, 2013.
Marofi et al.
, 2.
Crosscultural adaptation of CADE-Q SV were done to French-Canadian and Brazilian-Portuguese language (De Melo Ghisi et al.
, 2018.
De Melo Ghisi & Oh, 2.
Cross-cultural adaptations of CADE-Q II were done to Chinese and Brazilian language (Chen et al.
, 2018.
Santos et al.
, 2.
The COSMIN score for all studies were "good" because the percentage of missing items is NOT 10 BOX H Ae Criterion validity Criterion validity is Authe degree to which scores on a specific questionnaire relate to a gold standardAy (Terwee et al.
, 2.
Nine studies were performed criterion validity.
They used criteria such as duration of CR, monthly family income, and educational level of patients.
The COSMIN score was poor because the criterion used could not be respected a sufficient gold standard (Chen et al.
, 2018.
De Melo Ghisi et al.
, 2016.
De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2018.
Melo Ghisi et al.
, 2014.
De Melo Ghisi.
Grace et al.
, 2013.
De Melo Ghisi & Oh, 2021.
De Melo Ghisi.
Oh et al.
, 2013.
Santos et al.
, 2.
11 BOX I- Responsiveness Responsiveness is the ability of a questionnaire to distinguish clinically critical changes over Responsiveness of all studies was not reported.
Discussion The aim of this study was to evaluate and recognize the best questionairre according to psychometric properties.
This review covered fifteen articles that used seven different questionnaires, namely the CRNAT.
INCR.
CADE-Q.
CADE-Q SV.
CADE-Q II.
CNCR-Q, and the patient self-assessment tool for cardiac rehabilitation.
According to the COSMIN checklist, these tools did not score AuexcellentAy quality in all psychometric properties.
In other words, there was no vigorous and valid single scale for the measurement of needs in CAD patients.
The findings showed that while the first article published in 1989 (Phelan et al.
, 1.
yet the psychometric properties of these publications have not significantly increased to the year of 2021.
The reason for this problem might be related to the nature of the concept of need which is a subjective concept and each of patients defined this concept based on attitude, social and cultural Concerning the country of publication, the majority of studies were performed in Copyright A 2022.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 276 Canada (De Melo Ghisi et al.
, 2015.
De Melo Ghisi et al.
, 2016.
De Melo Ghisi.
Grace et al.
, 2013.
De Melo Ghisi & Oh, 2021.
De Melo Ghisi.
Oh et al.
, 2.
The INCR was developed to evaluate information needs in CR.
This scale assesses information need and is culturally adapted to Brazil.
This tool includes 11 dimensions.
After the validation process of Brazilian version of INCR questionnaire, one dimension of questionnaire including barriers/goal setting was deleted.
As the validation process was not performed with adequate sample, the author recommended future research was needed to assess whether the scale was sensitive to change, such as following participation in the education components of CR, or to test implementation of new education materials.
Finally, whether the INCR is a valuable and valid tool to identify information needs in individual patients should be further explored (De Melo Ghisi et al.
, 2.
The CADE-Q is another questionnaire that was developed by Ghisi et al.
, to calculate and describe coronary patientsAo awareness of CR programs.
Most of the psychometric properties of this questionnaire had been previously reported, and it had been adapted to English and Persian language (De Melo Ghisi.
Oh et al.
, 2013.
Marofi et al.
, 2.
Due to the limitations of CADE-Q including the lack of attention to all aspects of CR such as the psychosocial dimension, the author designed and validated CADE-Q II (De Melo Ghisi et al.
, 2.
This questionnaire was culturally adapted to Brazilian and Chinese patients (Chen et al.
, 2018.
Santos et al.
, 2.
Because CADE-Q II was long, there was little willingness to fill in the questionnaire so the CADEQ SV was developed (De Melo Ghisi et al.
, 2.
The CADE-Q SV was cross-culturally adapted to Brazilian-Portuguese and French-Canadian (De Melo Ghisi et al.
, 2018.
De Melo Ghisi & Oh.
When a new version of a CADE-Q questionnaire was developed, it should not only be updated, and have better theoretical basis, but it must also be shown to be at least as good as the original instrument in terms of validity and reliability.
In this context, results of the CADE-Q SV were consistent with those presented in previous versions of this instrument, particularly in relation to criterion validity .
orrelation to educational leve.
and all areas being considered internally consisted (A>0.
The overall mean, as well as the means of the areas were high, reinforcing the idea that CR patients are knowledgeable of the information that is important for It may also suggest that individuals with low socioeconomic levels or low literacy are not participating in these programs and strategies to eliminate barriers to access CR should be implemented (De Melo Ghisi et al.
, 2.
The patient self-assessment tool for cardiac rehabilitation and CRNAT are other tools for the assessment of CR needs.
None of the psychometric properties of these questionnaires had been reported except content validity (Phelan et al.
, 1989.
Smith et al.
, 2.
The newest questionnaire for need assessment is CNCR-Q that is designed by Sayadi et al.
This questionnaire is developed based on a definition of care needs in patients with CAD undergoing CR according to Islamic culture.
Sayadi et al.
added spiritual care needs for CAD patients.
This feature has not been mentioned in previous studies.
The questionnaire is a tool with 40 items.
After conducting face validity qualitatively, all tool items were considered important and were retained for the next steps.
After completing the steps for determining the content validity ratio (CVR) and content validity index (CVI) of 40 items, all items were preserved for decision making at a later The results of exploratory factor analysis revealed four factors.
Moreover, the factor analysis results in the elimination of three items and the final version of the questionnaire with 37 items remained (Sayadi et al.
, 2.
The general quality of the articles examining the measurement properties as rated by the COSMIN list was poor to excellent.
Several studies did not state adequate information in the article, thus it was difficult to evaluate their quality.
All studies which were reviewed in the study had described internal consistency as reliability, but in several studies, there was no information about other crucial properties.
Some tools had a lack of face validity and stability evaluation, so future studies should consider these properties once trying to validate tools.
Involved studies did not discuss measurement error, hypothesis testing, and responsiveness, which might be related to the nature of the concept of need, and because these criteria were more applicable for concepts which measured objective changes such as blood pressure in patients.
The highest methodological quality was the CADE-Q (De Melo Ghisi et al.
, 2.
CADE-Q II (De Melo Ghisi et al.
, 2.
and CNCR-Q (Sayadi et al.
, 2.
that in one box of COSMIN checklist scored as AuExcellent,Ay two boxes AuGood,Ay and one box Aupoor.
Ay Copyright A 2022.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 12.
, 2022, 277 Implications and limitations The strength of this review could be attributed to the fact that two investigators individually measured all records in full text, and concurrently with the third and fourth reviewer qualities whom were certified by double or triple evaluation of several studies.
The implication of this review includes, according to the aim of this study, to assist nurses in choosing valid tools in the field of CR, to assist nurses in selecting credible tools to more quickly identify the care needs of patients undergoing CR, and to reduce the readmission of heart patients by correctly identifying care needs.
It appears that the CADE-Q questionnaire can be recommended to nurses for using in need assessment.
However, this review had a limitation that required to be addressed.
Our search was limited to studies published in Persian or English.
So, studies published in other languages were not involved.
Conclusion This systematic review delivers a summary of 7 tools assessing needs in CAD patients undergoing CR.
Although, based on the COSMIN checklist, none of the studies was evaluated excellent in all boxes, the results of this study helped researchers to select the best quality questionnaire among existing questionnaires in this field.
In other words, there was no vigorous and valid single scale for the measurement of needs in CAD patients.
however, the CADE-Q questionnaire was good based on psychometric properties and a patient self-assessment tool for cardiac rehabilitation was poor based on psychometric properties.
This study proposes that future assessment studies on psychometric properties concern standards like the COSMIN checklist to increase the quality of the studies and to enhance the assessment of results.
Also, we encourage articleAos readers to explore how an instrumentAos psychometric properties might be improved and then re-tested with the result of the tool being of even greater use in clinical practice to decrease the mortality and morbidity of cardiovascular disease.
Acknowledgment As part of the fourth authorAos Ph.
thesis (Neda Sayad.
, this study was financially supported by the Nursing Care Research Centre in Chronic Diseases.
Ahvaz Jundishapur University of Medical Sciences, and Ahvaz.
Iran (Number CDCRC-9.
Author contribution NS and EM participated in the definition of intellectual content, literature search and data JA and KZ were being involved in the manuscript preparation, editing and review.
Conflict of interest The author.
declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
References