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    Manual Therapy: Letter To The Editor

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    Clinimetric analysis of a German version of the Neck Disability Index (NDI-G) was not emphasized in the abstract or conclusion. Determination of stable point estimates with the study's small sample are exceedingly difficult. Factor structure guarantees validity in the presence of high item diversity. Factor analysis is initially exploratory and ideally uses orthogonal rotation, a minimumsubject:item ratio of 20:1 to ensure strong factor structures are replicated reliably

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    Manual Therapy: Letter To The Editor

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    Clinimetric analysis of a German version of the Neck Disability Index (NDI-G) was not emphasized in the abstract or conclusion. Determination of stable point estimates with the study's small sample are exceedingly difficult. Factor structure guarantees validity in the presence of high item diversity. Factor analysis is initially exploratory and ideally uses orthogonal rotation, a minimumsubject:item ratio of 20:1 to ensure strong factor structures are replicated reliably

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    Clinimetric analysis of a German version of the Neck Disability Index (NDI-G) was not emphasized in the abstract or conclusion. Determination of stable point estimates with the study's small sample are exceedingly difficult. Factor structure guarantees validity in the presence of high item diversity. Factor analysis is initially exploratory and ideally uses orthogonal rotation, a minimumsubject:item ratio of 20:1 to ensure strong factor structures are replicated reliably

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    © All Rights Reserved
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    94 views2 pages

    Manual Therapy: Letter To The Editor

    Uploaded by

    ubiktrash1492
    Clinimetric analysis of a German version of the Neck Disability Index (NDI-G) was not emphasized in the abstract or conclusion. Determination of stable point estimates with the study's small sample are exceedingly difficult. Factor structure guarantees validity in the presence of high item diversity. Factor analysis is initially exploratory and ideally uses orthogonal rotation, a minimumsubject:item ratio of 20:1 to ensure strong factor structures are replicated reliably

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    Letter to the Editor

    Commentary on the article by Swanenburg et al. Validity and reliability


    of a German version of the Neck Disability Index (NDI-G) [Man Ther
    Articles in Press http://dx.doi.org/10.1016/j.math.2013.07.004]
    Keywords:
    Outcome measure
    Clinimetrics
    Cervical spine
    Neck Disability Index
    Dear Editor
    We commend Swanenburg et al. (2013) on translation, develop-
    ment, and clinimetric analysis of the NDI-G. However, the dual-
    factor structure with factor analysis and the high level of internal
    consistency (IC) highlighted in their discussion were not empha-
    sized in the abstract or conclusion. These points may imply some
    inconsistencies with the nal conclusions since determination of
    stable point estimates with the studys small sample are exceed-
    ingly difcult.
    Patient-reported outcome (PRO) tools provide the research evi-
    dence of an interventions effectiveness which can, subsequently,
    inuence health management and decision makers on treatment,
    policy, and recommendations for funding and service provisions
    (Lamb et al., 2013). Consequently, it is critical to analyze the clini-
    metric properties, to determine that they are within the accepted
    boundaries, then reect on the implications of these ndings,
    particularly when a cultural and linguistic adaptation has taken
    place (Cuesta-Vargas and Gabel, 2013).
    Factor structure guarantees validity in the presence of high item
    diversity (Cattell, 1982). Dual-factors should be reported indepen-
    dently (Doward and McKenna, 2004) as in recent papers support-
    ing modications to the NDI (van der Velde et al., 2009; Johansen
    et al., 2013; Walton and MacDermid, 2013) or alternatives (Gabel
    et al., submitted for publication). A single factor is essential if a sin-
    gle summated-score is used and ensures all items reect the same
    domain (Luce and Tukey, 1964). Factor analysis is initially explor-
    atory and ideally uses orthogonal rotation, a minimumsubject:item
    ratio of 20:1 to ensure strong factor structures are replicated reli-
    ably, and either maximum likelihood extraction or principal axis
    factoring. These methods produce generalizable and reproducible
    results without inating the variance estimates (Costello and
    Osborne, 2005). The NDI-G study used principal component anal-
    ysis, a common error by many researchers as principal component
    analysis is less desirable and normally only used when assumptions
    of multivariate normality are severely violated (Fabrigar et al.,
    1999) as there are no inherent advantages over maximum likeli-
    hood extraction or principal axis factoring. Subsequent, conrma-
    tory factor analysis minimizes noise often present among PRO-
    items in tools where IC is maximized (Boyle, 1991).
    The authors found the IC coefcient-alpha (a) of 0.96 might be
    a slight limitation as it exceeded the acceptable range . 0.75e
    0.95 (Terwee et al., 2007) and scored above results from other
    studies (Vernon, 2008). This consideration is important as IC
    values outside this window question the measures validity.
    Low IC indicates a lack of item-correlation, meaning analysis is
    not justied, whereas high IC indicates item-redundancy, where
    too many items are too similar (Boyle, 1991). The accepted IC win-
    dow ensures the essential construct is represented and the com-
    plex balance retained between the items and the laws of
    psychometric analysis (Cattell, 1982). It is well-recognized that
    misestimated alpha values are commonly due to small samples
    and multi-factor measures assessed as a single factor, both present
    in this study.
    Clinimetrics are the foundation that underlies PRO-validity. This
    study performed an analysis where the number of parameters esti-
    mated is not much smaller than the sample size itself. Conse-
    quently, there is limited expectation that an analysis such as this
    would replicate. For both the conclusion and abstract, it may be
    more appropriate to state that in addition to the recommendations
    proposed, use of the NDI-G in German-speaking countries should
    be guarded until further studies are completed that reassess and
    clarify the clinimetric properties, particularly the factor structure,
    in a larger population. This additional recommendation would be
    more consistent with the study ndings and recent research on
    the original NDI and proposed modied-NDI versions.
    Yours sincerely
    The authors state there is no conict of interest, including nan-
    cial support related to the issue addressed.
    References
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    in psychometric scales? Personal Indiv Differ 1991;12(3):291e4.
    Cattell RB. The psychometry of objective motivation measurement: a response to
    the critique of Cooper and Kline. Br J Ed Psych 1982;52:234e41.
    Costello AB, Osborne J. Best practices in exploratory factor analysis: four recom-
    mendations for getting the most from your analysis. Pract Assess Res Eval
    2005;10(7):1e9.
    Cuesta-Vargas AI, Gabel CP. Cross-cultural adaptation, reliability and validity of the
    Spanish version of the upper limb functional index. Health Qual Life Outcomes
    2013;11(126).
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    2004;7(S1):S4e8. DOI of original article: http://dx.doi.org/10.1016/j.math.2013.07.004.
    Contents lists available at ScienceDirect
    Manual Therapy
    j ournal homepage: www. el sevi er. com/ mat h
    Manual Therapy 19 (2014) e1ee2
    1356-689X/$ e see front matter 2013 Elsevier Ltd. All rights reserved.
    http://dx.doi.org/10.1016/j.math.2013.10.007
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    272e99.
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    (pii: S1529-9430(13)01473-3) in press.
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    Collaborators (91). Emergency department treatments and physiotherapy for
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    mental measurement. J Math Psychol 1964;1(1):1e27.
    Swanenburg J, Humphreys K, Langenfeld A, Brunner F, Wirth B. Validity and reli-
    ability of a German version of the Neck Disability Index (NDI-G). Man Ther
    2013. Aug 3, pii: S1356-689X(13)00122-7, http://dx.doi.org/10.1016/j.math.
    2013.07.004.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality
    criteria were proposed for measurement properties of health status question-
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    van der Velde G, Beaton D, Hogg-Johnston S, Hurwitz E, Tennant A. Rasch analysis
    provides new insights into the measurement properties of the Neck Disability
    Index. Arthritis Rheum 2009;61(4):544e51.
    Vernon H. The Neck Disability Index: state-of-the-art, 1991e2008. J Manipulative
    Physiol Ther 2008;31(7):491e502.
    Walton DM, MacDermid JC. A brief 5-item version of the Neck Disability Index
    shows good psychometric properties. Health Qual Life Outcomes
    2013;11(108).
    Charles Philip Gabel
    *
    Faculty of Science, Health and Education, Centre for Healthy Activities,
    Sport and Exercise, University of the Sunshine Coast,
    Queensland, Australia
    Antonio Cuesta-Vargas
    Department of Psychiatry and Physiotherapy,
    Faculty of Medicine, Malaga University, Spain
    E-mail address: acuesta@uma.es.
    Jason W. Osborne
    Educational and Counselling Psychology,
    University of Louisville, Louisville, KY, USA
    E-mail address: jason.osborne@louisville.edu.
    Markus Melloh
    Western Australian Institute for Medical Research (WAIMR),
    University of Western Australia, Nedlands,
    Western Australia, Australia
    E-mail address: markus.melloh@uwa.edu.au.
    *
    Corresponding author. PO Box 760, Coolum Beach, Queensland
    4573, Australia. Tel.: 61 7 5446 1022; fax: 61 7 5471 7022.
    E-mail address: cp.gabel@bigpond.com (C.P. Gabel).
    4 September 2013
    Letter to the Editor / Manual Therapy 19 (2014) e1ee2 e2

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