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    General Health Questionnaire-28 GHQ-28

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    General Health Questionnaire-28 GHQ-28

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    General Health Questionnaire-28 GHQ-28 (1)

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    General Health Questionnaire-28 (GHQ-28)

    Article in Journal of Physiotherapy · December 2011


    DOI: 10.1016/S1836-9553(11)70060-1 · Source: PubMed

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    202 93,522

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    Michele Sterling
    The University of Queensland
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    AppraisalClinimetrics

    General Health Questionnaire – 28 (GHQ-28)


    Description
    The GHQ-28 was developed by Goldberg in 1978 (Goldberg from 0 to 84. Using this method, a total score of 23/24 is
    1978) and has since been translated into 38 languages. the threshold for the presence of distress. Alternatively the
    Developed as a screening tool to detect those likely to GHQ-28 can be scored with a binary method where Not
    have or to be at risk of developing psychiatric disorders, at all, and No more than usual score 0, and Rather more
    the GHQ-28 is a 28-item measure of emotional distress than usual and Much more than usual score 1. Using this
    in medical settings. Through factor analysis, the GHQ-28 method any score above 4 indicates the presence of distress
    has been divided into four subscales. These are: somatic or ‘caseness’.
    symptoms (items 1–7); anxiety/insomnia (items 8–14);
    social dysfunction (items 15–21), and severe depression Reliability and validity: Numerous studies have investigated
    (items 22–28) (Goldberg 1978). It takes less than 5 minutes reliability and validity of the GHQ-28 in various clinical
    to complete. The GHQ-28 must be purchased and is populations. Test-retest reliability has been reported to
    available at the following website: https://shop.psych.acer. be high (0.78 to 0 0.9) (Robinson and Price 1982) and
    edu.au/acer-shop/product/ interrater and intrarater reliability have both been shown
    to be excellent (Cronbach’s α 0.9–0.95) (Failde and Ramos
    Instructions to client and scoring: Examples of some of 2000). High internal consistency has also been reported
    the items in use include ‘Have you found everything getting (Failde and Ramos 2000). The GHQ-28 correlates well
    on top of you?’, ‘Have you been getting scared or panicy with the Hospital Depression and Anxiety Scale (HADS)
    for no good reason?’, and ‘Have you been getting edgy and (Sakakibara et al. 2009) and other measures of depression
    bad tempered?’ Each item is accompanied by four possible (Robinson and Price 1982).
    responses: Not at all, No more than usual, Rather more
    than usual, and Much more than usual. There are different The GHQ-28 was developed to be a screening tool and for
    methods to score the GHQ-28. It can be scored from 0 to 3 this reason responsiveness in terms of Minimal Detectable
    for each response with a total possible score on the ranging Change (MDC) and Minimally Clinically Important
    Difference (MCID) have not been established.

    Commentary
    Physiotherapists are becoming more aware of the need to potential for confusion over the different scoring methods,
    screen for psychological and psychiatric co-morbidity in and this has implications for interpretation of scores
    patients under their care. This may be to adapt or modify derived from the questionnaire. There may also be some
    the physiotherapy approach to management or to institute concern over the severe depression subscale which includes
    referral to appropriate mental health care providers. some confronting questions for the patient to answer.
    Other tools such as the HADS may be less confronting for
    The GHQ-28 is one of the most widely used and validated physiotherapy use.
    questionnaires to screen for emotional distress and possible
    psychiatric morbidity. It has been tested in numerous Despite these limitations, the GHQ-28 remains one of the
    populations including people with stroke (Robinson and most robust screening tools available to assess psychological
    Price 1982), spinal cord injury (Sakakibara et al 2009), well-being and detect possible psychiatric morbidity.
    heart disease (Failde and Ramos 2000), and various Michele Sterling
    musculoskeletal conditions including whiplash associated The University of Queensland, Australia
    disorders (Sterling et al 2003) and occupational low back
    pain (Feyer et al 2000) amongst others. Thus for clinicians References
    there is a wealth of data with which to relate patient
    Failde I, Ramos R (2000) Europ J Epidem 16: 311.
    outcomes.
    Feyer A et al (2000) Occup Environ Med 57: 116.
    It assesses the client’s current state and asks if that differs Goldberg D (1978) Manual of the General Health Questionnaire.
    from his or her usual state. It is therefore sensitive to Windsor: NFER-Nelson.
    short-term distress or psychiatric disorders but not to long- Robinson R, Price T (1982) Stroke 13: 635.
    standing attributes of the client.
    Sakakibara B et al (2009) Spinal Cord 47: 841.
    There are some disadvantages to use of the GHQ-28 in Sterling M et al (2003) Pain 106: 481.
    physiotherapy practice. First, the questionnaire is not freely
    available and must be purchased. Second, there is the

    Journal of Physiotherapy 2011 Vol. 57 – © Australian Physiotherapy Association 2011 259


    AppraisalClinimetrics

    The Neer sign and Hawkins-Kennedy test for shoulder


    impingement
    Description
    Two clinical diagnostic tests that take little time to undertake pathoanatomy of this clinical test involved driving the
    and are commonly performed by primary practitioners greater tuberosity under the coracoacromial ligament
    dealing with shoulder subacromial impingement are the (Hawkins and Kennedy 1980). Hawkins and Kennedy
    Neer sign (Neer 1983) and Hawkins-Kennedy test (Hawkins (1980) noted that their impingement test was less reliable
    and Kennedy 1980). than the Neer impingement sign.
    Requirements for testing: The Neer sign constitutes the first Diagnostic accuracy: The Hawkins-Kennedy test has
    part of the Neer injection impingement test where one hand derived negative likelihood ratios between 0.00 and 0.88
    stabilises the patient’s scapula while the other hand raises and positive likelihood ratios between 1.14 and 2.12 in seven
    the arm into full flexion (Neer 1983). This was thought to evaluations across three studies (Hughes et al 2008). The
    cause the greater tuberosity to impinge against the anterior Neer sign has derived negative likelihood ratios between
    acromion, damaging the rotator cuff tendons, long head 0.31 and 0.93 and positive likelihood ratios between 1.03
    of biceps, and the subacromial bursa, with a positive test and 2.31 in seven evaluations across three studies (Hughes
    indicated by pain (Neer 1983). The second part of the test et al 2008).
    involved a subsequent xylocaine injection to reduce the pain
    and thereby differentiate impingement lesions from other Two studies investigated the combination of the Hawkins-
    causes of shoulder pain (Neer 1983). Kennedy test or the Neer sign for subacromial impingement
    (Hughes et al 2008). These studies derived negative
    The Hawkins-Kennedy test involves flexing the shoulder likelihood ratios to this combination of clinical tests between
    to 90° then forcibly internally rotating it (Hawkins and 0.16 to 0.95 and positive likelihood ratios between 1.04 and
    Kennedy 1980), although gentle internal rotation has 2.81. One study investigated the Hawkins-Kennedy test and
    also been suggested (Park et al 2005). A positive sign the Neer sign in combination to derive negative likelihood
    involves reproducing the pain of impingement (Hawkins ratios between 0.12 and 0.75 and positive likelihood ratios
    and Kennedy 1980). It was originally suggested that the between 1.35 and 2.63 (Ardic et al 2006).

    Commentary
    Recent evidence suggests the pathaetiology of shoulder A recent cadaver study has highlighted that the Hawkins-
    impingement involves a pre-existing dysfunctional rotator Kennedy test is less likely to involve the greater tuberosity
    cuff causing superior humeral head migration in shoulder and causes most compression anterior to the supraspinatus
    elevation that causes damage to the subacromial structures tendon at the rotator interval, while the Neer sign might
    (Lewis 2010). involve supraspinatus with internal rotation but might
    involve subscapularis with external rotation (Hughes et
    The higher the positive likelihood ratio the more probable al 2011). This study suggested that the position that most
    it is that a positive test will indicate the presence of the compressed the supraspinatus tendon was internal rotation
    condition. Positive likelihood ratios of 2–5 yield small in abduction.
    increases in the post-test probability of condition, 5–10
    moderate increases, and above 10 large increases (Grimes These shoulder impingement tests take little time and are
    and Shulz 2005). The smaller positive likelihood values easy to perform; however, if they do not inform clinical
    indicate that positive tests results are less likely to indicate reasoning, that is they are not useful in diagnosing
    impingement. For negative likelihood values, a lower impingement, then their continued use must be questioned.
    likelihood ratio indicates greater probability of a negative Future research needs to seek a valid anatomical basis for
    test excluding the condition and 0.2–0.5 is considered a impingement testing.
    small increase in the post-test probability of the condition, Phillip Hughes
    0.1–0.2 moderate, and below 0.1 a large increase (Grimes La Trobe University, Australia
    and Shulz 2005). The larger negative likelihood ratios
    indicated poor diagnostic accuracy. References
    Poor reliability may be a factor for lack of diagnostic Ardic F et al (2006) Am J Phys Med and Rehab 85: 53.
    accuracy of clinical tests. Reliability studies for these tests Calis M et al (2000) Ann Rheum Dis 59: 44.
    have demonstrated around 70% agreement between testers
    Green R et al (2008) Phys Ther Rev 13: 17.
    (Michener et al 2009) and above 98% in another study
    (Calis et al 2000). This disparity is surprising given the test Grimes D, Shulz K (2005) Lancet 365: 1500.
    outcome is determined by the presence or absence of pain. Hawkins R, Kennedy J (1980) Am J Sports Med 8: 151.
    Hughes P et al (2008) Aust J Physiother 54: 159.
    Studies investigating the diagnostic accuracy of
    impingement tests may have returned poor results because Hughes P et al (2011) J Sci Med Sport doi:10.1016/j.
    jsams.2011.07.001
    of a lack of anatomical validity of the tests. A systematic
    review of the anatomical basis of clinical tests for the Lewis J (2010) Br J Sports Med 44: 918.
    shoulder found that there was a lack of evidence supporting Michener L (2009) Arch Phys Med Rehab 90: 1898.
    the anatomical validity of impingement testing (Green et Neer C 1983 Clin Orthop Rel Res 173: 70.
    al 2008).
    Park H et al (2005) J Bone Joint Surg (Am) 87: 1446.

    260 Journal of Physiotherapy 2011 Vol. 57 – © Australian Physiotherapy Association 2011


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