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Clinical Research on Dyspnea
Author Bios
What is Dyspnea?
What Provokes Dyspnea?
The Nature of Dyspnea
Language of Dyspnea
Clinical Application
Research Application
Variability in Sensations
Challenges in Study
Mechanical Loads and Sense of Effort
Chemoreceptors
Mechanoreceptors
Neuro-Mechanical Dissociation
Phase of Respiration and Dyspnea
Physiology of Dyspnea
Respiratory System
Cardiovascular System
Measuring Dyspnea
Scaling Issues
Qualitative Aspects
Currently selected section: Reliability and Validity Overview
Reliability and Validity
Sensitivity and Specificity
Scales
Sensation vs. Perception vs. Symptom
Treating Dyspnea
Why Measure?
Cluster Analysis
Statistical vs. Clinical Significance
Standard Error of Measurement
Measuring Fatigue
Measuring Depression
Measuring Anxiety and Hyperventilation
Measuring Quality of Life
Conclusion

 

Chapter 23: Dyspnea: Reliability and Validity Overview
        

The research terms "reliability" and "validity" have connotations that depend on the context of the discussion. Both terms are used to judge the quality of multiple elements of a research project. For example, we can attempt to assess either the reliability or validity of a specific dependent variable. Sometimes investigators refer to the results of an entire investigation as "reliable;" in this context the implication is that the results were "statistically significant." We can also attempt to assess either the internal or external validity of a randomized clinical trial.

Most references to reliability turn on the need to demonstrate the "repeatability" or "consistency" of a particular measure, especially one designed to capture variations in subjective state such as health status or quality of life. Conceptually, reliability increases as measurement error decreases. Various ways to quantitatively document the repeatability of a measure include inter-rater agreement, test-retest reliability, and internal consistency. Discussions of these procedures are commonplace (e.g. http://trochim.cornell.edu/KB/reltypes.htm). Investigators should appreciate not only these procedures but also the routine and appropriate use of statistical tools used to estimate the degree to which measurement error is minimized, such as the correlation coefficient, coefficient alpha, or Kappa (e.g. http://www.geolog.com/msmnt/mrelobj-old.htm).

A measure can be reliable but not valid; but to be valid, a measure must be reliable. The validity of a measure refers to the degree to which it measures what it purports to measure. Unlike the relative ease with which reliability can be established, documenting validity is more difficult, both practically and theoretically. The validity of a measure is established through various levels of both conceptual and computational analyses. At the most immediate level, "face" validity is demonstrated if the questions or scale items seem to relate directly to the purpose of the measure: assessment of eye color is not likely to contribute to the valid assessment of dyspnea.

"Content" validity refers to how representative or adequate the items on the measure or instrument are as they relate to the entire domain or possible universe of the phenomena being measured. Content validity is established through the individual analysis and rating of item appropriateness by a panel of at least three to five experts. Criterion validity refers to the degree to which scores on a measure can predict current (concurrent validity) or future (predictive validity) performance or outcomes. For example, one validates a written test of driving by showing that it accurately predicts how well someone actually operates an automobile. Scores obtained on the Scholastic Aptitude Test are valid by showing that they predict some 'criterion' such as success in college. Construct validity is the most theoretical and difficult level of analysis, and refers to the degree to which the construct as described is a valid conceptualization of the phenomena. The determination of construct validity usually requires a number of studies conducted over a period of time.

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