Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2008 | Month : August | Volume : 2 | Issue : 4 | Page : 919 - 924

Reliability Of The Persian Version Of Coronary Revascularization Outcome Questionnaire (CROQ) In Cardiac Patients Undergoing CABG And PTCA Procedures

SHAHALI SH *, SHATERZADEH YAZDI MJ **,GOHARPEY SH***,RAHIM F ****

**Ph.D Pt, Department of Biomechanics, School of rehabilitation Ahwaz University of Medical Science E-mail: mj_shaterzadeh@yahoo.com *** Ph.D Pt, Department of Biomechanics,School of rehabilitation, Ahwaz University of Medical Science.E-mail: shgoharpey@yahoo.com ****M.sc of Bioinformatics,Research Center of Physiology, Ahwaz Joundishapour University of Medical Sciences, Ahwaz, Iran .E-mail: fakherraheem@yahoo.com

Correspondence Address :
*Shahali Sh,Department Of Biomechanics,
School of rehabilitation, Ahwaz Joundishapour University of Medical Sciences.P.O. Box: 61358-13453, Iran.
Tel:+98-611-3353605,Fax: +98-611-3353601.E-mail:shabnamshahali@yahoo.com

Abstract

Background and Aim: The quality of life is a major goal in the context of preventive and therapeutic cardiology. Up to now, there wasn’t any validated instrument for patient based outcome measurement, before and after CABG and PTCA procedures, in Iran. In this study, we have translated and evaluated the reliability of the Persian version of coronary revascularization outcome questionnaire (CROQ). The reliability of the Persian version of coronary revascularization outcome questionnaire was not known. We therefore aimed to assess the test-retest reliability and scale internal consistency of the instrument in two groups of patients undergoing CABG and PTCA procedures.
Method: This is a methodological study, and was conducted for the aim of: the Psychometric study of the Persian version of coronary revascularization outcome questionnaire (CROQ). The study's population was 60 patients (30 CABG and 30 PTCA). This instrument has 4 versions (2 versions for CABG and 2 versions for PTCA). It has pre and post operation versions for each group of patients. The patients were assessed 3 months after operation, by the post operation version. For testing the instrument's reliability, the assessment was repeated 1-2 weeks later.
Results: Psychometric tests confirmed the reliability, internal consistency, construct validity and responsiveness of the Persian version of CROQ.
Conclusion: For clinical trials evaluation, we need to compare quality of life before and after interventions, by an instrument. Disease specific measures are more responsive in detecting treatment effects than general measurements, so for this group of patients, disease specific measurement is necessary. With concern for the Psychometric test results, we encourage the use of CROQ in patients undergoing CABG and PTCA procedures.

Keywords

Quality of life, Angioplasty, Coronary artery bypass grafting, Reliability, questionnaire.

How to cite this article :

SHAHALI SH, SHATERZADEH YAZDI MJ,GOHARPEY SH,RAHIM F . RELIABILITY OF THE PERSIAN VERSION OF CORONARY REVASCULARIZATION OUTCOME QUESTIONNAIRE (CROQ) IN CARDIAC PATIENTS UNDERGOING CABG AND PTCA PROCEDURES. Journal of Clinical and Diagnostic Research [serial online] 2008 August [cited: 2019 Sep 15 ]; 2:919-924. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=919-924&id=302

Introduction
In the field of cardiology, there has been a long time tradition of assessing the effectiveness of new and emerging health technologies. These evaluations have invariably focused on measures of outcome such as mortality, morbidity and clinical function [18,1]. However, in recent years, there has been an increasing use of more patient focused outcome, in particular, quality of life (6). Health related quality of life (HRQOL) questionnaires are increasingly being used as primary outcome measures to assess treatment effectiveness in ischaemic heart disease. They have been used to evaluate the effectiveness of rehabilitation after acute myocardial infarction, to compare the results of percutaneous transluminal coronary angioplasty (PTCA) with and without stents, and PTCA with stents versus coronary bypass graft surgery (CABG) in multivessel disease (11),(7) . Quality of life measures may be disease specific or generic; the former focuses on the complaints that are attributable to a specific diagnosis or patient population. In contrast, the later is intended to be broadly applicable across different interventions, and across patients with different characteristics (17) Disease specific instruments tend to be more sensitive to detecting change in the health status than generic instruments (3),(20),(8) . Until recently, there have been no validated instruments to measure patient-based outcome before and after CABG and PTCA (12) Schroter and Lamping have developed a new patient-based instrument, the coronary revascularization outcome questionnaire, to measure health outcome and HRQOL before and after CABG and PTCA (14).

The CROQ includes items in the following domains: symptoms, physical functioning, psychosocial functioning, cognitive functioning, satisfaction and adverse effects. There are several validated and widely used disease specific questionnaires in various linguistic versions (English and Italian) for patients with heart diseases (12),(14) . There wasn't any instrument for assessment of quality of life in cardiac patients undergoing CABG and PTCA procedures, in Iran. In this sequence, we have begun to translate and test the reliability of CROQ in Persian.

Material and Methods

Questionnaire development
The translation procedure adopted by the International Quality Of Life Assessment (IQOLA) project, called for a series forward (into the target language) and backward (into English) translations of the questionnaire (2),(4),(5) . At the first step, CROQ was translated into Persian by two translators. Translators were required to place emphasis on the conceptual rather than the literal equivalence (forward translation). The common forward translation was given to another translator who translated the questionnaire back into English. The backward and forward translations were reviewed by researchers, and the Persian translation was revised in a few items. The Persian version of CROQ which we have developed has four different types: CROQ- CABG-pre and CROQ- PTCA-pre; to be administered before the patient undergoes coronary revascularization, and the CROQ- CABG-post and CROQ- PTCA-post; to be administered three months after CABG and PTCA, respectively. The former two questionnaires are identical in item content and differ only by name, but the later two differ from each other only in the content of adverse effects scale, as these problems differ for the two procedures. [Table /Fig 1]

Patients
A total of 60 patients (30 CABG and 30 PTCA) drawn from a convenience random sample, were used in this study. The sample involves those patients who were scheduled for elective surgery. Patients were supposed to complete the questionnaire by themselves. The exclusion criteria were; patients who couldn't read, understand or reply, patients who didn't graduate from guidance school, patients who didn't answer the questions completely (before or after surgery), and those who undergoing CABG and PTCA more than one time or undergoing this procedures collectively. All patients completed the consent form. After 3 months, all patients were invited to one cardiac center, where they completed post versions of questionnaires. One to two weeks later, they returned to the center and completed the post versions again, for re-test.

Statistical Analysis
SPSS version 15.0 was used for statistical analysis.Psychometric methods (19),(21)[,9] were used to produce item reduced versions of the questionnaires in this study: item-total correlation (item internal consistency), reliability (test-retest and scale internal consistency) and responsiveness of CROQ. Pearson correlation test was used for evaluating item-total correlation. The standard for item-total correlations in this questionnaire is more than 0.20 (14). For testing the reliability of the Persian version of the CROQ questionnaire, all patients were required to complete the post versions after 1 or 2 weeks again. Reliability of the Persian version of CROQ was studied by two ways: test-retest reliability (16) and scale internal consistency. Inter Class Coefficient (ICC), was used for test-retest reliability, and Cronbach's alpha for scale internal consistency. Standard for ICC and Cronbach's alpha is more than 0.70 in this questionnaire (14). Responsiveness is the ability of the scales to detect clinically important changes over time (4). Kolmogorov-Smirnov's test showed that the scale's data were not normally distributed, so Wilcoxon-Rank's non parametric test was used for the comparison between the results before and after three months after revascularization.

Results

Out of 30 CABG patients, 10 females (33.30%) and 20 males (66.70%) with 57(±9.61) years as mean age and 75.70(±9.23) kg weight, completed the questionnaire, respectively. Out of 30 PTCA patients, 11 females (36.70%) and 19 males (63.30%) with 52.30(±6.07) years as mean age and 73.86(±11.34) kg weight, completed the questionnaire, respectively (Table/Fig 2).

Item total correlations within scales were similar, and exceeded the criterion of 0.20 for two groups of patients. Correlations between items and their hypothesized scale were more than correlations between items and other scales (Table/Fig 3), (Table/Fig 4). Interclass correlation coefficients and Cronbach's alpha exceeded the criterion of 0.70 for all scales (Table/Fig 5),(Table/Fig 6) showed the results of Wilcoxon-rank non parametric test. Except of cognitive functioning in the CABG sample, there were significant changes in all scales in CABG and PTCA samples that were assessed before and after revascularization (p < 0.05).

Discussion

The CROQ is a practical and scientifically validated patient based measure of outcome for coronary revascularization that is acceptable to patients, and satisfies rigorous psychometric criteria for reliability, validity, and responsiveness. As the only validated instrument developed specifically for use before and after CABG and PTCA, and which is quick and easy to administer, the CROQ provides a rigorous method for improving the evaluation of outcomes in clinical trials and clinical audit. Our data show that each item of CROQ questionnaire contributed equally to the scale, because all item-total correlations exceeded the criterion of 0.20 (Table/Fig 3) and (Table/Fig 4). The scores for each question are significantly more closely correlated with their scales than with others. These results indicate that the questions in the CROQ possess good discrimination validity. The correlation range for each scale in the CABG group varies from 0.21 for adverse effects to 0.86 for cognitive functioning, and that in the PTCA group varies from 0.27 for the psychosocial satisfaction scale to 0.96 for the not classified group. These results consist of the number of questions per scale and their heterogeneity (10). For instance, the scales for adverse effects, psychosocial and satisfaction include 11, 14 and 6 items, which span a wide spectrum of adverse effects, psychosocial and satisfaction, whereas cognitive functioning and the not classified group (both include 3 items) which are shorter and, have more homogenous scales.
Inter Class Correlation Coefficient (ICC) exceeded the criterion of 0.70 for all scales indicating good test-retest reliability. This finding is like the finding that the developers of CROQ reported (14). Their reported Inter Class Coefficient (ICC) range is similar to that found in this study. The Cronbach's Alpha Coefficient always exceeded the criterion of 0.70 for all scales. This indicates good reliability. The most common method for demonstrating responsiveness is through a comparison of scores before and after treatment (15),(13). All scales in CABG samples have shown significant change before and after operation (p< 0.05), except to that of cognitive functioning. Pintor and colleagues (2002), after assessing the reliability of the Italian version of CROQ, reported similar findings for cognitive functioning (12). CROQ developers reported moderate responsiveness for the cognitive functioning scale in the CABG sample. These findings are more or less similar to this study's findings (14). There were significant changes in all scales in the PTCA sample and total scores, before and after revascularization. This means that the Persian version of CROQ has good responsiveness. This finding is similar to findings reported by the CROQ developers and the Italian version of this questionnaire (12),(14). Given its demonstrated high responsiveness, the CROQ is a promising new tool for use in clinical trials. It may detect important differences between procedures that have previously not been detected by less sensitive generic measures (14). The CROQ provides appropriate content, as it contains items directly addressing the impact of these procedures based on problems that patients reported to be important. As the CROQ is the only evaluated patient-based questionnaire that includes items specific to CABG and PTCA such as adverse effects and satisfaction, use of it in patients undergoing CABG and PTCA is encouraged.

Acknowledgement

We thank the patients who took part in this study.

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