German version of the whiplash disability questionnaire: reproducibility and responsiveness

Abstract

BackgroundThe Whiplash Disability Questionnaire (WDQ) poses a validated tool for the assessment of patients who experience whiplash-associated disorders. A German translation and cross-cultural adaptation was recently produced and presented high validity and internal consistency. As a follow-up, the presented study tests the translated Whiplash Disability Questionnaire’s (WDQ-G) retest reliability and responsiveness to change.MethodsThe WDQ-G was assessed on three different measurement events: first upon entry (ME1), second four days after entry (ME2), and third at discharge (ME3). Test-retest reliability data from ME1 and ME2 was analysed in a group of stable patients to obtain the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). To test the instrument’s responsiveness, WDQ-G change data were compared to concurrent instruments. The probability of each instrument, to correctly distinguish patients of the stable phase (ME1 to ME2) from patients who deemed to have improved between from ME1 to ME3, was analysed.ResultsIn total, 53 patients (35 females, age = 45 ± 12.2) were recruited. WDQ-G scores changed from ME1 to ME2 by 5.41 ± 11.6 points in a stable group. This corresponds to a test-retest reliability of ICC = 0.91 (95% CI = 0.80–0.95) with a SEM of 6.14 points. Minimal Detectable Change, at 95% confidence, was calculated to be 17 points change in scores. Area under Receiver Operator Characteristics of the WDQ-G’s responsiveness revealed a probability of 84.6% (95% CI = 76.2%–93%) to correctly distinguish between improved and stable patients. Optimal sensitivity (73.2%) and specificity (76.2%) was established at 11-point change.ConclusionsHigh retest reliability and good responsiveness of the WDQ-G support clinical implementation of the translated version. The data suggest, that change in total score greater than eleven points can be interpreted as clinical relevant from a patient’s perspective. Minimal Important Change is suggested at 15 points where there is still high specificity and a 90% confidence MDC.

Clinimetric Properties of Self-reported Disability Scales for Whiplash

“…SEM values were low, at 2.2/50 in the NDI 58 and 6.1 to 7.7/130 in the German and English versions of the WDQ, respectively. 48,56 Internal consistency was high (α > 0.8) in the NDI, though some estimates were suggestive of item redundancy (α = 0.96). 58 Estimates were similarly high for the WDQ (α > 0.89).…”

“…Test-retest reliability of the WDQ was assessed in 4 studies, 38,48,56,63 while measurement error was assessed in 2. 48,56 Test-retest intervals ranged from 2 to 5 days in 2 studies assessing the German 48 and English 56 versions, and 2 weeks in a third study assessing the German version.…”

“…Test-retest reliability of the WDQ was assessed in 4 studies, 38,48,56,63 while measurement error was assessed in 2. 48,56 Test-retest intervals ranged from 2 to 5 days in 2 studies assessing the German 48 and English 56 versions, and 2 weeks in a third study assessing the German version. 38 A fourth study compared "short-term and long-term reproducibility" of the English version, with test intervals of 24 hours and 1 month, respectively.…”

“…38 A fourth study compared "short-term and long-term reproducibility" of the English version, with test intervals of 24 hours and 1 month, respectively. 63 Two studies 48,56 reported ICCs with 95% CIs ranging from 0.89 (0.85-0.92) to 0.92 (0.82-0.96). The remaining 2 studies 38,63 did not specify the confidence interval for ICC estimates, which ranged from 0.90 to 0.97.…”

“…This was based on the hypotheses outlined in Appendix G (Supplemental Digital Content 7, http://links.lww.com/CJP/A809). One study 63 provided minimal information relating to the intervention provided, describing "physiotherapy treatment for whiplash-associated disorders," whilst the other 48 described a "multidisciplinary rehabilitation program," consisting of "active and passive physiotherapy and psychological treatment. "…”