Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

Abstract

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

Practical guidance on use of TEARS-Q to diagnose post-stroke emotionalism

“…This report involves an analysis of the data used in the original study, 1 and only brief background details will be given here. Participants were male or non-pregnant female, ⩾18 years of age, recruited up to two weeks after a clinical diagnosis of ischaemic or haemorrhagic stroke from acute stroke units of nine Scottish hospitals 2015–2018.…”

“…TEARS-Q has good internal consistency (Cronbach's alpha 0.87); acceptable discriminant validity (mean score difference of −7.18 between those diagnosed with post-stroke emotionalism from those without); coherent scale dimensionality (one factor accounts for 57% of item response variance), and diagnostic accuracy using a cut-point of 1.5. 1 Having established psychometric performance based on a single cut point, we sought more detailed evidence to inform the use of TEARS-Q in clinical practice. This was determined by means of a simple classification tree.…”

“…We developed and evaluated a self-reported questionnaire TEARS-Q (Testing Emotionalism After Recent Stroke-Questionnaire). 1 Post-stroke emotionalism is characterised by lessening of control of emotional expression, in particular unheralded crying episodes. 2 We constructed TEARS-Q based on post-stroke emotionalism crying diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning, (iii) crying not under usual social control, (iv) crying episodes occur at least once weekly.…”

“…We developed and evaluated a self-reported questionnaire TEARS-Q (Testing Emotionalism After Recent Stroke-Questionnaire). 1 Post-stroke emotionalism is characterised by lessening of control of emotional expression, in particular unheralded crying episodes. 2 …”

“…TEARS-Q has good internal consistency (Cronbach’s alpha 0.87); acceptable discriminant validity (mean score difference of −7.18 between those diagnosed with post-stroke emotionalism from those without); coherent scale dimensionality (one factor accounts for 57% of item response variance), and diagnostic accuracy using a cut-point of 1.5. 1 …”