Assessment in patients with NMD consists principally of measures of motor impairment since they are well known by clinicians and their measures do not require much equipment. The conventional treatments in patients with NMD are above-all focused on the diminution of motor impairments by maintaining or improving joint mobility, muscle strength and endurance. Nevertheless, a reduction of motor impairments does not directly lead to a higher ability in performing daily activities. Therefore, activity limitations should be measured specifically. A new scale of activity limitations was first developed in children and adults with NMD. The use of the Rasch model provided a scale to assess the fundamental psychometric qualities. Secondly, relationships between motor impairments and activity limitations were investigated to verify the assumption that reduced motor impairments do not necessarily lead to higher activity levels. Finally, to complete the investigation of psychometric qualities, a longitudinal study of the developed questionnaire was carried out to evaluate its sensitivity to change. Chapter 1 presents the development of ACTIVLIM, a Rasch-built measure of activity limitations and its validation in children and adults with NMD. ACTIVLIM is a self-reported questionnaire that assesses the difficulties adult patients and parents of affected children perceive when they or their children perform daily activities. This questionnaire originally included 126 daily activities and was submitted to 369 patients. The Rasch model selected 22 daily activities to define a linear and unidimensional measure of activity limitations in patients with NMD. The validity and the reproducibility of the results were also studied. A second section of Chapter 1 demonstrates why the measure of activity limitations in children with NMD as assessed using the ACTIVLIM questionnaire is based upon the perception of their parents. A third section of Chapter 1 compares the difficulties self-perceived by the patients with the difficulties observed by external examiners. The agreement between both measures is very good, indicating that the use of ACTIVLIM as a self-reporting questionnaire is a valid method to assess activity limitations in patients with NMD. Chapter 2 investigates the relationships between motor impairments and activity limitations as measured with the ACTIVLIM questionnaire. As the anatomical basis and pathophysiology are different from one NMD to another, the relationships between impairments and activity limitations were investigated in six main diagnostic groups and in the whole sample without diagnostic distinction. Gait speed and muscle weakness in proximal and flexor muscle groups were significantly but moderately correlated to the activity limitations, indicating that the latter cannot simply be inferred from motor impairments but should be independently measured and treated. Chapter 3 investigates the sensitivity to change of the ACTIVLIM questionnaire. As NMD are progressive disorders, it is important that the ACTIVLIM questionnaire be able to assess the change over time in the activity level of patients with NMD in order to characterize the disease course and to quantify the effects of new treatments on activity limitations in these patients. Finally, the last section discusses the results of the different chapters and presents perspectives for future research.

Introduction : L’évaluation des apprentissages a une importance indéniable en pédagogie des sciences de la santé et l’utilisation d’examens écrits est omniprésente, notamment en médecine. Toutefois, l’élaboration d’évaluations de haute qualité est souvent un défi pour les rédacteurs et les programmes. Il est donc important d’identifier des stratégies qui pourraient faciliter le travail des rédacteurs tout en ayant un impact positif sur la qualité des questions écrites, notamment l’utilisation de consignes lors de la rédaction. Méthodologie : Nous avons élaboré une liste de consignes de rédaction de questions d’examens par un processus itératif et rigoureux. 14 consignes discriminantes ont été retenues. À l’aide d’une étude de cas multiples, nous avons exploré l’utilisation de ces consignes de rédaction de questions auprès de quatre rédacteurs pour des examens d’un programme préclinique de médecine. Un questionnaire et une entrevue individuelle semi-dirigée ont été effectués pré et post utilisation des consignes. Les unités d’analyses et de comparaison étaient : la qualité et les propriétés psychométriques des questions pré et post utilisation des consignes, l’acceptabilité et l’utilisation de celles-ci. Résultats : Pour tous les participants, les questions rédigées respectaient majoritairement les consignes de rédaction. Quoique non statistiquement significative, nous avons observé une légère augmentation du coefficient de discrimination chez les rédacteurs (2 sur 4) qui utilisaient les consignes de manière active. Nos résultats suggèrent que l’appropriation que font les rédacteurs des consignes semble influencer leur perception de l’utilité et de l’acceptabilité des consignes. Conclusion : Les résultats obtenus semblent suggérer que l’utilisation d’une liste circonscrite de consignes de rédaction offre une bonne stratégie à adopter pour améliorer la qualité des questions. Les rédacteurs de questions qui sont mieux outillés et qui semblent adopter pleinement l'utilisation des consignes de rédaction y voient les impacts positifs sur la qualité de leurs questions. / Abstract : Introduction : The assessment of learners has an undeniable importance in health professions education and the use of written exams is omnipresent, notably in medicine. However, developing high-quality assessment is often a challenge for administrators and exam developers. It is therefore important to identify strategies that could facilitate their work while having a positive impact on the quality of the written exam questions, including the use of guidelines when developing exams. Methodology : We created a list of item-writing guidelines through a rigorous and systematic process. We identified 14 discriminant guidelines. Using a multiple case study, we explored the use of those questions writing guidelines with four exam developers at the preclinical phase of an undergraduate medicine program. A questionnaire was completed and a semi-directed individual interview was carried out before and after the use of guidelines. The units of analysis and comparison were: the quality and psychometric properties of questions pre- and post-use of the guidelines, the acceptability and the use of these guidelines. Results : For all the participants, the written questions respected mostly the instructions of drafting. Although not statistically significant, we observed a slight increase in the coefficient of discrimination among editors who actively used the instructions. Our results suggest that participants’ appropriation of the item-writing guidelines seemed to influence their perception of the usefulness and acceptability of instructions. Conclusion : The results seem to suggest that the use of a narrow list of writting guidelines provides a good strategy for improving the quality of the questions. Exam developers that are better equipped and seem to fully adopt the use of drafting guidelines see the positive impacts on the quality of their questions.

<b>Introduction:</b> Health-related websites have developed to be much more than information sites: they are used to exchange experiences and find support as well as information and advice. It is important that health professionals and website developers understand how content may impact users. This thesis documents the development and application of a tool to measure the impact of using health-related websites which contain experiential and/or factual information. <b>Methods:</b> A multi-method study with five stages. Stage 1: Questionnaire items based upon themes relating to the impact of using health-related websites were constructed following qualitative secondary analysis of 93 interviews relating to patient and carer experiences of health and a recent literature review. Items were assessed by an expert panel. Stage 2: Cognitive interviews were carried out to confirm acceptability of items. Stage 3: Item reduction steps were used to reduce the number of items. Stage 4: The validity and reliability of the remaining items were tested using traditional and modern psychometric methods. Stage 5: The new questionnaire was piloted in a randomised controlled trial. <b>Results:</b> Eighty-two items were constructed according to the key themes identified in Stage 1. Following expert and patient refinement, two independent item pools entered psychometric testing. The first item pool related to general views of using the internet in relation to health and the second item pool related to the impact of using a specific health-related website. Sub-scales and summary scores were found to have high construct validity, internal consistency and test-retest reliability. The questionnaire showed high completion rates and low counts of missing data in a trial setting. <b>Conclusion:</b> Analysis confirmed good psychometric properties in the eHIQ-Part 1 (11 items) and the eHIQ-Part 2 (26 items). Preliminary findings of trial data demonstrate the acceptability and feasibility of including the eHIQ in randomised controlled trials. This tool will enable the measurement of the impact of health-related websites containing various styles of information and support across a range conditions and facilitate their accurate evaluation in clinical trials.

The study’s aim was to obtain evidence of validity of the Learning Self-Regulation Questionnaire (LSRQ) internal structure and to verify metric invariance compared with a previous research study. The participants were 237 university students from the first three academic semesters of a private university in three Peruvian cities (two in the North of Peru, and one in Lima). The analysis was performed by a semi-confirmatory factor analysis, specifying as comparison matrix: a) the configuration derived from a previous study, and b) the free estimation loadings factors. The results indicate that two dimensions represent the instrument structure satisfactorily; but the metric invariance compared to a previous study was not satisfactory. The re-specification of the model, by removing two items with factorial complexity problems and the free estimation of the items, was successful. These results are discussed so as to the interpretation of their scores and the lack of metric invariance. / El objetivo del estudio fue obtener evidencias de validez de la estructura interna del Cuestionario de Autorregulación del Aprendizaje (Learning Self-Regulation Questionnaire; LSRQ) y verificar la invarianza métrica comparada con un estudio previo. Los participantes fueron 237 estudiantes universitarios de los tres primeros ciclos académicos de una universidad privada, procedentes de tres ciudades del Perú (dos del norte y una de Lima). El análisis se realizó mediante un análisis factorial semiconfirmatorio, especificando como matriz de comparación (a) la configuración derivada de un estudio previo, y (b) la estimación libre de las cargas factoriales. Los resultados indican que dos dimensiones representan satisfactoriamente la estructura del instrumento; pero la invarianza métrica respecto a un estudio previo no fue satisfactoria. La reespecificación del modelo, mediante la eliminación de dos ítems con problemas de complejidad factorial y la estimación libre de los ítems, obtuvieron resultados satisfactorios. Se discuten estos resultados en el marco de la interpretación de sus puntajes y la falta de invarianza métrica.

It is presented the structure and psychometric studies of the “School Motivation Questionnaire”. The SMQ is a self-report questionnaire with 101 items, organized in sixteen scales that measure the students´ goal orientations, the perceived classroom goal structures, the perceived teacher’s autonomy support and the use of learning strategies. Twelve scales are adapted from the “Learning Climate Questionnaire”, “Perceptions of Instrumentality” and “Cuestionário a Estudiantes”. Four scales and five additional items are created new. The psychometric studies rely on a convenience sample consisting of 9th and 12th grade students ( = 485) of Portuguese schools. The factorial and construct validity, verified through several exploratory factorial analyses to the data, presents a final solution of six factors, labelled Strategies (F1), Teacher Extrinsic Goals (F2), Student Extrinsic Goals, Externally Regulated (F3) Teacher Intrinsic Goals (F4), Student Extrinsic Goals, Internally Regulated (F5), and Student Intrinsic Goals (F6). The six-factor solution explains a significant variance of the scale results (53.95%). Good coefficients of internal consistency are obtained for all factors, never below (.858; F6). In sum there is strong evidence to support the multi-dimensionality of SMQ, upholding that the data obtained is exploratory and applies for future validation studies. / Se presenta la estructura y los estudios psicométricos del “Cuestionario de Motivación Escolar“. El CME es un cuestionario de auto informe con 101 ítems, organizados en dieciséis escalas que miden las orientaciones de las metas de los estudiantes, la percepción de las estructuras de las metas de clase, las percepciones del apoyo del profesor a la autonomía y el uso de estrategias de aprendizaje. Doce escalas son una adaptación del “Learning Climate Questionnaire”, “Perceptions of Instrumentality” y “Cuestionario a Estudiantes”. Cuatro escalas y cinco frases adicionales se crearon para este estudio. Los estudios psicométricos se basan en una muestra de conveniencia compuesta por estudiantes de los grados 9 y 12 (N = 485) de las escuelas portuguesas. La validez factorial y la construcción ha sido verificada a través de varios análisis factoriales exploratorios de los datos, y presenta una solución definitiva de seis factores, siendo Estrategias (F1), Metas extrínsecas de los docentes (F2), Metas extrínsecas de los estudiantes, reguladas externamente (F3), Metas intrínsecas de los docentes (F4), Metas extrínsecas de los estudiantes ,reguladas internamente (F5), y Metas intrínsecas de los estudiantes (F6). La solución de seis factores explica una variación significativa de los resultados de la escala (53,95%). Se encontraron buenos coeficientes de consistencia interna para todos los factores, nunca por debajo de (.858; F6). En suma, hay una fuerte evidencia para apoyar la multidimensionalidad del CME. Estos resultados son exploratorios y servirán como una base para estudios de validación posteriores.

Measures of adult attachment developed in English have been translated and validated in multiple Spanish-speaking countries, yet to this date no self-report adult attachment instrument has been systematically examined for validation with Latinos/Hispanic Americans. The present study examined psychometric properties of a Spanish version of a widely used adult attachment scale, the Experiences in Close Relationships Scale (ECRS), with a bilingual college student sample. Following the dual-language split half (DLSH) quantitative method of evaluating semantic equivalence, 209 bilingual, Latinos/Hispanic American college students recruited from a large public university completed a DLSH version of the ECRS (half English, half Spanish). Internal consistency reliability and DLSH reliability were within acceptable limits, although significantly smaller than coefficients of the English ECRS completed by a large Caucasian sample (n = 459); 3- to 8-week test-retest reliability was also adequate. Exploratory factor analysis revealed a two-factor solution with 35 items accounting for 40% of the variance, which was similar to the English ECRS. Convergent validity was supported by findings that showed significant associations of attachment dimensions with social self-efficacy, self-esteem, depressive symptoms, and comfort with self-disclosure, but not interpersonal trust. Evidence for discriminant validity was found in that attachment dimensions were not significantly associated with social desirability. Theoretical implications, limitations, and future directions of the study will be discussed based on adult attachment theory and cross-cultural perspectives.

Title: Internal consistency of assessment set of clinical features of patients with multiple sclerosis and its correlation with the degree of neurological impairment. Objectives: The aim of this work is to verify the internal consistency of Assessment set of clinical features in patients with multiple sclerosis and its correlation with the degree of neurological disability that would comprehensively and objectively judged effect of physiotherapy in patients with MS. Method: Clinical Examination set of functions includes well-known, standard and validated assessments that evaluate the function associated with the central movement disorders focusing on the clinical manifestations of RS (Low-Contrast Letter Acuity Test contrasting vision, Motricity Index assesses muscle strength, spasticity Modified Ashworth Scale, Berg balance Scale equilibrium, Nine Hole Peg Test investigate fine motor skills, Timed 25 - Foot Walk assess walking speed over a distance of 7.5 m, Paced Auditory Serial Addition Test investigates cognitive function, and auditory information processing speed, simple computational skills and ability to concentrate after the duration of the test. Belong to this set as evaluation of righting, equilibrium and protective reactions, examination dysdiadochokinesia, ataxia, and test evaluation...

The failure to translate evidence into clinical practice has been repeatedly highlighted. This failure is partly attributed to disregarding the context within which healthcare is delivered. The aim of this thesis was to develop and psychometrically evaluate the Context Assessment for Community Health (COACH) tool, and, through that process, provide opportunities to measure aspects of context perceived to be important for Knowledge Translation (KT) interventions in low- and middle-income countries (LMIC). All four studies in this thesis were mainly undertaken in Quang Ninh province, Vietnam during 2008–2014. Study II, however, was also conducted in four other LMICs (Bangladesh, Nicaragua, South Africa, and Uganda). Study I employed inductive content analysis of 16 focus group discussions to explore the influence of context in a community-based facilitation intervention in Vietnam. Studies II and III reported on the development of the COACH tool and assessment of its psychometric properties. Study IV used the COACH tool in a survey among health workers in Vietnam. To date, three sources of evidence regarding validity of the COACH tool have been provided, that is, test content, response processes, and internal instrument structure, with promising psychometric characteristics. The COACH tool could be used as means of characterizing aspects of context ahead of KT interventions, for tailoring KT strategies, and for further understanding of the results of KT interventions. / Context Assessment for Community Health

Après avoir analysé au travers d'une recherche exploratoire et clinique, certains des facteurs de protection mis en jeu lors d'un traumatisme, une investigation approfondie de la littérature internationale a été menée afin de mettre en évidence la pertinence d'un instrument permettant d'appréhender la présence d'un panel plus large de facteurs de résilience. Face auxlimites des outils psychométriques actuels et en vue de les pallier, une échelle de mesure a été élaborée. Ainsi, cette thèse sur travaux rapporte les étapes de développement et de validation d'un outil construit afin d'évaluer les facteurs de protection concourant à la résilience. Une analyse factorielle exploratoire des données a été conduite auprès de 299 participants francophones dans le but d'éprouver la structure de l'I.F.R-40 (Inventaire des Facteurs de Résilience). La validité convergente, la stabilité temporelle de même que la cohérence interne de l'outil ont fait l'objet d'une évaluation. Les résultats obtenus soutiennent une structure en trois dimensions (facteurs de protection personnels, familiaux et extra-Familiaux) et appuient la validité ainsi que la fidélité de l'I.F.R-40. D'autres analyses ont également été menées afin devalider la structure factorielle de l'Inventaire des Facteurs de Résilience (I.F.R-40) au moyen d'une A.F.C (Analyse Factorielle Confirmatoire). Les analyses réalisées confirment la présence de trois facteurs, interprétés en termes de facteurs de protection familiaux, facteurs de protection individuels et facteurs de protection extrafamiliaux. L'étude de la validité divergente confirme les liens prédits entre l'I.F.R-40 et l'échelle composite de dépression de Berndt et Kaiser (1999). Enfin, l'I.F.R-40 différencie les adolescents exposés à un traumatisme présentant des scores de dépression à la MDI-C de ceux ne manifestant pas de dépression. Ainsi, l'I.F.R-40 est une échelle tridimensionnelle présentant des propriétés psychométriques satisfaisantes. Les résultats sont discutés à la lumière de leurs implications à la fois théoriques et pratiques. / After having analysed through an exploratory and clinical research, some protection factors playing a part after a traumatism, an in-Depth investigation of international literature was conducted in order to bring to light the relevance of an instrument enabling to comprehend the presence of a larger set of resilience factors. Confronted with the limits of actual psychometric tools and in order to overcome them, a measurement scale has been worked out. Thus, this thesis reports the development and validation steps of a tool constructed with the aim of evaluating the protection factors working together towards resilience. An exploratory factorial data analysis was conducted on 299 French-Speaking participants to test the structure of the I.R.F-40 (Inventory of Resilience Factors). The convergent validity, the temporal stability as well as the internal consistency of the tool have been assessed. The results obtained approve of the three dimension structure (personal, familial and extra-Familial protection factors) and support the validity as well as the reliability of the I.R.F-40. Other analyses have also been conducted in order to validate the factorial structure of the Inventory of Resilience Factors (I.R.F-40) thanks to C.F.A (Confirmatory Factorial Analysis). The analyses conducted confirm the presence of three factors, interpretedin terms of familial protection factors, individual protection factors and extra-Familial protection factors. The study of the divergent validity confirms the predicted links between the I.R.F-40 and Berndt and Kaiser’s composite depression scale (1999). Finally, the I.R.F-40 differentiates the adolescents exposed to a traumatism and who have depression scores atMDI-C to those who experience no depression. Therefore, the I.R.F-40 is a three dimension scale presenting satisfactory psychometric properties. The results are discussed in the light of both their theoretical and practical implications.

L’addiction à Internet a fait l’objet de nombreuses études à travers le monde durant les vingt dernières années. Pourtant aucun consensus au sujet de sa définition ou de ses critères diagnostiques n’a encore été admis, soulevant ainsi de nombreux débats. Ce travail a pour objectif d’étudier la conceptualisation de l’addiction à Internet principalement au travers de ses outils d’évaluation, et de combler un manque de données empiriques au sein d’échantillons français.Étude 1 – Objectif : Déterminer le nombre d’outils de mesure de l’addiction à Internet et mettre en avant leurs qualités psychométriques. Résultats : Quarante-cinq outils mesurant l’addiction à Internet ont été identifiés dont seulement dix-sept ayant été évalués plus d’une fois en termes de propriétés psychométriques. La plupart des échelles existantes nécessitent de plus amples travaux de validation. Bien que critiqué, l’Internet Addiction Test (IAT) est l’échelle présentant le plus de supports empiriques. Cependant, de nombreuses échelles prometteuses requièrent un examen plus approfondi. Étude 2 – Objectif : Évaluer les qualités psychométriques de l’Online Cognition Scale (OCS). Résultats : Les analyses factorielles de l’OCS suggéraient un meilleur ajustement du modèle avec une solution à 5 facteurs (27 items), comparé au modèle original (36 items). Nos résultats mettent en avant une excellente consistance interne et des corrélations inter items et test-retest satisfaisantes. Les scores de l’OCS étaient significativement corrélés avec ceux de l’IAT, du temps passé en ligne et des symptômes dépressifs au cours des deux passations. Étude 3 – Objectifs : Évaluer les qualités psychométriques de la Generalized Problematic Internet Use Scale-2 et la pertinence du modèle d’Utilisation Problématique Généralisée d’Internet (UPGI) au sein d’étudiants français. Résultats : Les résultats de la modélisation en équations structurelles soutiennent ce modèle conceptuel de l’addiction à Internet, et un bon ajustement du modèle aux données. Les qualités psychométriques de la version française de la GPIUS-2 étaient satisfaisantes, notamment la fiabilité, et les validités convergente et concurrente, confirmant l’utilité de cet outil multidimensionnel. Étude 4 – Objectif : Explorer la relation entre l’UPGI et les Utilisations Problématiques Spécifiques d’Internet (UPSI). Résultats : Nos analyses mettent avant des relations significatives entre l’UPGI, les symptômes psychopathologiques et la plupart des UPSI, avec de nombreuses différences en fonction du genre et de l’âge. Alors que les scores d’UPSIcommunication prédisaient ceux d’UPGI chez l’ensemble des participants, ceux d’UPSIrecherche d’informations et jeux en ligne, ainsi que les symptômes dépressifs n’étaient significatifs que chez les femmes, les hommes et les jeunes adultes, et l’UPSIconsommation de vidéo/musique et le temps passé en ligne uniquement chez les femmes et les jeunes adultes. / Internet addiction has been the subject of numerous studies worldwide, during the last twenty years. Yet, no consensus on its definition or diagnosis criteria has been admitted, which therefore is triggering numerous debates. The present research aims to study the conceptualization of Internet addiction mainly through its assessment tools, and to fill in the lack of empirical data among French samples.Study 1 - Aim: To assess the measurement tools for Internet addiction and their psychometric properties. Results: Forty-five tools assessing Internet addiction were identified, of which only seventeen had been evaluated more than once in terms of their psychometric properties. Most of the existing scales for Internet addiction require further validation work. Despite criticism, the Internet Addiction Test (IAT) appears to be the scale with the most empirical support. However, numerous promising scales warrant further examination.Study 2 - Aim: To evaluate the psychometric properties of the Online Cognition Scale (OCS). Results: Confirmatory factorial analyses showed that the 4-factor solution did not demonstrate satisfactory fit but the 5-factor model was found to better fit the data. Our results revealed that the scale scores demonstrated excellent internal consistency and satisfying inter-item correlation and test-retest reliability. The OCS was significantly correlated with the IAT, time spent online and depressive symptoms at both time points.Study 3 - Aim: To evaluate the psychometric properties of the Generalized Problematic Internet Use Scale-2 and the relevance of the Generalized Problematic Internet Use (GPIU) model among French users. Results: Path analysis provided support for this conceptual model of problematic Internet use, and a good fit to the data. The psychometric properties of the French version of the GPIUS-2 were satisfying, including reliability, concurrent and convergent validities, suggesting the usefulness of this multidimensional tool.Study 4 - Aim: To explore the relationship between GPIU and Specific Problematic Internet Uses (SPIU) Results: Our analysis revealed significant relationships between GPIU, psychopathological symptoms and most of SPIU, with many differences according to gender and age. SPIUcommunication scores significantly predict GPIU scores among the whole sample, whereas SPIUinformation seeking and gaming, and depressive symptoms were only significant among women, men and young adults, and SPIUconsumption of video/music and time spent online, among women and young adults.