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RELIABILITY AND VALIDITY OF THE BURULI ULCER FUNCTIONAL LIMITATION SCORE QUESTIONNAIRE

The reliability and validity of the earlier developed Buruli ulcer functional limitation score (BUFLS) questionnaire was assessed. Of 638 former Buruli ulcer patients (of 678 individuals examined), sufficient items on daily activities ( 13 of the 19) were applicable to calculate a score. To determine the validity, the functional limitation scores of the 638 individuals were compared with the global impression of the limitations, range of motion (ROM), and the social impact (change of occupation or education) of Buruli ulcer. To determine inter-observer reliability, the functional limitation score was reassessed in 107 participants within one and three weeks after the first interview by another interviewer and interpreter. Both global impression and ROM correlated well with the functional limitation scores ( = 0.66 and = 0.61). The inter-observer reliability of 107 participants as measured by an intra-class correlation coefficient of 0.86 was very good. The functional limitation scores measured in the second assessment were significantly higher than in the first assessment. This should be taken into account when the functional limitation score is used for the individual patient. The BUFLS can be used as for between group comparisons of endpoints in clinical trials and in the planning of resources.

Received June 1, 2004. Accepted for publication August 12, 2004.

Acknowledgments: We thank Ilona Hospers, Irene Wiersma, Valentin Gangbe, Adrien Hadjinde, Wilfried Houegnon, Gabriel A. Hagen, and Dennis Agyeman for their help with this study.

Financial support: This study was supported by the NWO (Dutch Organization for Scientific Research). Marieke J. van Wezel, Margijske H. G. van Roest, Michiel Beets, and IJsbrand Zijlstra received support funding from the Marco Polo fund, the Hendrik Muller’s Vaderlandsch fund, the National Dermatology fund, and the Groningen University fund.

Authors’ addresses: Ymkje Stienstra, Marieke J. van Wezel, Margijske H.G. van Roest, Michiel Beets, IJsbrand Zijlstra, Winette T. A. van der Graaf, and Tjip S. van der Werf, Department of Internal Medicine, Groningen University Hospital, PO Box 30.001, 9700 RB Groningen, The Netherlands, Fax: 31-50-361-3216, E-mails: y.stienstra{at}int.azg.nl and t.s.van.der.werf{at}int.azg.nl. Pieter U. Dijkstra, Department of Rehabilitation, Groningen University Hospital, PO Box 30.001, 9700 RB Groningen, The Netherlands. R. Christian Johnson, Programme National de Lutte Contre l’Ulcère de Buruli, Ministère de la Santé Publique, Cotonou, Benin, Edwin O. Ampadu, Ministry of Health, National Buruli Ulcer Control Program, Korle Bu, Accra, Ghana. Jules Gbovi, Centre de Santé, Unité de Traitement des Ulcères de Buruli, Lalo, Benin. Claude Zinsou, Centre Sanitaire et Nutritionnel Gbemontin, Zagnanado, Benin. Samuel Etuaful, Saint Martin’s Catholic Hospital, Agroyesum, Ghana. Erasmus Y. Klutse, Dunkwa Governmental Hospital, Dunkwa, Ghana.