An Evaluation of Psychometric Properties of Needs Assessment Instruments in Patients with Coronary Artery Disease Undergoing Cardiac Rehabilitation Programs: A Systematic Review

Abstract

Background: Coronary Artery Disease is the foremost reason of illnesses and death in the world. Assessment of the needs is a priority in these patients. However, there is a paucity of tools for the evaluation of needs, with the controversy surrounding their validity.Purpose: This review aimed to evaluate the psychometric properties of tools used to assess needs of patients with CAD undergoing cardiac rehabilitation (CR) plans.Methods: An online literature search combined with manual search was carried out on 11 databases to identify relevant articles. The terms used in the search were: cardiac rehabilitation AND coronary artery disease, cardiac rehabilitation AND acute coronary syndrome, and questionnaires OR need assessment OR tool OR scale. Articles from 1989 to 2021 were selected using some inclusion criteria and no validation studies were excluded. The quality of the questionnaires was evaluated by researchers using consensus-based standards for the selection of health status measurement instruments (COSMIN) list. Data analysis had been done by calculating overall methodological quality scores per study on a measurement property using COSMIN checklist. A methodological quality score per box was obtained by taking the lowest rating of any item in a box (‘worse score counts’).Results: Of 653 articles, 15 papers were involved in the study. Six studies reported cross-cultural validity, nine studies for criterion validity, and none reported measurement error, hypothesis testing, and responsiveness. There is no vigorous and valid single scale for the measurement of needs in CAD patients Overall, the CADEQ questionnaire was good and a patient self-assessment tool for cardiac rehabilitation was poor based on psychometric properties.Conclusions: The findings of this study disclosed that even though it has been more than 32 years, from 1989 to 2021, of the development in need assessment instruments; each instrument has as a minimum of one “poor” psychometric property according to the COSMIN checklist.  So, it is recommended for the next studies to design and develop instruments with better psychometric validities for clinical environment.