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and shows that the CQR is the only validated method&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the CQR<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> validation literature it may be determined that highly frequent types of specific evidence validity refer to patient classification&#44; and the convergent and divergent relationship with other criteria&#46; However&#44; the less used&#44; more ignored method is that of internal structure validity &#8211; i&#46;e&#46; the scalability of the CQR which analyses the item-score relationships to define the configuration of the total scoring&#46; Only 2 replication studies have researched their internal structure&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> and in them the single dimensionality of the CQE was not corroborated&#46; In other words&#44; the 19 items were not grouped into a single statistical dimension&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This implies 3 things&#58; firstly&#44; that there was no empirical justification to use a single score derived from the simple or weighted sum of the items&#46; Second&#44; some equivalence problems of the CQR compared with other similar measures may be caused by this problem of scalability &#40;see Marras et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#41;&#46; Third&#44; the situation seems to describe <span class="elsevierStyleItalic">validity induction&#44;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which occurs when the validity affirmation is supported by a tool using 1&#41; studies from other cultural contexts &#40;for example&#44; citing the original study<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> or another made in another country&#44; with a different type of participant&#44; and&#47;or clinical situation&#41;&#44; 2&#41; selecting the type of irrelevant evidence &#40;for example&#44; declaring that Cronbach&#8217;s alpha reliability indicates the validity of the scoring&#41; or 3&#41; exchanging specific validity evidence &#40;for example&#44; inferring that the predictive capacity of the CQR is proof of satisfaction with treatment or with the validity in general&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">For the latter implication&#44; although it has been recognised that the CQR obtains appropriate levels of prediction in studies with patients who suffer from arthritis and has acceptable levels of reliability&#44; this evidence is not exchangeable with the evidence required to demonstrate that the total score may be interpreted as a unit&#46; In any described situation&#44; the evidence of inducing validity is the omission of analysing the CQR scalability to uphold the interpretation of a single score&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">How can the use of a single score be justified if the empirical evidence that must uphold it is missing or questionable&#63; Can the studies which question the single dimensionality of the CQR<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> be taken into account&#63; The strongest outcomes to date on the internal structure or scalability of the CQR do not guarantee that a single score be used&#44; unless they reduce the number of items<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#59; another option of interpretation is to accept the multidimensionality of the CQR&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and that the rheumatologist must assess whether they wish to use it in this way or not&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We conclude that&#44; due to the apparent inconsistency in the factorial CQR structure&#44; studies with the CQR must include corroboration of their internal structure&#44; take advantage of current validation recommendations&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and highlight any international collaborations within them&#46;</p></span>"
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Letter to the Editor
Metric studies of the compliance questionnaire on rheumatology (CQR): A case of validity induction?
Estudios métricos del Compliance Questionnaire on Rheumatology (CQR): ¿un caso de inducción de la validez?
César Merino-Sotoa, Marisol Angulo-Ramosb,
Corresponding author
noa_c22@yahoo.es

Corresponding author.
a Universidad de San Martin de Porres, Lima, Peru
b Universidad Católica Los Ángeles de Chimbote, Chimbote, Peru
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    "titulo" => "Metric studies of the compliance questionnaire on rheumatology &#40;CQR&#41;&#58; A case of validity induction&#63;"
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        "titulo" => "Estudios m&#233;tricos del <span class="elsevierStyleItalic">Compliance Questionnaire on Rheumatology</span> &#40;CQR&#41;&#58; &#191;un caso de inducci&#243;n de la validez&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This letter highlights several issues in the literature regarding the metric properties of the <span class="elsevierStyleItalic">Compliance Questionnaire on Rheumatology</span> &#40;CQR&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which demonstrate a strong essential weakness of the studies that use them&#44; together with conclusions extracted from them&#46; The CQR is possibly one of the adherence measures that is being incorporated into most frequently into studies&#46; In a recent bibliographic review&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 5 out of the 9 selected studies used it&#46; Furthermore&#44; recommendation 16 of the Spanish Rheumatology Society&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> suggests developing validation studies for treatment adherence measures with methotrexate &#40;MTX&#41;&#44; and shows that the CQR is the only validated method&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the CQR<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> validation literature it may be determined that highly frequent types of specific evidence validity refer to patient classification&#44; and the convergent and divergent relationship with other criteria&#46; However&#44; the less used&#44; more ignored method is that of internal structure validity &#8211; i&#46;e&#46; the scalability of the CQR which analyses the item-score relationships to define the configuration of the total scoring&#46; Only 2 replication studies have researched their internal structure&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> and in them the single dimensionality of the CQE was not corroborated&#46; In other words&#44; the 19 items were not grouped into a single statistical dimension&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This implies 3 things&#58; firstly&#44; that there was no empirical justification to use a single score derived from the simple or weighted sum of the items&#46; Second&#44; some equivalence problems of the CQR compared with other similar measures may be caused by this problem of scalability &#40;see Marras et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#41;&#46; Third&#44; the situation seems to describe <span class="elsevierStyleItalic">validity induction&#44;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which occurs when the validity affirmation is supported by a tool using 1&#41; studies from other cultural contexts &#40;for example&#44; citing the original study<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> or another made in another country&#44; with a different type of participant&#44; and&#47;or clinical situation&#41;&#44; 2&#41; selecting the type of irrelevant evidence &#40;for example&#44; declaring that Cronbach&#8217;s alpha reliability indicates the validity of the scoring&#41; or 3&#41; exchanging specific validity evidence &#40;for example&#44; inferring that the predictive capacity of the CQR is proof of satisfaction with treatment or with the validity in general&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">For the latter implication&#44; although it has been recognised that the CQR obtains appropriate levels of prediction in studies with patients who suffer from arthritis and has acceptable levels of reliability&#44; this evidence is not exchangeable with the evidence required to demonstrate that the total score may be interpreted as a unit&#46; In any described situation&#44; the evidence of inducing validity is the omission of analysing the CQR scalability to uphold the interpretation of a single score&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">How can the use of a single score be justified if the empirical evidence that must uphold it is missing or questionable&#63; Can the studies which question the single dimensionality of the CQR<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> be taken into account&#63; The strongest outcomes to date on the internal structure or scalability of the CQR do not guarantee that a single score be used&#44; unless they reduce the number of items<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#59; another option of interpretation is to accept the multidimensionality of the CQR&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and that the rheumatologist must assess whether they wish to use it in this way or not&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We conclude that&#44; due to the apparent inconsistency in the factorial CQR structure&#44; studies with the CQR must include corroboration of their internal structure&#44; take advantage of current validation recommendations&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and highlight any international collaborations within them&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Merino-Soto C&#44; Angulo-Ramos M&#46; Estudios m&#233;tricos del <span class="elsevierStyleItalic">Compliance Questionnaire on Rheumatology</span> &#40;CQR&#41;&#58; &#191;un caso de inducci&#243;n de la validez&#63; Reumatol Cl&#237;n&#46; 2022&#59;18&#58;497&#8211;498&#46;</p>"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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