Development of COSMIN-guided symptom assessment scale for children with fracture and its reliability and validity test

ZHAO Yongxin; CAI Chunhui; ZHANG Jiao; CHEN Yizhen; GU Ying; WANG Dahui

doi:10.12104/j.issn.1674-4748.2025.04.003

Abstract：Objective:To construct a symptom assessment scale for children with fractures and test its reliability and validity.Methods:Following the COSMIN guidelines,a preliminary draft of the scale was formed through literature analysis,qualitative interviews,and two rounds of expert consultation.The items were analyzed by critical ratio method and correlation coefficient method,and the items were deleted after comprehensive consideration of expert opinions and clinical significance.Afterwards,exploratory factor analysis was used to optimize the items again to form a test scale.Evaluating the content validity of the test scale from the perspectives of experts and children,and using exploratory factor analysis to evaluate the structural validity of the scale.The reliability of the scale was evaluated by measuring the Cronbach's α coefficients of each dimension and the total scale.Results:The first draft of the scale contained 16 items,one item was deleted from the item analysis,and three common factors including neurological and psychological symptoms,somatic symptoms,and gastrointestinal symptoms were extracted during the exploratory factor analysis.From the perspective of expert,the content validity index at the item level(I-CVI)ranges from 0.867 to 1.000,and the average content validity index at the scale level(S-CVI/Ave)was 0.967.From the perspective of pediatric patients,all items in the scale were easy to understand.Confirmatory factor analysis showed that the model fit well(χ2/ν=2.626,CFI=0.904,RMSEA=0.095).Cronbach's α coefficient of the three dimensions of the scale ranged from 0.753 to 0.946,and the total Cronbach's α coefficient of the scale was 0.874.Conclusion:The scale constructed in this study has good reliability and validity,and can be used to evaluate the symptoms of children with fractures aged 6～18 years.