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Title: A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis
Authors: Feng, Allen L.
Wesely, Nicholas C.
Hoehle, Lloyd P.
Phillips, Katie M.
Yamasaki, Alisa
Campbell, Adam P.
Gregorio, Luciano L. [UNIFESP]
Killeen, Thomas E.
Caradonna, David S.
Meier, Josh C.
Gray, Stacey T.
Sedaghat, Ahmad R.
Keywords: chronic rhinosinusitis
disease severity
Issue Date: 2017
Publisher: Wiley
Citation: International Forum Of Allergy & Rhinology. Hoboken, v. 7, n. 12, p. 1140-1148, 2017.
Abstract: BackgroundPrevious studies have identified subdomains of the 22-item Sino-Nasal Outcome Test (SNOT-22), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT-22. This study aims to validate the existence of underlying symptom subdomains of the SNOT-22 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology. MethodsA total of 800 patients with CRS were included into this cross-sectional study (400 CRS patients from Boston, MA, and 400 CRS patients from Reno, NV). Their SNOT-22 responses were analyzed using exploratory factor analysis (EFA) to determine the number of symptom subdomains. A CFA was performed to develop a validated measurement model for the underlying SNOT-22 subdomains along with various tests of validity and goodness of fit. ResultsEFA demonstrated 4 distinct factors reflecting: sleep, nasal, otologic/facial pain, and emotional symptoms (Cronbach's alpha, >0.7; Bartlett's test of sphericity, p < 0.001; Kaiser-Meyer-Olkin >0.90), independent of geographic locale. The corresponding CFA measurement model demonstrated excellent measures of fit (root mean square error of approximation, <0.06; standardized root mean square residual, <0.08; comparative fit index, >0.95; Tucker-Lewis index, >0.95) and measures of construct validity (heterotrait-monotrait [HTMT] ratio, <0.85; composite reliability, >0.7), again independent of geographic locale. ConclusionThe use of the 4-subdomain structure for SNOT-22 (reflecting sleep, nasal, otologic/facial pain, and emotional symptoms of CRS) was validated as the most appropriate to calculate SNOT-22 subdomain scores for patients from different geographic regions using CFA.
ISSN: 2042-6976
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