The Short Form Endometriosis Health Profile Questionnaire (EHP-5): psychometric validity assessment of a Croatian version

The Short Form Endometriosis Health Profile Questionnaire (EHP-5): psychometric validity assessment of a Croatian version | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Short Form Endometriosis Health Profile Questionnaire (EHP-5): psychometric validity assessment of a Croatian version Mislav Mikuš, Luka Matak, Goran Vujić, Bernarda Škegro, Ivan Škegro, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1627557/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: To translate, adapt and validate the Endometriosis Health Profile-5 (EHP-5) in Croatian population. Methods: This validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. A 150 consecutive patients with surgically proven endometriosis were enrolled. The translation to Croatian followed standardized procedure. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test-retest reliability was calculated using intraclass correlation coefficient (ICC). The t-test for independent samples was used to assess known-groups validity. Results: Both EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach’s Alpha coefficient (α=0.793 and α=0.842, respectively). Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (ICC=0.896 and 0.936, respectively). The independent t-test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p<0.001) on EHP-5 (M=50.63) compared with women who reported their pain 6 or less (M=26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p<0.001), whereby infertile women had higher average result on EHP-5 (M=49.55) compared with fertile women (M=34.36). Conclusion: The Croatian version of the EHP-5 have very good psychometric characteristics and can be used as a reliable tool for assessing patients with endometriosis in everyday clinical practice. Introduction Endometriosis presents one of the most common chronic gynecological conditions associated with cyclic pelvic pain, infertility or both [ 1 , 2 ]. It affects approximately 20% women hospitalized for pelvic pain and 50% of infertile women [ 3 ]. There is a median delay of eight years from first symptom onset to an endometriosis diagnosis which causes a negative impact on the health-related quality of life (HRQoL) [ 4 ]. The symptoms of endometriosis vary from mild to severe, but in most cases, women suffering from endometriosis are exposed to monthly intake of analgesics and generally have a poorer HRQoL. Nevertheless, the typical recurrent lower abdominal pain, possible side effects of treatment and lack of understanding by other people have significant negative impact on the personal and psychosocial status of patients’ daily life [ 5 , 6 ]. Given that numerous studies have confirmed an association between endometriosis and poor HRQoL, disease-specific instruments were needed to be developed to assess the aspects of quality of life affected by a specific disease or disorder [ 7 ]. Two decades ago, Jones and associates published the Endometriosis Health Profile-30 (EHP-30), one of the first standardized, disease specific instrument that evaluates the HRQoL in women with endometriosis [ 8 ]. Although the EHP-30 questionnaire demonstrated high reliability and validity, it presents a lengthy measure [ 8 , 9 ]. In order to overcome time impracticality of EHP-30, same group of authors developed Endometriosis Health Profile-5 (EHP-5) [ 10 ]. The EHP-5 questionnaire is proved to be a reliable and valid questionnaire with its special feature in clinical settings where an expeditious endometriosis health status measure is required [ 10 – 14 ]. In the Croatian language, there is no validated questionnaire for evaluating the impact of endometriosis on quality of life. The present study was conducted with the aim to translate, adapt and validate the EHP-5 in Croatia. Methods Participants and study design A prospective observational study was conducted between July 2019 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Croatia. The study was approved by the Institutional Review Board and all participants gave their written consent before inclusion. This validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. Since our Department has almost 250 operative procedures annually which include ovarian, pelvic and/or extra pelvic endometriosis, we believe that this study will bring new tool not only for preoperative assessment but postoperative surveillance. The study has been previously registered and described at clinicaltrials.gov (Identifier: NCT04491305). To be eligible for participation, subjects are required to fulfill the following conditions: 1) females 18 years or older; 2) pathohistologically confirmed endometriosis after surgical treatment or indicated diagnostic laparoscopy; 3) fluent and literate in Croatian language; and 4) ability to independently understand the questions in the questionnaires. The following are the exclusion criteria: 1) neurological or psychiatric disorders (e.g. epilepsy, multiple sclerosis, depression, schizophrenia); 2) diagnosed vulvodynia and active vulvovaginitis; 3) pregnancy; 4) any form of prior conservative and/or surgical treatment for endometriosis; 5) missing data in any of the responses of the core part of questionnaire and 6) lack of informed consent. Questionnaires Endometriosis Health Profile-5 (EHP-5) is a reliable and valid self-report questionnaire to assess health-related quality of life in endometriosis, reffering to the 4 previous weeks. The first part of the questionnaire consists 5 items about pain, control and powerlesness, emotions, social support and self image. The second part contains 6 items about work life, relation with children, sexual intercourse, medical profession, treatment and infertility. Items are scored from 0 (never) to 4 (always). Total score is then transformed on a scale with a range 0 to 100, with the latter indicating worst possible health status [ 10 , 11 , 13 ]. Depression, Anxiety and Stress Scale – 21 (DASS-21) is a 21-item scale designed to assess emotional states of depression, anxiety and stress [ 15 , 16 ]. Each of those three subscales is based on 7 items, which are all scored from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). The total score for each one of the subscales is obtained by summing 7 items and then multiplying them by 2. A higher result indicate higher degree of emotional states of depression, anxiety and stress. The questionnaire has been translated and validated to Croatian and showed very good psychometric characteristics [ 17 ]. Visual Analogue Scale (VAS) is a self-report unidimensional measure of pain intensity. A 100 milimeters line represents the continuum from 0 mm (abscence of pain) to 100 mm (unbearable pain). Scores are expressed by measuring the line in millimeters, with results ranging from 0 to 100. The scale has been widely used in diverse adult populations, including those with women suffering from endometriosis [ 18 , 19 ]. Translation and culture adaptation The translation to Croatian followed standardized procedure in which expert group, consisted of two gynecologists, a methodologist and an authorized translator, ensured cross-cultural equivalence of questionnaire. The initial translation was carried out independently by the two gynecologists, expert in field of gynecological surgery. They met and discussed discrepancies in translation and created a new, joint version of EHP-5 questionnaire afterwards. A new version was then sent to an authorized translator who did not have access to the original version. Finally, an expert group have reviewed all versions of the translations and concluded that there were no major discrepancies and to ensure that the final version of a translated questionnaire is culturally congruent. Preliminary pilot-testing was conducted on a small sample (N = 20) in order to check if participants understood questions and were asked for suggestions on how to improve the questionnaire. Preliminary results showed that all items from EHP-5 were easily understandable and that the questionnaire was well received. The Croatian version of EHP-5 were then established ( Appendix ). Statistical analysis Continuous data is presented as mean ± standard deviation (SD), while discrete data is presented as frequencies and percentage. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test-retest reliability was calculated using intraclass correlation coefficient (ICC). The t-test for independent samples was used to assess known-groups validity, a type of construct validity, where was explored the ability of the EHP-5 questionnaire to reflect differences between groups who are expected to differ due to their known characteristics. Concurrent validity, a type of criterion validity, was computed in order to assess similar domains between newly translated EHP-5 questionnaire and already known existing measures (VAS and DASS-21). Therefore, Spearman's correlation coefficients were calculated in order to examine the strength of the relationship between similar items from EHP-5 with VAS and DASS-21 subscales. Significance level was set as p < 0.05. Data analysis was perfomed using SPSS 23.0 (IBM Corp., Armonk, NY). Results Sample characteristics During the study period, 150 consecutive women with surgically proven endometriosis were enrolled. Among them, 27 women did not fulfill inclusion criteria and 12 women refused to participate. Final analysis included 111 women who completed questionnaires at the initial visit ( T 0 ) and 81 of them completed questionnaires again two weeks after on a control visit or via e-mail ( T 1 ). Baseline characteristics are shown in Table 1 . Table 1 Demographic and clinical data. min – max M ± sd Age 19–52 34.98 ± 6.784 Bodyweight 49–105 65.43 ± 10.900 BMI 16.8–39.5 23.56 ± 4.411 0 1 2 3 4 Parity 64 (57.7%) 25 (22.5%) 17 (15.3%) 4 (3.6%) 1 (0.9%) Cesarean delivery 97 (87.4%) 12 (10.8%) 2 (1.8%) Primary school High school University Education 28 (25.2%) 37 (33.3%) 46 (41.5%) NO YES Employment 12 (10.8%) 99 (89.2%) Single Married Divorced Marital status 21 (18.9%) 80 (72.1%) 10 (9.0%) NO YES Prior contraceptive use 79 (71.2%) 32 (28.8%) NO YES Primary sterility 78 (70.3%) 33 (29.7%) 1 2 3 4 rASM stage 29 (26.1%) 59 (53.2%) 20 (18.0%) 3 (2.7%) NO YES DIE 95 (85.6%) 16 (14.4%) Reliability As seen from Table 2 , both EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach’s Alpha coefficient (α = 0.793 and α = 0.842, respectively). Furthermore, test-retest reliability was computed by the Intraclass Correlation Coefficient (ICC), with 81 patients completing EHP-5 on two time points: baseline and two weeks after. Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (0.896 and 0.936, respectively). Table 2 Cronbach's Alpha internal consistency and Intraclass Correlation Coefficient reliability Number of items Cronbach's Alpha Test-retest reliability ICC EHP-5 CORE 5 0.793 0.896 (95% CI 0.859–0.927) EHP-5 MODULAR 6 0.842 0.936 (95% CI 0.881–0.972) Construct validity Known-groups validity was carried out to test the validity of EHP-5 (Table 3 ). We hypothesized that women who report less pain with VAS scale and who are infertile will report lower quality of life measured by the EHP-5 questionnaire. The independent t-test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p < 0.001) on EHP-5 (M = 50.63) compared with women who reported their pain 6 or less (M = 26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p < 0.001), whereby infertile women had higher average result on EHP-5 (M = 49.55) compared with fertile women (M = 34.36). Concurrent validity Concurrent validity was assessed by correlating VAS and DASS-21 subscales, which both have very good psychometric properties in Croatian, with EHP-5 core items (Table 4 ). We found statistically significant high correlation between similar domains – 1st item on EHP-5 questionnaire that measures pain with VAS scale (r = 0.766, p < 0.01). Furthermore, 3rd item (mood swings during the last 4 weeks because of endometriosis) moderately correlated with depressive and anxiety subscales from DASS-21 indicating that women who had more often mood swings have also reported more depressive and anxious symptoms (r = 0.560 and r = 0.486, respectively). Table 3 Construct validity – known-groups comparisons EHP-5 M ± sd t-statistic p-value Pain VAS <7 (N = 55) 26.91 ± 18.571 -6.598 < 0.001 ≥7 (N = 56) 50.63 ± 19.284 Infertility No (N = 78) 34.36 ± 22.868 -3.884 < 0.001 Yes (N = 33) 49.55 ± 16.834 Table 4. Concurrent validity – correlation coefficients between EHP-5 items, VAS and DASS-21 subscales 1 2 3 4 5 VAS DEPR ANX STR 1 1.000 0.497 ** 0.138 0.251 ** 0.417 ** 0.766 ** 0.200 * 0.184 0.299 ** 2 1.000 0.401 ** 0.530 ** 0.491 ** 0.645 ** 0.389 ** 0.204 * 0.384 ** 3 1.000 0.616 ** 0.579 ** 0.127 0.560 ** 0.486 ** 0.602 ** 4 1.000 0.527 ** 0.247 ** 0.450 ** 0.386 ** 0.513 ** 5 1.000 0.394 ** 0.419 ** 0.284 ** 0.533 ** VAS 1.000 0.165 0.108 0.275 ** DEPR 1.000 0.566 ** 0.686 ** ANX 1.000 0.687 ** STR 1.000 **p < 0.01; *p < 0.05 Discussion The present study provides validity and reliability evidence to support the use of the Croatian version of the EHP-5 in everyday monitoring and measuring HRQoL of women with endometriosis. Our findings, although with negligible distinctions, are principally consistent with only three other EHP-5 cross-cultural adaptations and psychometric evaluations published to date [ 11 , 14 , 20 ]. It is important to emphasize that we have demonstrated very good internal consistency and test-retest reliability of both core and modular part of questionnaire. Moreover, our study signifies pain and infertility as the most detrimental factors on overall quality of life among Croatian women with endometriosis. In order to avoid a risk of spectrum bias, we have included consecutive patients with pathohistologically proven endometriosis. The rationale for not involving asymptomatic controls in this study was to display EHP-5 performance as true as possible. In the French version of EHP-5 psychometric evaluation, Fauconnier and associates have used purposeful sampling design from two different medical centres in order to have better EHP-5 discriminative validity analysis [ 20 ]. Although limitations are inevitable in creating the most favourable target population sample, methodological consensus is still lacking [ 21 ]. Another debatable issue is optimal EHP-5 scoring method since there is no precise recommendation from original questionnaire developers [ 10 ]. We have adopted evaluation of the dimensional aspect of the EHP-5 separately for the core and the modular part which is consistent to the Turkish and Iranian study [ 11 , 14 ]. In opposition to separate dimensional aspect evaluation, French EHP-5 version developers have merged all the ratings from core and modular part of questionnaire [ 20 ]. A similar scoring method was applied in retrospective study which have estimated impact of laparoscopic treatment of endometriosis on HRQoL [ 12 ]. Regardless of implemented scoring method, all abovementioned studies, including ours, have found adequate internal consistency [ 11 , 14 , 20 ]. In terms of internal consistency, our findings are nearly equivalent to Turkish study, showing very good Cronbach's Alpha coefficient of both core and modular part of EHP-5 [ 11 ]. This similarity can be explained by comparable initial study setting, inclusion/exclusion criteria and final distribution of disease severity in analyzed sample. Excellent internal consistency (Cronbach α = 0.92) reported by Fauconnier et al. should be interpreted with caution, suggesting that some questionnaire items may be redundant [ 22 ]. The evaluation of the core and modular part of questionnaires with 2-week test–retest reliability was performed by Turkish authors using Pearson's product moment correlation coefficient, revealing very good consistence across repeated administration of questionnaire [ 11 ]. Their findings are consistent with ours although we have evaluated 2-week test–retest reliability via ICC. Other two published EHP-5 validation studies did not assess test-retest reliability [ 14 , 20 ]. Our study has demonstrated that pain and infertility had the highest possible negative impact on quality of life for patients with endometriosis which is consistent with findings of Turkish and Iranian authors [ 11 , 14 ]. However, possible cultural differences and baseline characteristics of sample population determined different responding pattern in French validation study, emphasizing sexual intercourse as one of the most detrimental factors on overall quality of life among patients with endometriosis [ 20 ]. In conclusion, the Croatian version of the EHP-5 was successfully translated, adapted and validated so the questionnaire is now ready for use as a reliable tool for assessing patients with endometriosis in everyday clinical practice. We believe that this validation study will encourage more researches in field of endometriosis preoperative assessment and postoperative surveillance using EHP-5. This short and simple tool will certainly successfully replace current lack of biomedical markers in tracking the progression of endometriosis. Declarations Funding The authors have no relevant financial or non-financial interests to disclose. Acknowledgments None. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mislav Mikuš, Luka Matak, Goran Vujić, Bernarda Škegro and Ivan Škegro. The first draft of the manuscript was written by Mislav Mikuš and Mario Ćorić and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. 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Qual Life Res 18(3):313–333. https://doi.org/10.1007/s11136-009-9451-9 Tsang S, Royse CF, Terkawi AS (2017) Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 11(Suppl 1):S80–S89. https://doi.org/10.4103/sja.SJA_203_17 Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 07 Jun, 2022 Reviewers invited by journal 01 Jun, 2022 Editor assigned by journal 11 May, 2022 First submitted to journal 05 May, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1627557","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":110459385,"identity":"ee616def-2d08-4cc2-a3ae-981baf81c8a5","order_by":0,"name":"Mislav Mikuš","email":"","orcid":"","institution":"University Hospital Center Zagreb","correspondingAuthor":false,"prefix":"","firstName":"Mislav","middleName":"","lastName":"Mikuš","suffix":""},{"id":110459386,"identity":"73212542-cd84-45c5-a7b5-04ec0cb009e4","order_by":1,"name":"Luka Matak","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACPjB5gIGBjYEZSDJIyBDUwsbAwNgA0cKWANLCQ7wWBgYeAzBJWIvY4ecPfpxhsOuT7vn86kaNBQ8D++GjG/BqkU4zbOy5wZDcJnN2m3XOMaDDeNLSbuDXkmDYwPOBIZlNInebcQ4bUIsEjxkBLekfG/+AteQ8M875R5SWHMNmnhsMdkAtzI9z24jTUjhb5oxEAptEmhlzbp8EDxshv/BLp2/4+OaYjb38jOTHn3O+1cnxsx8+hlcLFEgkNgBtlADbS4RyMLAHYuYPxKoeBaNgFIyCkQUAThRCXFx3MTYAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-9679-0198","institution":"General Hospital Zadar","correspondingAuthor":true,"prefix":"","firstName":"Luka","middleName":"","lastName":"Matak","suffix":""},{"id":110459387,"identity":"8d3a82ed-a6eb-4c49-a325-b0bd8b8eff0d","order_by":2,"name":"Goran Vujić","email":"","orcid":"","institution":"University Hospital Center Zagreb","correspondingAuthor":false,"prefix":"","firstName":"Goran","middleName":"","lastName":"Vujić","suffix":""},{"id":110459388,"identity":"6bc951f7-5b6d-4a4a-afa8-ed5e631dc24a","order_by":3,"name":"Bernarda Škegro","email":"","orcid":"","institution":"Sestre milosrdnice University Hospital Center","correspondingAuthor":false,"prefix":"","firstName":"Bernarda","middleName":"","lastName":"Škegro","suffix":""},{"id":110459389,"identity":"bfc03094-1e62-4b35-8164-cd5a6c85bee6","order_by":4,"name":"Ivan Škegro","email":"","orcid":"","institution":"University Hospital Center Zagreb","correspondingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Škegro","suffix":""},{"id":110459390,"identity":"b1d685ed-fee9-4f81-97b0-3f30e51cf2f9","order_by":5,"name":"Goran Augustin","email":"","orcid":"","institution":"University Hospital Center Zagreb","correspondingAuthor":false,"prefix":"","firstName":"Goran","middleName":"","lastName":"Augustin","suffix":""},{"id":110459391,"identity":"e4ad47b9-9f25-4a38-88a2-8641ef12f49d","order_by":6,"name":"Antonio Simone Lagana","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Antonio","middleName":"Simone","lastName":"Lagana","suffix":""},{"id":110459392,"identity":"67913428-f6dc-4264-9b5d-8b47ae42194e","order_by":7,"name":"Mario Ćorić","email":"","orcid":"","institution":"University Hospital Center Zagreb","correspondingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Ćorić","suffix":""}],"badges":[],"createdAt":"2022-05-05 22:44:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1627557/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1627557/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":22225909,"identity":"0f70f571-6e84-4455-a9fd-86ad071f709a","added_by":"auto","created_at":"2022-06-03 14:26:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":367108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1627557/v1/017a75b2-6b21-4474-a242-8c0ad81aa5fe.pdf"},{"id":22225904,"identity":"c6eda48e-6a2f-48e3-8fbe-9be0803937be","added_by":"auto","created_at":"2022-06-03 14:26:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13385,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-1627557/v1/b5f914fe257f524343f2c06b.docx"}],"financialInterests":"","formattedTitle":"The Short Form Endometriosis Health Profile Questionnaire (EHP-5): psychometric validity assessment of a Croatian version","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis presents one of the most common chronic gynecological conditions associated with cyclic pelvic pain, infertility or both [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It affects approximately 20% women hospitalized for pelvic pain and 50% of infertile women [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. There is a median delay of eight years from first symptom onset to an endometriosis diagnosis which causes a negative impact on the health-related quality of life (HRQoL) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The symptoms of endometriosis vary from mild to severe, but in most cases, women suffering from endometriosis are exposed to monthly intake of analgesics and generally have a poorer HRQoL. Nevertheless, the typical recurrent lower abdominal pain, possible side effects of treatment and lack of understanding by other people have significant negative impact on the personal and psychosocial status of patients\u0026rsquo; daily life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Given that numerous studies have confirmed an association between endometriosis and poor HRQoL, disease-specific instruments were needed to be developed to assess the aspects of quality of life affected by a specific disease or disorder [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Two decades ago, Jones and associates published the Endometriosis Health Profile-30 (EHP-30), one of the first standardized, disease specific instrument that evaluates the HRQoL in women with endometriosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although the EHP-30 questionnaire demonstrated high reliability and validity, it presents a lengthy measure [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In order to overcome time impracticality of EHP-30, same group of authors developed Endometriosis Health Profile-5 (EHP-5) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The EHP-5 questionnaire is proved to be a reliable and valid questionnaire with its special feature in clinical settings where an expeditious endometriosis health status measure is required [\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Croatian language, there is no validated questionnaire for evaluating the impact of endometriosis on quality of life. The present study was conducted with the aim to translate, adapt and validate the EHP-5 in Croatia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and study design\u003c/h2\u003e \u003cp\u003eA prospective observational study was conducted between July 2019 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Croatia. The study was approved by the Institutional Review Board and all participants gave their written consent before inclusion. This validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. Since our Department has almost 250 operative procedures annually which include ovarian, pelvic and/or extra pelvic endometriosis, we believe that this study will bring new tool not only for preoperative assessment but postoperative surveillance. The study has been previously registered and described at clinicaltrials.gov (Identifier: NCT04491305). To be eligible for participation, subjects are required to fulfill the following conditions: 1) females 18 years or older; 2) pathohistologically confirmed endometriosis after surgical treatment or indicated diagnostic laparoscopy; 3) fluent and literate in Croatian language; and 4) ability to independently understand the questions in the questionnaires. The following are the exclusion criteria: 1) neurological or psychiatric disorders (e.g. epilepsy, multiple sclerosis, depression, schizophrenia); 2) diagnosed vulvodynia and active vulvovaginitis; 3) pregnancy; 4) any form of prior conservative and/or surgical treatment for endometriosis; 5) missing data in any of the responses of the core part of questionnaire and 6) lack of informed consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaires\u003c/h2\u003e \u003cp\u003eEndometriosis Health Profile-5 (EHP-5) is a reliable and valid self-report questionnaire to assess health-related quality of life in endometriosis, reffering to the 4 previous weeks. The first part of the questionnaire consists 5 items about pain, control and powerlesness, emotions, social support and self image. The second part contains 6 items about work life, relation with children, sexual intercourse, medical profession, treatment and infertility. Items are scored from 0 (never) to 4 (always). Total score is then transformed on a scale with a range 0 to 100, with the latter indicating worst possible health status [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDepression, Anxiety and Stress Scale \u0026ndash; 21 (DASS-21) is a 21-item scale designed to assess emotional states of depression, anxiety and stress [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Each of those three subscales is based on 7 items, which are all scored from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). The total score for each one of the subscales is obtained by summing 7 items and then multiplying them by 2. A higher result indicate higher degree of emotional states of depression, anxiety and stress. The questionnaire has been translated and validated to Croatian and showed very good psychometric characteristics [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVisual Analogue Scale (VAS) is a self-report unidimensional measure of pain intensity. A 100 milimeters line represents the continuum from 0 mm (abscence of pain) to 100 mm (unbearable pain). Scores are expressed by measuring the line in millimeters, with results ranging from 0 to 100. The scale has been widely used in diverse adult populations, including those with women suffering from endometriosis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTranslation and culture adaptation\u003c/h2\u003e \u003cp\u003eThe translation to Croatian followed standardized procedure in which expert group, consisted of two gynecologists, a methodologist and an authorized translator, ensured cross-cultural equivalence of questionnaire. The initial translation was carried out independently by the two gynecologists, expert in field of gynecological surgery. They met and discussed discrepancies in translation and created a new, joint version of EHP-5 questionnaire afterwards. A new version was then sent to an authorized translator who did not have access to the original version. Finally, an expert group have reviewed all versions of the translations and concluded that there were no major discrepancies and to ensure that the final version of a translated questionnaire is culturally congruent. Preliminary pilot-testing was conducted on a small sample (N\u0026thinsp;=\u0026thinsp;20) in order to check if participants understood questions and were asked for suggestions on how to improve the questionnaire. Preliminary results showed that all items from EHP-5 were easily understandable and that the questionnaire was well received. The Croatian version of EHP-5 were then established (\u003cspan refid=\"Sec13\" class=\"InternalRef\"\u003eAppendix\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous data is presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while discrete data is presented as frequencies and percentage. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test-retest reliability was calculated using intraclass correlation coefficient (ICC). The t-test for independent samples was used to assess known-groups validity, a type of construct validity, where was explored the ability of the EHP-5 questionnaire to reflect differences between groups who are expected to differ due to their known characteristics. Concurrent validity, a type of criterion validity, was computed in order to assess similar domains between newly translated EHP-5 questionnaire and already known existing measures (VAS and DASS-21). Therefore, Spearman's correlation coefficients were calculated in order to examine the strength of the relationship between similar items from EHP-5 with VAS and DASS-21 subscales. Significance level was set as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Data analysis was perfomed using SPSS 23.0 (IBM Corp., Armonk, NY).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eSample characteristics\u003c/h2\u003e\n\u003cp\u003eDuring the study period, 150 consecutive women with surgically proven endometriosis were enrolled. Among them, 27 women did not fulfill inclusion criteria and 12 women refused to participate. Final analysis included 111 women who completed questionnaires at the initial visit (\u003cem\u003eT\u003c/em\u003e\u003csub\u003e\u003cem\u003e0\u003c/em\u003e\u003c/sub\u003e) and 81 of them completed questionnaires again two weeks after on a control visit or via e-mail (\u003cem\u003eT\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e). Baseline characteristics are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic and clinical data.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003emin \u0026ndash; max\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u0026ndash;52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e34.98\u0026thinsp;\u0026plusmn;\u0026thinsp;6.784\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBodyweight\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49\u0026ndash;105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e65.43\u0026thinsp;\u0026plusmn;\u0026thinsp;10.900\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.8\u0026ndash;39.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e23.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.411\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" width=\"100%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e64 (57.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e25 (22.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e17 (15.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e4 (3.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e1 (0.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCesarean delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e97 (87.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e12 (10.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e2 (1.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary school\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eHigh school\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eUniversity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e28 (25.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e37 (33.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e46 (41.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNO\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e12 (10.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e99 (89.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSingle\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDivorced\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e21 (18.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e80 (72.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e10 (9.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNO\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrior contraceptive use\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e79 (71.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e32 (28.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNO\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary sterility\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e78 (70.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e33 (29.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003erASM stage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e29 (26.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e59 (53.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e20 (18.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e3 (2.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNO\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDIE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e95 (85.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e16 (14.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eReliability\u003c/h2\u003e\n\u003cp\u003eAs seen from Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, both EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach\u0026rsquo;s Alpha coefficient (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.793 and \u0026alpha;\u0026thinsp;=\u0026thinsp;0.842, respectively). Furthermore, test-retest reliability was computed by the Intraclass Correlation Coefficient (ICC), with 81 patients completing EHP-5 on two time points: baseline and two weeks after. Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (0.896 and 0.936, respectively).\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable\u0026nbsp;2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCronbach's Alpha internal consistency and Intraclass Correlation Coefficient reliability\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of items\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCronbach's Alpha\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest-retest reliability ICC\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEHP-5 CORE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.793\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.896 (95% CI 0.859\u0026ndash;0.927)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEHP-5 MODULAR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.842\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.936 (95% CI 0.881\u0026ndash;0.972)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eConstruct validity\u003c/h2\u003e\n\u003cp\u003eKnown-groups validity was carried out to test the validity of EHP-5 (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). We hypothesized that women who report less pain with VAS scale and who are infertile will report lower quality of life measured by the EHP-5 questionnaire. The independent t-test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) on EHP-5 (M\u0026thinsp;=\u0026thinsp;50.63) compared with women who reported their pain 6 or less (M\u0026thinsp;=\u0026thinsp;26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereby infertile women had higher average result on EHP-5 (M\u0026thinsp;=\u0026thinsp;49.55) compared with fertile women (M\u0026thinsp;=\u0026thinsp;34.36).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ch2 class=\"colspec\" align=\"left\"\u003eConcurrent validity\u003c/h2\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003cp\u003eConcurrent validity was assessed by correlating VAS and DASS-21 subscales, which both have very good psychometric properties in Croatian, with EHP-5 core items (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). We found statistically significant high correlation between similar domains \u0026ndash; 1st item on EHP-5 questionnaire that measures pain with VAS scale (r\u0026thinsp;=\u0026thinsp;0.766, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, 3rd item (mood swings during the last 4 weeks because of endometriosis) moderately correlated with depressive and anxiety subscales from DASS-21 indicating that women who had more often mood swings have also reported more depressive and anxious symptoms (r\u0026thinsp;=\u0026thinsp;0.560 and r\u0026thinsp;=\u0026thinsp;0.486, respectively).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable\u0026nbsp;3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eConstruct validity \u0026ndash; known-groups comparisons\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEHP-5 M\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003et-statistic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePain VAS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;7 (N\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26.91\u0026thinsp;\u0026plusmn;\u0026thinsp;18.571\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e-6.598\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;7 (N\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e50.63\u0026thinsp;\u0026plusmn;\u0026thinsp;19.284\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfertility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e34.36\u0026thinsp;\u0026plusmn;\u0026thinsp;22.868\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e-3.884\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e49.55\u0026thinsp;\u0026plusmn;\u0026thinsp;16.834\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\n\u003cp\u003e\u003cstrong\u003eTable 4. Concurrent validity \u0026ndash; correlation coefficients between EHP-5 items, VAS and DASS-21 subscales\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" style=\"width: 1025px;\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 70px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"width: 75.7188px;\" align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 100.281px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003eVAS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003eDEPR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 101px;\" align=\"left\"\u003e\n\u003cp\u003eANX\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 102px;\" align=\"left\"\u003e\n\u003cp\u003eSTR\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.497\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.251\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.417\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.766\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.200\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.184\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.299\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.401\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.530\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.491\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.645\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.389\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.204\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.384\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.616\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.579\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.127\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.560\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.486\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.602\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.527\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.247\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.450\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.386\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.513\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.394\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.419\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.284\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.533\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003eVAS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.275\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003eDEPR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.566\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.686\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003eANX\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.687\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 70px;\" align=\"left\"\u003e\n\u003cp\u003eSTR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 75.7188px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 100.281px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 101px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 102px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 954px;\" colspan=\"10\"\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study provides validity and reliability evidence to support the use of the Croatian version of the EHP-5 in everyday monitoring and measuring HRQoL of women with endometriosis. Our findings, although with negligible distinctions, are principally consistent with only three other EHP-5 cross-cultural adaptations and psychometric evaluations published to date [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is important to emphasize that we have demonstrated very good internal consistency and test-retest reliability of both core and modular part of questionnaire. Moreover, our study signifies pain and infertility as the most detrimental factors on overall quality of life among Croatian women with endometriosis.\u003c/p\u003e \u003cp\u003eIn order to avoid a risk of spectrum bias, we have included consecutive patients with pathohistologically proven endometriosis. The rationale for not involving asymptomatic controls in this study was to display EHP-5 performance as true as possible. In the French version of EHP-5 psychometric evaluation, Fauconnier and associates have used purposeful sampling design from two different medical centres in order to have better EHP-5 discriminative validity analysis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although limitations are inevitable in creating the most favourable target population sample, methodological consensus is still lacking [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother debatable issue is optimal EHP-5 scoring method since there is no precise recommendation from original questionnaire developers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. We have adopted evaluation of the dimensional aspect of the EHP-5 separately for the core and the modular part which is consistent to the Turkish and Iranian study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In opposition to separate dimensional aspect evaluation, French EHP-5 version developers have merged all the ratings from core and modular part of questionnaire [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A similar scoring method was applied in retrospective study which have estimated impact of laparoscopic treatment of endometriosis on HRQoL [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regardless of implemented scoring method, all abovementioned studies, including ours, have found adequate internal consistency [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of internal consistency, our findings are nearly equivalent to Turkish study, showing very good Cronbach's Alpha coefficient of both core and modular part of EHP-5 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This similarity can be explained by comparable initial study setting, inclusion/exclusion criteria and final distribution of disease severity in analyzed sample. Excellent internal consistency (Cronbach α\u0026thinsp;=\u0026thinsp;0.92) reported by Fauconnier et al. should be interpreted with caution, suggesting that some questionnaire items may be redundant [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The evaluation of the core and modular part of questionnaires with 2-week test\u0026ndash;retest reliability was performed by Turkish authors using Pearson's product moment correlation coefficient, revealing very good consistence across repeated administration of questionnaire [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Their findings are consistent with ours although we have evaluated 2-week test\u0026ndash;retest reliability via ICC. Other two published EHP-5 validation studies did not assess test-retest reliability [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has demonstrated that pain and infertility had the highest possible negative impact on quality of life for patients with endometriosis which is consistent with findings of Turkish and Iranian authors [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, possible cultural differences and baseline characteristics of sample population determined different responding pattern in French validation study, emphasizing sexual intercourse as one of the most detrimental factors on overall quality of life among patients with endometriosis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, the Croatian version of the EHP-5 was successfully translated, adapted and validated so the questionnaire is now ready for use as a reliable tool for assessing patients with endometriosis in everyday clinical practice. We believe that this validation study will encourage more researches in field of endometriosis preoperative assessment and postoperative surveillance using EHP-5. This short and simple tool will certainly successfully replace current lack of biomedical markers in tracking the progression of endometriosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mislav Miku\u0026scaron;, Luka Matak, Goran Vujić, Bernarda \u0026Scaron;kegro and Ivan \u0026Scaron;kegro. The first draft of the manuscript was written by Mislav Miku\u0026scaron; and Mario Ćorić and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKennedy S, Bergqvist A, Chapron C, D\u0026rsquo;Hooghe T, Dunselman G, Greb R, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20(10):2698\u0026ndash;2704. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/humrep/dei135\u003c/span\u003e\u003cspan address=\"10.1093/humrep/dei135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchliep KC, Mumford SL, Peterson CM, Chen Z, Johnstone EB, Sharp HT, Buck Louis GM (2015) Pain typology and incident endometriosis. Hum Reprod 30(10):2427\u0026ndash;2438. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/humrep/dev147\u003c/span\u003e\u003cspan address=\"10.1093/humrep/dev147\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA (2018) Risk for and consequences of endometriosis: A critical epidemiologic review. 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Saudi J Anaesth 11(Suppl 1):S80\u0026ndash;S89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/sja.SJA_203_17\u003c/span\u003e\u003cspan address=\"10.4103/sja.SJA_203_17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-1627557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1627557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo translate, adapt and validate the Endometriosis Health Profile-5 (EHP-5) in Croatian population.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. A 150 consecutive patients with surgically proven endometriosis were enrolled. The translation to Croatian followed standardized procedure. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test-retest reliability was calculated using intraclass correlation coefficient (ICC). The t-test for independent samples was used to assess known-groups validity.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eBoth EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach’s Alpha coefficient (α=0.793 and α=0.842, respectively). Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (ICC=0.896 and 0.936, respectively). The independent t-test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p\u0026lt;0.001) on EHP-5 (M=50.63) compared with women who reported their pain 6 or less (M=26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p\u0026lt;0.001), whereby infertile women had higher average result on EHP-5 (M=49.55) compared with fertile women (M=34.36).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe Croatian version of the EHP-5 have very good psychometric characteristics and can be used as a reliable tool for assessing patients with endometriosis in everyday clinical practice.\u003c/p\u003e","manuscriptTitle":"The Short Form Endometriosis Health Profile Questionnaire (EHP-5): psychometric validity assessment of a Croatian version","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-03 14:26:00","doi":"10.21203/rs.3.rs-1627557/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2022-06-07T15:54:35+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-06-01T16:29:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-05-11T09:51:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2022-05-05T18:42:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c1940e82-9eb2-4619-af5f-03d38b5e01e3","owner":[],"postedDate":"June 3rd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-06-28T11:40:56+00:00","versionOfRecord":[],"versionCreatedAt":"2022-06-03 14:26:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1627557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1627557","identity":"rs-1627557","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}