Validation of the Wisconsin Upper Respiratory Symptom Survey-24, Chinese version

Validation of the Wisconsin Upper Respiratory Symptom Survey-24, Chinese 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 Validation of the Wisconsin Upper Respiratory Symptom Survey-24, Chinese version Yuanyuan Wang, Zehui He, Simin Chen, Yuntao Liu, Fang Li, Bruce Barrett, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.22729/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Feb, 2022 Read the published version in Annals of Medicine → Version 1 posted You are reading this latest preprint version Abstract Background The Wisconsin Upper Respiratory Symptom Survey (WURSS) is a validated English questionnaire to evaluate the severity of upper respiratory tract infections (URTIs). We aimed to develop a Chinese version of WURSS-24 (WURSS-24-C) and evaluate its reliability, validity and minimal important difference (MID). Methods The WURSS-24 was translated into Mandarin Chinese using the forward-backward translation procedure. People with Jackson-defined common cold symptoms within 48 hours of onset were recruited in Guangzhou, China, and followed for up to 14 days. The SF-8 (24 hours recall) assessing general mental and physical health was used as external comparator. Reliability, validity, and MID were evaluated. Results The WURSS-24-C was developed and found to be acceptable, relevant, and easy to complete in cognitive debriefing interviews. A total number of 300 participants (age 28.4±9.3, female 70%) were monitored for 2,500 person-days. Factor analysis: Exploratory factor analysis (EFA) suggested 4 domains, defined as activity and function, systemic symptoms, nasal symptoms, and throat symptoms. Confirmatory factor analysis (CFA) supported this 4-domain model with a Comparative Fit Index (CFI) of 0.93. Reliability assessment of the 4-domain-structure found Cronbach’s alphas of 0.943, 0.859, 0.882 and 0.849, respectively. Convergent validity indicator: The Pearson correlation coefficients between daily WURSS-24-C and the SF-8 were -0.780 and -0.721, for the SF-8 physical and mental health respectively. Estimates of MID for individual items varied from -0.41 to -1.14. Conclusion The WURSS-24-C is a reliable and valid questionnaire for assessing illness-specific quality-of-life health status in Chinese speaking patients with URTIs. Infectious Diseases WURSS Upper respiratory infection Reliability Validity Quality of life Common cold Validation Psychometrics Figures Figure 1 Figure 2 Figure 3 Background Upper respiratory tract infections (URTIs), including the common cold and influenza, are among the most common human illnesses [ 1 , 2 ]. Although generally mild and self-limited, these illnesses can lead to pneumonia and can even be life-threatening, especially in elderly persons and those with underlying disease, such as chronic obstructive pulmonary disease, heart failure and chronic kidney disease, etc [ 3 – 5 ]. In addition, URTIs lead to increases in inappropriate antibiotics use [ 6 – 7 ], hospitalizations and mortality [ 8 ], resulting in substantial economic burden. Those with URTIs usually have symptoms such as sore throat, rhinitis, rhinorrhea, cough and malaise, which are associated with poorer health-related quality of life (HRQoL) [ 2 ]. Although laboratory measures of URTI, like counts of white blood cells and identification of virus are sometimes useful, none of them correlate well with specific symptoms and functional impairments [ 9 ]. Proper assessment of both HRQoL and symptoms is therefore urgently required. The Wisconsin Upper Respiratory Symptom Survey (WURSS), developed by Barrett et al [ 10 , 11 ], is such an illness-specific questionnaire instrument assessing URTIs emphasizing patient-oriented outcomes. WURSS has different language versions including English, Spanish, French, German, Korean, etc., whose reliability and validity have been tested in previous studies [ 12 , 13 ]. WURSS-24 is a version aiming to assess influenza-like illness, and has been used for extensive assessment of patients with URTIs in clinical practice [ 14 , 15 ]. However, the lack of WURSS Chinese version limits its potential application in China. In the present study, we translated the WURSS-24, and evaluated the validity, reliability and MID of the Mandarin Chinese version in Chinese patients with URTIs. Methods The present study was designed as a prospective observational study. It was approved by the ethical committee of Guangdong provincial hospital of Chinese medicine, Guangzhou, China (GPHCM; B2016-090-02). Written informed consent was provided by all participants. Translation of the WURSS-24 A three-step linguistic validation procedure was employed. Forward translation Independent forward translations were performed by two bicultural native speakers of Chinese. One is a professional of clinical medicine, comprehending health care terminology and the content area of the construct of the instrument. Another is familiar with colloquial phrases, health care slang and jargon, idiomatic expressions, and emotional terms in common use. Then reconciliation of two forward translations was made by a third bilingual and bicultural independent translator regarding ambiguities and discrepancies of words, sentences and meanings. Back translation Following forward translation, a literal back translation was completed by two native speakers of American English, who have the same characteristics described above in forward translation. They were blind to the original version of the survey. The translation reconciliation was finished by a committee, including all the four bilinguals and a respiratory clinician. They compared the back-translated version with the source to highlight and investigate discrepancies between the source and the translation. After the proofing/formatting of the reconciled translation, the committee detected possible translation discrepancies between different language versions, and harmonized linguistic solutions across both languages. Cognitive debriefing interviews and finial review A group of 5 subjects were recruited in mainland China to evaluate alternative wording and to check understanding, interpretation and cultural relevance of the translation. In the cognitive debriefing, 5 participants were interviewed to comment on questionnaire items and instructions. All of them are native speakers residing in mainland China who were experiencing a common cold illness. The final revision of WURSS-24-C was adapted according to the review of cognitive debriefing results and reporting. This process involves comparing each subject’s interpretation of the translation with the source version to highlight discrepancies and adjust translations as needed; as well as, compiling and documenting the detailed accounts of each subject interview. Participants Participants with new-onset common cold were recruited from smartphone online application and in outpatient in Guangdong provincial hospital of Chinese medicine. This hospital has four hospital branches located in different districts of Guangzhou city, Guangdong province, South China. Participants were recruited at outpatient clinics, or by advertisement on WeChat, a widely used chatting app in China with function of messaging and social networking. Respondents were invited by research assistants to meet for screening and informed consent. Inclusion, exclusion and termination criteria Participants who satisfied the following criteria were included: (1) age 18 or older; (2) diagnosis of “common cold” or “influenza” by research physicians according to Jackson scale[ 16 , 17 ], with at least one symptom from the following cold symptoms (or synonyms): a) nasal discharge (runny nose), b) nasal obstruction (plugged nose, stopped up nose, stuffiness), c) sneezing ,or d) sore throat (scratchy throat). (3) With onset of symptoms within 48 hours. (4) Physically and mentally prepared and willing to participate. The exclusion criteria were: (1) Any symptoms likely due to allergy, or other non-URTI cause, such as asthma, allergic rhinitis, etc.; or (2) those patients who require hospitalization; or (3) those with previous history of chronic respiratory diseases, such as chronic obstructive pulmonary disease, bronchiectasis, sinusitis recurring more than twice per year, anatomical nasal obstruction or deformity, otitis, and exudative pharyngitis. The observation of the participants was terminated if one of the following criteria was fulfilled: (1) The disease of common cold progressed to lower respiratory tract infection, such as bronchitis or pneumonia, etc., confirmed by chest X-ray or physical examination by physicians. (2) The condition of the common cold was getting worse or developing into complications that requires hospitalization. (3) The course of the illness exceeded 14 days. Sample size According to one guideline for cross-cultural health care research [ 18 ], the sample size should be at least 10 subjects for each item of the instrument scale and for item analysis and exploratory factor analysis. Therefore a sample of at least 240(= 24 × 10) participants were considered the minimum required. Measures Participants were asked to fill in the WURSS-24-C every day until they answered “Not sick” two days in a row to the question, “How sick do you feel today?”, otherwise to a maximum of 14 days. Summary scores for WURSS-24-C were calculated by summing scores of individual item scores, excluding the first and last items, which had categorically different reference domains, and were analyzed separately. Another health-related questionnaire, the SF-8 (24 hours recall)[ 19 ] was simultaneously applied to the study population along with the WURSS-24-C daily. The SF-8 is a short form 24-hour recall version of the widely used SF-36[ 20 ], and yields separate summary scores for physical and mental health, calculated using algorithms and scoring software provided by Optumlnsight Life Sciences, Inc (QualityMetric Health Outcomes(tm) Scoring Software 4.5). Medicine was permitted during the study. Protocol adherence was supported by regular message contact. WURSS-24-C and SF-8 were returned at an in-person exit interview or mailed to the researchers after the cold ended. Statistical analysis Data were double entered, with resolution of discrepancies by comparison to paper questionnaires. Missing data, disallowed values, and outliers were hand-checked, and corrected if appropriate. Data were presented in frequencies for categorical variables and means (Standard Deviations, SD) for continuous variables if normal distribution was confirmed. Exploratory factor analysis (EFA) was used to extract the factor structure using the principal components analysis method [ 21 ]. The data of Day 3 was used for this analysis based on the usual duration and recovery process of the common cold. Factorial structures were assessed for 22 items (excluding the first and last items measuring global severity and global change) using principal component analysis. Confirmatory factor analysis (CFA) was followed to assess the model fit, according to the method of Mulaik [ 22 ]. Several goodness-of-fit indices were reported including goodness of fit index (GFI), adjusted goodness of fit index (AGFI), normed fit index (NFI), comparative fit index (CFI), standardized root mean square residual (SRMR) and root mean square error of approximation (RMSEA). Reliability was chosen as the measure of internal consistency, using the data of Day 3 with the factor structure conducted by EFA, and estimated by using Cronbach's alpha coefficient. Convergent validity was evaluated by testing correlation between WURSS-24-C and SF-8. Correlations was calculated using Pearson’s correlation coefficients. Minimal important different (MID) was considered as day-to-day change for those indicating minimal improvement. Using methods developed by Guyatt et al. [ 23 , 24 ], MID was defined as the average amount of instrument-assessed change for all subjects who rated themselves as “a litter better” or “somewhat better”. Statistical analysis was performed using SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and LISREL 8.8 (Scientific Software International, Chicago, IL, USA) Results Translation of WURSS-24 and cognitive debriefing interviews No major difficulties were experienced during the forward translation process; minor discrepancies were harmonized after discussion by the committee. After comparison of the back-translated version with the original English version, there was no significant differences in linguistic and conceptual contents. We then adapted a reconciled translation across both languages and used it in the cognitive debriefing interviews. There were 5 subjects (3 female and 2 males, aging from 21–69) interviewed who reported no difficulty in understanding the items or answering the questions. The final version was produced after iterative refinement, reconciliation, and proof-reading ( Supplementary item 1 ). Baseline characteristics and descriptive data A total of 315 participants were initially enrolled from May 2018 to February 2019. Eleven participants did not return their questionnaires, 4 participants’ information were incomplete, and therefore 300 were included in the analysis, for 2,500 person-days covered by this study. Table 1 described sociodemographic and clinical characteristics for the study participants. The mean age of participants was 28.4 years (SD = 9.3) and 70% of participants were women. Almost all of the participants (99.3%) were Han population, some 76% were at least high school education level, and 89% did not smoke. Most of the participants (96.3%) were healthy people without comorbidities. The mean time from first symptom to enrollment were 20.8 hours (SD = 14.6). A majority of 181 (60.3%) had body temperature that was normal at enrollment; 77 (25.7%) had low fever (37.3 ~ 38℃), 35 (11.7%) had temperature of 38.1 ~ 39℃, and 7 (2.3%) were higher than 39℃. 140 out of 300 participants had not taken medicine before enrollment, others had taken Chinese medicine (115), antipyretic analgesics (31), antivirals (27), and antihistamine (3). Table 1 Demographics of the study participants who had common cold during May 2018 to February 2019 visited Guangdong provincial hospital of Chinese medicine, China Variable Value Number of participants 300 Age, years Mean (SD) 28.4(9.3) Gender, no./total (%) Female 210(70) Ethnicity, no./total (%) Han 298(99.3) Education, highest, no./total (%) High school or less educated 76(25.4) College degree 121(40.3) Graduate degree 103(34.3) Tobacco use, no./total (%) Current 31(10.3) Past 2(0.7) Nonsmoker 267(89) Comorbidities/Disease history, no./total (%) No 289(96.3) Yes 11(3.7) 3 pharyngitis, 2 anemia, 1 chronic bronchitis, 1 hypertension 1 hypothyroidism, 1 optic neuritis, 1 calculus of kidney and 1 appendicitis Time from first symptom to enrollment (hours) Mean (SD) 20.8(14.6) Inter-quartile range 24–30 Maximum body temperature before enrollment Mean (SD) 37.3(0.7) ≤ 37.2℃, no./total (%) 181(60.3) 37.3 ~ 38℃, no./total (%) 77(25.7) 38.1 ~ 39℃, no./total (%) 35(11.7) ༞39℃, no./total (%) 7(2.3) Having taken medicine before enrollment, no . No medicine 140 Chinese medicine 115 Antipyretic analgesics 31 Antivirals 27 Antihistamine 3 Other 6 The total WURSS-24-C scores of all participants from the 1st to the 14th day are shown in Table 2 . All of the participants filled in the questionnaire for at least 3 days. A total of 27(9%) participants continued to report being sick at the end of their 14-day monitoring period. The symptoms and functions improved over time. The mean score ranged from 54.11 (SD = 30.28) in the first day to 7.69 (SD = 10.33) in the 14th day. Table 2 The WURSS-24-C item and summary descriptive statistics Day N Mean (SD) Min Max 1 300 54.11(30.28) 4 137 2 300 49.82(27.67) 0 130 3 300 41.74(27.39) 0 108 4 298 30.89(27.14) 0 125 5 290 21.00(22.05) 0 123 6 264 13.78(18.35) 0 112 7 223 10.16(15.67) 0 82 8 168 8.79(14.55) 0 87 9 119 8.41(14.23) 0 71 10 81 8.02(12.73) 0 66 11 57 7.70(12.83) 0 66 12 41 9.59(14.47) 0 66 13 32 10.63(14.03) 0 45 14 27 7.96(10.33) 0 30 Factor analysis The scree plot of the EFA indicated that the 4-domain structure was accepted which explained 68.25% of the total square deviation. The 4 domains were defined as activity and function, systemic symptom, nasal symptom, and throat symptom. The factor loading coefficients of individual items in each domain are showed in Table 3 , only those with promax rotation factor loaded greater than 0.4 were accepted. All of the items loaded onto the 4-domain structure. Table 3 The factor loading of WURSS-24-C items Item Symptom 1 2 3 4 2 Runny nose 0.867 3 Plugged nose 0.759 4 Sneezing 0.812 5 Sore throat 0.721 6 Scratchy throat 0.798 7 Cough 0.686 8 Hoarseness 0.654 9 Head congestion 0.563 10 Chest congestion 0.552 11 Feeling tired 0.505 0.586 12 Headache 0.786 13 Body aches 0.812 14 Fever 0.687 15 Think clearly 0.693 16 Sleep well 0.636 17 Breath easily 0.426 0.664 18 Walk/Climb stairs 0.828 19 Accomplish daily activities 0.868 20 Work outside the home 0.864 21 Work inside the home 0.839 22 Interact with others 0.845 23 Live your personal life 0.843 Definition of the 4 domains Activity and Systemic Nasal Throat function symptom symptom symptom Cronbach’s α 0.943 0.859 0.882 0.849 CFA was performed to evaluate the 4-factor structure validity of the WURSS-24-C. The goodness-of-fit indices and the structure graphs are shown in Fig. 1 . The CFI was 0.94, RMSEA was 0.14, and SRMR was 0.11, which suggest acceptable model fit in this four factorial model (Fig. 1 ). Reliability After establishing the 4-domain-structure, we tested the Cronbach’s alpha for internal reliability. Cronbach alpha coefficients were 0.943, 0.859, 0.882 and 0.849 for activity and function, systemic symptom, nasal symptom, and throat symptom respectively (Table 3 ). In addition, we tested the internal reliability of the whole questionnaire (based on the data of Day 3), of which the Cronbach’s alpha was 0.940. Convergent validity Figure 2 showed daily change of illness severity over time as measured by the WURSS-24-C and the SF-8(both physical and mental health scores). The number of participants decreased as their symptoms decreased, from N = 300 on Day 1 to N = 27 on Day 14. As measured by the SF-8, the trend of general physical health and mental health was similar during the illness process. WURSS-24-C had similar change with the SF-8. All changes were more rapid in the first 7 days than the later periods. Convergent validity was respectively evaluated by the scores of SF-8 physical/mental and the total scores of the WURSS-24-C. The Pearson correlation coefficient of the WURSS-24-C yielded − 0.780 for SF-8 physical health, and − 0.721 for SF-8 mental health (Fig. 3 ). Frequency, Severity and MID Table 4 displayed the pattern of experienced symptoms and functional limitations in the first three days. The most reported items were Feeling tired (98%) and Sleep well (91.7%), followed by nasal symptoms: Plugged nose (87.7%); affected abilities: Think clearly (86.3%); and throat symptoms: Sore throat (85.7%). The most severe symptom was Plugged nose with a score of 3.50, followed by Feeling tired (3.37), Sore throat (3.34) and Runny nose (3.31). MID was presented item-by-item for the WURSS-24-C, ranged from − 0.41( Chest congestion ) to -1.14 ( How sick ). Table 4 Frequency, severity and minimal important difference of WURSS-24 Items Item Symptom Frequency% Severity MID 1 How sick 100.0 4.11(1.20) -1.14 2 Runny nose 85.0 3.31(1.57) -0.88 3 Plugged nose 87.7 3.50(1.58) -0.95 4 Sneezing 84.3 3.10(1.54) -0.91 5 Sore throat 85.7 3.34(1.57) -0.95 6 Scratchy throat 83.3 2.84(1.54) -0.73 7 Cough 82.7 3.18(1.68) -0.67 8 Hoarseness 75.3 2.81(1.67) -0.74 9 Head congestion 83.7 2.80(1.68) -0.75 10 Chest congestion 59.0 2.03(1.57) -0.41 11 Feeling tired 98.0 3.37(1.56) -1.06 12 Headache 83.7 2.70(1.71) -0.73 13 Body aches 68.0 2.36(1.48) -0.61 14 Fever 60.7 2.19(1.40) -0.58 15 Think clearly 86.3 2.54(1.42) -0.76 16 Sleep well 91.7 2.99(1.51) -0.93 17 Breathe easily 84.0 3.10(1.65) -0.83 18 Walk/Climb stairs 84.3 2.49(1.52) -0.73 19 Accomplish daily activities 81.0 2.24(1.41) -0.67 20 Work outside the home 81.7 2.60(1.57) -0.73 21 Work inside the home 78.3 2.22(1.44) -0.61 22 Interact with others 79.3 2.40(1.45) -0.67 23 Live your personal life 77.7 2.29(1.32) -0.63 Discussion The current study confirmed that the Chinese version of WURSS-24-C demonstrated highly acceptable reliability and validity, similar to that found during validation studies of the original English language instrument [ 10 , 11 ]. Exploratory and confirmatory procedures was used to assess item/domain structure of the WURSS-24-C. This version contained four domains, which was different from the original WURSS-21[ 11 ] with three domains (activity and function, nasal symptom and throat symptom). In the WURSS-21 study, the following items Head congestion , Chest congestion , Feeling tired was in the nasal symptom domain, which might not be suitable. In the WURSS-24-C, these items were included in the new domain defined as Systemic symptoms, which also contained the items for assessment of influenza-like illness, Headache , Body aches and Fever (Fig. 1 ). CFA then further indicated that individual items of the WURSS-24-C, agreed well with this 4-dimensional structure model, as fit indices met criteria suggested by Hu and Bentler [ 25 ]. As a measure of the reliability of a scale, Cronbach alpha has been widely used since it was developed by Lee Cronbach in 1951[ 26 ]. According to Tavakol [ 27 ] and Devellis [ 28 ], the alpha values of 0.8 to 0.9 are excellent, but if a coefficient alpha greater than 0.9, it may suggest redundancies and show that the test length should be shortened. We tested the 4 domains of the WURSS-24-C, and the Cronbach alpha perfectly ranges from 0.849 to 0.882, except for the “activity and function”, which is up to 0.943. Compared with the original version of WURSS-21, for which the value is 0.961[ 11 ], we believe this 9-item dimension might be further reduced or adjusted. Then we tested the reliability of the whole WURSS-24-C and found the value was over 0.90. This result suggested that the WURSS-24 might allow leeway for a shorter version, such as the WURSS-11developed by English-language WURSS researchers [ 29 ]. Convergent validity was evaluated by the Pearson correlation coefficient. According to Colton [ 24 ], correlations ranging from 0.50 to 0.75 are moderate to good; and values greater than 0.75 are considered good to excellent. The WURSS-24-C yielded correlation coefficient was over 0.75 when compared with SF-8 physical. The association was stronger than that between the WURSS-24-C with SF-8 mental, for which the coefficient was − 0.721. The results were similar to that of the original version of the WURSS [ 11 ]. Minimal important difference (MID) refers to the smallest difference in a score that is recognized as worthwhile or important [ 23 ]. For clinicians, MID could be used to determine meaningful clinical change in patients. Our results estimated MID for individual items of the WURSS-24-C, which could be considered clinically relevant in patients with URTIs. Compared with the data of the original WURSS-21[ 11 ], the instruments yielded similar MIDs indices, which indicated the WURSS-24-C could be sensitively reflected changes in items. Strengths of this study include its large sample size, regional representativeness, careful translation of WURSS-24-C using three-step linguistic validation procedure, and high quality statistical analysis. Our study should, nonetheless, be interpreted along with several limitations. First, all participants were from the southern part of China with narrow age range, limiting generalizability. Second, the test-retest reliability and other reliability and validity assessments were not evaluated in this study. Therefore, participants from a broader range of age groups from other parts of China and additional instruments as for the evaluation might be needed in future studies. Conclusion In summary, the 24-item Chinese version of WURSS (WURSS-24-C) is a reliable and valid instrument applicable to Chinese URTIs patients for assessment of HRQoL. The WURSS-24-C could thus be incorporated into future research. Abbreviations WURSS: the Wisconsin Upper Respiratory Symptom Survey; WURSS-24-C: the Chinese version of Wisconsin Upper Respiratory Symptom Survey with 24 items; URTIs: upper respiratory tract infections; HRQoL: health-related quality of life; SF-8: the 8-item short-form; MID: minimal important difference; EFA: exploratory factor analysis; CFA: confirmatory factor analysis; CFI: comparative Fit Index; GFI: goodness of fit index; AGFI: adjusted goodness of fit index; NFI: normed fit index; SRMR: standardized root mean square residual; SRMR: root mean square error of approximation; SD: standard deviations; NSAIDs: non-steroidal anti-inflammatory drugs. Declarations Ethics approval and consent to participate This study was approved by the ethical committees of Guangdong provincial hospital of traditional Chinese medicine, Guangzhou, China (GPHCM; B2016-090-02). Written informed consent was provided by all participants. Consent for publication Not applicable. Availability of data and materials The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request and approved by Guangdong provincial hospital of Chinese medicine. Competing interests The authors declare that they have no competing interests. Funding The study was funded by China National Science and Technology Major Project, NO:2017ZX10305501-006; Guangdong Provincial Key Laboratory of TCM Research on Emergency, NO: 2017B030314176; Evidence-based Capacity Building Project of Traditional Chinese Medicine, NO: 2019XZZX-LG003; and the Specific Research Fund for TCM Science and Technology of Guangdong Provincial Hospital of Chinese Medicine, NO YK2013B2N04. GS acknowledges partial support by the Science and Technology Research Fund from Guangdong provincial hospital of Chinese medicine, China (No. YN2018QL08). The funding body was not involved in the design, conduct, data collection, analysis, interpretation and writing of this study. Authors’ contributions YW contributed to the design, supervised data collection and analysis, and wrote the manuscript. ZH contributed to the design, conducted statistical analysis, and contributed to the manuscript. SC conducted data collection, entered, cleaned and analyzed data, and contributed to the manuscript. YL contributed to the design, coordinated data collection, and contributed to the manuscript. FL coordinated data collection and contributed to the manuscript.BB contributed to the research idea and give advice for statistical analysis and results interpretation, and helped write and revise the manuscript. CSL was responsible for supervision or mentorship. ZZ contributed to the design, conducted statistical analysis, and contributed to the manuscript.GS contributed to the design, supervised data collection and analysis, and contributed to the manuscript. All authors contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Acknowledgements The authors thank the Wisconsin Alumni Research Foundation, University of Wisconsin-Madison, for the permission to use the WURSS. References Mylotte JM. Epidemiology of Respiratory Infection. Pathy’s Princ Pract Geriatr Med Fifth Ed 2012; 1 :549– 54. doi:10.1002/9781119952930.ch46 Allan GM, Arroll B. Prevention and treatment of the common cold: making sense of the evidence. Can Med Assoc J 2014; 186 :190–9. doi:10.1503/cmaj.121442 Hurst JR, Donaldson GC, Wilkinson TMA, et al. 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Evaluating the Use of Exploratory Factor Analysis in Developmental Disability Psychological Research. J Autism Dev Disord 2010; 40 :8–20. doi:10.1007/s10803-009-0816-2 Mulaik SA. Confirmatory Factor Analysis. In: Handbook of Multivariate Experimental Psychology. Boston, MA: : Springer US 1988. 259–88. doi:10.1007/978-1-4613-0893-5_7 Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10 :407–15. doi:10.1016/0197-2456(89)90005-6 Guyatt GH, Walter S NG. Measuring change over time: Assessing the usefulness of evaluative instruments. J Chron Dis 1987; 40 :171–8. doi:10.1136/bmj.1.4644.68 Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model 1999; 6 :1–55. doi:10.1080/10705519909540118 Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297–334. doi:10.1007/BF02310555 Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ 2011; 2 :53–5. doi:10.5116/ijme.4dfb.8dfd Vogelzang JL. Health Measurement Scales: A Practical Guide to Their Development and Use. J Nutr Educ Behav 2015; 47 :484.e1. doi:10.1016/j.jneb.2015.03.007 Obasi CN, Brown R, Barrett B. Item reduction of the Wisconsin Upper Respiratory Symptom Survey (WURSS-21) leads to the WURSS-11. Qual Life Res 2014; 23 :1293–8. doi:10.1007/s11136-013-0561-z Supplementary Files YuanyuanWangGuobinSuetal.supplemental.pdf Cite Share Download PDF Status: Published Journal Publication published 23 Feb, 2022 Read the published version in Annals of Medicine → Version 1 posted 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. 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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-13303","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":331884,"identity":"693f126b-bc05-48c1-bbef-c0c4c374c36c","order_by":1,"name":"Yuanyuan Wang","email":"","orcid":"https://orcid.org/0000-0003-2145-0804","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Wang","suffix":""},{"id":331885,"identity":"fd474b1b-a563-4432-846c-4aabcca98df0","order_by":2,"name":"Zehui He","email":"","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zehui","middleName":"","lastName":"He","suffix":""},{"id":331886,"identity":"9d3213fa-25e8-4f3c-9dec-1c00dd09fabf","order_by":3,"name":"Simin Chen","email":"","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Simin","middleName":"","lastName":"Chen","suffix":""},{"id":331887,"identity":"2154a6b9-ba6d-4f7f-afa7-790b70663869","order_by":4,"name":"Yuntao Liu","email":"","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuntao","middleName":"","lastName":"Liu","suffix":""},{"id":331888,"identity":"6d3ba1d2-8cd5-47d6-aa8b-261788829156","order_by":5,"name":"Fang Li","email":"","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Li","suffix":""},{"id":331889,"identity":"be475de6-97af-4ec3-a9b7-005ef22b2cc0","order_by":6,"name":"Bruce Barrett","email":"","orcid":"","institution":"University of Wisconsin Madison","correspondingAuthor":false,"prefix":"","firstName":"Bruce","middleName":"","lastName":"Barrett","suffix":""},{"id":331890,"identity":"ff870c50-5e12-4f33-bd76-81caab9c19f4","order_by":7,"name":"Cecilia Stålsby Lundborg","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"Stålsby","lastName":"Lundborg","suffix":""},{"id":331891,"identity":"5e9deedf-ded6-4ec1-a0d4-8aa4b64a6cf7","order_by":8,"name":"Zhongde Zhang","email":"","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhongde","middleName":"","lastName":"Zhang","suffix":""},{"id":331892,"identity":"b06caca2-0717-4b71-91a4-49a1d277d723","order_by":9,"name":"Guobin Su","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYHACNoYEEMXexnCARC08x0jRAgYSaUSql49IPvbg4Q4Ge4ObzxIPMPyxIazF8EZaukHiGYbEDbfTDhxgbCPCKsMZOWYSiW0MCQa30xsOMDYcJl4L0GHHG4AO+0+EXyQgWhg33GA7cICB7QBhLQY8z4B+aZNInHkmLeFAYlsyEba0Jx97+LPNxp7v+DHjDx/+2BFhC8QlEhBeAmENQFsaiFE1CkbBKBgFIxsAAGjrO8onjl/WAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-5073-9848","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Guobin","middleName":"","lastName":"Su","suffix":""}],"badges":[],"createdAt":"2020-02-04 16:04:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.22729/v1","doiUrl":"https://doi.org/10.21203/rs.2.22729/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1080/07853890.2022.2043559","type":"published","date":"2022-02-23T07:34:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":455084,"identity":"07be5d0f-9555-4fed-a4f1-7ad849034e66","added_by":"auto","created_at":"2020-02-05 23:00:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":93406,"visible":true,"origin":"","legend":"The 4-domains model fit confirmatory factor analysis (CFA) for the WURSS-24-C. Chi-Square=1673.47, df=203, P-value=0.0000. GFI: Goodness of Fit Index; AGFI: Adjusted Goodness of Fit Index; NNFI: Non-Normed Fit Index; CFI: Comparative Fit Index; SRMR: Standardized Root Mean Square Residual; RMSEA: Root Mean Square Error of Approximation.","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/1b0c5a1a-12c8-4238-b42f-47cc914efcea/v1/fig1.png"},{"id":455085,"identity":"ef1d2183-8a2f-480a-9d6d-1ea3f3a0389e","added_by":"auto","created_at":"2020-02-05 23:00:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":157447,"visible":true,"origin":"","legend":"The average daily score of WURSS-24-C and SF-8 from Day 1 to Day 14. Sample size diminishes as participants’ colds resolve, from N=300 on Day 1 to N=27 on Day 14.\n\nThe center of the notched boxes is the median summed score for that day. The top of the notched boxes indicates the 25% and 75% percentiles, respectively. The notches portray the median ±1.57 (interquartile range=IQR) / N-2 and thus can be compared to assess difference at the P = 0.05 level of significance. The ends of the vertical lines indicate the last actual data point within 1.5 (IQR) from the 25%ile and 75%ile. The symbols above and below these lines are actual outlying data points.","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/1b0c5a1a-12c8-4238-b42f-47cc914efcea/v1/fig2.png"},{"id":455086,"identity":"62e03393-1c7c-43a7-bbf9-e9db9943efcd","added_by":"auto","created_at":"2020-02-05 23:00:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":309497,"visible":true,"origin":"","legend":"The scatterplot correlations of the WURSS-24-C with SF-8. Data shown represent Day 2,3 and 4, where sample size was N=300, N=300, and N=298, respectively.\n\nThe WURSS-24 correlated more statistically with physical than mental health, yielding Pearson correlation coefficient of -0.780 for SF-8 physical health, and -0.721 for SF-8 mental health.","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/1b0c5a1a-12c8-4238-b42f-47cc914efcea/v1/fig3.png"},{"id":18554736,"identity":"bfe8b724-1458-420c-865d-7e1b0baf8647","added_by":"auto","created_at":"2022-02-24 07:34:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1288273,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-13303/v1/ff97c7b5-9aa4-47a5-b212-f7b1247f7871.pdf"},{"id":455083,"identity":"b1efa70d-15c5-4b5b-b90f-e3689d13e376","added_by":"auto","created_at":"2020-02-05 23:00:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":757099,"visible":true,"origin":"","legend":"","description":"","filename":"YuanyuanWangGuobinSuetal.supplemental.pdf","url":"https://assets-eu.researchsquare.com/files/1b0c5a1a-12c8-4238-b42f-47cc914efcea/v1/Yuanyuan Wang, Guobin Su, et al. supplemental.pdf"}],"financialInterests":"","formattedTitle":"Validation of the Wisconsin Upper Respiratory Symptom Survey-24, Chinese version","fulltext":[{"header":"Background","content":" \u003cp\u003eUpper respiratory tract infections (URTIs), including the common cold and influenza, are among the most common human illnesses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although generally mild and self-limited, these illnesses can lead to pneumonia and can even be life-threatening, especially in elderly persons and those with underlying disease, such as chronic obstructive pulmonary disease, heart failure and chronic kidney disease, etc [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In addition, URTIs lead to increases in inappropriate antibiotics use [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], hospitalizations and mortality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], resulting in substantial economic burden.\u003c/p\u003e \u003cp\u003eThose with URTIs usually have symptoms such as sore throat, rhinitis, rhinorrhea, cough and malaise, which are associated with poorer health-related quality of life (HRQoL) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although laboratory measures of URTI, like counts of white blood cells and identification of virus are sometimes useful, none of them correlate well with specific symptoms and functional impairments [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Proper assessment of both HRQoL and symptoms is therefore urgently required.\u003c/p\u003e \u003cp\u003eThe Wisconsin Upper Respiratory Symptom Survey (WURSS), developed by Barrett et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], is such an illness-specific questionnaire instrument assessing URTIs emphasizing patient-oriented outcomes. WURSS has different language versions including English, Spanish, French, German, Korean, etc., whose reliability and validity have been tested in previous studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. WURSS-24 is a version aiming to assess influenza-like illness, and has been used for extensive assessment of patients with URTIs in clinical practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the lack of WURSS Chinese version limits its potential application in China. In the present study, we translated the WURSS-24, and evaluated the validity, reliability and MID of the Mandarin Chinese version in Chinese patients with URTIs.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eThe present study was designed as a prospective observational study. It was approved by the ethical committee of Guangdong provincial hospital of Chinese medicine, Guangzhou, China (GPHCM; B2016-090-02). Written informed consent was provided by all participants.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTranslation of the WURSS-24\u003c/h2\u003e \u003cp\u003eA three-step linguistic validation procedure was employed.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eForward translation\u003c/h2\u003e \u003cp\u003eIndependent forward translations were performed by two bicultural native speakers of Chinese. One is a professional of clinical medicine, comprehending health care terminology and the content area of the construct of the instrument. Another is familiar with colloquial phrases, health care slang and jargon, idiomatic expressions, and emotional terms in common use. Then reconciliation of two forward translations was made by a third bilingual and bicultural independent translator regarding ambiguities and discrepancies of words, sentences and meanings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eBack translation\u003c/h2\u003e \u003cp\u003eFollowing forward translation, a literal back translation was completed by two native speakers of American English, who have the same characteristics described above in forward translation. They were blind to the original version of the survey.\u003c/p\u003e \u003cp\u003eThe translation reconciliation was finished by a committee, including all the four bilinguals and a respiratory clinician. They compared the back-translated version with the source to highlight and investigate discrepancies between the source and the translation. After the proofing/formatting of the reconciled translation, the committee detected possible translation discrepancies between different language versions, and harmonized linguistic solutions across both languages.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eCognitive debriefing interviews and finial review\u003c/h2\u003e \u003cp\u003eA group of 5 subjects were recruited in mainland China to evaluate alternative wording and to check understanding, interpretation and cultural relevance of the translation. In the cognitive debriefing, 5 participants were interviewed to comment on questionnaire items and instructions. All of them are native speakers residing in mainland China who were experiencing a common cold illness.\u003c/p\u003e \u003cp\u003eThe final revision of WURSS-24-C was adapted according to the review of cognitive debriefing results and reporting. This process involves comparing each subject\u0026rsquo;s interpretation of\u003c/p\u003e \u003cp\u003ethe translation with the source version to highlight discrepancies and adjust translations as needed; as well as, compiling and documenting the detailed accounts of each subject interview.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants with new-onset common cold were recruited from smartphone online application and in outpatient in Guangdong provincial hospital of Chinese medicine. This hospital has four hospital branches located in different districts of Guangzhou city, Guangdong province, South China. Participants were recruited at outpatient clinics, or by advertisement on WeChat, a widely used chatting app in China with function of messaging and social networking. Respondents were invited by research assistants to meet for screening and informed consent.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eInclusion, exclusion and termination criteria\u003c/h2\u003e \u003cp\u003eParticipants who satisfied the following criteria were included: (1) age 18 or older; (2) diagnosis of \u0026ldquo;common cold\u0026rdquo; or \u0026ldquo;influenza\u0026rdquo; by research physicians according to Jackson scale[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], with at least one symptom from the following cold symptoms (or synonyms): a) nasal discharge (runny nose), b) nasal obstruction (plugged nose, stopped up nose, stuffiness), c) sneezing ,or d) sore throat (scratchy throat). (3) With onset of symptoms within 48 hours. (4) Physically and mentally prepared and willing to participate.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were: (1) Any symptoms likely due to allergy, or other non-URTI cause, such as asthma, allergic rhinitis, etc.; or (2) those patients who require hospitalization; or (3) those with previous history of chronic respiratory diseases, such as chronic obstructive pulmonary disease, bronchiectasis, sinusitis recurring more than twice per year, anatomical nasal obstruction or deformity, otitis, and exudative pharyngitis.\u003c/p\u003e \u003cp\u003eThe observation of the participants was terminated if one of the following criteria was fulfilled: (1) The disease of common cold progressed to lower respiratory tract infection, such as bronchitis or pneumonia, etc., confirmed by chest X-ray or physical examination by physicians. (2) The condition of the common cold was getting worse or developing into complications that requires hospitalization. (3) The course of the illness exceeded 14 days.\u003c/p\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eAccording to one guideline for cross-cultural health care research [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the sample size should be at least 10 subjects for each item of the instrument scale and for item analysis and exploratory factor analysis. Therefore a sample of at least 240(=\u0026thinsp;24\u0026thinsp;\u0026times;\u0026thinsp;10) participants were considered the minimum required.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section4\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eParticipants were asked to fill in the WURSS-24-C every day until they answered \u0026ldquo;Not sick\u0026rdquo; two days in a row to the question, \u0026ldquo;How sick do you feel today?\u0026rdquo;, otherwise to a maximum of 14 days. Summary scores for WURSS-24-C were calculated by summing scores of individual item scores, excluding the first and last items, which had categorically different reference domains, and were analyzed separately. Another health-related questionnaire, the SF-8 (24 hours recall)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] was simultaneously applied to the study population along with the WURSS-24-C daily. The SF-8 is a short form 24-hour recall version of the widely used SF-36[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and yields separate summary scores for physical and mental health, calculated using algorithms and scoring software provided by Optumlnsight Life Sciences, Inc (QualityMetric Health Outcomes(tm) Scoring Software 4.5).\u003c/p\u003e \u003cp\u003eMedicine was permitted during the study. Protocol adherence was supported by regular message contact. WURSS-24-C and SF-8 were returned at an in-person exit interview or mailed to the researchers after the cold ended.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were double entered, with resolution of discrepancies by comparison to paper questionnaires. Missing data, disallowed values, and outliers were hand-checked, and corrected if appropriate. Data were presented in frequencies for categorical variables and means (Standard Deviations, SD) for continuous variables if normal distribution was confirmed.\u003c/p\u003e \u003cp\u003eExploratory factor analysis (EFA) was used to extract the factor structure using the principal components analysis method [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The data of Day 3 was used for this analysis based on the usual duration and recovery process of the common cold. Factorial structures were assessed for 22 items (excluding the first and last items measuring global severity and global change) using principal component analysis.\u003c/p\u003e \u003cp\u003eConfirmatory factor analysis (CFA) was followed to assess the model fit, according to the method of Mulaik [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Several goodness-of-fit indices were reported including goodness of fit index (GFI), adjusted goodness of fit index (AGFI), normed fit index (NFI), comparative fit index (CFI), standardized root mean square residual (SRMR) and root mean square error of approximation (RMSEA).\u003c/p\u003e \u003cp\u003eReliability was chosen as the measure of internal consistency, using the data of Day 3 with the factor structure conducted by EFA, and estimated by using Cronbach's alpha coefficient.\u003c/p\u003e \u003cp\u003eConvergent validity was evaluated by testing correlation between WURSS-24-C and SF-8.\u003c/p\u003e \u003cp\u003eCorrelations was calculated using Pearson\u0026rsquo;s correlation coefficients.\u003c/p\u003e \u003cp\u003eMinimal important different (MID) was considered as day-to-day change for those indicating minimal improvement. Using methods developed by Guyatt et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], MID was defined as the average amount of instrument-assessed change for all subjects who rated themselves as \u0026ldquo;a litter better\u0026rdquo; or \u0026ldquo;somewhat better\u0026rdquo;.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and LISREL 8.8 (Scientific Software International, Chicago, IL, USA)\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTranslation of WURSS-24 and cognitive debriefing interviews\u003c/h2\u003e \u003cp\u003eNo major difficulties were experienced during the forward translation process; minor discrepancies were harmonized after discussion by the committee. After comparison of the back-translated version with the original English version, there was no significant differences in linguistic and conceptual contents. We then adapted a reconciled translation across both languages and used it in the cognitive debriefing interviews. There were 5 subjects (3 female and 2 males, aging from 21\u0026ndash;69) interviewed who reported no difficulty in understanding the items or answering the questions. The final version was produced after iterative refinement, reconciliation, and proof-reading (\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSupplementary item 1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics and descriptive data\u003c/h2\u003e \u003cp\u003eA total of 315 participants were initially enrolled from May 2018 to February 2019. Eleven participants did not return their questionnaires, 4 participants\u0026rsquo; information were incomplete, and therefore 300 were included in the analysis, for 2,500 person-days covered by this study.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e described sociodemographic and clinical characteristics for the study participants. The mean age of participants was 28.4\u0026nbsp;years (SD\u0026thinsp;=\u0026thinsp;9.3) and 70% of participants were women. Almost all of the participants (99.3%) were Han population, some 76% were at least high school education level, and 89% did not smoke. Most of the participants (96.3%) were healthy people without comorbidities. The mean time from first symptom to enrollment were 20.8 hours (SD\u0026thinsp;=\u0026thinsp;14.6). A majority of 181 (60.3%) had body temperature that was normal at enrollment; 77 (25.7%) had low fever (37.3\u0026thinsp;~\u0026thinsp;38℃), 35 (11.7%) had temperature of 38.1\u0026thinsp;~\u0026thinsp;39℃, and 7 (2.3%) were higher than 39℃. 140 out of 300 participants had not taken medicine before enrollment, others had taken Chinese medicine (115), antipyretic analgesics (31), antivirals (27), and antihistamine (3).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDemographics of the study participants who had common cold during May 2018 to February 2019 visited Guangdong provincial hospital of Chinese medicine, China\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNumber of participants\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e300\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAge, years\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMean (SD)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e28.4(9.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGender, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e210(70)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEthnicity, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHan\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e298(99.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducation, highest, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHigh school or less educated\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e76(25.4)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCollege degree\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e121(40.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGraduate degree\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e103(34.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTobacco use, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCurrent\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e31(10.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePast\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2(0.7)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNonsmoker\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e267(89)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eComorbidities/Disease history, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNo\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e289(96.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eYes\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11(3.7) 3 pharyngitis, 2 anemia, 1 chronic\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ebronchitis, 1 hypertension 1 hypothyroidism, 1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eoptic neuritis, 1 calculus of kidney and 1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eappendicitis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTime from first symptom to enrollment (hours)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMean (SD)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e20.8(14.6)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eInter-quartile range\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u0026ndash;30\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMaximum body temperature before enrollment\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMean (SD)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e37.3(0.7)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026le;\u0026thinsp;37.2℃, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e181(60.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e37.3\u0026thinsp;~\u0026thinsp;38℃, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e77(25.7)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e38.1\u0026thinsp;~\u0026thinsp;39℃, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e35(11.7)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e༞39℃, no./total (%)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7(2.3)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHaving taken medicine before enrollment, no\u003c/span\u003e.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNo medicine\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e140\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eChinese medicine\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e115\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAntipyretic analgesics\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAntivirals\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAntihistamine\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOther\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe total WURSS-24-C scores of all participants from the 1st to the 14th day are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. All of the participants filled in the questionnaire for at least 3 days. A total of 27(9%) participants continued to report being sick at the end of their 14-day monitoring period. The symptoms and functions improved over time. The mean score ranged from 54.11 (SD\u0026thinsp;=\u0026thinsp;30.28) in the first day to 7.69 (SD\u0026thinsp;=\u0026thinsp;10.33) in the 14th day.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eThe WURSS-24-C item and summary descriptive statistics\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDay\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eMean (SD)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eMin\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eMax\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e300\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e54.11(30.28)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e137\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e300\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e49.82(27.67)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e130\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e300\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e41.74(27.39)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e108\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e298\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30.89(27.14)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e125\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e5\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e290\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e21.00(22.05)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e123\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e6\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e264\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.78(18.35)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e112\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e7\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e223\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.16(15.67)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e82\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e8\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e168\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.79(14.55)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e87\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e9\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e119\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.41(14.23)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e71\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e10\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e81\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.02(12.73)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e66\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e11\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e57\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.70(12.83)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e66\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e12\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.59(14.47)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e66\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e13\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.63(14.03)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e14\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.96(10.33)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFactor analysis\u003c/h2\u003e \u003cp\u003eThe scree plot of the EFA indicated that the 4-domain structure was accepted which explained 68.25% of the total square deviation. The 4 domains were defined as activity and function, systemic symptom, nasal symptom, and throat symptom. The factor loading coefficients of\u003c/p\u003e \u003cp\u003eindividual items in each domain are showed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, only those with promax rotation factor loaded greater than 0.4 were accepted. All of the items loaded onto the 4-domain structure.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eThe factor loading of WURSS-24-C items\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eItem\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSymptom\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eRunny nose\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.867\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePlugged nose\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.759\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSneezing\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.812\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e5\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSore throat\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.721\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e6\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eScratchy throat\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.798\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e7\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCough\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.686\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e8\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHoarseness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.654\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e9\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHead congestion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.563\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e10\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eChest congestion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.552\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e11\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFeeling tired\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.505\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.586\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e12\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHeadache\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.786\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e13\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eBody aches\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.812\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e14\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFever\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.687\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e15\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eThink clearly\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.693\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e16\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSleep well\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.636\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e17\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eBreath easily\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.426\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.664\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e18\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWalk/Climb stairs\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.828\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e19\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAccomplish daily activities\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.868\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e20\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWork outside the home\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.864\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e21\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWork inside the home\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.839\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e22\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eInteract with others\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.845\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e23\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eLive your personal life\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.843\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDefinition of the 4 domains\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eActivity and\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSystemic\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eNasal\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eThroat\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003efunction\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003esymptom\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003esymptom\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003esymptom\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCronbach\u0026rsquo;s α\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.943\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.859\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.882\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.849\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCFA was performed to evaluate the 4-factor structure validity of the WURSS-24-C. The goodness-of-fit indices and the structure graphs are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The CFI was 0.94, RMSEA was 0.14, and SRMR was 0.11, which suggest acceptable model fit in this four factorial model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eAfter establishing the 4-domain-structure, we tested the Cronbach\u0026rsquo;s alpha for internal reliability. Cronbach alpha coefficients were 0.943, 0.859, 0.882 and 0.849 for activity and function, systemic symptom, nasal symptom, and throat symptom respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, we tested the internal reliability of the whole questionnaire (based on the data of Day 3), of which the Cronbach\u0026rsquo;s alpha was 0.940.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eConvergent validity\u003c/h2\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed daily change of illness severity over time as measured by the WURSS-24-C and the SF-8(both physical and mental health scores). The number of participants decreased as their symptoms decreased, from N\u0026thinsp;=\u0026thinsp;300 on Day 1 to N\u0026thinsp;=\u0026thinsp;27 on Day 14. As measured by the SF-8, the trend of general physical health and mental health was similar during the illness process.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWURSS-24-C had similar change with the SF-8. All changes were more rapid in the first 7 days than the later periods.\u003c/p\u003e \u003cp\u003eConvergent validity was respectively evaluated by the scores of SF-8 physical/mental and the total scores of the WURSS-24-C. The Pearson correlation coefficient of the WURSS-24-C yielded \u0026minus;\u0026thinsp;0.780 for SF-8 physical health, and \u0026minus;\u0026thinsp;0.721 for SF-8 mental health (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFrequency, Severity and MID\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e displayed the pattern of experienced symptoms and functional limitations in the first three days. The most reported items were \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eFeeling tired\u003c/span\u003e (98%) and \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eSleep well\u003c/span\u003e (91.7%), followed by nasal symptoms: \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003ePlugged nose\u003c/span\u003e (87.7%); affected abilities: \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eThink clearly\u003c/span\u003e (86.3%); and throat symptoms: \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eSore throat\u003c/span\u003e (85.7%). The most severe symptom was \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003ePlugged nose\u003c/span\u003e with a score of 3.50, followed by \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eFeeling tired\u003c/span\u003e (3.37), \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eSore throat\u003c/span\u003e (3.34) and \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eRunny nose\u003c/span\u003e (3.31). MID was presented item-by-item for the WURSS-24-C, ranged from \u0026minus;\u0026thinsp;0.41(\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eChest congestion\u003c/span\u003e) to -1.14 (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eHow sick\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFrequency, severity and minimal important difference of WURSS-24 Items\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eItem\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSymptom\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eFrequency%\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSeverity\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eMID\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHow sick\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e100.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.11(1.20)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.14\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eRunny nose\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e85.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.31(1.57)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.88\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePlugged nose\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e87.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.50(1.58)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.95\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSneezing\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e84.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.10(1.54)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.91\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e5\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSore throat\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e85.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.34(1.57)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.95\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e6\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eScratchy throat\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e83.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.84(1.54)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.73\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e7\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCough\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e82.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.18(1.68)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.67\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e8\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHoarseness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e75.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.81(1.67)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.74\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e9\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHead congestion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e83.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.80(1.68)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.75\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e10\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eChest congestion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e59.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.03(1.57)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.41\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e11\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFeeling tired\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e98.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.37(1.56)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.06\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e12\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHeadache\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e83.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.70(1.71)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.73\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e13\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eBody aches\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e68.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.36(1.48)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.61\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e14\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFever\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e60.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.19(1.40)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.58\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e15\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eThink clearly\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e86.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.54(1.42)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.76\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e16\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSleep well\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e91.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.99(1.51)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.93\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e17\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eBreathe easily\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e84.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.10(1.65)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.83\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e18\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWalk/Climb stairs\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e84.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.49(1.52)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.73\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e19\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAccomplish daily activities\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e81.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.24(1.41)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.67\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e20\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWork outside the home\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e81.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.60(1.57)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.73\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e21\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWork inside the home\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e78.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.22(1.44)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.61\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e22\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eInteract with others\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e79.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.40(1.45)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.67\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e23\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eLive your personal life\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e77.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.29(1.32)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.63\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":" \u003cp\u003eThe current study confirmed that the Chinese version of WURSS-24-C demonstrated highly acceptable reliability and validity, similar to that found during validation studies of the original English language instrument [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExploratory and confirmatory procedures was used to assess item/domain structure of the WURSS-24-C. This version contained four domains, which was different from the original WURSS-21[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] with three domains (activity and function, nasal symptom and throat symptom). In the WURSS-21 study, the following items \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eHead congestion\u003c/span\u003e, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eChest congestion\u003c/span\u003e, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eFeeling tired\u003c/span\u003e was in the nasal symptom domain, which might not be suitable. In the WURSS-24-C, these items were included in the new domain defined as Systemic symptoms, which also contained the items for assessment of influenza-like illness, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eHeadache\u003c/span\u003e, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eBody aches\u003c/span\u003e and \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eFever\u003c/span\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). CFA then further indicated that individual items of the WURSS-24-C, agreed well with this 4-dimensional structure model, as fit indices met criteria suggested by Hu and Bentler [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a measure of the reliability of a scale, Cronbach alpha has been widely used since it was developed by Lee Cronbach in 1951[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to Tavakol [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and Devellis [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], the alpha values of 0.8 to 0.9 are excellent, but if a coefficient alpha greater than 0.9, it may suggest redundancies and show that the test length should be shortened. We tested the 4 domains of the WURSS-24-C, and the Cronbach alpha perfectly ranges from 0.849 to 0.882, except for the \u0026ldquo;activity and function\u0026rdquo;, which is up to 0.943. Compared with the original version of WURSS-21, for which the value is 0.961[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], we believe this 9-item dimension might be further reduced or adjusted. Then we tested the reliability of the whole WURSS-24-C and found the value was over 0.90. This result suggested that the WURSS-24 might allow leeway for a shorter version, such as the WURSS-11developed by English-language WURSS researchers [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConvergent validity was evaluated by the Pearson correlation coefficient. According to Colton [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], correlations ranging from 0.50 to 0.75 are moderate to good; and values greater than 0.75 are considered good to excellent. The WURSS-24-C yielded correlation coefficient was over 0.75 when compared with SF-8 physical. The association was stronger than that between the WURSS-24-C with SF-8 mental, for which the coefficient was \u0026minus;\u0026thinsp;0.721. The results were similar to that of the original version of the WURSS [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMinimal important difference (MID) refers to the smallest difference in a score that is recognized as worthwhile or important [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. For clinicians, MID could be used to determine meaningful clinical change in patients. Our results estimated MID for individual items of the WURSS-24-C, which could be considered clinically relevant in patients with URTIs. Compared with the data of the original WURSS-21[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], the instruments yielded similar MIDs indices, which indicated the WURSS-24-C could be sensitively reflected changes in items.\u003c/p\u003e \u003cp\u003eStrengths of this study include its large sample size, regional representativeness, careful translation of WURSS-24-C using three-step linguistic validation procedure, and high quality statistical analysis. Our study should, nonetheless, be interpreted along with several limitations. First, all participants were from the southern part of China with narrow age range, limiting generalizability. Second, the test-retest reliability and other reliability and validity assessments\u003c/p\u003e \u003cp\u003ewere not evaluated in this study. Therefore, participants from a broader range of age groups from other parts of China and additional instruments as for the evaluation might be needed in future studies.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eIn summary, the 24-item Chinese version of WURSS (WURSS-24-C) is a reliable and valid instrument applicable to Chinese URTIs patients for assessment of HRQoL. The WURSS-24-C could thus be incorporated into future research.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eWURSS: the Wisconsin Upper Respiratory Symptom Survey; WURSS-24-C: the Chinese version of Wisconsin Upper Respiratory Symptom Survey with 24 items; URTIs: upper respiratory tract infections; HRQoL: health-related quality of life; SF-8: the 8-item short-form; MID: minimal important difference; EFA: exploratory factor analysis; CFA: confirmatory factor analysis; CFI: comparative Fit Index; GFI: goodness of fit index; AGFI: adjusted goodness of fit index; NFI: normed fit index; SRMR: standardized root mean square residual; SRMR: root mean square error of approximation; SD: standard deviations; NSAIDs: non-steroidal anti-inflammatory drugs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethical committees of Guangdong provincial hospital of traditional Chinese medicine, Guangzhou, China (GPHCM; B2016-090-02). Written informed consent was provided by all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used or analyzed during the current study are available from the corresponding author upon reasonable request and approved by Guangdong provincial hospital of Chinese medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by China National Science and Technology Major Project, NO:2017ZX10305501-006; Guangdong Provincial Key Laboratory of TCM Research on Emergency, NO: 2017B030314176; Evidence-based Capacity Building Project of Traditional Chinese Medicine, NO: 2019XZZX-LG003; and the Specific Research Fund for TCM Science and Technology of Guangdong Provincial Hospital of Chinese Medicine, NO YK2013B2N04. GS acknowledges partial support by the Science and Technology Research Fund from Guangdong provincial hospital of Chinese medicine, China (No. YN2018QL08). The funding body was not involved in the design, conduct, data collection, analysis, interpretation and writing of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYW contributed to the design, supervised data collection and analysis, and wrote the manuscript. ZH contributed to the design, conducted statistical analysis, and contributed to the manuscript. SC conducted data collection, entered, cleaned and analyzed data, and contributed to the manuscript. YL contributed to the design, coordinated data collection, and contributed to the manuscript. FL coordinated data collection and contributed to the manuscript.BB contributed to the research idea and give advice for statistical analysis and results interpretation, and helped write and revise the manuscript. CSL was responsible for supervision or mentorship. ZZ contributed to the design, conducted statistical analysis, and contributed to the manuscript.GS contributed to the design, supervised data collection and analysis, and contributed to the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Wisconsin Alumni Research Foundation, University of Wisconsin-Madison, for the permission to use the WURSS.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMylotte JM. 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Validation of a short form Wisconsin upper respiratory symptom survey (WURSS-21). Health Qual Life Outcomes 2009;\u003cstrong\u003e7\u003c/strong\u003e:76. doi:10.1186/1477-7525-7-76\u003c/li\u003e\n\u003cli\u003eWisconsin Upper Respiratory Symptom Survey (WURSS). \u003ca href=\"https://www.fammed.wisc.edu/wurss/\"\u003ehttps://www.fammed.wisc.edu/wurss/\u003c/a\u003e. Accessed 17 December 2019.\u003c/li\u003e\n\u003cli\u003eYang S-Y, Kang W, Yeo Y, et al. Reliability and validity of Wisconsin Upper Respiratory Symptom Survey, Korean version. J Epidemiol 2011;\u003cstrong\u003e21\u003c/strong\u003e:313\u0026ndash;8. doi:10.2188/jea.JE20100160\u003c/li\u003e\n\u003cli\u003eZgierska A, Obasi CN, Brown R, et al. Randomized Controlled Trial of Mindfulness Meditation and Exercise for the Prevention of Acute Respiratory Infection: Possible Mechanisms of Action. Evidence-Based Complement Altern Med 2013;\u003cstrong\u003e2013\u003c/strong\u003e:1\u0026ndash;14. doi:10.1155/2013/952716\u003c/li\u003e\n\u003cli\u003eJiwa M, Krejany CJ, Kanjo E, et al. Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology. Fam Pract Published Online First: 14 January 2019. doi:10.1093/fampra/cmy134\u003c/li\u003e\n\u003cli\u003eJackson GG, Dowling HF, Anderson TO, Riff L, Saporta J TM. Susceptibility and immunity to common upper respiratory viral infections\u0026mdash;The common cold. Ann Intern Med 1960;\u003cstrong\u003e53\u003c/strong\u003e:719. doi:10.7326/0003-4819-53-4-719\u003c/li\u003e\n\u003cli\u003eJackson G, Dowling H, Muldoon RL. VII. Present Concepts of the Common Cold. Am J Public Heal Nations Heal 1962;\u003cstrong\u003e52\u003c/strong\u003e:940\u0026ndash;5. doi:10.2105/AJPH.52.6.940\u003c/li\u003e\n\u003cli\u003eSousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. J Eval Clin Pract 2011;\u003cstrong\u003e17\u003c/strong\u003e:268\u0026ndash;74. doi:10.1111/j.1365-2753.2010.01434.x\u003c/li\u003e\n\u003cli\u003eRoberts B, Browne J, Ocaka KF, et al. The reliability and validity of the SF-8 with a conflict-affected population in northern Uganda. Health Qual Life Outcomes 2008;\u003cstrong\u003e6\u003c/strong\u003e:1\u0026ndash;10. doi:10.1186/1477-7525-6-108\u003c/li\u003e\n\u003cli\u003eWare JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;\u003cstrong\u003e30\u003c/strong\u003e:473\u0026ndash;83.http://www.ncbi.nlm.nih.gov/pubmed/1593914\u003c/li\u003e\n\u003cli\u003eNorris M, Lecavalier L. Evaluating the Use of Exploratory Factor Analysis in Developmental Disability Psychological Research. 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Struct Equ Model 1999;\u003cstrong\u003e6\u003c/strong\u003e:1\u0026ndash;55. doi:10.1080/10705519909540118\u003c/li\u003e\n\u003cli\u003eCronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297\u0026ndash;334. doi:10.1007/BF02310555\u003c/li\u003e\n\u003cli\u003eTavakol M, Dennick R. Making sense of Cronbach\u0026rsquo;s alpha. Int J Med Educ 2011;\u003cstrong\u003e2\u003c/strong\u003e:53\u0026ndash;5. doi:10.5116/ijme.4dfb.8dfd\u003c/li\u003e\n\u003cli\u003eVogelzang JL. Health Measurement Scales: A Practical Guide to Their Development and Use. J Nutr Educ Behav 2015;\u003cstrong\u003e47\u003c/strong\u003e:484.e1. doi:10.1016/j.jneb.2015.03.007\u003c/li\u003e\n\u003cli\u003eObasi CN, Brown R, Barrett B. Item reduction of the Wisconsin Upper Respiratory Symptom Survey (WURSS-21) leads to the WURSS-11. Qual Life Res 2014;\u003cstrong\u003e23\u003c/strong\u003e:1293\u0026ndash;8. doi:10.1007/s11136-013-0561-z\u003c/li\u003e\n\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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"WURSS; Upper respiratory infection; Reliability; Validity; Quality of life; Common cold; Validation; Psychometrics","lastPublishedDoi":"10.21203/rs.2.22729/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.22729/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground \u003c/p\u003e\u003cp\u003eThe Wisconsin Upper Respiratory Symptom Survey (WURSS) is a validated English questionnaire to evaluate the severity of upper respiratory tract infections (URTIs). We aimed to develop a Chinese version of WURSS-24 (WURSS-24-C) and evaluate its reliability, validity and minimal important difference (MID). \u003c/p\u003e\u003cp\u003eMethods \u003c/p\u003e\u003cp\u003eThe WURSS-24 was translated into Mandarin Chinese using the forward-backward translation procedure. People with Jackson-defined common cold symptoms within 48 hours of onset were recruited in Guangzhou, China, and followed for up to 14 days. The SF-8 (24 hours recall) assessing general mental and physical health was used as external comparator. Reliability, validity, and MID were evaluated. \u003c/p\u003e\u003cp\u003eResults \u003c/p\u003e\u003cp\u003eThe WURSS-24-C was developed and found to be acceptable, relevant, and easy to complete in cognitive debriefing interviews. A total number of 300 participants (age 28.4±9.3, female 70%) were monitored for 2,500 person-days. Factor analysis: Exploratory factor analysis (EFA) suggested 4 domains, defined as activity and function, systemic symptoms, nasal symptoms, and throat symptoms. Confirmatory factor analysis (CFA) supported this 4-domain model with a Comparative Fit Index (CFI) of 0.93. Reliability assessment of the 4-domain-structure found Cronbach’s alphas of 0.943, 0.859, 0.882 and 0.849, respectively. Convergent validity indicator: The Pearson correlation coefficients between daily WURSS-24-C and the SF-8 were -0.780 and -0.721, for the SF-8 physical and mental health respectively. Estimates of MID for individual items varied from -0.41 to -1.14. \u003c/p\u003e\u003cp\u003eConclusion \u003c/p\u003e\u003cp\u003eThe WURSS-24-C is a reliable and valid questionnaire for assessing illness-specific quality-of-life health status in Chinese speaking patients with URTIs.\u003c/p\u003e","manuscriptTitle":"Validation of the Wisconsin Upper Respiratory Symptom Survey-24, Chinese version","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-02-05 23:00:40","doi":"10.21203/rs.2.22729/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d1118cf-78b5-4afb-ad45-baa809c5ed8a","owner":[],"postedDate":"February 5th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":56092,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2022-02-24T07:34:23+00:00","versionOfRecord":{"articleIdentity":"rs-13303","link":"https://doi.org/10.1080/07853890.2022.2043559","journal":{"identity":"annals-of-medicine","isVorOnly":true,"title":"Annals of Medicine"},"publishedOn":"2022-02-23 07:34:23","publishedOnDateReadable":"February 23rd, 2022"},"versionCreatedAt":"2020-02-05 23:00:40","video":"","vorDoi":"10.1080/07853890.2022.2043559","vorDoiUrl":"https://doi.org/10.1080/07853890.2022.2043559","workflowStages":[]},"version":"v1","identity":"rs-13303","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-13303","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}