Polish translation, cultural adaptation, and validity confirmation of the Scored Patient-Generated Subjective Global Assessment

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The aim of this study was to perform translation, cultural adaptation, as well as linguistic and content validation of the translated and culturally adapted version of the PG-SGA for the Polish setting. Methods: The study was performed in concordance with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Principles. Patients (n=174) and healthcare professionals (HCPs, n=188) participated in the study. Comprehensibility and difficulty were assessed by patients for the PG-SGA Short Form, and by HCPs for the professional component. Content validity was assessed for the full PG-SGA by HCPs only. Evaluations were operationalized by a 4-point scale. Item and scale indices were calculated using the average item ratings divided by the number of respondents. Item indices <0.78 required further analysis of the item, while scale indices ≥0.90 were defined as excellent and 0.80–0.89 as acceptable. Results: The PG-SGA Short Form was rated as excellent for content validity (Scale-CVI = 0.90) by HCPs and easy to comprehend (Scale-CI = 0.96) and use (Scale-DI = 0.94) by patients. The professional component of the PG-SGA was perceived as acceptable for content validity (Scale-CVI = 0.80), comprehension (Scale-CI = 0.87) and difficulty (Scale-DI = 0.80). The physical exam was rated the least comprehensible, the most difficult, and with the lowest content validity. We found significant differences in scale indices (p<0.05 for all) between HCPs with different professions and between those being familiar with PG-SGA and not. Conclusion: Translation and cultural adaptation of the PG-SGA for the Polish setting preserved the purpose and conceptual meaning of the original PG-SGA. Validation revealed that the Polish version of PG-SGA is well understood and easy to complete by patients and professionals, and considered relevant by professionals. However, detailed results indicate the need for appropriate training of the Polish HCPs, especially physicians and nurses, mainly in the worksheets related to the metabolic demand and physical exam. PG-SGA Patient-Generated Subjective Global Assessment validity nutritional assessment malnutrition screening Introduction Both acute and chronic diseases may lead to malnutrition, which has been defined as “a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat-free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease” [ 1 , 2 ]. Disease-related malnutrition increases complication rates and mortality, it is also associated with longer hospital stays, and causes an increased financial burden on healthcare organizations [ 1 , 3 ]. Malnutrition is multifactorial and multidimensional, and adequately identifying malnutrition and its key determinants must be regarded as essential [ 4 , 5 ]. According to the consensus established by the Global Leadership Initiative on Malnutrition (GLIM), which has been formed by representatives of major clinical nutrition societies including the European Society for Clinical Nutrition and Metabolism (ESPEN), the American Society for Clinical Nutrition and Metabolism (ASPEN), Federación Latinoamericana de Terapia Nutricional, Nutrición Clínica y Metabolismo (FELANPE), and the Parenteral and Enteral Nutrition Society of Asia (PENSA), the process of malnutrition diagnosis includes two steps. The first step is malnutrition risk screening and the second step is nutritional assessment for diagnosis and severity grading of malnutrition. The diagnosis of malnutrition must encompass both phenotypic criteria (i.e., weight loss, low body mass index, and reduced muscle mass) and etiologic criteria (i.e., reduced food intake or absorption and burden associated with disease or inflammation), whereby at least one etiologic and one phenotypic criterion is required to diagnose malnutrition [ 6 ]. Consistent with these guidelines are the ESPEN recommendations that the patient's nutritional care should be provided in a systematic way, that involves identifying malnourished patients or patients at risk of malnutrition using validated screening tools, followed by implementation of adequate intervention and monitoring the results of the intervention [ 7 ]. In Poland, the concept of the two-step approach of screening and assessment has been implemented, and accordingly, two tools, i.e., Nutritional Risk Score 2002 (NRS 2002) or Subjective Global Assessment (SGA), are obligatorily used in all Polish hospital wards on the patient admission and then every 14 days of the hospitalization. In elderly patients, Mini Nutritional Assessment (MNA) is also used. The other tool recommended by ESPEN, i.e., the Malnutrition Universal Screening Tool (MUST) is available as well [ 7 , 8 ]. In a recent study aiming to audit the nutritional status of 10,863 hospitalized patients in 25 European countries, including Poland, another simple and frequently used tool - Malnutrition Screening Tool (MST) was applied. The prevalence of malnutrition risk and malnutrition in Polish hospital wards, based on ESPEN diagnostic criteria [ 7 ], was found to be 25% and 9%, respectively. Both prevalence rates represented a lower percentage compared to prevalence rate identified in other European countries participating in the survey (30% and 13%, respectively) [ 9 ]. However, the frequency of particular nutritional risk factors in hospitalized patients, i.e., unintended body weight loss or insufficient recent food intake were approximately two times higher than the frequency of malnutrition risk both in Polish and in whole European study population. The study also revealed that managing patients with malnutrition or risk of malnutrition in Polish hospital wards is inferior to that carried out in European facilities involved in the survey. For example, it showed four times lower commitment of nutrition experts in managing patients with identified malnutrition or risk of malnutrition. This may result in noticed lower supply of special diets (8% vs 16%) and oral nutritional supplements (4% vs 12%) in Polish hospital wards [ 9 ]. One of the measures to assist in the elaboration of a comprehensive concept of nutritional care for patients could be the implementation of tools that integrate the process of identification of malnourished patients with the decision-making pathway for the implementation of appropriate management. A tool that addresses not only screening, and assessment, but also monitoring and triaging for interventions is the Patient-Generated Subjective Global Assessment (PG-SGA) [ 10 ]. The PG-SGA adequately covers all domains of the construct of malnutrition[ 5 ]. The PG-SGA is a two-page form that is fitted with a scoring system. The first page is patient-generated, including four boxes that address patients’ weight, food intake, symptoms affecting food intake (i.e., nutrition impact symptoms), and level of activity and functioning. The latter two components extend beyond the GLIM criteria and broaden the assessment of phenotypic and etiologic hallmarks of malnutrition with relevant inputs for triaging for interventions [ 11 ]. The second page is a professional component consisting of five worksheets designed to score: weight loss, patients’ diagnosis in relation to nutritional requirements, metabolic stress and body composition (muscle, fat and fluid status), and finally, to summarize the total PG-SGA with its conversion in nutritional triage recommendation and patient’s global assessment stage categorization. Combining patient- and professional-generated data allows complex insights into the nutritional status of patients, which makes PG-SGA a unique tool for use in nutritional care. The PG-SGA has been shown to be more sensitive and specific in the nutritional assessment of cancer patients than other tools [ 12 ] and is often considered a semi-gold standard for nutritional screening in oncology [ 13 , 14 ]. The validity of PG-SGA has also been confirmed in evaluating the nutritional status of nephrology and neurology patients, in elderly and palliative care, amongst others [ 15 – 18 ]. The PG-SGA has already been culturally adapted and linguistically validated for use in various settings worldwide, including Dutch, Portuguese, German, Thai and more recently Greek and Japanese, as well as Norwegian, Danish and Italian [ 19 – 27 ]. The development of these new PG-SGA language versions was based on the Principles of Good Practice for the Translation and Cultural Adaptation Process (ISPOR) [ 28 ]. So far, there is no validated Polish version of the PG-SGA available. Therefore, we aimed to translate and culturally adapt the original English PG-SGA for the Polish setting, and to assess the linguistic validity as perceived by the Polish population, both patients and healthcare professionals, and content validity by healthcare professionals. Methods Translation and cultural adaptation The translation and cultural adaptation process of the PG-SGA for the Polish setting has been carried out with permission and in close cooperation with the key developer and copyright holder of the PG-SGA (FO) and an international expert on translation and cultural adaptation of the PG-SGA (HJ-W). The entire process of translation, cultural adaptation, and content and linguistic validation was conducted between August 2016 and January 2021, according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guideline “ Translation and Cultural Adaptation of Patient-Reported Outcomes Measures - Principles of Good Practice ” (ISPOR principles) [ 28 ]. The ISPOR principles consist of the ten steps in the translation and cultural adaptation process: Step 1) Preparation – the project manager made contact with the key developer of the original version of the PG-SGA and the international expert on translation and cultural adaptation of the PG-SGA. Step 2) Forward Translation – this step was carried out by three native Polish speakers (the project manager/key in-country consultant and two project co-managers) who are experts on the subject of nutritional assessment and with sufficient knowledge of the English language. Step 3) Reconciliation – the independent three forward translations were compared with each other and transferred into one integrated forward translation (Polish PG-SGA version 1) that has been subject to verification by an independent group of experts in terms of cultural and semantic content. The group of experts ( n = 20) included dietitians ( n = 5), physicians ( n = 8), nurses ( n = 2), pharmacist ( n = 1), psychologist ( n = 3) and physiotherapist ( n = 1). After consensus was reached, the reconciled forward translation, i.e., Polish PG-SGA version 2 (Polish PG-SGA v2) was finalized. Step 4) Back Translation - two back translations of the reconciled forward translation were independently carried out by two certificated translation companies. Step 5, 6) Back Translation Review and Harmonization - all differences between the original English version and the two back translations were discussed at a meeting of the project manager/key in-country consultant and two project co-managers, the developer of the PG-SGA, and the international expert on cross-cultural adaptation of the PG-SGA. The Polish PG-SGA v2 was adapted, if needed, to harmonize with the original English version. Linguistic and content validation The linguistic and content validation of PG-SGA Polish v2 included steps 7–9 of the ISPOR guidelines. Step 7 concerns cognitive debriefing of the Polish translation in a heterogenous group of patients and healthcare professionals. The purpose of this step is to ensure that the translation is comprehensible and easy to complete by general population of patients and healthcare professionals, and that the healthcare professionals perceive the Polish PG-SGA as relevant. Step 7) Cognitive Debriefing – this step comprises cognitive debriefing of the Polish PG-SGA v2 with patients and healthcare professionals’ groups. Three components were used to evaluate the items in the Polish PG-SGA v2: Comprehensibility - how clearly is the item described in the tool? Difficulty - how difficult is it to answer the item (does the respondent need more knowledge or skills to be able to answer the item)? Content validity - does the respondent consider the item relevant to the concept of malnutrition? Patients group For the cognitive debriefing, 174 patients from various regions of Poland evaluated comprehensibility and difficulty of the PG-SGA patient component, i.e., the Polish PG-SGA Short Form version 2 (Polish PG-SGA SF v2). The adult, Polish native speaking participants were recruited between May 2018 and December 2020, from Lower-Silesian Oncology Center in Wroclaw, Uzdrowisko Wysowa S.A. dialysis station (SPA Hospital) in Wysowa Zdrój and University Clinical Hospital in Wroclaw (Table 1 ). The comprehensibility and difficulty evaluation was carried out using a questionnaire. The questionnaire contained demographic information and thirty-six questions addressing comprehensibility, six addressing difficulty and four open-ended questions with feedback on the Polish wordings. The degree of difficulty and comprehensibility was assessed by a 4-point Likert scale. The questionnaire was used before in other studies concerning cultural adaptation and validation of the PG-SGA [ 20 , 21 , 25 , 29 ] Table 1 Characteristics of the patient participants (n = 174) Variables Gender, % (n) a Female 52 (74) Age [years], mean (± SD) 56 (± 16.1) Education level % (n) Primary school 6 (11) Secondary school 49 (84) Higher education 35 (60) Basic vocational school 10 (18) Diagnosis, % (n) Kidney failure 34 (59) CVD 28 (49) Cancer 16 (28) Other 22 (38) a stated by 143 patients; CVD – cardiovascular disease Healthcare professionals In parallel, 188 healthcare professionals (HCPs) participated in evaluating comprehensibility, difficulty and content validity of the full Polish PG-SGA v2. These group of participants consisted of physicians, nurses, dietitians, nutritionists and medical students recruited from hospitals and primary health care clinics from various regions of Poland, Lower-Silesian Oncology Center in Wroclaw, Uzdrowisko Wysowa S.A. dialysis station (SPA Hospital) in Wysowa Zdrój, University Clinical Hospital in Wroclaw, Wroclaw Medical University and University of Applied Sciences in Nysa (Table 2 ). They were asked to provide demographic information (sixteen questions) and to complete a questionnaire consisting of thirty-eight questions on comprehensibility and thirty-eight on difficulty of the professional component of the PG-SGA (i.e., the Worksheets), and seventy-five on content validity of the full version PG-SGA. Additionally, the respondents were asked to complete eight open-ended questions for feedback on the Polish wordings of the professional component of the PG-SGA. The degree of difficulty, comprehensibility and content validity was assessed by a 4-point Likert scale. The questionnaire has previously been used before in other studies concerning cultural adaptation and validation of the PG-SGA [ 20 , 21 , 25 , 28 ]. Table 2 Characteristics of HCP participants (n = 188) Variables Current profession, % (n) Nutritionist 5 (9) Dietitian 5 (9) Physician 42 (78) Nurse 25.0 (47) Student, dietetics 5 (10) Student, medicine 4 (7) Student, pharmacy 11 (21) Student, nursing 3 (6) Other 1 (1) Place of employment, % (n) Hospital 22 (42) Private practice 9 (17) Primary healthcare 16 (31) University 50 (94) Years of experience in the current profession a , median (min-max) 8 (0.5–41) Caring for the patient population, % (n) Oncological 20 (37) Nephrological 28 (52) Surgical 7 (13) Geriatric 24 (45) Other 35 (66) Familiar with PG-SGA - Yes, % (n) 19 (36) Experience with PG-SGA - Yes, % (n) 6 (12) a stated by 143 professionals The Wroclaw Medical University Bioethics Committee (KB-540/2019) approved the study. Each participant (patient and healthcare professional) provided informed consent before participating in the study after reading the consent form of participation in the study: This is the study on the validation of the translated and culturally adapted PG-SGA form for the Polish setting. Completing the survey will take you approximately 20 minutes and is completely anonymous. The study aims to assess comprehensibility and difficulty of PG-SGA Short Form by patients, and additionally content validity, comprehensibility and difficulty of short form and professional component by HCPs. Comprehensibility means how clearly is the item described in the tool. Difficulty - how difficult is to answer the item (e.g. do you need more knowledge or skills to be able to answer the item). Content validity answers the question if you consider the item relevant to the concept of malnutrition. Evaluations are operationalized by a 4-point scale. If you do not wish to continue with the survey you can stop answering the questions on the form at any time. Step 8) Review of Cognitive Debriefing and Finalization - the results of the questionnaire posed to patients and health care professionals were reviewed by the project manager and co-managers as well as the developer of the PG-SGA, and the international expert on translation and cultural adaptation of the PG-SGA. Based on the respondents’ suggestions, necessary changes to improve the translated items were discussed with and approved by the developer of the PG-SGA (FO). After review, the Polish version of the PG-SGA was finalized by the project manager and co-managers. Step 9) Proofreading - the finalized Polish version of the PG-SGA was proofread by the project manager and co-managers to check possible grammar and spelling errors, as well as the legibility of the graphic form. Step 10) Final Report - the final report includes a description of all stages of validation and cultural adaptation of the Polish version of PG-SGA and conclusions drawn on the basis of the obtained validation results. Statistical analysis For item and scale scores calculations, scores of 1 and 2 were recoded into 0, as ‘not present’, while scores of 3 and 4 were recoded into 1, indicating ‘present’, according to Sealy et al.[ 19 ]. Item indices were calculated by dividing the number of respondents who considered the item to be ‘present’ by the total number of respondents. Indices were calculated for each item for comprehensibility (I-CI), difficulty (I-DI), and content validity (I-CVI). Item indices < 0.78 required further analysis of the item. The Scale Indexes were calculated by averaging all item indices for the respective construct: for comprehensibility as Scale Comprehensibility Index (S-CI), for difficulty as Scale Difficulty Index (S-DI), and for content validity as Scale Content Validity Index (S-CVI). Patients evaluated comprehensibility and difficulty of the patient component of the PG-SGA only, and therefore the patient Scale Indices (S-CI and S-DI) are only referring to the PG-SGA SF. HCPs evaluated content validity of the PG-SGA SF and of the professional component of the PG-SGA, resulting in a total scale index for the full PG-SGA. Comprehensibility and difficulty were evaluated by HCPs only, for the professional component of the PG-SGA. Scale indices 0.80–0.89 were considered acceptable and ≥ 0.90 as excellent. All calculations of the item indices and index scores were performed in Excel. Continuous variables are presented as means and standard deviation (SD) or medians and range. Categorical variables are presented as frequencies (number) and percentage. The Chi 2 test was used for distribution comparison of categorical variables between groups. The independent sample t-test (for parametric data) or Mann-Whitney U-test (for non-parametric data) were used to analyse differences between two groups, while one-way ANOVA or Kruskal Wallis test was used for more than two groups. Post hoc analyses were performed for intergroup comparison of data. All statistical analyses were performed using STATISTICA v. 13.3 (StatSoft, Inc., Tulsa, USA). A p -value < 0.05 was considered to indicate statistically significant differences. Results Step 1–6 During the forward translation process, in which three independent Polish translations of PG-SGA were produced, 36/55 items of the patient component and 66/97 items of the professional component differed between each other. The reconciliation step (data are available upon request to the corresponding author) resulted in the Polish PG-SGA v1. Then, back translations provided by two independent persons revealed additional thirty discrepancies after review against the original version, which were further discussed with the developer of the original version of the PG-SGA and the international expert on translation and cultural adaptation of the PG-SGA (data can be made available upon request to the corresponding author). After harmonization, the Polish PG-SGA v2 was then included into cognitive debriefing and exploration of content validity by questionnaires administered to patients and HCPs. Step 7 To ensure inclusion of a heterogenous population of patients, 174 patients with different diagnoses, including kidney failure (34%), cardio-vascular diseases (CVD) (28%), different cancers (16%) and other diseases completed the evaluation of comprehensibility and difficulty of the Polish PG-SGA SF v.2. Detailed characteristics of the participating patients is presented in Table 1 . Among 188 HCPs who completed the questionnaire developed for specialists, 78 were physicians, 47 nurses, 45 students of different faculties (pharmacy, dietetics, medicine and nursing), and 18 dietitians/ nutritionists. The median time of experience within their respective fields was 8.0 (range: 0.5–41.0) years. From the total group of HCPs, 19% were familiar with the PG-SGA, mainly from literature, courses, or other sources (e.g., their own research). However, only 6% of all professionals had experience with PG-SGA. Detailed characteristics of the participating HCPs is presented in Table 2 . The indices of comprehensibility, difficulty (as perceived by patients), and content validity (as perceived by HCPs for the Polish PG-SGA SF v2) are presented in Table 3 . Comprehensibility of SF PG-SGA was perceived as excellent by the patient group, with S-CI = 0.96 and individual item scores ranging from 0.90 to 1.00. Scores given by patients on difficulty fell into the excellent range (S-DI = 0.94) with individual item scores ranging from 0.93 to 0.95. Content validity for the patient component as perceived by the HCPs was excellent, with S-CVI = 0.90. No item indices were below acceptable range (< 0.80). Table 3 Indices for comprehensibility, difficulty and content validity for the patients-component of the Polish Patient-Generated Subjective Global Assessment Item Patients HCPs n CI n DI n CVI Box 1: Weight 1a I currently weigh about _kg 173 0.99 171 0.95 188 0.97 1b I am about _cm tall 173 0.99 187 0.95 1c One month ago, I weighted about _kg 170 1.00 186 0.94 1d Six months ago, I weighted about _kg 171 0.99 187 0.94 1e Weight (decreased/not change/increased) 171 0.96 167 0.95 183 0.93 Box 2: Food intake 2a As compared to my normal intake, I would rate my food intake during the past months as 162 0.96 173 0.95 185 0.97 2a1Unchanged/more than usual/less than usual 171 0.96 187 0.93 2b I am now taking 166 0.95 172 0.93 176 0.85 2b1 Normal food, but less than normal amount 169 0.96 186 0.83 2b2 Little soild foods 171 0.91 186 0.80 2b3 Only liquids 169 0.94 186 0.88 2b4 Only nutritional supplements 170 0.91 186 0.87 2b5 Very little of anything 171 0.90 185 0.86 2b6 Only tube feeding or nutrition by vein 171 0.94 185 0.92 Box 3: Symptoms 172 0.93 3a. I have the following problems that have kept me from eating enough during the past 2 weeks 155 0.96 187 0.95 3a1 no problems eating 173 0.98 186 0.89 3a2 no appetite. Just did not feel like eating 170 0.96 187 0.95 3a3 Vomiting 170 0.97 186 0.95 3a4 Nausea 170 0.95 187 0.92 3a5 Diarrhea 170 0.97 187 0.96 3a6 Constipation 171 0.95 187 0.91 3a7 Dry mouth 169 0.97 186 0.88 3a8 Mouth sores 170 0.96 187 0.94 3a9 Smells bother me 171 0.96 187 0.82 3a10Things taste funny or have no taste 170 0.94 187 0.86 3a11 Feel full quickly 173 0.97 187 0.88 3a12 Problems swallowing 170 0.97 187 0.95 3a13 Fatigue 173 0.96 187 0.81 3a14 Pain: where?____________ 169 0.98 186 0.95 3a15 other 169 0.96 163 0.82 Box 4: Activities and Function 172 0.94 4a Over the past month I would generally rate my activity as 171 0.95 186 0.89 4a1 Normal with no limitation 170 0.95 185 0.86 4a2 Not my normal self, but able to be up and about with fairly 171 0.96 184 0.88 4a3 Not feeling up to most things, but in bed of chair less than half the day 171 0.95 184 0.91 4a4 Able to do little activity and spend most of the day in bed or chair 169 0.95 184 0.91 4a5 Pretty much bedridden, rarely up of bed 169 0.96 181 0.92 Scale Indices patient-generated component 5860 0.96 1027 0.94 6661 0.90 CVI – Content Validity Indices; CI - Comprehensibility Indices; DI - Difficulty Indices Further analyses indicated that scales of comprehensibility and difficulty were significantly different among patients with different levels of education (Table 4 ). The highest S-CVI was perceived by patients with the highest education level (university). On the other hand, patients with secondary school evaluated difficulty at the lowest rate among all participants. Education level did not disclose scores of comprehensibility and difficulty below excellent range (> 0.90). Table 4 Comprehensibility and difficulty of patient component Polish version of PG-SGA per level of patient education and age. Scale CI p-value Scale DI p -value Level of education Primary school 0.95 ab 0.014 0.98 a 0.025 Secondary school 0.95 b 0.95 ab Vocational school 0.94 ab 0.85 b University 0.98 a 0.96 a Age ≤ 65 years 0.96 0.121 0.94 0.689 > 65 years 0.96 0.94 Differences were evaluated using U-Mann Whitney test ( p < 0.05), the values in the same column that share the same letter are not significantly different; CI - Comprehensibility Indexes; DI - Difficulty Indexes Table 5 presents comprehensibility, difficulty and content validity of the professional component of the Polish PG-SGA v2 as perceived by HCPs. Overall, comprehensibility, difficulty and content validity of worksheets were perceived as acceptable (S-CI = 0.87, SDI = 0.80 and S-VI = 0.86, respectively). In detail, comprehensibility and difficulty of 10/38 and 6/38 items, respectively, were perceived as below acceptable range (< 0.80). Moreover, content validity of 14/34 items fell below the predefined cutoff of 0.80. For comprehensibility and difficulty, all item scores that fell below cutoff for acceptability were from Worksheet 4 ( Physical exam ). For content validity, item scores below cutoff were from Worksheet 3 ( Metabolic demand ) and Worksheet 4 ( Physical exam ). Table 5 Indices for content validity, comprehensibility and difficulty for the professional component of the Polish Patient-Generated Subjective Global Assessment Item n CVI n CI N DI Worksheet 1 173 0.92 183 0.92 178 0.84 Scoring weight (Wt) loss 181 0.91 177 0.90 174 0.84 Worksheet 2. Disease and its relations to nutritional requirements 182 0.96 166 0.93 178 0.93 2a Cancer 184 0.96 184 0.93 185 0.90 2b. AIDS 184 0.94 184 0.95 185 0.88 2c. Pulmonary or cardiac cachexia 186 0.95 184 0.96 185 0.90 2d. Chronic renal insufficiency 186 0.96 184 0.96 185 0.91 2e. Presence of decubitus, open wound or fistula 186 0.94 184 0.96 184 0.91 2f. Presence of trauma 186 0.90 184 0.91 184 0.88 2g. Age greater than 65 185 0.88 184 0.95 183 0.91 2h. All relevant diagnoses 176 0.91 184 0.89 182 0.85 2i. Primary disease staging (circle if known or appropriate) I, II, III, IV, other 179 0.83 182 0.81 Worksheet 3. Metabolic demand 156 0.88 169 0.83 173 0.81 3a. Fever 185 0.88 184 0.88 184 0.85 3b. Fever duration 185 0.88 184 0.89 184 0.79 3c. Corticosteroids 185 0.88 183 0.86 183 0.79 Worksheet 4. Physical exam 161 0.88 172 0.80 168 0.70 4a. Temples 184 0.73 182 0.83 182 0.64 4b. Clavicles 187 0.66 185 0.79 184 0.67 4c. Shoulders (deltoids) 187 0.74 185 0.79 184 0.73 4d. (Interosseus muscles) 187 0.67 184 0.73 184 0.62 4e. Scapula (latissimus dorsi, trapezius, deltoids) 187 0.68 185 0.78 184 0.68 4f. Thigh (quadriceps) 187 0.78 185 0.84 184 0.78 4g. Calf (gastrocnemius) 187 0.76 185 0.83 184 0.80 4h. Global muscle status rating 185 0.87 184 0.86 183 0.77 4i. Orbital fat pads 185 0.62 185 0.86 184 0.54 4j. Triceps skinfold 185 0.75 185 0.78 184 0.72 4k Fat overlying lower ribs 186 0.70 185 0.79 183 0.69 4l. Global fat deficit rate 184 0.88 184 0.86 183 0.77 4m. Ankle edema 186 0.92 185 0.92 184 0.85 4n Sacral edema 186 0.82 185 0.87 184 0.81 4o. Ascites 185 0.93 185 0.90 184 0.81 4p. Global fluid status rating 186 0.92 185 0.90 184 0.80 Worksheet 5 Global Assessment Categories Stage A: well nourished; Stage B: moderate/suspected malnutrition; Stage C: severely malnourished 175 0.94 180 0.93 181 0.86 Nutritional triage recommendations: 181 0.93 180 0.89 183 0.83 Triage: 0–1, no intervention required at this time. Re-assessment on routine and regular basis during treatment 185 0.89 184 0.93 Triage: 2–3, patient and family education by dietitian, nurse, or other clinician with pharmacologic intervention as indicated by symptom survey (box 3) and lab values as appropriate 184 0.89 184 0.91 Triage: 4–8, requires intervention by dietitian, in conjunction with nurse or physician as indicated by symptoms (box 3) 185 0.93 184 0.92 Triage ≥ 9, indicates a critical need for improved symptom management and/or nutrient intervention options 185 0.92 184 0.93 Scale Indices professionals component 7129 0.86 7120 0.87 6380 0.80 Scale Indices full PG-SGA 11904 0.88 Items below acceptable range (< 0.78) are marked in bold; CVI – Content Validity Indices; CI - Comprehensibility Indices; DI - Difficulty Indices We found significant differences in all (content validity, comprehensibility and difficulty) scale indices ( p < 0.05 for all) between HCPs with different professions, as well as in S-CVI and S-CI between HCPs being familiar with PG-SGA vs those who being not. Those HCPs who were familiar with PG-SGA perceived the Polish PG-SGA v2 as less comprehensible and with lower content validity than those who were unfamiliar (Table 6 ). Table 6 Content validity, comprehensibility and difficulty of Polish version per profession, prior experience and familiarity with PG-SGA. Scale-CVI p -value Scale-CI p -value Scale-DI p -value Profession Physicians 0.83 c < 0.01 0.83 b < 0.01 0.75 b < 0.01 Nurses 0.91 a 0.86 ab 0.75 b Dietitians 0.95 b 0.96 c 0.93 a Students 0.90 a 0.91 a 0.87 a Experience Yes 0.88 0.18 0.88 0.71 0.77 0.66 No 0.88 0.87 0.80 Familiarity Yes 0.85 < 0.01 0.84 0.03 0.77 0.14 No 0.89 0.88 0.81 Items below acceptable range (< 0.78) are marked in bold; Differences were evaluated using U-Mann Whitney test ( p < 0.05), the values in the same column that share the same letter are not significantly different; CVI – Content Validity Indexes; CI - Comprehensibility Indexes; DI - Difficulty Indexes; Table 7 presents significant differences in the evaluation of content validity, comprehensibility, and difficulty of particular items among HCPs. Physicians followed by nurses rated particular items at the lowest score of content validity, comprehensibility, and difficulty. For content validity, most differences among HCPs were observed in Worksheet 4 ( Physical exam ), with the lowest scores among physicians and nurses. For comprehensibility, differences in scores between HCPs also concerned items mainly related to Worksheet 4 ( Physical exam ), with the lowest percentages of a high rating from physicians and nurses. Additionally, Worksheet 3 ( Metabolic demand ) and Worksheet 4 ( Physical exam ) were perceived as difficult also mostly by physicians and nurses. The difficulty of some items of Nutritional Triage Recommendations was evaluated as below the cutoff for acceptability only by physicians, presented significant higher percentages of a low rating for these items in comparison with other specialists. Table 7 Significant differences between groups of HCPs in content validity, comprehensibility and difficulty evaluation Items Students Nurses Dietitians /nutritionists Physicians Pearson Chi2 ( p -value) RELEVANCE/CONTENT VALIDITY Smells bother me 0.83 0.91 0.94 0.72 0.035 Fatigue 0.80 0.96 0.88 0.71 0.010 Scoring Weight Loss 0.93 0.98 1.00 0.85 0.048 Age greater than 65 0.94 0.96 1.00 0.79 0.005 All relevant diagnoses 0.98 0.95 1.00 0.84 0.009 Primary disease staging (circle if known or appropriate) I II III IV Other 0.86 0.98 0.94 0.67 0.0002 Worksheet 3 – Metabolic Demand 0.95 0.97 0.93 0.77 0.003 Corticosteroids 0.91 0.98 0.88 0.81 0.021 Clavicles (pectoralis & deltoids) 0.85 0.73 0.82 0.47 < 0.001 Shoulders (deltoids) 0.85 0.78 0.88 0.62 0.012 Interosseous muscles 0.83 0.78 0.82 0.48 < 0.001 Scapula (latissimus dorsi. trapezius. deltoids) 0.83 0.71 0.88 0.53 < 0.001 Orbital fat pads 0.78 0.67 0.82 0.45 < 0.001 Triceps skin fold 0.89 0.73 1.00 0.61 < 0.001 Fat overlying lower ribs 0.78 0.76 1.00 0.55 < 0.001 Sacral edema 0.81 0.96 0.94 0.72 0.003 COMPREHENSIBILITY Fever 0.96 0.80 1.00 0.85 0.044 Clavicles (pectoralis & deltoids) 0.91 0.78 0.88 0.70 0.030 Scapula (latissimus dorsi. trapezius. deltoids) 0.91 0.71 0.88 0.71 0.028 Calf (gastrocnemius) 0.93 0.73 0.94 0.79 0.033 Orbital fat pads 0.83 0.73 0.76 0.54 0.006 DIFFICULTY Pulmonary or cardiac cachexia 0.98 0.86 1.00 0.84 0.044 Metabolic demand 0.89 0.73 1.00 0.77 0.049 Fever 0.96 0.73 0.94 0.84 0.014 Corticosteroids 0.91 0.72 1.00 0.82 0.027 Clavicles (pectoralis & deltoids) 0.80 0.64 0.82 0.56 0.021 Interosseus muscles 0.78 0.60 0.65 0.52 0.038 Orbital fat pads 0.74 0.51 0.59 0.43 0.009 Triceps skin fold 0.85 0.60 0.88 0.68 0.020 Global fat deficit rating 0.87 0.60 0.94 0.76 0.006 Ankle edema 0.89 0.71 1.00 0.88 0.011 Global fluid status rating 0.91 0.67 1.00 0.77 0.007 Nutritional Triage Recommendations: 0.93 0.80 1.00 0.75 0.013 0–1 0.91 0.80 1.00 0.75 0.026 2–3 0.91 0.80 1.00 0.75 0.026 4–8 0.91 0.80 1.00 0.75 0.026 ≥ 9 0.89 0.80 1.00 0.75 0.046 Items below acceptable range (< 0.78) are marked in bold Step 8–10 After cognitive debriefing, in consideration of the individual comments given by the respondents to particular items, the key country members, the developer of the PG-SGA, and the international expert on translation and cultural adaptation of the PG-SGA consulted together and agreed to make some changes to the final Polish PG-SGA version 3 (Polish PG-SGA v3). These changes improved items in clarification and for better adaptation to the Polish settings (Table 8 ). For instance, in Box 2 about Food intake, the Polish answer item “very little of anything” was replaced by "very small amounts of any food”, “solid foods” was changed to “foods with solid consistency”, while in Box 3 the phrase: „eating enough” was changed to „adequate amounts of food”. Additionally, in the professional component, in Worksheet 1 we decided to bold weight loss in 1 month, because HCPs were often confused about which information on weight loss they should use (1 month vs. 6 months). All comments and suggestions from the patients and HCPs were taken into account and individually considered in finalizing the culturally adapted and linguistically validated version of the Polish Scored PG-SGA. Table 8 Changes of expression most often raised by patients and HCPs (PG-SGA Polish version) after review of Cognitive Debriefing Results and Finalization steps. Before After Reason Box PATIENTS B1 masa ciała (eng. body weight) waga (eng. body weight) The word „waga” is more common and used in colloquial language, while „masa ciała” is more specific, often used by specialists. B2 Bardzo małe ilości czegokolwiek (eng. very little of anything) Bardzo małe ilości jakichkolwiek pokarmów (eng. very small amounts of any food) It sounds better in Polish. B2 Preparaty odżywcze (eng. nutritional supplements) Preparaty odżywcze odżywki (np. nutridrinki, odżywki) (eng. nutritional supplements (e.g. nutridrinks, supplements) Examples of nutritional supplements were added, because some patients were confused what „preparaty odżywcze” are. B2 Pokarmy stałe (eng. solid foods) Pokarmy o stałej konsystencji (eng. foods with solid consistency) The word „konsystencja” was added because in Polish „stały” means also (except of solid) that something is done routinely, constantly. B3 wystarczających ilości pokarmów (eng. eating enough) odpowiednich ilości pokarmów (eng. adequate amounts of food) It sounds better in Polish. B4 Normalną bez ograniczeń (eng. normal, with no limitations) Taką jak zwykle, bez ograniczeń (eng. as usual, with no limitations) The word „normalna” was changed into „taka jak zwykle”, because patients were confused what normal physical activity means. The phrase: physical activity as usual relates more to the comparison between before and currently, than to the so-called norm. Worksheet HCPs W1 Weigh loss in 1 month vs weight loss in 6 months We decided to bold weight loss in 1 month HCPs were confused which weight loss should they use (1-month vs 6-months). W2 Lack of semicolon between I and II clinical stage Semicolon inserted Editorial error W3 72 godziny (eng. 72 hours) 72 godziny (3 dni) (eng 72 hours (3 days)) The HCPs had a problem with which accuracy to determine the duration of fever (e.g. whether 71.5 hours is still < 3 days). The addition of the unit "day" makes it easier to relate the duration of the fever to the needs of the sheet. Discussion Translation and cultural adaptation of the original PG-SGA (©2005) according to ISPOR Principles resulted in the Polish version which has preserved the purpose and conceptual meaning of the original PG-SGA. Independent forward and back translations, reconciliation and harmonization with the key developer and the international expert on translation and cultural adaptation of the PG-SGA and further cognitive debriefing with a large group of heterogeneous patients and HCPs delivered another new language version of the PG-SGA with conceptual and cognitive equivalence. Linguistic and content validation revealed that the patient component of the Polish version of the PGSGA was very well comprehensible and easy to complete for the patient. Obtained results indicated that the Polish version of the patient component, i.e., PG-SGA Short Form, can be further completed without any additional instruction from HCPs. Moreover, HCPs indicated that the patient component of the Polish version of the PGSGA was relevant. Similar results on the patient component were obtained in other studies performed in Denmark [19], Germany [20], Norway [24], Greece [21], Japan [22], the Netherlands [25], Thailand [26] and Italy [27]. In all mentioned studies, content validity, as well as comprehensibility and difficulty of the PG-SGA Short Form were perceived as excellent. This indicated that the translated and culturally adapted PG-SGA Short Form is considered feasible to perform by patients, in various countries and/or cultures. Our results revealed that comprehensibility and difficulty of the PG-SGA Short Form did not differ between older (age > 65 years) or younger adult patients. This indicates that the Polish version of the PG-SGA Short Form is understandable and easy to complete for both younger and older patients. However, the level of patients’ education had an impact on the results. Perceived comprehensibility was best by patients graduated from university, followed by those who graduated primary, secondary, and vocational school. Most patients perceived the PG-SGA Short Form as very easy to complete (i.e., excellent difficulty), with the exception of those with a vocational education, who found the difficulty acceptable. In contrast, the mean indices for difficulty were the highest in patients with primary education. It should be noted that the representation of patients with these two levels of education was the lowest (respectively 6% and 10%) in the entire recruited group, and concluding about the reasons for such a distribution of results is not possible. In the Japanese study, the relationship between educational level and difficulty was also analyzed, and in that study no relationship between education level and difficulty of the PG-SGA Short Form as perceived by patients was found [ 22 ]. Comprehensibility and difficulty of the professional component of the Polish version of the PG-SGA were considered acceptable by HCPs (S-CI = 0.87 and S-DI = 0.80, respectively). These results are in contrast to the results of the Norwegian [ 24 ], German [ 20 ], Dutch [ 19 ], Japanese[ 22 ] and Thai [ 26 ] studies, in which the professional component of the PG-SGA scored below acceptance in the constructs of difficulty, and additionally of comprehensibility in the Norwegian study [ 24 ]. On the other hand, in a recently published study on the validation of the Greek version of the PG-SGA [ 21 ], comprehensibility and difficulty of the professional component were perceived as excellent (≥ 0.90). Also in the Italian study, comprehensibility, as well as content validity, were perceived as excellent, but difficulty was considered acceptable by professionals [ 27 ]. Despite presented differences in comprehensibility and difficulty, relevance of the professional component of the PG-SGA was perceived as excellent in almost all performed studies on validation of translations and culturally adaptations of the PG-SGA [ 20 , 24 ]. Only results of our study and the Dutch study[ 19 ] indicated that professionals perceived content validity of the PG-SGA as acceptable. Additionally, content validity of the Full PG-SGA was perceived in the current and other studies as acceptable[ 19 ] or even excellent [ 20 , 24 ]. Lower ratings on relevance obtained in our study and the Dutch study[ 19 ] came mainly from low ratings of the Physical exam in Worksheet 4. In line with other studies on linguistic and content validation of the PG-SGA, Worksheet 4 (Physical exam) was considered the most difficult, most incomprehensible, and with the lowest scores on content validity from all worksheets of the professional component of the PG-SGA. Difficulty considered by HCPs was below acceptance for about 70% of items from this worksheet, and these items concerned mainly evaluation of muscle status. Additionally, HCPs evaluated that comprehensibility of about one-third of all items from Worksheet 4 , i.e., the physical exam, was below acceptable range. Most importantly, the content validity of almost 60% of all items from this worksheet was considered unacceptable. This indicated that HCPs seem to feel no need to perform a physical exam, especially so detailed for muscle status rating. It is unclear why relevance of the physical exam was rated low by the Polish HCPs, but we speculate that insufficient knowledge about how to apply the PG-SGA plays a role. For example, the inclusion of seven muscles groups in Worksheet 4 does not mean that all seven muscle groups need to be evaluated in every patient. Previous studies have demonstrated that a one-day training on the PG-SGA increases perceived comprehensibility and difficulty. In the Dutch study performed in dietitians [ 30 ], difficulty and comprehensibility indices related to muscle status in Worksheet 4 increased from 0.16 to 0.54 and from 0.41 to 0.91 after the training, respectively. Also, in the Portuguese study [ 31 ] that was performed in a sample of mostly dietitians as well, training in the PG-SGA improved ratings on difficulty, mostly concerning items of Physical exam . In that study, the maximum difference in scale index scores on the difficulty of particular items related to the physical exam was 0.258. These studies [ 30 , 31 ] demonstrate high effectiveness of training, in which knowledge and skills on applying the PG-SGA are expanded, on perceived difficulty, and comprehensibility especially among HCPs who had no experience with this questionnaire. We hypothesize that higher scores on difficulty and comprehensibility may in turn result in improved perceived relevance of the physical exam of the PG-SGA. Additional advantages of training could be more reliable results. Detailed analysis of results among different HCPs revealed that physicians evaluated comprehensibility, difficulty and content validity lowest, while difficulty was even below acceptable threshold. These results would indicate that physicians were more conscious of a possible lack of experience, especially in the term of muscle status rating. However, in the Norwegian study [ 24 ], no significant differences between type of HCP or familiarity with the PG-SGA were found. In our study, only 6% of all participants had actually been experienced with the PG-SGA before, and the familiarity with PG-SGA was reported by 19% of HCPs and came mainly from the literature. Additionally, in our study, we found a significant difference in comprehensibility and content validity depending on the knowledge of the tool. Surprisingly, HCPs who had prior knowledge on the PG-SGA, evaluated content validity and comprehensibility lower than those who were not familiar with PG-SGA. These results indicate that training in the use of PG-SGA before daily practice is needed for everyone, including those already familiar with PG-SGA from the literature. Theoretical knowledge did not translate into higher content validity, i.e., perceived relevance. Implications for practice and research Nutritional screening tools are used to identify patients at nutritional risk. To be useful, a tool must be practical, easy to carry out, cost-effective, not time-consuming, highly sensitive, have good specificity, and be highly reliable, that means, having a small variation between observers and separate time points. All these conditions are met by the PG-SGA [ 32 , 33 ] and moreover, it is a tool for nutritional assessment, triage and monitoring. It has demonstrated good sensitivity, specificity and positive and negative predictive value, as well as very good predictive value for overall survival and quality of life in patients at risk of malnutrition [ 33 , 34 , 35 ]. The use of ISPOR Principles during the translation and cultural adaptation of the original English version of PG-SGA into other languages ensures that the original purpose and intention of the key developer will be preserved and will ensure the cultural equivalence of the tool. So far, the PG-SGA has been translated and culturally adapted into eleven languages and linguistically validated in this way, and more language versions similarly produced are being developed [ 36 ]. The results for the Polish translation and cultural adaptation indicate that the Polish PG-SGA version maintained purpose, meaning, and format equivalent to the original PG-SGA. Furthermore, the acceptable values for content validity reflect that the Polish version presented in this paper is ready for use in clinical practice and in future studies conducted in the Polish language. In connection with the above, the PG-SGA can be easily implemented in the Polish language, and scientific and clinical results will be reliable and consistent with international data derived from validated versions of this tool. Nevertheless, before implementing the full PG-SGA in clinical practice, training of professionals is recommended. Strengths and limitations of the study A major strength of the current study is the application of the ISPOR Principles, similar to the previous studies on new language versions of the PG-SGA, as this gives a unique opportunity to compare the obtained results between the studies. Secondly, the forward translations were performed by three persons instead of two as in other studies [ 19 , 20 , 24 ] and the translated text was verified by 20 independent experts. Thanks to such a meticulous approach to the task, 32 differences in the translation of wordings were identified, which, after harmonization, allowed us to obtain the optimal version of the translation. Thirdly, we included a very large group of patients (n = 174) and HCPs (n = 188) in the cognitive debriefing and linguistic and content validation. To the best of our knowledge, this is the largest number of participants included in the PG-SGA linguistic and content validation studies to date. Fourthly, involvement of patients and HCPs from many centers located throughout Poland, allowed us to consider our study as representative for the whole country. Finally, with a large group of HCPs and patients with different disease entities from different health care centers, differentiated in terms of gender, age and education, our study sample is representative for the heterogeneous patient populations being at risk for malnutrition, and allowed for determining content validity, comprehensibility, and difficulty per type of HCP. The study also has some limitations. The uneven distribution of numbers in the subgroups, both among patients and HCPs, could have influenced the results of the statistical analyses. Conclusions Translation and cultural adaptation of the PG-SGA for the Polish setting according to ISPOR Principles preserved the purpose and conceptual meaning of the original PG-SGA. The linguistic and content validation revealed that the Polish version of PG-SGA is well understood and easy to complete by patients and professionals and considered relevant by professionals. However, detailed results for content validity, comprehensibility, and difficulty of the professional component of PG-SGA indicate the need for appropriate training of the Polish HCPs, especially physicians and nurses, mainly in the worksheets related to the metabolic demand and physical exam. Declarations Acknowledgements We thank all participating professionals and patients for their invaluable contribution to the study. Statements & Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Katarzyna Zabłocka-Słowińska, Joanna Pieczyńska, Anna Prescha, Maciej Bladowski, Damian Gajecki, Dorota Kamińska, Katarzyna Neubauer Faith Ottery, Harriët Jager-Wittenaar . The first draft of the manuscript was written by Katarzyna Zabłocka-Słowińska, Joanna Pieczyńska, Anna Prescha and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. This is an observational study. The Wroclaw Medical University Bioethics Committee (KB- 540/2019) approved the study. Competing Interests Dr Jager-Wittenaar was co-developer of the PG-SGA based pt-Global webtool. Dr Ottery is the creator and copyright holder of the PG-SGA (c) and all derivatives. Dr Zabłocka-Słowińska, Dr Pieczyńska, Dr Prescha, Dr Bladowski, Dr Gajecki, Dr Kamińska, Dr Neubauer, have nothing to disclose. Author Contribution All authors contributed to the study conception and design. 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Cite Share Download PDF Status: Published Journal Publication published 04 Sep, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 16 Jul, 2024 Reviews received at journal 16 Jul, 2024 Reviewers agreed at journal 16 Jul, 2024 Reviewers agreed at journal 21 May, 2024 Reviews received at journal 13 May, 2024 Reviewers agreed at journal 30 Apr, 2024 Reviewers invited by journal 15 Apr, 2024 Editor assigned by journal 15 Apr, 2024 Submission checks completed at journal 06 Mar, 2024 First submitted to journal 26 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-3991268","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276871806,"identity":"818c0b38-4b92-4cee-b2e6-3f23b07a5a62","order_by":0,"name":"Katarzyna Zabłocka-Słowińska","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABdklEQVRIie2ST0vDMBiH3xHoLsFeUzq2r1ARJmWTfZWEQr3oHAykB5HAoLvovSLoV9Bv0BHoLmO9TuahUvBcGIiyofbftiroWbDPKfklT5s3bwBKSv4gpDhB0MuTAAADSABROsgS2MkVVFS0XKG5UnHWSpwkn/hVSbcgvF7bKsrQHy2slejKvPq06GnthjJ0UUQtUduXPbY4sB9rUL0cBdSCbqao2EDKBIs+ccFQHc3cvcZUInQisO6YQj22nzHgqaHRCfQzpQ4GKJwIxl1wVawJWoeTF2D2HGuzKo8VgYEcNQmz4zBT5BC9cU2wW7cyWKaKHKAoVfzxYKlvlPe1ohJDUjgV7M5FUvoXlVAgqeKanlrZKHytKE7Y1Ll7yO6FJLWSWq6cIKnlIz6YaeoXU4GltBaP5LUQn4UPfNViN+NhOO9Z7QbxKYoiy+xovrc3ez0VHTm5seis3ZWLfR9AsT/fkLJuEvolPf9xf8r2AZSUlJT8Rz4B3TWJOOiF7VQAAAAASUVORK5CYII=","orcid":"","institution":"University of Opole","correspondingAuthor":true,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Zabłocka-Słowińska","suffix":""},{"id":276871807,"identity":"2b97ffc1-3b79-4b80-9ac3-75f268b62840","order_by":1,"name":"Joanna Pieczyńska","email":"","orcid":"","institution":"Wroclaw Medical University","correspondingAuthor":false,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Pieczyńska","suffix":""},{"id":276871808,"identity":"22f599d6-b6cc-4017-baf3-d7937a1e3c90","order_by":2,"name":"Anna Prescha","email":"","orcid":"","institution":"Wroclaw Medical University","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Prescha","suffix":""},{"id":276871809,"identity":"7f2753d2-bd14-48e0-bd79-f798e6ada83c","order_by":3,"name":"Maciej Bladowski","email":"","orcid":"","institution":"Wroclaw Medical University","correspondingAuthor":false,"prefix":"","firstName":"Maciej","middleName":"","lastName":"Bladowski","suffix":""},{"id":276871810,"identity":"a6e441a7-4ad6-4dd8-8404-51d4daa1187c","order_by":4,"name":"Damian Gajecki","email":"","orcid":"","institution":"Wroclaw Medical University","correspondingAuthor":false,"prefix":"","firstName":"Damian","middleName":"","lastName":"Gajecki","suffix":""},{"id":276871812,"identity":"2d2efdaf-1c2d-4a66-9bb9-7bed005ff1f1","order_by":5,"name":"Dorota Kamińska","email":"","orcid":"","institution":"Wroclaw Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dorota","middleName":"","lastName":"Kamińska","suffix":""},{"id":276871814,"identity":"7507828e-2829-4485-8f6c-c69a182da473","order_by":6,"name":"Katarzyna Neubauer","email":"","orcid":"","institution":"Wroclaw Medical University","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Neubauer","suffix":""},{"id":276871816,"identity":"a68a57a9-cdfd-4a54-8481-b74aeeeebf55","order_by":7,"name":"Faith Ottery","email":"","orcid":"","institution":"Ottery \u0026 Associates, LLC, Oncology Care Consultants","correspondingAuthor":false,"prefix":"","firstName":"Faith","middleName":"","lastName":"Ottery","suffix":""},{"id":276871817,"identity":"c447fe00-4b5d-4bea-a6b6-e220989404f7","order_by":8,"name":"Harriët Jager-Wittenaar","email":"","orcid":"","institution":"Hanze University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Harriët","middleName":"","lastName":"Jager-Wittenaar","suffix":""}],"badges":[],"createdAt":"2024-02-26 15:12:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3991268/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3991268/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-08808-5","type":"published","date":"2024-09-04T15:58:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64186155,"identity":"42ec691a-bf53-41cb-863a-8375d2f28701","added_by":"auto","created_at":"2024-09-09 16:25:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1365330,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3991268/v1/e5d05399-261f-47b8-9f74-d4791f0f0c69.pdf"}],"financialInterests":"Competing interest reported. Dr Jager-Wittenaar was co-developer of the PG-SGA based pt-Global webtool. \nDr Ottery is the creator and copyright holder of the PG-SGA (c) and all derivatives. \n\nDr Zabłocka-Słowińska, Dr Pieczyńska, Dr Prescha, Dr Bladowski, Dr Gajecki, Dr Kamińska, Dr Neubauer, have nothing to disclose.","formattedTitle":"Polish translation, cultural adaptation, and validity confirmation of the Scored Patient-Generated Subjective Global Assessment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBoth acute and chronic diseases may lead to malnutrition, which has been defined as \u0026ldquo;a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat-free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Disease-related malnutrition increases complication rates and mortality, it is also associated with longer hospital stays, and causes an increased financial burden on healthcare organizations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalnutrition is multifactorial and multidimensional, and adequately identifying malnutrition and its key determinants must be regarded as essential [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to the consensus established by the Global Leadership Initiative on Malnutrition (GLIM), which has been formed by representatives of major clinical nutrition societies including the European Society for Clinical Nutrition and Metabolism (ESPEN), the American Society for Clinical Nutrition and Metabolism (ASPEN), Federaci\u0026oacute;n Latinoamericana de Terapia Nutricional, Nutrici\u0026oacute;n Cl\u0026iacute;nica y Metabolismo (FELANPE), and the Parenteral and Enteral Nutrition Society of Asia (PENSA), the process of malnutrition diagnosis includes two steps. The first step is malnutrition risk screening and the second step is nutritional assessment for diagnosis and severity grading of malnutrition. The diagnosis of malnutrition must encompass both phenotypic criteria (i.e., weight loss, low body mass index, and reduced muscle mass) and etiologic criteria (i.e., reduced food intake or absorption and burden associated with disease or inflammation), whereby at least one etiologic and one phenotypic criterion is required to diagnose malnutrition [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Consistent with these guidelines are the ESPEN recommendations that the patient's nutritional care should be provided in a systematic way, that involves identifying malnourished patients or patients at risk of malnutrition using validated screening tools, followed by implementation of adequate intervention and monitoring the results of the intervention [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Poland, the concept of the two-step approach of screening and assessment has been implemented, and accordingly, two tools, i.e., Nutritional Risk Score 2002 (NRS 2002) or Subjective Global Assessment (SGA), are obligatorily used in all Polish hospital wards on the patient admission and then every 14 days of the hospitalization. In elderly patients, Mini Nutritional Assessment (MNA) is also used. The other tool recommended by ESPEN, i.e., the Malnutrition Universal Screening Tool (MUST) is available as well [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In a recent study aiming to audit the nutritional status of 10,863 hospitalized patients in 25 European countries, including Poland, another simple and frequently used tool - Malnutrition Screening Tool (MST) was applied. The prevalence of malnutrition risk and malnutrition in Polish hospital wards, based on ESPEN diagnostic criteria [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], was found to be 25% and 9%, respectively. Both prevalence rates represented a lower percentage compared to prevalence rate identified in other European countries participating in the survey (30% and 13%, respectively) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the frequency of particular nutritional risk factors in hospitalized patients, i.e., unintended body weight loss or insufficient recent food intake were approximately two times higher than the frequency of malnutrition risk both in Polish and in whole European study population. The study also revealed that managing patients with malnutrition or risk of malnutrition in Polish hospital wards is inferior to that carried out in European facilities involved in the survey. For example, it showed four times lower commitment of nutrition experts in managing patients with identified malnutrition or risk of malnutrition. This may result in noticed lower supply of special diets (8% vs 16%) and oral nutritional supplements (4% vs 12%) in Polish hospital wards [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. One of the measures to assist in the elaboration of a comprehensive concept of nutritional care for patients could be the implementation of tools that integrate the process of identification of malnourished patients with the decision-making pathway for the implementation of appropriate management. A tool that addresses not only screening, and assessment, but also monitoring and triaging for interventions is the Patient-Generated Subjective Global Assessment (PG-SGA) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe PG-SGA adequately covers all domains of the construct of malnutrition[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The PG-SGA is a two-page form that is fitted with a scoring system. The first page is patient-generated, including four boxes that address patients\u0026rsquo; weight, food intake, symptoms affecting food intake (i.e., nutrition impact symptoms), and level of activity and functioning. The latter two components extend beyond the GLIM criteria and broaden the assessment of phenotypic and etiologic hallmarks of malnutrition with relevant inputs for triaging for interventions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The second page is a professional component consisting of five worksheets designed to score: weight loss, patients\u0026rsquo; diagnosis in relation to nutritional requirements, metabolic stress and body composition (muscle, fat and fluid status), and finally, to summarize the total PG-SGA with its conversion in nutritional triage recommendation and patient\u0026rsquo;s global assessment stage categorization. Combining patient- and professional-generated data allows complex insights into the nutritional status of patients, which makes PG-SGA a unique tool for use in nutritional care.\u003c/p\u003e \u003cp\u003eThe PG-SGA has been shown to be more sensitive and specific in the nutritional assessment of cancer patients than other tools [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and is often considered a semi-gold standard for nutritional screening in oncology [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The validity of PG-SGA has also been confirmed in evaluating the nutritional status of nephrology and neurology patients, in elderly and palliative care, amongst others [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The PG-SGA has already been culturally adapted and linguistically validated for use in various settings worldwide, including Dutch, Portuguese, German, Thai and more recently Greek and Japanese, as well as Norwegian, Danish and Italian [\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The development of these new PG-SGA language versions was based on the Principles of Good Practice for the Translation and Cultural Adaptation Process (ISPOR) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. So far, there is no validated Polish version of the PG-SGA available. Therefore, we aimed to translate and culturally adapt the original English PG-SGA for the Polish setting, and to assess the linguistic validity as perceived by the Polish population, both patients and healthcare professionals, and content validity by healthcare professionals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTranslation and cultural adaptation\u003c/h2\u003e \u003cp\u003eThe translation and cultural adaptation process of the PG-SGA for the Polish setting has been carried out with permission and in close cooperation with the key developer and copyright holder of the PG-SGA (FO) and an international expert on translation and cultural adaptation of the PG-SGA (HJ-W).\u003c/p\u003e \u003cp\u003eThe entire process of translation, cultural adaptation, and content and linguistic validation was conducted between August 2016 and January 2021, according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guideline \u0026ldquo;\u003cem\u003eTranslation and Cultural Adaptation of Patient-Reported Outcomes Measures - Principles of Good Practice\u003c/em\u003e\u0026rdquo; (ISPOR principles) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The ISPOR principles consist of the ten steps in the translation and cultural adaptation process:\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 1) Preparation\u003c/b\u003e \u0026ndash; the project manager made contact with the key developer of the original version of the PG-SGA and the international expert on translation and cultural adaptation of the PG-SGA.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 2) Forward Translation\u003c/b\u003e \u0026ndash; this step was carried out by three native Polish speakers (the project manager/key in-country consultant and two project co-managers) who are experts on the subject of nutritional assessment and with sufficient knowledge of the English language.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 3) Reconciliation\u003c/b\u003e \u0026ndash; the independent three forward translations were compared with each other and transferred into one integrated forward translation (Polish PG-SGA version 1) that has been subject to verification by an independent group of experts in terms of cultural and semantic content. The group of experts (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20) included dietitians (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5), physicians (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8), nurses (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2), pharmacist (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), psychologist (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3) and physiotherapist (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1). After consensus was reached, the reconciled forward translation, i.e., Polish PG-SGA version 2 (Polish PG-SGA v2) was finalized.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 4) Back Translation\u003c/b\u003e - two back translations of the reconciled forward translation were independently carried out by two certificated translation companies.\u003c/p\u003e \u003cp\u003e\u003cb\u003eStep 5, 6) Back Translation Review and Harmonization\u003c/b\u003e - all differences between the original English version and the two back translations were discussed at a meeting of the project manager/key in-country consultant and two project co-managers, the developer of the PG-SGA, and the international expert on cross-cultural adaptation of the PG-SGA. The Polish PG-SGA v2 was adapted, if needed, to harmonize with the original English version.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eLinguistic and content validation\u003c/h2\u003e \u003cp\u003e The linguistic and content validation of PG-SGA Polish v2 included steps 7\u0026ndash;9 of the ISPOR guidelines. Step 7 concerns cognitive debriefing of the Polish translation in a heterogenous group of patients and healthcare professionals. The purpose of this step is to ensure that the translation is comprehensible and easy to complete by general population of patients and healthcare professionals, and that the healthcare professionals perceive the Polish PG-SGA as relevant.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 7) Cognitive Debriefing\u003c/b\u003e \u0026ndash; this step comprises cognitive debriefing of the Polish PG-SGA v2 with patients and healthcare professionals\u0026rsquo; groups.\u003c/p\u003e \u003cp\u003eThree components were used to evaluate the items in the Polish PG-SGA v2:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eComprehensibility\u003c/b\u003e - how clearly is the item described in the tool?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDifficulty\u003c/b\u003e - how difficult is it to answer the item (does the respondent need more knowledge or skills to be able to answer the item)?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eContent validity\u003c/b\u003e - does the respondent consider the item relevant to the concept of malnutrition?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePatients group\u003c/h2\u003e \u003cp\u003eFor the cognitive debriefing, 174 patients from various regions of Poland evaluated comprehensibility and difficulty of the PG-SGA patient component, i.e., the Polish PG-SGA Short Form version 2 (Polish PG-SGA SF v2). The adult, Polish native speaking participants were recruited between May 2018 and December 2020, from Lower-Silesian Oncology Center in Wroclaw, Uzdrowisko Wysowa S.A. dialysis station (SPA Hospital) in Wysowa Zdr\u0026oacute;j and University Clinical Hospital in Wroclaw (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The comprehensibility and difficulty evaluation was carried out using a questionnaire. The questionnaire contained demographic information and thirty-six questions addressing comprehensibility, six addressing difficulty and four open-ended questions with feedback on the Polish wordings. The degree of difficulty and comprehensibility was assessed by a 4-point Likert scale. The questionnaire was used before in other studies concerning cultural adaptation and validation of the PG-SGA [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\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 \u003cp\u003eCharacteristics of the patient participants (n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender,\u0026nbsp;% (n) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge [years], mean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (\u0026plusmn;\u0026thinsp;16.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation\u0026nbsp;level\u0026nbsp;% (n)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u0026nbsp;school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u0026nbsp;school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u0026nbsp;education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasic\u0026nbsp;vocational\u0026nbsp;school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiagnosis,\u0026nbsp;% (n)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney\u0026nbsp;failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003ea\u003c/sup\u003e stated by 143 patients; CVD \u0026ndash; cardiovascular disease\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare professionals\u003c/h2\u003e \u003cp\u003eIn parallel, 188 healthcare professionals (HCPs) participated in evaluating comprehensibility, difficulty and content validity of the full Polish PG-SGA v2. These group of participants consisted of physicians, nurses, dietitians, nutritionists and medical students recruited from hospitals and primary health care clinics from various regions of Poland, Lower-Silesian Oncology Center in Wroclaw, Uzdrowisko Wysowa S.A. dialysis station (SPA Hospital) in Wysowa Zdr\u0026oacute;j, University Clinical Hospital in Wroclaw, Wroclaw Medical University and University of Applied Sciences in Nysa (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). They were asked to provide demographic information (sixteen questions) and to complete a questionnaire consisting of thirty-eight questions on comprehensibility and thirty-eight on difficulty of the professional component of the PG-SGA (i.e., the Worksheets), and seventy-five on content validity of the full version PG-SGA. Additionally, the respondents were asked to complete eight open-ended questions for feedback on the Polish wordings of the professional component of the PG-SGA. The degree of difficulty, comprehensibility and content validity was assessed by a 4-point Likert scale. The questionnaire has previously been used before in other studies concerning cultural adaptation and validation of the PG-SGA [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\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 \u003cp\u003eCharacteristics of HCP participants (n\u0026thinsp;=\u0026thinsp;188)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCurrent\u0026nbsp;profession, % (n)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritionist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietitian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.0 (47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent,\u0026nbsp;\u0026nbsp;dietetics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026nbsp;(10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent,\u0026nbsp;medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent,\u0026nbsp;pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent,\u0026nbsp;nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePlace of\u0026nbsp;employment, % (n)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u0026nbsp;practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u0026nbsp;healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience in the current profession\u003csup\u003ea\u003c/sup\u003e, median (min-max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.5\u0026ndash;41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCaring\u0026nbsp;for the\u0026nbsp;patient\u0026nbsp;population, % (n)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOncological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026nbsp;(13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeriatric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamiliar\u0026nbsp;with PG-SGA -\u0026nbsp;Yes, % (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience\u0026nbsp;with PG-SGA -\u0026nbsp;Yes, % (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003ea\u003c/sup\u003e stated by 143 professionals\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e The Wroclaw Medical University Bioethics Committee (KB-540/2019) approved the study. Each participant (patient and healthcare professional) provided informed consent before participating in the study after reading the consent form of participation in the study:\u003c/p\u003e \u003cp\u003e \u003cem\u003eThis is the study on the validation of the translated and culturally adapted PG-SGA form for the Polish setting. Completing the survey will take you approximately 20 minutes and is completely anonymous. The study aims to assess comprehensibility and difficulty of PG-SGA Short Form by patients, and additionally content validity, comprehensibility and difficulty of short form and professional component by HCPs. Comprehensibility means how clearly is the item described in the tool. Difficulty - how difficult is to answer the item (e.g. do you need more knowledge or skills to be able to answer the item). Content validity answers the question if you consider the item relevant to the concept of malnutrition. Evaluations are operationalized by a 4-point scale. If you do not wish to continue with the survey you can stop answering the questions on the form at any time.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 8) Review of Cognitive Debriefing and Finalization\u003c/b\u003e - the results of the questionnaire posed to patients and health care professionals were reviewed by the project manager and co-managers as well as the developer of the PG-SGA, and the international expert on translation and cultural adaptation of the PG-SGA. Based on the respondents\u0026rsquo; suggestions, necessary changes to improve the translated items were discussed with and approved by the developer of the PG-SGA (FO). After review, the Polish version of the PG-SGA was finalized by the project manager and co-managers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 9) Proofreading\u003c/b\u003e - the finalized Polish version of the PG-SGA was proofread by the project manager and co-managers to check possible grammar and spelling errors, as well as the legibility of the graphic form.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 10) Final Report\u003c/b\u003e - the final report includes a description of all stages of validation and cultural adaptation of the Polish version of PG-SGA and conclusions drawn on the basis of the obtained validation results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eFor item and scale scores calculations, scores of 1 and 2 were recoded into 0, as \u0026lsquo;not present\u0026rsquo;, while scores of 3 and 4 were recoded into 1, indicating \u0026lsquo;present\u0026rsquo;, according to Sealy et al.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Item indices were calculated by dividing the number of respondents who considered the item to be \u0026lsquo;present\u0026rsquo; by the total number of respondents. Indices were calculated for each item for comprehensibility (I-CI), difficulty (I-DI), and content validity (I-CVI). Item indices\u0026thinsp;\u0026lt;\u0026thinsp;0.78 required further analysis of the item.\u003c/p\u003e \u003cp\u003eThe Scale Indexes were calculated by averaging all item indices for the respective construct: for comprehensibility as Scale Comprehensibility Index (S-CI), for difficulty as Scale Difficulty Index (S-DI), and for content validity as Scale Content Validity Index (S-CVI). Patients evaluated comprehensibility and difficulty of the patient component of the PG-SGA only, and therefore the patient Scale Indices (S-CI and S-DI) are only referring to the PG-SGA SF. HCPs evaluated content validity of the PG-SGA SF and of the professional component of the PG-SGA, resulting in a total scale index for the full PG-SGA. Comprehensibility and difficulty were evaluated by HCPs only, for the professional component of the PG-SGA. Scale indices 0.80\u0026ndash;0.89 were considered acceptable and \u0026ge;\u0026thinsp;0.90 as excellent.\u003c/p\u003e \u003cp\u003eAll calculations of the item indices and index scores were performed in Excel.\u003c/p\u003e \u003cp\u003eContinuous variables are presented as means and standard deviation (SD) or medians and range. Categorical variables are presented as frequencies (number) and percentage. The Chi\u003csup\u003e2\u003c/sup\u003e test was used for distribution comparison of categorical variables between groups. The independent sample t-test (for parametric data) or Mann-Whitney U-test (for non-parametric data) were used to analyse differences between two groups, while one-way ANOVA or Kruskal Wallis test was used for more than two groups. Post hoc analyses were performed for intergroup comparison of data. All statistical analyses were performed using STATISTICA v. 13.3 (StatSoft, Inc., Tulsa, USA). A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistically significant differences.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStep 1\u0026ndash;6\u003c/h2\u003e \u003cp\u003eDuring the forward translation process, in which three independent Polish translations of PG-SGA were produced, 36/55 items of the patient component and 66/97 items of the professional component differed between each other. The reconciliation step (data are available upon request to the corresponding author) resulted in the Polish PG-SGA v1. Then, back translations provided by two independent persons revealed additional thirty discrepancies after review against the original version, which were further discussed with the developer of the original version of the PG-SGA and the international expert on translation and cultural adaptation of the PG-SGA (data can be made available upon request to the corresponding author). After harmonization, the Polish PG-SGA v2 was then included into cognitive debriefing and exploration of content validity by questionnaires administered to patients and HCPs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStep 7\u003c/h2\u003e \u003cp\u003eTo ensure inclusion of a heterogenous population of patients, 174 patients with different diagnoses, including kidney failure (34%), cardio-vascular diseases (CVD) (28%), different cancers (16%) and other diseases completed the evaluation of comprehensibility and difficulty of the Polish PG-SGA SF v.2. Detailed characteristics of the participating patients is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAmong 188 HCPs who completed the questionnaire developed for specialists, 78 were physicians, 47 nurses, 45 students of different faculties (pharmacy, dietetics, medicine and nursing), and 18 dietitians/ nutritionists. The median time of experience within their respective fields was 8.0 (range: 0.5\u0026ndash;41.0) years. From the total group of HCPs, 19% were familiar with the PG-SGA, mainly from literature, courses, or other sources (e.g., their own research). However, only 6% of all professionals had experience with PG-SGA. Detailed characteristics of the participating HCPs is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe indices of comprehensibility, difficulty (as perceived by patients), and content validity (as perceived by HCPs for the Polish PG-SGA SF v2) are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Comprehensibility of SF PG-SGA was perceived as excellent by the patient group, with S-CI\u0026thinsp;=\u0026thinsp;0.96 and individual item scores ranging from 0.90 to 1.00. Scores given by patients on difficulty fell into the excellent range (S-DI\u0026thinsp;=\u0026thinsp;0.94) with individual item scores ranging from 0.93 to 0.95. Content validity for the patient component as perceived by the HCPs was excellent, with S-CVI\u0026thinsp;=\u0026thinsp;0.90. No item indices were below acceptable range (\u0026lt;\u0026thinsp;0.80).\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 \u003cp\u003eIndices for comprehensibility, difficulty and content validity for the patients-component of the Polish Patient-Generated Subjective Global Assessment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eHCPs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eDI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eCVI\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBox 1: Weight\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1a I currently weigh about _kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1b I am about _cm tall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1c One month ago, I weighted about _kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1d Six months ago, I weighted about _kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1e Weight (decreased/not change/increased)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBox 2: Food intake\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2a As compared to my normal intake, I would rate my food intake during the past months as\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2a1Unchanged/more than usual/less than usual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b I am now taking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b1 Normal food, but less than normal amount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b2 Little soild foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b3 Only liquids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b4 Only nutritional supplements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b5 Very little of anything\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b6 Only tube feeding or nutrition by vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBox 3: Symptoms\u003c/p\u003e \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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a. I have the following problems that have kept me from eating enough during the past 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a1 no problems eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a2 no appetite. Just did not feel like eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a3 Vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a4 Nausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a5 Diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a6 Constipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a7 Dry mouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a8 Mouth sores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a9 Smells bother me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a10Things taste funny or have no taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a11 Feel full quickly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a12 Problems swallowing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a13 Fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a14 Pain: where?____________\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a15 other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBox 4: Activities and Function\u003c/p\u003e \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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a Over the past month I would generally rate my activity as\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a1 Normal with no limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a2 Not my normal self, but able to be up and about with fairly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a3 Not feeling up to most things, but in bed of chair less than half the day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a4 Able to do little activity and spend most of the day in bed or chair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a5 Pretty much bedridden, rarely up of bed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\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=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale Indices patient-generated component\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5860\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e6661\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eCVI \u0026ndash; Content Validity Indices; CI - Comprehensibility Indices; DI - Difficulty Indices\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurther analyses indicated that scales of comprehensibility and difficulty were significantly different among patients with different levels of education (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The highest S-CVI was perceived by patients with the highest education level (university). On the other hand, patients with secondary school evaluated difficulty at the lowest rate among all participants. Education level did not disclose scores of comprehensibility and difficulty below excellent range (\u0026gt;\u0026thinsp;0.90).\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 \u003cp\u003eComprehensibility and difficulty of patient component Polish version of PG-SGA per level of patient education and age.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScale CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScale DI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVocational school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.94 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eDifferences were evaluated using U-Mann Whitney test (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the values in the same column that share the same letter are not significantly different; CI - Comprehensibility Indexes; DI - Difficulty Indexes\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents comprehensibility, difficulty and content validity of the professional component of the Polish PG-SGA v2 as perceived by HCPs. Overall, comprehensibility, difficulty and content validity of worksheets were perceived as acceptable (S-CI\u0026thinsp;=\u0026thinsp;0.87, SDI\u0026thinsp;=\u0026thinsp;0.80 and S-VI\u0026thinsp;=\u0026thinsp;0.86, respectively). In detail, comprehensibility and difficulty of 10/38 and 6/38 items, respectively, were perceived as below acceptable range (\u0026lt;\u0026thinsp;0.80). Moreover, content validity of 14/34 items fell below the predefined cutoff of 0.80. For comprehensibility and difficulty, all item scores that fell below cutoff for acceptability were from Worksheet 4 (\u003cem\u003ePhysical exam\u003c/em\u003e). For content validity, item scores below cutoff were from Worksheet 3 (\u003cem\u003eMetabolic demand\u003c/em\u003e) and Worksheet 4 (\u003cem\u003ePhysical exam\u003c/em\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndices for content validity, comprehensibility and difficulty for the professional component of the Polish Patient-Generated Subjective Global Assessment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoring weight (Wt) loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet 2. Disease and its relations to nutritional requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2a Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2b. AIDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2c. Pulmonary or cardiac cachexia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2d. Chronic renal insufficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2e. Presence of decubitus, open wound or fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2f. Presence of trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2g. Age greater than 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2h. All relevant diagnoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2i. Primary disease staging (circle if known or appropriate) I, II, III, IV, other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet 3. Metabolic demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3a. Fever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3b. Fever duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3c. Corticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet 4. Physical exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.70\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4a. Temples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4b. Clavicles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4c. Shoulders (deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4d. (Interosseus muscles)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4e. Scapula (latissimus dorsi, trapezius, deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4f. Thigh (quadriceps)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4g. Calf (gastrocnemius)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4h. Global muscle status rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4i. Orbital fat pads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4j. Triceps skinfold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.72\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4k Fat overlying lower ribs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.70\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.69\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4l. Global fat deficit rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4m. Ankle edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4n Sacral edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4o. Ascites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4p. Global fluid status rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet 5 Global Assessment Categories\u003c/p\u003e \u003cp\u003eStage A: well nourished; Stage B: moderate/suspected malnutrition; Stage C: severely malnourished\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional triage recommendations:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriage: 0\u0026ndash;1, no intervention required at this time. Re-assessment on routine and regular basis during treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriage: 2\u0026ndash;3, patient and family education by dietitian, nurse, or other clinician with pharmacologic intervention as indicated by symptom survey (box 3) and lab values as appropriate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriage: 4\u0026ndash;8, requires intervention by dietitian, in conjunction with nurse or physician as indicated by symptoms (box 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriage\u0026thinsp;\u0026ge;\u0026thinsp;9, indicates a critical need for improved symptom management and/or nutrient intervention options\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale Indices professionals component\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e7129\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.86\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e7120\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.87\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e6380\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.80\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale Indices full PG-SGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e11904\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.88\u003c/b\u003e\u003c/p\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eItems below acceptable range (\u0026lt;\u0026thinsp;0.78) are marked in bold; CVI \u0026ndash; Content Validity Indices;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eCI - Comprehensibility Indices; DI - Difficulty Indices\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe found significant differences in all (content validity, comprehensibility and difficulty) scale indices (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all) between HCPs with different professions, as well as in S-CVI and S-CI between HCPs being familiar with PG-SGA vs those who being not. Those HCPs who were familiar with PG-SGA perceived the Polish PG-SGA v2 as less comprehensible and with lower content validity than those who were unfamiliar (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContent validity, comprehensibility and difficulty of Polish version per profession, prior experience and familiarity with PG-SGA.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScale-CVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScale-CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eScale-DI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietitians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.93\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.87\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamiliarity\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eItems below acceptable range (\u0026lt;\u0026thinsp;0.78) are marked in bold; Differences were evaluated using U-Mann Whitney test (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the values in the same column that share the same letter are not significantly different; CVI \u0026ndash; Content Validity Indexes; CI - Comprehensibility Indexes; DI - Difficulty Indexes;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e presents significant differences in the evaluation of content validity, comprehensibility, and difficulty of particular items among HCPs. Physicians followed by nurses rated particular items at the lowest score of content validity, comprehensibility, and difficulty. For content validity, most differences among HCPs were observed in Worksheet 4 (\u003cem\u003ePhysical exam\u003c/em\u003e), with the lowest scores among physicians and nurses. For comprehensibility, differences in scores between HCPs also concerned items mainly related to Worksheet 4 (\u003cem\u003ePhysical exam\u003c/em\u003e), with the lowest percentages of a high rating from physicians and nurses. Additionally, Worksheet 3 (\u003cem\u003eMetabolic demand\u003c/em\u003e) and Worksheet 4 (\u003cem\u003ePhysical exam\u003c/em\u003e) were perceived as difficult also mostly by physicians and nurses. The difficulty of some items of Nutritional Triage Recommendations was evaluated as below the cutoff for acceptability only by physicians, presented significant higher percentages of a low rating for these items in comparison with other specialists.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSignificant differences between groups of HCPs in content validity, comprehensibility and difficulty evaluation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDietitians\u003c/p\u003e \u003cp\u003e/nutritionists\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePearson\u003c/p\u003e \u003cp\u003eChi2 \u003c/p\u003e \u003cp\u003e(\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eRELEVANCE/CONTENT VALIDITY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmells bother me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.72\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoring Weight Loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge greater than 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll relevant diagnoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary disease staging (circle if known or appropriate) I II III IV Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet 3 \u0026ndash; Metabolic Demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicles (pectoralis \u0026amp; deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulders (deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterosseous muscles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.48\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScapula (latissimus dorsi. trapezius. deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.53\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrbital fat pads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriceps skin fold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat overlying lower ribs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSacral edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.72\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eCOMPREHENSIBILITY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicles (pectoralis \u0026amp; deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.70\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScapula (latissimus dorsi. trapezius. deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalf (gastrocnemius)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrbital fat pads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eDIFFICULTY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary or cardiac cachexia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetabolic demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.72\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavicles (pectoralis \u0026amp; deltoids)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterosseus muscles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.65\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.52\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrbital fat pads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.43\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriceps skin fold\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal fat deficit rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkle edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal fluid status rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional Triage Recommendations:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eItems below acceptable range (\u0026lt;\u0026thinsp;0.78) are marked in bold\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStep 8\u0026ndash;10\u003c/h2\u003e \u003cp\u003eAfter cognitive debriefing, in consideration of the individual comments given by the respondents to particular items, the key country members, the developer of the PG-SGA, and the international expert on translation and cultural adaptation of the PG-SGA consulted together and agreed to make some changes to the final Polish PG-SGA version 3 (Polish PG-SGA v3). These changes improved items in clarification and for better adaptation to the Polish settings (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). For instance, in Box 2 about Food intake, the Polish answer item \u0026ldquo;very little of anything\u0026rdquo; was replaced by \"very small amounts of any food\u0026rdquo;, \u0026ldquo;solid foods\u0026rdquo; was changed to \u0026ldquo;foods with solid consistency\u0026rdquo;, while in Box 3 the phrase: \u0026bdquo;eating enough\u0026rdquo; was changed to \u0026bdquo;adequate amounts of food\u0026rdquo;. Additionally, in the professional component, in Worksheet 1 we decided to bold weight loss in 1 month, because HCPs were often confused about which information on weight loss they should use (1 month vs. 6 months). All comments and suggestions from the patients and HCPs were taken into account and individually considered in finalizing the culturally adapted and linguistically validated version of the Polish Scored PG-SGA.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges of expression most often raised by patients and HCPs (PG-SGA Polish version) after review of Cognitive Debriefing Results and Finalization steps.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReason\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePATIENTS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emasa ciała (eng. body weight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ewaga (eng. body weight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe word \u0026bdquo;waga\u0026rdquo; is more common and used in colloquial language, while \u0026bdquo;masa ciała\u0026rdquo; is more specific, often used by specialists.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBardzo małe ilości czegokolwiek (eng. very little of anything)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBardzo małe ilości jakichkolwiek pokarm\u0026oacute;w (eng. very small amounts of any food)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIt sounds better in Polish.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparaty odżywcze\u003c/p\u003e \u003cp\u003e(eng. nutritional supplements)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreparaty odżywcze odżywki (np. nutridrinki, odżywki) (eng. nutritional supplements (e.g. nutridrinks, supplements)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExamples of nutritional supplements were added, because some patients were confused what \u0026bdquo;preparaty odżywcze\u0026rdquo; are.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePokarmy stałe (eng. solid foods)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePokarmy o stałej konsystencji (eng. foods with solid consistency)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe word \u0026bdquo;konsystencja\u0026rdquo; was added because in Polish \u0026bdquo;stały\u0026rdquo; means also (except of solid) that something is done routinely, constantly.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewystarczających ilości pokarm\u0026oacute;w (eng. eating enough)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eodpowiednich ilości pokarm\u0026oacute;w (eng. adequate amounts of food)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIt sounds better in Polish.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormalną bez ograniczeń (eng. normal, with no limitations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaką jak zwykle, bez ograniczeń (eng. as usual, with no limitations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe word \u0026bdquo;normalna\u0026rdquo; was changed into \u0026bdquo;taka jak zwykle\u0026rdquo;, because patients were confused what normal physical activity means. The phrase: physical activity as usual relates more to the comparison between before and currently, than to the so-called norm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorksheet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHCPs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eW1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeigh loss in 1 month vs weight loss in 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWe decided to bold weight loss in 1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHCPs were confused which weight loss should they use (1-month vs 6-months).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eW2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of semicolon between I and II clinical stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSemicolon inserted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEditorial error\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eW3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 godziny\u003c/p\u003e \u003cp\u003e(eng. 72 hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 godziny (3 dni)\u003c/p\u003e \u003cp\u003e(eng 72 hours (3 days))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe HCPs had a problem with which accuracy to determine the duration of fever (e.g. whether 71.5 hours is still\u0026thinsp;\u0026lt;\u0026thinsp;3 days). The addition of the unit \"day\" makes it easier to relate the duration of the fever to the needs of the sheet.\u003c/p\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\u003eTranslation and cultural adaptation of the original PG-SGA (\u0026copy;2005) according to ISPOR Principles resulted in the Polish version which has preserved the purpose and conceptual meaning of the original PG-SGA. Independent forward and back translations, reconciliation and harmonization with the key developer and the international expert on translation and cultural adaptation of the PG-SGA and further cognitive debriefing with a large group of heterogeneous patients and HCPs delivered another new language version of the PG-SGA with conceptual and cognitive equivalence.\u003c/p\u003e \u003cp\u003eLinguistic and content validation revealed that the patient component of the Polish version of the PGSGA was very well comprehensible and easy to complete for the patient. Obtained results indicated that the Polish version of the patient component, i.e., PG-SGA Short Form, can be further completed without any additional instruction from HCPs. Moreover, HCPs indicated that the patient component of the Polish version of the PGSGA was relevant. Similar results on the patient component were obtained in other studies performed in Denmark [19], Germany [20], Norway [24], Greece [21], Japan [22], the Netherlands [25], Thailand [26] and Italy [27]. In all mentioned studies, content validity, as well as comprehensibility and difficulty of the PG-SGA Short Form were perceived as excellent. This indicated that the translated and culturally adapted PG-SGA Short Form is considered feasible to perform by patients, in various countries and/or cultures.\u003c/p\u003e \u003cp\u003eOur results revealed that comprehensibility and difficulty of the PG-SGA Short Form did not differ between older (age\u0026thinsp;\u0026gt;\u0026thinsp;65 years) or younger adult patients. This indicates that the Polish version of the PG-SGA Short Form is understandable and easy to complete for both younger and older patients. However, the level of patients\u0026rsquo; education had an impact on the results. Perceived comprehensibility was best by patients graduated from university, followed by those who graduated primary, secondary, and vocational school. Most patients perceived the PG-SGA Short Form as very easy to complete (i.e., excellent difficulty), with the exception of those with a vocational education, who found the difficulty acceptable. In contrast, the mean indices for difficulty were the highest in patients with primary education. It should be noted that the representation of patients with these two levels of education was the lowest (respectively 6% and 10%) in the entire recruited group, and concluding about the reasons for such a distribution of results is not possible. In the Japanese study, the relationship between educational level and difficulty was also analyzed, and in that study no relationship between education level and difficulty of the PG-SGA Short Form as perceived by patients was found [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComprehensibility and difficulty of the professional component of the Polish version of the PG-SGA were considered acceptable by HCPs (S-CI\u0026thinsp;=\u0026thinsp;0.87 and S-DI\u0026thinsp;=\u0026thinsp;0.80, respectively). These results are in contrast to the results of the Norwegian [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], German [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Dutch [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Japanese[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and Thai [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] studies, in which the professional component of the PG-SGA scored below acceptance in the constructs of difficulty, and additionally of comprehensibility in the Norwegian study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. On the other hand, in a recently published study on the validation of the Greek version of the PG-SGA [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], comprehensibility and difficulty of the professional component were perceived as excellent (\u0026ge;\u0026thinsp;0.90). Also in the Italian study, comprehensibility, as well as content validity, were perceived as excellent, but difficulty was considered acceptable by professionals [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Despite presented differences in comprehensibility and difficulty, relevance of the professional component of the PG-SGA was perceived as excellent in almost all performed studies on validation of translations and culturally adaptations of the PG-SGA [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Only results of our study and the Dutch study[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] indicated that professionals perceived content validity of the PG-SGA as acceptable. Additionally, content validity of the Full PG-SGA was perceived in the current and other studies as acceptable[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] or even excellent [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Lower ratings on relevance obtained in our study and the Dutch study[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] came mainly from low ratings of the \u003cem\u003ePhysical exam\u003c/em\u003e in \u003cem\u003eWorksheet 4.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIn line with other studies on linguistic and content validation of the PG-SGA, \u003cem\u003eWorksheet 4 (Physical exam)\u003c/em\u003e was considered the most difficult, most incomprehensible, and with the lowest scores on content validity from all worksheets of the professional component of the PG-SGA. Difficulty considered by HCPs was below acceptance for about 70% of items from this worksheet, and these items concerned mainly evaluation of muscle status. Additionally, HCPs evaluated that comprehensibility of about one-third of all items from \u003cem\u003eWorksheet 4\u003c/em\u003e, i.e., the physical exam, was below acceptable range. Most importantly, the content validity of almost 60% of all items from this worksheet was considered unacceptable. This indicated that HCPs seem to feel no need to perform a physical exam, especially so detailed for muscle status rating. It is unclear why relevance of the physical exam was rated low by the Polish HCPs, but we speculate that insufficient knowledge about how to apply the PG-SGA plays a role. For example, the inclusion of seven muscles groups in Worksheet 4 does not mean that all seven muscle groups need to be evaluated in every patient. Previous studies have demonstrated that a one-day training on the PG-SGA increases perceived comprehensibility and difficulty. In the Dutch study performed in dietitians [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], difficulty and comprehensibility indices related to muscle status in Worksheet 4 increased from 0.16 to 0.54 and from 0.41 to 0.91 after the training, respectively. Also, in the Portuguese study [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] that was performed in a sample of mostly dietitians as well, training in the PG-SGA improved ratings on difficulty, mostly concerning items of \u003cem\u003ePhysical exam\u003c/em\u003e. In that study, the maximum difference in scale index scores on the difficulty of particular items related to the physical exam was 0.258. These studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] demonstrate high effectiveness of training, in which knowledge and skills on applying the PG-SGA are expanded, on perceived difficulty, and comprehensibility especially among HCPs who had no experience with this questionnaire. We hypothesize that higher scores on difficulty and comprehensibility may in turn result in improved perceived relevance of the physical exam of the PG-SGA. Additional advantages of training could be more reliable results.\u003c/p\u003e \u003cp\u003eDetailed analysis of results among different HCPs revealed that physicians evaluated comprehensibility, difficulty and content validity lowest, while difficulty was even below acceptable threshold. These results would indicate that physicians were more conscious of a possible lack of experience, especially in the term of muscle status rating. However, in the Norwegian study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], no significant differences between type of HCP or familiarity with the PG-SGA were found. In our study, only 6% of all participants had actually been experienced with the PG-SGA before, and the familiarity with PG-SGA was reported by 19% of HCPs and came mainly from the literature. Additionally, in our study, we found a significant difference in comprehensibility and content validity depending on the knowledge of the tool. Surprisingly, HCPs who had prior knowledge on the PG-SGA, evaluated content validity and comprehensibility lower than those who were not familiar with PG-SGA. These results indicate that training in the use of PG-SGA before daily practice is needed for everyone, including those already familiar with PG-SGA from the literature. Theoretical knowledge did not translate into higher content validity, i.e., perceived relevance.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practice and research\u003c/h2\u003e \u003cp\u003eNutritional screening tools are used to identify patients at nutritional risk. To be useful, a tool must be practical, easy to carry out, cost-effective, not time-consuming, highly sensitive, have good specificity, and be highly reliable, that means, having a small variation between observers and separate time points. All these conditions are met by the PG-SGA [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and moreover, it is a tool for nutritional assessment, triage and monitoring. It has demonstrated good sensitivity, specificity and positive and negative predictive value, as well as very good predictive value for overall survival and quality of life in patients at risk of malnutrition [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of ISPOR Principles during the translation and cultural adaptation of the original English version of PG-SGA into other languages ensures that the original purpose and intention of the key developer will be preserved and will ensure the cultural equivalence of the tool. So far, the PG-SGA has been translated and culturally adapted into eleven languages and linguistically validated in this way, and more language versions similarly produced are being developed [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The results for the Polish translation and cultural adaptation indicate that the Polish PG-SGA version maintained purpose, meaning, and format equivalent to the original PG-SGA. Furthermore, the acceptable values for content validity reflect that the Polish version presented in this paper is ready for use in clinical practice and in future studies conducted in the Polish language. In connection with the above, the PG-SGA can be easily implemented in the Polish language, and scientific and clinical results will be reliable and consistent with international data derived from validated versions of this tool. Nevertheless, before implementing the full PG-SGA in clinical practice, training of professionals is recommended.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e \u003cp\u003eA major strength of the current study is the application of the ISPOR Principles, similar to the previous studies on new language versions of the PG-SGA, as this gives a unique opportunity to compare the obtained results between the studies. Secondly, the forward translations were performed by three persons instead of two as in other studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and the translated text was verified by 20 independent experts. Thanks to such a meticulous approach to the task, 32 differences in the translation of wordings were identified, which, after harmonization, allowed us to obtain the optimal version of the translation. Thirdly, we included a very large group of patients (n\u0026thinsp;=\u0026thinsp;174) and HCPs (n\u0026thinsp;=\u0026thinsp;188) in the cognitive debriefing and linguistic and content validation. To the best of our knowledge, this is the largest number of participants included in the PG-SGA linguistic and content validation studies to date. Fourthly, involvement of patients and HCPs from many centers located throughout Poland, allowed us to consider our study as representative for the whole country. Finally, with a large group of HCPs and patients with different disease entities from different health care centers, differentiated in terms of gender, age and education, our study sample is representative for the heterogeneous patient populations being at risk for malnutrition, and allowed for determining content validity, comprehensibility, and difficulty per type of HCP.\u003c/p\u003e \u003cp\u003eThe study also has some limitations. The uneven distribution of numbers in the subgroups, both among patients and HCPs, could have influenced the results of the statistical analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTranslation and cultural adaptation of the PG-SGA for the Polish setting according to ISPOR Principles preserved the purpose and conceptual meaning of the original PG-SGA. The linguistic and content validation revealed that the Polish version of PG-SGA is well understood and easy to complete by patients and professionals and considered relevant by professionals. However, detailed results for content validity, comprehensibility, and difficulty of the professional component of PG-SGA indicate the need for appropriate training of the Polish HCPs, especially physicians and nurses, mainly in the worksheets related to the metabolic demand and physical exam.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all participating professionals and patients for their invaluable contribution to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Statements \u0026amp; Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by\u0026nbsp;\u003c/em\u003eKatarzyna Zabłocka-Słowińska, Joanna Pieczyńska, Anna Prescha, Maciej Bladowski, Damian Gajecki, Dorota Kamińska, Katarzyna Neubauer Faith Ottery, Harri\u0026euml;t Jager-Wittenaar\u003cem\u003e. The first draft of the manuscript was written by\u0026nbsp;\u003c/em\u003eKatarzyna Zabłocka-Słowińska, Joanna Pieczyńska, Anna Prescha\u003cem\u003e\u0026nbsp;and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis is an observational study. The Wroclaw Medical University Bioethics Committee (KB-\u003c/em\u003e540/2019) approved the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eDr Jager-Wittenaar was co-developer of the PG-SGA based pt-Global webtool. Dr Ottery is the creator and copyright holder of the PG-SGA (c) and all derivatives. Dr Zabłocka-Słowińska, Dr Pieczyńska, Dr Prescha, Dr Bladowski, Dr Gajecki, Dr Kamińska, Dr Neubauer, have nothing to disclose.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Katarzyna Zabłocka-Słowińska, Joanna Pieczyńska, Anna Prescha, Maciej Bladowski, Damian Gajecki, Dorota Kamińska, Katarzyna Neubauer Faith Ottery, Harri\u0026euml;t Jager-Wittenaar. The first draft of the manuscript was written by Katarzyna Zabłocka-Słowińska, Joanna Pieczyńska, Anna Prescha and all authors commented on previous versions of the manuscript. 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Routledge; 2019. pp. 898\u0026ndash;907. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/01635581.2019.1595045\u003c/span\u003e\u003cspan address=\"10.1080/01635581.2019.1595045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang YH, Xie FY, Chen YW, Wang HX, Tian WX, Sun WG, et al. Evaluating the Nutritional Status of Oncology Patients and Its Association with Quality of Life. Biomedical and Environmental Sciences. 2018;31: 637\u0026ndash;644. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3967/bes2018.088\u003c/span\u003e\u003cspan address=\"10.3967/bes2018.088\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003cspan\u003ehttps://pt-global.org/page_id13/\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"PG-SGA, Patient-Generated Subjective Global Assessment; validity, nutritional assessment, malnutrition screening","lastPublishedDoi":"10.21203/rs.3.rs-3991268/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3991268/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe Scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated nutritional screening, assessment, monitoring, and triage tool. The aim of this study was to perform translation, cultural adaptation, as well as linguistic and content validation of the translated and culturally adapted version of the PG-SGA for the Polish setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The study was performed in concordance with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Principles. Patients (n=174) and healthcare professionals (HCPs, n=188) participated in the study. Comprehensibility and difficulty were assessed by patients for the PG-SGA Short Form, and by HCPs for the professional component. Content validity was assessed for the full PG-SGA by HCPs only. Evaluations were operationalized by a 4-point scale. Item and scale indices were calculated using the average item ratings divided by the number of respondents. Item indices \u0026lt;0.78 required further analysis of the item, while scale indices ≥0.90 were defined as excellent and 0.80–0.89 as acceptable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The PG-SGA Short Form was rated as excellent for content validity (Scale-CVI = 0.90) by HCPs and easy to comprehend (Scale-CI = 0.96) and use (Scale-DI = 0.94) by patients. The professional component of the PG-SGA was perceived as acceptable for content validity (Scale-CVI = 0.80), comprehension (Scale-CI = 0.87) and difficulty (Scale-DI = 0.80). The physical exam was rated the least comprehensible, the most difficult, and with the lowest content validity. We found significant differences in scale indices (p\u0026lt;0.05 for all) between HCPs with different professions and between those being familiar with PG-SGA and not.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eTranslation and cultural adaptation of the PG-SGA for the Polish setting preserved the purpose and conceptual meaning of the original PG-SGA. Validation revealed that the Polish version of PG-SGA is well understood and easy to complete by patients and professionals, and considered relevant by professionals. However, detailed results indicate the need for appropriate training of the Polish HCPs, especially physicians and nurses, mainly in the worksheets related to the metabolic demand and physical exam.\u003c/p\u003e","manuscriptTitle":"Polish translation, cultural adaptation, and validity confirmation of the Scored Patient-Generated Subjective Global Assessment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 18:00:31","doi":"10.21203/rs.3.rs-3991268/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-16T20:47:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-16T18:55:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308971709347039574885359359655133552881","date":"2024-07-16T06:40:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181651644339556001002709650847791207848","date":"2024-05-21T10:56:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-13T09:09:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326093328566940886440639846882179677969","date":"2024-04-30T07:45:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-15T13:13:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-15T13:08:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-07T02:04:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-02-26T14:46:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0246b5d1-5528-47f2-9560-58213c1b486f","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:16:49+00:00","versionOfRecord":{"articleIdentity":"rs-3991268","link":"https://doi.org/10.1007/s00520-024-08808-5","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-09-04 15:58:07","publishedOnDateReadable":"September 4th, 2024"},"versionCreatedAt":"2024-03-11 18:00:31","video":"","vorDoi":"10.1007/s00520-024-08808-5","vorDoiUrl":"https://doi.org/10.1007/s00520-024-08808-5","workflowStages":[]},"version":"v1","identity":"rs-3991268","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3991268","identity":"rs-3991268","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}