Validation of a Patient-Reported Questionnaire on Adjunctive Methods to Accelerate Orthodontic Tooth Movement

Validation of a Patient-Reported Questionnaire on Adjunctive Methods to Accelerate Orthodontic Tooth Movement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validation of a Patient-Reported Questionnaire on Adjunctive Methods to Accelerate Orthodontic Tooth Movement Ayat Hussein, Yassir Yassir, Noor Al-Hasani, Grant McIntyrec This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9226251/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to develop and validate a patient-reported questionnaire to comprehensively assess perceptions during adjunctive orthodontic therapy, ensuring methodological rigor and cross-cultural applicability. Material and Methods A structured questionnaire was developed, consisting of 21 items investigating the emotional, physical, and functional domains. A multi-phase validation process was then implemented. Orthodontic experts (n = 12) evaluated the content validity using Lynn’s criteria. In addition, both the orthodontic experts and 30 patients assessed face validity to ensure clarity, readability, and relevance. Based on expert consensus, the questionnaire was refined, expanded to 22 items, and subjected to a second round of validation. To guarantee cross-cultural applicability, the instrument was translated into Arabic by a certified bureau, using forward and back-translation. Reliability was examined using Cronbach’s alpha to measure internal consistency across domains. Results The questionnaire demonstrated exceptional content validity (S-CVI = 1.00), perfect face validity (100% agreement), and acceptable internal consistency reliability (Cronbach’s alpha 0.722 for pain/discomfort items; 0.708 for pain/function items; 0.750 for psychosocial items). The instrument successfully captured multidimensional aspects of patient perception, including pain intensity, analgesic use, functional difficulties, and psychosocial consequences. The translation ensured linguistic accuracy and cultural adaptability in English and Arabic. Conclusion This validated bilingual questionnaire provides a reliable tool for assessing patient perceptions of adjunctive orthodontic acceleration techniques. It offers a practical framework for integrating patient perspectives into orthodontic research/clinical protocols. Its methodological strength and cross-cultural adaptability establish a valuable reference for future patient-centered investigations. Importantly, it represents the first questionnaire dedicated to adjunctive orthodontic methods. Patient-reported outcomes Questionnaire validation Orthodontic acceleration Cross-cultural adaptation Introduction The questionnaire plays an essential role in research by featuring a set list of questions designed to collect vital information from respondents. Generally, it is used in conjunction with surveys to gather both quantitative and qualitative data. The primary purpose of questionnaires is to extract specific information, which can subsequently be analyzed to identify patterns, viewpoints, behaviors, or insights related to a particular subject. 1 , 2 Validating a questionnaire is a fundamental aspect of the research process, ensuring that the instrument accurately and reliably measures the intended constructs or variables. 2 , 3 Validation serves to confirm that the questionnaire effectively captures the underlying concepts it is designed to assess, thereby improving the credibility and integrity of the gathered data. 4 , 5 This process is critical because it addresses various uncontrollable factors that can influence data quality, such as respondent misunderstanding, bias, or environmental distractions during data collection. 6 – 8 Validation procedures for questionnaires encompass a range of categories and subcategories, each tailored to specific types of instruments and research objectives. 2 , 3 Rather than applying a one-size-fits-all approach, each questionnaire undergoes a particular validation method that best suits its unique design and intended use. 8 , 9 This ensures that the instrument accurately measures the constructs it aims to assess while maintaining reliability and validity across different contexts. 4 , 10 Content validity involves a systematic and quantitative evaluation to ensure that a questionnaire comprehensively covers the construct it aims to measure. 11 , 12 This process entails assessing the suitability of each item and discarding those that are not relevant by utilizing the Content Validity Index (CVI). 11 , 13 Typically, this evaluation is conducted by a panel of experts, with a minimum of three specialists recommended to provide diverse perspectives, although involving more experts can enhance the robustness of the validation process. 8 The essence of the expert panel work is to estimate the relevance and clarity of each questionnaire item. 14 In general, validation is a qualitative process by which the adequacy of a questionnaire or measurement instrument is determined by using two different rounds with a minimum of a 10-day interval between them, during which the feedback and required adjustments should be considered to enhance the accuracy and comprehension of the questionnaire. 8 – 12 Face validity, on the other hand, is the process that determines the appropriateness of the content of questionnaire or measurement instrument, where the two rounds are used, The elements that are investigated by this type of validation include readability, language clarity, feasibility, and formatting consistency. Even though face validation is usually regarded as a most basic and the weakest type of validation, it is essential in the initial phase of the instrument development since it helps to determine whether the items are comprehendible and applicable to the target audience. 15 , 16 To secure the measurement of the intended constructs, content and face validation must be used. This method, called "validation by assumption". 17–19 To effectively use the questionnaire for cross-cultural research, it may need translation for cultural adaptation and universal understanding. Translating presents challenges as the original content meaning and intent must be preserved. Translation approaches include using an unqualified individual, a qualified team, or the back-translation method. 20 – 22 Most research in orthodontics predominantly focuses on the orthodontist's perspective, emphasizing factors such as patient compliance and adaptability to treatment. However, more attention needs to be given to understanding patients’ experiences of discomfort during orthodontic treatment. Moreover, an in-depth review of the current literature reveals that the majority of research on patient discomfort during orthodontic treatment focuses predominantly on pain-related aspects, while overlooking a multitude of other factors linked to the patient's physical and psychological health. 23 In orthodontics, for adjunctive interventions like osteoperforation, accelerated tooth movement injections, and laser applications to be effective, they need to meet two criteria: technically, they should be beneficial and applicable, and practically, they should be easy to administer and comfortable for patients. 24 – 27 Including patients' perspectives on new orthodontic treatments combined with adjunctive therapies will allow researchers to evaluate the treatments advantages and disadvantages by examining various aspects of oral health-related quality of life (OHRQoL). Existing instruments for assessing orthodontic perception often rely on limited measures and lack cultural adaptation, leaving patient experiences with adjunctive orthodontic modalities underexplored. Therefore, this study aims to develop and validate a bilingual questionnaire to address that gap, offering a reliable and culturally adapted tool that enables systematic evaluation of patient perceptions and supports evidence-based optimization of adjunctive orthodontic care. To the best of our knowledge, this will be the first culturally adapted instrument specifically targeting patient experiences with adjunctive orthodontic modalities in our region. Subjects and methods Study design This study is a cross-sectional research design which is a part of a randomized clinical trial structure. The Ethics Committee of the College of Dentistry at the University of Baghdad approved the study under reference number 1014 in January 21, 2025 and registered in ClinicalTrials.gov on February 26th, 2025, with a registration ID: NCT06847880. The Design of the questionnaire The initial draft of this questionnaire was developed by gathering relevant questions from multiple questionnaires which studied patient discomfort experiences in orthodontic treatment. 28–40 The Sample The research validation process involves the following participant groups: Specialist orthodontists: comprised of a quota sample of 12 participants to assess both the content and face validity of the questionnaire. They were belonged to the education and healthcare sectors and had between 2 to 20 years of experience. Orthodontic patients: a sample of patients undergoing fixed appliance orthodontic treatment was randomly selected as part of the broader clinical trial, based on predefined inclusion and exclusion criteria. These participants represented typical orthodontic cases recruited from routine clinical settings, including specialized governmental dental centers, private clinics, and the Department of Orthodontics at the College of Dentistry, University of Baghdad. Their role was to assess the face validity of the questionnaire by evaluating its clarity, relevance, and comprehensibility. All participants provided written informed consent to confirm their voluntary involvement. For patients younger than 18 years, parental consent was obtained. The study procedures adhered to the ethical standards of the institutional research committee and complied with the principles of the Declaration of Helsinki. Inclusion Criteria : Patients aged 12 years and above, who are indicated for fixed appliance orthodontic treatment. Patients with moderate to severe crowding (4–9 mm) of the mandibular anterior teeth as per the Little's Irregularity Index (LII). Treatment with or without two mandibular first premolars extraction. Presence of all the mandibular permanent teeth, except the third molars. The overbite and overjet should not impede bracket placement on the mandibular anterior teeth. Exclusion Criteria : History of previous orthodontic intervention. History of trauma or root resorption in the mandibular anterior teeth. Presence of mandibular anterior teeth crowding of less than 4 mm or greater than 9 mm (LII). Existence of blocked-out teeth precluding engagement with the aligning archwire. History of systemic diseases, especially diabetes and bone diseases. Patients with periodontitis and obvious loss of tooth attachment according to Plaque and Bleeding on Probing indices. Pregnant and lactating mothers. Mouth breathing patients and smokers. Healthy patients who used any medications (such as anti-inflammatory or antimicrobial drugs) or supplements (such as vitamins). Validation Process To formulate questions that are validated, relevant, and easily comprehensible for patients who speak Arabic, the initially selected questions were subjected to a series of structured steps: Step 0: Initial Questionnaire Construction The preliminary version of the questionnaire was developed following an exhaustive review of validated instruments assessing patient discomfort and perception during orthodontic treatment. 28–40 Items were selected for their relevance to adjunctive orthodontic procedures. There were 21 items that were collected so as to be inclusive of physical, functional, and emotional domains, while maintaining respondent manageability. The pool of items was collected and narrowed down by the principal investigator under the guidance of a senior orthodontic specialist and both clinical and linguistic validity were maintained by the authors before the item pool was reviewed by an expert panel. Step 1: First Round of Content and Face validation by Experts All professionals were invited to participate in a content validity panel in the form of an invitation letter. All the questions of the questionnaire were rated through 4-point Likert scale; 1 (not relevant), 2 (somewhat relevant), 3 (relevant), and 4 (very relevant). The professionals made their evaluations on their own. The assessment process classified items rated 1 or 2 as irrelevant and items rated 3 or 4 as relevant. The Content Validity Index (CVI) was used for measuring questionnaire validity. Using Lynn's approach, the Item-Level Content Validity Index (I-CVI) was calculated by dividing expert ratings of 3 or 4 to the total expert count. An item qualified as valid when the I-CVI rating reached or exceeded 0.78. Since the questionnaire included 12 experts, 10 of them should rate 3 or 4 for the items to remain in the study, otherwise it would be removed. On the other hand, the Scale-Level CVI (S-CVI) was used to measure the questionnaire validity through averaging the I-CVI values. The questionnaire overall needed to attain a minimum S-CVI value of 0.9 to qualify as valid. 11 , 41 , 42 The experts who validated the content also assessed the face validity of the questionnaire. They examined the clarity, readability, and the general suitability of the questionnaire. The evaluation was conducted through a 4-point Likert scale that ranged from 1 for strongly disagree to 4 for strongly agree. Step 2: Questionnaire modification Based on the first round results, the questionnaire underwent several changes. Some items were modified or merged, new items were added, and items deemed non-valid (I-CVI < 0.78) were excluded. Step 3: Second round of content validation by experts A group of 12 experts from the initial content validation were asked again to assess the modified version of the questionnaire. Step 4: Translation process A certified professional translation bureau translated the questionnaire from English to Arabic language. Three qualified translators were participated in this translation process. Two independent translators worked on the translation of the English questionnaire to Arabic. The team leader reviewed and merged both versions to create one accurate Arabic version. A back-translation method was used to verify the accuracy and maintain consistency of the Arabic version. Step 5: Face Validation by Patients A total of 30 orthodontic patients (under fixed appliance orthodontic treatment) were invited to validate the face validity of the questionnaire. The participants received the translated and validated questionnaires to evaluate the readability and clarity of questionnaire items with a specific face validation form. Step 6: Reliability The internal consistency reliability of the translated and validated questionnaire was used to assess the inter-item correlation. On the other hand, the long-term stability of the questionnaire cannot be assessed using a test-retest reliability method, as it captures an evolving experience of orthodontic patients undergoing adjunctive treatment. Statistical Analysis The I-CVI, S-CVI, and the percentages of face validity agreement were calculated using an Excel spreadsheet (Excel, Microsoft Office Professional Plus 2019, Washington, USA). The Statistical Package for Social Sciences (SPSS) version 26.0 released by SPSS Inc. (Chicago, IL, USA) was used for statistical analysis. The internal consistency reliability was tested using the Cronbach's alpha analysis. Results Step 1: First Round of Content and Face validation by Experts In this round of content validation, each of the 21 items was found to be relevant to the core concept (I-CVI ≥ 0.78). As a result, all questionnaire items were retained. Similarly, the average S-CVI for the entire questionnaire was 0.94 (valid) (Table 1 ). In the face validation, the questionnaire had a total agreement of 91.7 which shows that it is adequate. Nonetheless, certain specialists suggested changes to some of the items in order to make them more suitable Table 1 First round of content validation by 12 orthodontic experts No. Items Responses I-CVI Validity 1 Do you have Pain/discomfort/soreness in : Teeth Not at all A little A lot 1.00 Valid 2 Jaws Not at all A little A lot 1.00 Valid 3 Gingiva Not at all A little A lot 1.00 Valid 4 Muscles Not at all A little A lot 0.92 Valid 5 Headache Not at all A little A lot 0.83 Valid 6 Did you have pain during the intervention? Yes No 1.00 Valid 7 How would you describe the intensity of pain during the intervention? None Mild Moderate Severe 1.00 Valid 8 Have you taken analgesics for pain? Yes No 1.00 Valid 9 Do you have pain in your teeth when they are in contact? Yes No 0.92 Valid 10 Did you stay at home from school or work specifically due to discomfort following the intervention? Yes No 0.83 Valid 11 Where did you feel the pain Anterior teeth Posterior teeth All the dentition Cannot locate 0.92 Valid 12 Do you have difficulty in : Speech Not at all A little A lot 0.92 Valid 13 Sleeping Not at all A little A lot 0.92 Valid 14 Eating/Chewing/Biting Not at all A little A lot 0.92 Valid 15 Tooth brushing Not at all A little A lot 0.92 Valid 16 Has the following been affected due to treatment? Physical activity Not at all A little A lot 0.83 Valid 17 Social activity 1.00 Valid 18 School/work 1.00 Valid 19 Emotional Status 1.00 Valid 20 How would you describe the duration of the intervention visit Normal Lengthy 1.00 Valid 21 How would you describe the intervention visit Normal Annoying 0.92 Valid Step 2: Questionnaire Modification Following the first round of expert review, the research team reviewed all comments and recommendations. Modifications to the questionnaire were made following collective expert consensus and statistical criteria of validity (I-CVI ≥ 0.78). While individual suggestions were taken into account, changes were only implemented when supported by more than one reviewer or were in line with the study methodological framework. All revisions were completed by the authors following synthesis from expert consultation of 12 orthodontic specialists. Based on the recommendations made by the experts, the questionnaire underwent the following modifications: The phrase “After the intervention” was added to items 1, 2, 3, 4, 5, 8, 9, 12, 13, 14, 15, 16, 17, and 19. The phrase “Temporomandibular Joints” was added to item 2. The responses to items 1, 2, 3, 4, and 5 were changed to “Yes/No” instead of “Not at all, A little, A lot” . The format of the response to items 1–5 was altered to binary (Yes/No) to indicate their diagnostic quality, and items 14–20 were kept in the form of a graded scale since they measured the subjective impact. The phrase “If you have pain in your teeth after the intervention” was added to item 11. The word “Biting” was deleted from the item 14 “Eating/Chewing/Biting” . The sequence of some items was changed. The phrase “e.g., sport” was added to item 16. Item 18 was deleted. The phrase “Happiness/Depression” was added to item 19. The phrase “due to treatment addition” was deleted, and the word “adversely” was added to items 16, 17, and 19. The definition of the word “intervention” was provided at the end of the questionnaire based on the adjunctive treatment type. Addition of a new item: “After the intervention, do you have feelings of” with sub-items "Swelling" and "Numbness" and responses “Yes and "No” . Step 3: Second Round of Content Validation by Experts In this phase a follow-up validation process was performed to evaluate both the newly introduced and the modified questionnaire items. This validation included the same group of 12 experts in orthodontics and occurred one month after the initial evaluation in the first round. The results showed that all items achieved an I-CVI of 1.00. Furthermore, the questionnaire as a whole had a S-CVI/Ave score of 1.00 (Table 2 ). Step 4: Translation Procedure The final and revised version of the validated questionnaire was translated from English to Arabic by a certified translation bureau. To guarantee the content integrity, the authors carefully reviewed the translated version by back translation method and confirmed that the main concepts of each item were preserved (Table 3 , 4 ). Step 5: Patient Face Validation Face validity of the questionnaire was carried out in 20 patients. Their feedback noted that the questionnaire was clear, well-structured and understandable. This process led to a perfect agreement in terms of face validity with an overall agreement rate of 100%. Step 6: Reliability A data of 30 patients who filled the questionnaire was tested for internal consistency reliability. The overall questionnaire achieved acceptable internal consistency with Cronbach’s alpha level of 0.70. Three sections could also be measured. The first section related to pain/discomfort (items 1–13) with Cronbach’s alpha level of 0.722. The second section related to pain/discomfort and function (items 1–17) with Cronbach’s alpha level of 0.708. In addition, the third section related to physical/social/emotional activities (item 18–20) with Cronbach’s alpha level of 0.750. Table 2 Second round of content validation by 12 orthodontic experts No. Items Responses I-CVI Validity 1 Did you have pain during the intervention*? Yes No 1.00 Valid 2 How would you describe the intensity of pain during the intervention? None Mild Moderate Severe 1.00 Valid 3 Have you taken analgesics for pain after the intervention? Yes No 1.00 Valid 4 After the intervention, do you have Pain/discomfort/soreness in : Teeth Yes No 1.00 Valid 5 Jaws/Temporomandibular Joints Yes No 1.00 Valid 6 Gingiva Yes No 1.00 Valid 7 Muscles Yes No 1.00 Valid 8 Head Yes No 1.00 Valid 9 If you have pain in your teeth after the intervention, where did you feel the pain Anterior teeth Posterior teeth All the dentition Cannot locate 1.00 Valid 10 After the intervention, do you have pain in your teeth when they are in contact? Yes No 1.00 Valid 11 After the intervention, do you have the feelings of : Swelling Yes No 1.00 Valid 12 Numbness Yes No 1.00 Valid 13 Did you stay at home from school or work specifically due to discomfort following the intervention? Yes No 1.00 Valid 14 After the intervention, do you have difficulty in : Speech Not at all A little A lot 1.00 Valid 15 Sleeping Not at all A little A lot 1.00 Valid 16 Eating/Chewing Not at all A little A lot 1.00 Valid 17 Tooth brushing Not at all A little A lot 1.00 Valid 18 Has the following been adversely affected after the intervention ? Physical activity (e.g. sport) Not at all A little A lot 1.00 Valid 19 Social activity Not at all A little A lot 1.00 Valid 20 Emotional Status (Happiness/Depression) Not at all A little A lot 1.00 Valid 21 How would you describe the duration of the intervention visit Normal Lengthy 1.00 Valid 22 How would you describe the intervention visit Normal Annoying 1.00 Valid Table 3 Revised and final version of the validated questionnaire (English version). Items Responses Did you have pain during the intervention*? Yes No How would you describe the intensity of pain during the intervention? None Mild Moderate Severe Have you taken analgesics for pain after the intervention? Yes No After the intervention, did you have pain/discomfort/soreness in? Teeth Yes No Jaws/Temporomandibular Joints Yes No Gingiva Yes No Muscles Yes No Head Yes No If you have pain in your teeth after the intervention, where did you feel the pain Anterior teeth Posterior teeth All the dentition Cannot locate After the intervention, do you have pain in your teeth when they are in contact? Yes No After the intervention, do you have the feelings of : Swelling Yes No Numbness Yes No Did you stay at home from school or work specifically due to discomfort following the intervention? Yes No After the intervention, do you have difficulty in : Speech Not at all A little A lot Sleeping Not at all A little A lot Eating/Chewing Not at all A little A lot Tooth brushing Not at all A little A lot Has the following been adversely affected after the intervention? Physical activity (e.g. sport) Not at all A little A lot Social activity Not at all A little A lot Emotional Status (Happiness/Depression) Not at all A little A lot How would you describe the duration of the intervention visit Normal Lengthy How would you describe the intervention visit Normal Annoying Table 4 Revised and final version of the validated questionnaire (Arabic version). ردود الفعل البنود كلا نعم هل شعرت بألم أثناء التداخل العلاجي*؟ شديد متوسط خفيف لا يوجد كيف تصف شدة الألم خلال التداخل العلاجي؟ كلا نعم هل تناولت مسكنات للألم بعد التداخل العلاجي؟ كلا نعم الأسنان بعد التداخل العلاجي، هل شعرت بألم / عدم راحة / تقرح في؟ كلا نعم الفكين / مفصل الفك الصدغي كلا نعم اللثة كلا نعم العضلات كلا نعم الرأس لا يمكن تحديده جميع الأسنان الأسنان الخلفية الأسنان الأمامية إذا شعرت بألم في الأسنان بعد التداخل العلاجي، أين شعرت به؟ كلا نعم بعد التداخل العلاجي، هل شعرت بألم في أسنانك عند الاطباق؟ كلا نعم تورم بعد التداخل العلاجي، هل شعرت بـ كلا نعم خدر كلا نعم هل بقيت في المنزل أو توقفت عن المدرسة / العمل بسبب الانزعاج الناتج عن التداخل العلاجي ؟ كثيراً قليلاً لا على الإطلاق الكلام بعد التداخل العلاجي، هل واجهت صعوبة في كثيراً قليلاً لا على الإطلاق النوم كثيراً قليلاً لا على الإطلاق الأكل / المضغ كثيراً قليلاً لا على الإطلاق تنظيف الأسنان بالفرشاة كثيراً قليلاً لا على الإطلاق النشاط البدني (مثل الرياضة) هل تأثرت الأمور التالية سلبًا بعد التداخل العلاجي؟ كثيراً قليلاً لا على الإطلاق النشاط الاجتماعي كثيراً قليلاً لا على الإطلاق الحالة العاطفية (السعادة / الاكتئاب) طويلة طبيعية كيف تصف مدة زيارة التداخل العلاجي؟ مزعجة طبيعية كيف تصف زيارة التداخل العلاجي؟ Discussion The OHRQoL plays a vital role in clinical trials to evaluate the outcomes of preventive and therapeutic programs, aiding specialists in improving the quality of oral health treatments. 43 Recognizing its importance, the World Health Organization has emphasized the inclusion of quality-of-life measures in clinical studies. 44 , 45 , 46 Although extensive research has been conducted on patient experience, impact, and satisfaction with orthodontic treatment, there is limited emphasis on patient perception during adjunctive orthodontic treatment. Most of these studies have relied solely on the visual analogue scales (VAS) to assess pain and discomfort without addressing other aspects comprehensively through the use of questionnaires, so this study is considered the first to develop/utilize a questionnaire to comprehensively examine patient perception during adjunctive orthodontic treatment, providing valuable insights that can enhance compliance, address challenges, and optimize treatment protocols. For content and face validity, experts were selected following guidelines from Grant and Davis 47 and Rubio et al ., 48 ensuring substantial clinical expertise and teaching experience. The validity of questionnaire content depends on expert evaluations, but including unqualified individuals can undermine the process. 49 , 50 Increasing the number of expert reviewers enhances reliability by incorporating diverse perspectives shaped by varying educational backgrounds and experience levels. 11 , 33 , 51 While some studies may require a single validation round, this research conducted two rounds for refinement, aligning with the recommendations by Lynn 11 , Haynes et al . 52 , Rubio et al ., 48 and Polit et al .. 53 Polit et al . 53 suggests beginning with 8 to 12 experts before narrowing it down to 3 to 5 in later stages. In this study, 12 experts participated in both rounds, reinforcing the trustworthiness of the assessment. During the first round of content validation, all questionnaire items were deemed valid and relevant to the underlying construct (I-CVI ≥ 0.78). The S-CVI for the overall questionnaire was 0.94, exceeding the 0.90 threshold for validity. Comparing these results with the standards established by Lynn 11 and Polit et al ., 53 the content validity is excellent. However, some experts suggested some modifications to certain items to enhance their appropriateness. Face validity was assessed through feedback from professionals and patients, following the systematic approach outlined by Trochim et al .. 54 While face validity can encourage respondent participation, it is considered the weakest form of validation and should not be used in isolation, as noted by Waltz et al .. 41 In this study, content and face validation complemented each other, with quantitative and qualitative feedback. This lines up with Lynn 11 , who emphasized expert involvement in identifying omissions and suggesting improvements. Clarity and readability were evaluated by experts, with the questionnaire achieving 96.4% agreement. Adjustments were made to streamline its content. Additionally, thirty patients reviewed the validated and translated questionnaire using a face validation form, following strategies from Zamanzadeh et al ., 55 Yassir et al ., 19 and Haik and Yassir. 14 Their assessments resulted in excellent agreement on readability and comprehension. Regarding the translation process, A rigorous translation methodology was accomplished on the validated questionnaire, with linguistic accuracy and conceptual fidelity. The English to Arabic translation was accomplished by an official translation bureau using the services of highly qualified bilingual professionals. The English version was translated to Arabic by two translators and then a critical assessment and synthesis was carried out by the team leader. This approach to methodology is consistent with the suggestions of Goranson et al ., 22 that recommend multi-translator validation as a way of increasing reliability and contextual accuracy. To further safeguard the original content, a back-translation procedure was adopted, following the standardized procedures of WHODAS 2.0. 56 This is a holistic approach to translation that ensures that the meaning is preserved, and that the methodology is accurate, as per the academic and linguistic standards. Analysis of reliability revealed that the questionnaire demonstrated had a high degree of internal consistency, which is indicated by the Cronbach alpha coefficients of the three sections (0.722, 0.708, and 0.750, respectively), which support the reliability of the questionnaire and its structural consistency. But, as this scale is meant to measure a condition which by nature changes with time, test-retest reliability is not an appropriate measure of the stability of the scale. 57 Given that patients' responses and perceptions naturally change over time due to their progression through treatment, measuring repeatability through a test-retest approach becomes inherently challenging. 19 Limitations of the study The study included only 12 experts and 30 patients, which was insufficient for conducting factor analysis or other advanced statistical tests. As a result, validity assessments relied on expert evaluations rather than statistical validation, limiting construct validity. Test-retest reliability is not applicable due to the conditional variability. Conclusions This study successfully developed and validated a bilingual questionnaire to assess patient perceptions during adjunctive orthodontic therapy. The instrument showed strong validity and acceptable reliability, providing a practical framework for integrating patient perspectives into orthodontic research and clinical protocols. This validated tool addresses a key gap in orthodontic patient-reported outcome measures and is expected to facilitate systematic evaluation of patient experiences, contributing to evidence-based optimization of adjunctive care. And thus, this represents the first study to provide a culturally adapted instrument specifically designed to capture patient experiences with adjunctive orthodontic modalities in the region, marking an important step toward advancing patient-centered orthodontic research and practice. Declarations Source of Funding The study is self-funded. Supplementary material Supplementary data are available upon request. Conflicts of interest None to declare. Ethical approval This study was part of a randomized clinical trial that registered at ClinicalTrials.gov on 26February 2025 (Registration number: NCT06847880). The Ethics Committee of the College of Dentistry at the University of Baghdad approved the study under reference number 1014 in January 21, 2025. Consent All participants, or their legal guardians in the case of minors, provided written informed consent to participate in the study and for the publication of anonymized data in scientific reports. Data availability statement Data is available upon request. References Groves RM, Fowler FJ Jr, Couper MP, Lepkowski JM, Singer E, Tourangeau R. Survey methodology. 2nd ed. Wiley; 2011. DeVellis RF, Thorpe CT. Scale development: Theory and applications. 5th ed. Sage; 2021. Nunnally J, Bernstein I. Psychometric Theory. 3rd ed. New York: MacGraw-Hill; 1994. Cortina JM. What is coefficient alpha? An examination of theory and applications. 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Acta Inf Med. 2018;26(2). https://doi.org/10.5455/aim.2018.26.139-143 . Sugimori T, Yamaguchi M, Shimizu M, Kikuta J, Hikida T, Hikida M, Murakami Y, Suemitsu M, Kuyama K, Kasai K. Micro-osteoperforations accelerate orthodontic tooth movement by stimulating periodontal ligament cell cycles. Am J Orthod Dentofac Orthop. 2018;154(6). https://doi.org/10.1016/j.ajodo.2018.01.023 . Ali FA, Salman LH. Acceleration of canine movement by laser assisted flapless corticotomy [An innovative approach in clinical orthodontics]. J Bagh Coll Dent. 2014;26(3). Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofac Orthop. 1989;96(1). https://doi.org/10.1016/0889-5406(89)90228-x . Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofac Orthop. 1998;114(6). https://doi.org/10.1016/s0889-5406(98)70201-x . Miyawaki S, Yasuhara M, Koh Y. Discomfort caused by bonded lingual orthodontic appliances in adult patients as examined by retrospective questionnaire. Am J Orthod Dentofac Orthop. 1999;115(1). https://doi.org/10.1016/s0889-5406(99)70320-3 . Feldmann I, List T, Feldmann H, Bondemark L. Pain intensity and discomfort following surgical placement of orthodontic anchoring units and premolar extraction: a randomized controlled trial. Angle Orthod. 2007;77(4). https://doi.org/10.2319/062506-257.1 . Bhogal PS. A study to investigate discomfort associated with fixed orthodontic appliances [dissertation]. Birmingham (UK): University of Birmingham; 2009. Feldmann I, List T, Bondemark L. Orthodontic anchoring techniques and its influence on pain, discomfort, and jaw function—a randomized controlled trial. Eur J Orthod. 2012;34(1). https://doi.org/10.1093/ejo/cjq171 . Gandhi P, Goel M, Batra P. Relative comparison and assessment of patient's attitude and discomfort between two different types of fixed functional appliances: A comprehensive survey. J Orthod Res. 2013;1(3). http://dx.doi.org/10.4103/2321-3825.123317 . Marques LS, Paiva SM, Vieira-Andrade RG, Pereira LJ, Ramos-Jorge ML. Discomfort associated with fixed orthodontic appliances: determinant factors and influence on quality of life. Dent Press J Orthod. 2014;19. https://doi.org/10.1590/2176-9451.19.3.102-107.oar . Rakhshan H, Rakhshan V. Pain and discomfort perceived during the initial stage of active fixed orthodontic treatment. Saudi Dent J. 2015;27(2). https://doi.org/10.1016/j.sdentj.2014.11.002 . Wiedel AP, Bondemark L. A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances. Angle Orthod. 2016;86(2). https://doi.org/10.2319/040215-219.1 . Matić S, Nikolić P. Perception of pain, social, and functional discomfort during orthodontic treatment. Srp Arh Celok Lek. 2017;145(1–2). http://dx.doi.org/10.2298/SARH151222013M . Batwa W. Differences in self-perceived pain and jaw discomfort between adult and adolescent orthodontic patients. EC Dent Sci. 2018;17. https://doi.org/10.2319/040215-219.1 . Noviaranny IY, bt Abd Halim NH, PATIENT'S DISCOMFORT ASSOCIATED WITH FIXED ORTHODONTIC, APPLIANCES TREATMENT. J Health Dent Sci. 2023;3(1). http://dx.doi.org/10.54052/jhds . Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and Health Research. 3rd ed. New York, NY: Springer Publishing Co; 2005. Yassir YA, Kadhum AS, Saloom HF, McIntyre GT, Bearn DR. Development of patient information leaflets for fixed, removable, and functional appliances for Arabic-speaking orthodontic patients. Saudi Dent J. 2021;33(3). https://doi.org/10.1016/j.sdentj.2019.12.001 . Zhou Y, Wang Y, Wang X, Volière G, Hu R. The impact of orthodontic treatment on the quality of life a systematic review. BMC Oral Health. 2014;14. https://doi.org/10.1186/1472-6831-14-66 . Cunningham SJ, Hunt NP. Quality of life and its importance in orthodontics. J orthod. 2001;28(2). https://doi.org/10.1093/ortho/28.2.152 . Cunningham SJ, O’Brien C. Quality of life and orthodontics. Semin Orthod. 2007;13(2). https://doi.org/10.1053/j.sodo.2007.03.005 . Al-Dahan ZA, Da'aj ST. The impact of an Oral Health Education (OHE) program by teachers and mothers on adolescents' oral health J. Bagh Coll Dent. 2018;30(4). https://doi.org/10.26477/jbcd.v30i4.2555 . Grant JS, Davis LL. Selection and use of content experts for instrument development. Res Nurs Health. 1997;20(3). https://doi.org/10.1002/(SICI)1098-240X . (199706)20:3%3C269::AID-NUR9%3E3.0.CO;2-G. Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: Conducting a content validity study in social work research. Soc Work Res. 2003;27(2). https://doi.org/10.1093/swr/27.2.94 . Sangoseni O, Hellman M, Hill C. Development and validation of a questionnaire to assess the effect of online learning on behaviors, attitudes, and clinical practices of physical therapists in the United States regarding evidenced-based clinical practice. Internet J Allied Health Sci Pract. 2013;11(2). https://doi.org/10.46743/1540-580X/2013.1439 . Lenz ER. Measurement in nursing and health research. 5th ed. Springer publishing company; 2017. Fillenbaum GG, Smyer MA. The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol. 1981;36(4). https://doi.org/10.1093/geronj/36.4.428 . Haynes SN, Richard D, Kubany ES. Content validity in psychological assessment: A functional approach to concepts and methods. Psychol Assess. 1995;7(3). http://dx.doi.org/10.1037/1040-3590.7.3.238 . Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4). https://doi.org/10.1002/nur.20199 . Trochim WM, Donnelly JP, Arora K. Research methods: The essential knowledge base.2nd ed. Cengage Learning. 2016. Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar AR. Design and implementation content validity study: develop ment of an instrument for measuring patient-centered communication. J Caring Sci. 2015;4(2). https://doi.org/10.15171/jcs.2015.017 . Organization WHO. Translation and linguistic evaluation protocol and supporting material; WHODAS 2.0 Translation package, version 1.0. 2020. DeVon HA, Block ME, Moyle-Wright P, Ernst DM, Hayden SJ, Lazzara DJ, Savoy SM, Kostas‐Polston E. A psychometric toolbox for testing validity and reliability. J Nurs Scholarsh. 2007;39(2). https://doi.org/10.1111/j.1547-5069.2007.00161.x . Additional Declarations No competing interests reported. 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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-9226251","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619773722,"identity":"1677a406-2035-493e-afc3-d12a87b7b0f7","order_by":0,"name":"Ayat Hussein","email":"","orcid":"","institution":"Dijlah University College","correspondingAuthor":false,"prefix":"","firstName":"Ayat","middleName":"","lastName":"Hussein","suffix":""},{"id":619773723,"identity":"5fae3914-db18-4de2-bea9-52da658ea79c","order_by":1,"name":"Yassir Yassir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYLCCBCAEgQMMFUCSmbmBFC1nQFoYidDCANXCwNgGJvFrMTh+/PGHh3vSEvv7jz88XDmvNpq/HajlR8U23FrO5JhJJDzLSZxxI8fg4Nltx3NnHGZsYOw5cxu3lgM5bAwJByoSG27wMBxs3HYstwGohZmxDY+W888ffwBpmX/++IODjXOO5c4nqOVGgoFEwoGcxA0HEgwONjbU5G4gpEXyxhugXw6kGW8E+aXh2IHcjUAtB/H5he98+uOPPw4ky847f/zxx4aautx55w8ffPCjArcWhQMQ2rEBQh8GkwdwqgcCeahSeyi/Dp/iUTAKRsEoGKEAAI+fbJMtxaXzAAAAAElFTkSuQmCC","orcid":"","institution":"University of Baghdad","correspondingAuthor":true,"prefix":"","firstName":"Yassir","middleName":"","lastName":"Yassir","suffix":""},{"id":619773724,"identity":"906b2187-a940-4931-be48-e99f33ed4bfe","order_by":2,"name":"Noor Al-Hasani","email":"","orcid":"","institution":"University of Baghdad","correspondingAuthor":false,"prefix":"","firstName":"Noor","middleName":"","lastName":"Al-Hasani","suffix":""},{"id":619773725,"identity":"a6a22fde-58f1-4c98-adaf-5ac9eba3615c","order_by":3,"name":"Grant McIntyrec","email":"","orcid":"","institution":"University of Dundee","correspondingAuthor":false,"prefix":"","firstName":"Grant","middleName":"","lastName":"McIntyrec","suffix":""}],"badges":[],"createdAt":"2026-03-25 18:09:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9226251/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9226251/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107613789,"identity":"129571db-f95f-4731-bce0-9c13ec9504fc","added_by":"auto","created_at":"2026-04-23 08:57:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1459267,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9226251/v1/93378002-6946-478e-ac47-fd86191e596d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validation of a Patient-Reported Questionnaire on Adjunctive Methods to Accelerate Orthodontic Tooth Movement","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe questionnaire plays an essential role in research by featuring a set list of questions designed to collect vital information from respondents. Generally, it is used in conjunction with surveys to gather both quantitative and qualitative data. The primary purpose of questionnaires is to extract specific information, which can subsequently be analyzed to identify patterns, viewpoints, behaviors, or insights related to a particular subject.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eValidating a questionnaire is a fundamental aspect of the research process, ensuring that the instrument accurately and reliably measures the intended constructs or variables.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Validation serves to confirm that the questionnaire effectively captures the underlying concepts it is designed to assess, thereby improving the credibility and integrity of the gathered data.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This process is critical because it addresses various uncontrollable factors that can influence data quality, such as respondent misunderstanding, bias, or environmental distractions during data collection.\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Validation procedures for questionnaires encompass a range of categories and subcategories, each tailored to specific types of instruments and research objectives.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Rather than applying a one-size-fits-all approach, each questionnaire undergoes a particular validation method that best suits its unique design and intended use.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This ensures that the instrument accurately measures the constructs it aims to assess while maintaining reliability and validity across different contexts.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eContent validity involves a systematic and quantitative evaluation to ensure that a questionnaire comprehensively covers the construct it aims to measure.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This process entails assessing the suitability of each item and discarding those that are not relevant by utilizing the Content Validity Index (CVI).\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Typically, this evaluation is conducted by a panel of experts, with a minimum of three specialists recommended to provide diverse perspectives, although involving more experts can enhance the robustness of the validation process.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e The essence of the expert panel work is to estimate the relevance and clarity of each questionnaire item.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In general, validation is a qualitative process by which the adequacy of a questionnaire or measurement instrument is determined by using two different rounds with a minimum of a 10-day interval between them, during which the feedback and required adjustments should be considered to enhance the accuracy and comprehension of the questionnaire.\u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Face validity, on the other hand, is the process that determines the appropriateness of the content of questionnaire or measurement instrument, where the two rounds are used, The elements that are investigated by this type of validation include readability, language clarity, feasibility, and formatting consistency. Even though face validation is usually regarded as a most basic and the weakest type of validation, it is essential in the initial phase of the instrument development since it helps to determine whether the items are comprehendible and applicable to the target audience.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e To secure the measurement of the intended constructs, content and face validation must be used. This method, called \"validation by assumption\".\u003csup\u003e17\u0026ndash;19\u003c/sup\u003e To effectively use the questionnaire for cross-cultural research, it may need translation for cultural adaptation and universal understanding. Translating presents challenges as the original content meaning and intent must be preserved. Translation approaches include using an unqualified individual, a qualified team, or the back-translation method.\u003csup\u003e\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMost research in orthodontics predominantly focuses on the orthodontist's perspective, emphasizing factors such as patient compliance and adaptability to treatment. However, more attention needs to be given to understanding patients\u0026rsquo; experiences of discomfort during orthodontic treatment. Moreover, an in-depth review of the current literature reveals that the majority of research on patient discomfort during orthodontic treatment focuses predominantly on pain-related aspects, while overlooking a multitude of other factors linked to the patient's physical and psychological health.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In orthodontics, for adjunctive interventions like osteoperforation, accelerated tooth movement injections, and laser applications to be effective, they need to meet two criteria: technically, they should be beneficial and applicable, and practically, they should be easy to administer and comfortable for patients.\u003csup\u003e\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Including patients' perspectives on new orthodontic treatments combined with adjunctive therapies will allow researchers to evaluate the treatments advantages and disadvantages by examining various aspects of oral health-related quality of life (OHRQoL).\u003c/p\u003e \u003cp\u003eExisting instruments for assessing orthodontic perception often rely on limited measures and lack cultural adaptation, leaving patient experiences with adjunctive orthodontic modalities underexplored. Therefore, this study aims to develop and validate a bilingual questionnaire to address that gap, offering a reliable and culturally adapted tool that enables systematic evaluation of patient perceptions and supports evidence-based optimization of adjunctive orthodontic care. To the best of our knowledge, this will be the first culturally adapted instrument specifically targeting patient experiences with adjunctive orthodontic modalities in our region.\u003c/p\u003e"},{"header":"Subjects and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study is a cross-sectional research design which is a part of a randomized clinical trial structure. The Ethics Committee of the College of Dentistry at the University of Baghdad approved the study under reference number 1014 in January 21, 2025 and registered in ClinicalTrials.gov on February 26th, 2025, with a registration ID: NCT06847880.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe Design of the questionnaire\u003c/h3\u003e\n\u003cp\u003eThe initial draft of this questionnaire was developed by gathering relevant questions from multiple questionnaires which studied patient discomfort experiences in orthodontic treatment. \u003csup\u003e28\u0026ndash;40\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eThe Sample\u003c/h3\u003e\n\u003cp\u003eThe research validation process involves the following participant groups:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSpecialist orthodontists: comprised of a quota sample of 12 participants to assess both the content and face validity of the questionnaire. They were belonged to the education and healthcare sectors and had between 2 to 20 years of experience.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOrthodontic patients: a sample of patients undergoing fixed appliance orthodontic treatment was randomly selected as part of the broader clinical trial, based on predefined inclusion and exclusion criteria. These participants represented typical orthodontic cases recruited from routine clinical settings, including specialized governmental dental centers, private clinics, and the Department of Orthodontics at the College of Dentistry, University of Baghdad. Their role was to assess the face validity of the questionnaire by evaluating its clarity, relevance, and comprehensibility.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e All participants provided written informed consent to confirm their voluntary involvement. For patients younger than 18 years, parental consent was obtained. The study procedures adhered to the ethical standards of the institutional research committee and complied with the principles of the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInclusion Criteria\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients aged 12 years and above, who are indicated for fixed appliance orthodontic treatment.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients with moderate to severe crowding (4\u0026ndash;9 mm) of the mandibular anterior teeth as per the Little's Irregularity Index (LII).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTreatment with or without two mandibular first premolars extraction.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePresence of all the mandibular permanent teeth, except the third molars.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe overbite and overjet should not impede bracket placement on the mandibular anterior teeth.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eExclusion Criteria\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of previous orthodontic intervention.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of trauma or root resorption in the mandibular anterior teeth.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePresence of mandibular anterior teeth crowding of less than 4 mm or greater than 9 mm (LII).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExistence of blocked-out teeth precluding engagement with the aligning archwire.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of systemic diseases, especially diabetes and bone diseases.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients with periodontitis and obvious loss of tooth attachment according to Plaque and Bleeding on Probing indices.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePregnant and lactating mothers.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMouth breathing patients and smokers.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealthy patients who used any medications (such as anti-inflammatory or antimicrobial drugs) or supplements (such as vitamins).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eValidation Process\u003c/h3\u003e\n\u003cp\u003eTo formulate questions that are validated, relevant, and easily comprehensible for patients who speak Arabic, the initially selected questions were subjected to a series of structured steps:\u003c/p\u003e\n\u003ch3\u003eStep 0: Initial Questionnaire Construction\u003c/h3\u003e\n\u003cp\u003eThe preliminary version of the questionnaire was developed following an exhaustive review of validated instruments assessing patient discomfort and perception during orthodontic treatment. \u003csup\u003e28\u0026ndash;40\u003c/sup\u003e Items were selected for their relevance to adjunctive orthodontic procedures. There were 21 items that were collected so as to be inclusive of physical, functional, and emotional domains, while maintaining respondent manageability.\u003c/p\u003e \u003cp\u003eThe pool of items was collected and narrowed down by the principal investigator under the guidance of a senior orthodontic specialist and both clinical and linguistic validity were maintained by the authors before the item pool was reviewed by an expert panel.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStep 1: First Round of Content and Face validation by Experts\u003c/h2\u003e \u003cp\u003eAll professionals were invited to participate in a content validity panel in the form of an invitation letter. All the questions of the questionnaire were rated through 4-point Likert scale; 1 (not relevant), 2 (somewhat relevant), 3 (relevant), and 4 (very relevant). The professionals made their evaluations on their own. The assessment process classified items rated 1 or 2 as irrelevant and items rated 3 or 4 as relevant. The Content Validity Index (CVI) was used for measuring questionnaire validity. Using Lynn's approach, the Item-Level Content Validity Index (I-CVI) was calculated by dividing expert ratings of 3 or 4 to the total expert count. An item qualified as valid when the I-CVI rating reached or exceeded 0.78. Since the questionnaire included 12 experts, 10 of them should rate 3 or 4 for the items to remain in the study, otherwise it would be removed. On the other hand, the Scale-Level CVI (S-CVI) was used to measure the questionnaire validity through averaging the I-CVI values. The questionnaire overall needed to attain a minimum S-CVI value of 0.9 to qualify as valid.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe experts who validated the content also assessed the face validity of the questionnaire. They examined the clarity, readability, and the general suitability of the questionnaire. The evaluation was conducted through a 4-point Likert scale that ranged from 1 for strongly disagree to 4 for strongly agree.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStep 2: Questionnaire modification\u003c/h3\u003e\n\u003cp\u003eBased on the first round results, the questionnaire underwent several changes. Some items were modified or merged, new items were added, and items deemed non-valid (I-CVI\u0026thinsp;\u0026lt;\u0026thinsp;0.78) were excluded.\u003c/p\u003e\n\u003ch3\u003eStep 3: Second round of content validation by experts\u003c/h3\u003e\n\u003cp\u003eA group of 12 experts from the initial content validation were asked again to assess the modified version of the questionnaire.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStep 4: Translation process\u003c/h2\u003e \u003cp\u003eA certified professional translation bureau translated the questionnaire from English to Arabic language. Three qualified translators were participated in this translation process. Two independent translators worked on the translation of the English questionnaire to Arabic. The team leader reviewed and merged both versions to create one accurate Arabic version. A back-translation method was used to verify the accuracy and maintain consistency of the Arabic version.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStep 5: Face Validation by Patients\u003c/h2\u003e \u003cp\u003eA total of 30 orthodontic patients (under fixed appliance orthodontic treatment) were invited to validate the face validity of the questionnaire. The participants received the translated and validated questionnaires to evaluate the readability and clarity of questionnaire items with a specific face validation form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStep 6: Reliability\u003c/h2\u003e \u003cp\u003eThe internal consistency reliability of the translated and validated questionnaire was used to assess the inter-item correlation. On the other hand, the long-term stability of the questionnaire cannot be assessed using a test-retest reliability method, as it captures an evolving experience of orthodontic patients undergoing adjunctive treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe I-CVI, S-CVI, and the percentages of face validity agreement were calculated using an Excel spreadsheet (Excel, Microsoft Office Professional Plus 2019, Washington, USA). The Statistical Package for Social Sciences (SPSS) version 26.0 released by SPSS Inc. (Chicago, IL, USA) was used for statistical analysis. The internal consistency reliability was tested using the Cronbach's alpha analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStep 1: First Round of Content and Face validation by Experts\u003c/h2\u003e \u003cp\u003eIn this round of content validation, each of the 21 items was found to be relevant to the core concept (I-CVI\u0026thinsp;\u0026ge;\u0026thinsp;0.78). As a result, all questionnaire items were retained. Similarly, the average S-CVI for the entire questionnaire was 0.94 (valid) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the face validation, the questionnaire had a total agreement of 91.7 which shows that it is adequate. Nonetheless, certain specialists suggested changes to some of the items in order to make them more suitable\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\u003eFirst round of content validation by 12 orthodontic experts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eResponses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eI-CVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValidity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eDo you have Pain/discomfort/soreness in\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTeeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eJaws\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGingiva\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMuscles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHeadache\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDid you have pain during the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the intensity of pain during the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHave you taken analgesics for pain?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you have pain in your teeth when they are in contact?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDid you stay at home from school or work specifically due to discomfort following the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eWhere did you feel the pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePosterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAll the dentition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCannot locate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDo you have difficulty in\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSpeech\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSleeping\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEating/Chewing/Biting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTooth brushing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eHas the following been affected due to treatment?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSocial activity\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSchool/work\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEmotional Status\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the duration of the intervention visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLengthy\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the intervention visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnnoying\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 \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eValid\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 \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStep 2: Questionnaire Modification\u003c/h2\u003e \u003cp\u003eFollowing the first round of expert review, the research team reviewed all comments and recommendations. Modifications to the questionnaire were made following collective expert consensus and statistical criteria of validity (I-CVI\u0026thinsp;\u0026ge;\u0026thinsp;0.78). While individual suggestions were taken into account, changes were only implemented when supported by more than one reviewer or were in line with the study methodological framework. All revisions were completed by the authors following synthesis from expert consultation of 12 orthodontic specialists.\u003c/p\u003e \u003cp\u003eBased on the recommendations made by the experts, the questionnaire underwent the following modifications:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe phrase \u003cb\u003e\u0026ldquo;After the intervention\u0026rdquo;\u003c/b\u003e was added to items 1, 2, 3, 4, 5, 8, 9, 12, 13, 14, 15, 16, 17, and 19.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe phrase \u003cb\u003e\u0026ldquo;Temporomandibular Joints\u0026rdquo;\u003c/b\u003e was added to item 2.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe responses to items 1, 2, 3, 4, and 5 were changed to \u003cb\u003e\u0026ldquo;Yes/No\u0026rdquo;\u003c/b\u003e instead of \u003cb\u003e\u0026ldquo;Not at all, A little, A lot\u0026rdquo;\u003c/b\u003e. The format of the response to items 1\u0026ndash;5 was altered to binary (Yes/No) to indicate their diagnostic quality, and items 14\u0026ndash;20 were kept in the form of a graded scale since they measured the subjective impact.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe phrase \u003cb\u003e\u0026ldquo;If you have pain in your teeth after the intervention\u0026rdquo;\u003c/b\u003e was added to item 11.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe word \u003cb\u003e\u0026ldquo;Biting\u0026rdquo;\u003c/b\u003e was deleted from the item 14 \u003cb\u003e\u0026ldquo;Eating/Chewing/Biting\u0026rdquo;\u003c/b\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe sequence of some items was changed.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe phrase \u003cb\u003e\u0026ldquo;e.g., sport\u0026rdquo;\u003c/b\u003e was added to item 16.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eItem 18 was deleted.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe phrase \u003cb\u003e\u0026ldquo;Happiness/Depression\u0026rdquo;\u003c/b\u003e was added to item 19.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe phrase \u003cb\u003e\u0026ldquo;due to treatment addition\u0026rdquo;\u003c/b\u003e was deleted, and the word \u0026ldquo;adversely\u0026rdquo; was added to items 16, 17, and 19.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe definition of the word \u003cb\u003e\u0026ldquo;intervention\u0026rdquo;\u003c/b\u003e was provided at the end of the questionnaire based on the adjunctive treatment type.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAddition of a new item: \u003cb\u003e\u0026ldquo;After the intervention, do you have feelings of\u0026rdquo;\u003c/b\u003e with sub-items \"Swelling\" and \"Numbness\" and responses \u003cb\u003e\u0026ldquo;Yes and \"No\u0026rdquo;\u003c/b\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStep 3: Second Round of Content Validation by Experts\u003c/h2\u003e \u003cp\u003eIn this phase a follow-up validation process was performed to evaluate both the newly introduced and the modified questionnaire items. This validation included the same group of 12 experts in orthodontics and occurred one month after the initial evaluation in the first round. The results showed that all items achieved an I-CVI of 1.00. Furthermore, the questionnaire as a whole had a S-CVI/Ave score of 1.00 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStep 4: Translation Procedure\u003c/h2\u003e \u003cp\u003eThe final and revised version of the validated questionnaire was translated from English to Arabic by a certified translation bureau. To guarantee the content integrity, the authors carefully reviewed the translated version by back translation method and confirmed that the main concepts of each item were preserved (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStep 5: Patient Face Validation\u003c/h2\u003e \u003cp\u003eFace validity of the questionnaire was carried out in 20 patients. Their feedback noted that the questionnaire was clear, well-structured and understandable. This process led to a perfect agreement in terms of face validity with an overall agreement rate of 100%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStep 6: Reliability\u003c/h2\u003e \u003cp\u003eA data of 30 patients who filled the questionnaire was tested for internal consistency reliability. The overall questionnaire achieved acceptable internal consistency with Cronbach\u0026rsquo;s alpha level of 0.70. Three sections could also be measured. The first section related to pain/discomfort (items 1\u0026ndash;13) with Cronbach\u0026rsquo;s alpha level of 0.722. The second section related to pain/discomfort and function (items 1\u0026ndash;17) with Cronbach\u0026rsquo;s alpha level of 0.708. In addition, the third section related to physical/social/emotional activities (item 18\u0026ndash;20) with Cronbach\u0026rsquo;s alpha level of 0.750.\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\u003eSecond round of content validation by 12 orthodontic experts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eResponses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e I-CVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValidity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDid you have pain during the intervention*?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the intensity of pain during the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHave you taken analgesics for pain after the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have Pain/discomfort/soreness in\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTeeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eJaws/Temporomandibular Joints\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGingiva\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMuscles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHead\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIf you have pain in your teeth after the intervention, where did you feel the pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePosterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAll the dentition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCannot locate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have pain in your teeth when they are in contact?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have the feelings of\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSwelling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNumbness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDid you stay at home from school or work specifically due to discomfort following the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have difficulty in\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSpeech\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSleeping\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEating/Chewing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTooth brushing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHas the following been adversely affected after the intervention ?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity (e.g. sport)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSocial activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eEmotional Status (Happiness/Depression)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the duration of the intervention visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLengthy\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the intervention visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnnoying\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 \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \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\u003eRevised and final version of the validated questionnaire (English version).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e \u003cp\u003eResponses\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\u003e\u003cb\u003eDid you have pain during the intervention*?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the intensity of pain during the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave you taken analgesics for pain after the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, did you have pain/discomfort/soreness in?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTeeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eJaws/Temporomandibular Joints\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGingiva\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMuscles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHead\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf you have pain in your teeth after the intervention, where did you feel the pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePosterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAll the dentition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCannot locate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have pain in your teeth when they are in contact?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have the feelings of\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSwelling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumbness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDid you stay at home from school or work specifically due to discomfort following the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAfter the intervention, do you have difficulty in\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSpeech\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSleeping\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEating/Chewing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTooth brushing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHas the following been adversely affected after the intervention?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity (e.g. sport)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSocial activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEmotional Status (Happiness/Depression)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eA lot\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the duration of the intervention visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eLengthy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow would you describe the intervention visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eAnnoying\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRevised and final version of the validated questionnaire (Arabic version).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eردود الفعل\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eالبنود\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eكلا\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eنعم\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eهل شعرت بألم أثناء التداخل العلاجي*؟\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eشديد\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eمتوسط\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eخفيف\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eلا يوجد\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eكيف تصف شدة الألم خلال التداخل العلاجي؟\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eهل تناولت مسكنات للألم بعد التداخل العلاجي؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالأسنان\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eبعد التداخل العلاجي، هل شعرت بألم / عدم راحة / تقرح في؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالفكين / مفصل الفك الصدغي\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eاللثة\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالعضلات\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالرأس\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eلا يمكن تحديده\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eجميع الأسنان\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eالأسنان الخلفية\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eالأسنان الأمامية\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eإذا شعرت بألم في الأسنان بعد التداخل العلاجي، أين شعرت به؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eبعد التداخل العلاجي، هل شعرت بألم في أسنانك عند الاطباق؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eتورم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c10\" namest=\"c9\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eبعد التداخل العلاجي، هل شعرت بـ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eخدر\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكلا\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003eنعم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eهل بقيت في المنزل أو توقفت عن المدرسة / العمل بسبب الانزعاج الناتج عن التداخل العلاجي ؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالكلام\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c10\" namest=\"c9\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eبعد التداخل العلاجي، هل واجهت صعوبة في\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالنوم\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالأكل / المضغ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eتنظيف الأسنان بالفرشاة\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالنشاط البدني (مثل الرياضة)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c10\" namest=\"c9\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eهل تأثرت الأمور التالية سلبًا بعد التداخل العلاجي؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالنشاط الاجتماعي\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eكثيراً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eقليلاً\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eلا على الإطلاق\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eالحالة العاطفية (السعادة / الاكتئاب)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eطويلة\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eطبيعية\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eكيف تصف مدة زيارة التداخل العلاجي؟\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eمزعجة\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eطبيعية\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003eكيف تصف زيارة التداخل العلاجي؟\u003c/b\u003e\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\u003eThe OHRQoL plays a vital role in clinical trials to evaluate the outcomes of preventive and therapeutic programs, aiding specialists in improving the quality of oral health treatments.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Recognizing its importance, the World Health Organization has emphasized the inclusion of quality-of-life measures in clinical studies.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough extensive research has been conducted on patient experience, impact, and satisfaction with orthodontic treatment, there is limited emphasis on patient perception during adjunctive orthodontic treatment. Most of these studies have relied solely on the visual analogue scales (VAS) to assess pain and discomfort without addressing other aspects comprehensively through the use of questionnaires, so this study is considered the first to develop/utilize a questionnaire to comprehensively examine patient perception during adjunctive orthodontic treatment, providing valuable insights that can enhance compliance, address challenges, and optimize treatment protocols.\u003c/p\u003e \u003cp\u003eFor content and face validity, experts were selected following guidelines from Grant and Davis\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e and Rubio \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e48\u003c/sup\u003e ensuring substantial clinical expertise and teaching experience. The validity of questionnaire content depends on expert evaluations, but including unqualified individuals can undermine the process.\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIncreasing the number of expert reviewers enhances reliability by incorporating diverse perspectives shaped by varying educational backgrounds and experience levels.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e While some studies may require a single validation round, this research conducted two rounds for refinement, aligning with the recommendations by Lynn\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, Haynes \u003cem\u003eet al\u003c/em\u003e.\u003csup\u003e52\u003c/sup\u003e, Rubio \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e48\u003c/sup\u003e and Polit \u003cem\u003eet al\u003c/em\u003e..\u003csup\u003e53\u003c/sup\u003e Polit \u003cem\u003eet al\u003c/em\u003e.\u003csup\u003e53\u003c/sup\u003e suggests beginning with 8 to 12 experts before narrowing it down to 3 to 5 in later stages. In this study, 12 experts participated in both rounds, reinforcing the trustworthiness of the assessment.\u003c/p\u003e \u003cp\u003eDuring the first round of content validation, all questionnaire items were deemed valid and relevant to the underlying construct (I-CVI\u0026thinsp;\u0026ge;\u0026thinsp;0.78). The S-CVI for the overall questionnaire was 0.94, exceeding the 0.90 threshold for validity. Comparing these results with the standards established by Lynn\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e and Polit \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e53\u003c/sup\u003e the content validity is excellent. However, some experts suggested some modifications to certain items to enhance their appropriateness.\u003c/p\u003e \u003cp\u003eFace validity was assessed through feedback from professionals and patients, following the systematic approach outlined by Trochim \u003cem\u003eet al\u003c/em\u003e..\u003csup\u003e54\u003c/sup\u003e While face validity can encourage respondent participation, it is considered the weakest form of validation and should not be used in isolation, as noted by Waltz \u003cem\u003eet al\u003c/em\u003e..\u003csup\u003e41\u003c/sup\u003e In this study, content and face validation complemented each other, with quantitative and qualitative feedback. This lines up with Lynn\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, who emphasized expert involvement in identifying omissions and suggesting improvements.\u003c/p\u003e \u003cp\u003eClarity and readability were evaluated by experts, with the questionnaire achieving 96.4% agreement. Adjustments were made to streamline its content. Additionally, thirty patients reviewed the validated and translated questionnaire using a face validation form, following strategies from Zamanzadeh \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e\u003cb\u003e55\u003c/b\u003e\u003c/sup\u003e Yassir \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e19\u003c/sup\u003e and Haik and Yassir.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Their assessments resulted in excellent agreement on readability and comprehension.\u003c/p\u003e \u003cp\u003eRegarding the translation process, A rigorous translation methodology was accomplished on the validated questionnaire, with linguistic accuracy and conceptual fidelity. The English to Arabic translation was accomplished by an official translation bureau using the services of highly qualified bilingual professionals. The English version was translated to Arabic by two translators and then a critical assessment and synthesis was carried out by the team leader. This approach to methodology is consistent with the suggestions of Goranson \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e22\u003c/sup\u003e that recommend multi-translator validation as a way of increasing reliability and contextual accuracy. To further safeguard the original content, a back-translation procedure was adopted, following the standardized procedures of WHODAS 2.0.\u003csup\u003e56\u003c/sup\u003e This is a holistic approach to translation that ensures that the meaning is preserved, and that the methodology is accurate, as per the academic and linguistic standards.\u003c/p\u003e \u003cp\u003eAnalysis of reliability revealed that the questionnaire demonstrated had a high degree of internal consistency, which is indicated by the Cronbach alpha coefficients of the three sections (0.722, 0.708, and 0.750, respectively), which support the reliability of the questionnaire and its structural consistency. But, as this scale is meant to measure a condition which by nature changes with time, test-retest reliability is not an appropriate measure of the stability of the scale.\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e Given that patients' responses and perceptions naturally change over time due to their progression through treatment, measuring repeatability through a test-retest approach becomes inherently challenging.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe study included only 12 experts and 30 patients, which was insufficient for conducting factor analysis or other advanced statistical tests. As a result, validity assessments relied on expert evaluations rather than statistical validation, limiting construct validity.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTest-retest reliability is not applicable due to the conditional variability.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study successfully developed and validated a bilingual questionnaire to assess patient perceptions during adjunctive orthodontic therapy. The instrument showed strong validity and acceptable reliability, providing a practical framework for integrating patient perspectives into orthodontic research and clinical protocols. This validated tool addresses a key gap in orthodontic patient-reported outcome measures and is expected to facilitate systematic evaluation of patient experiences, contributing to evidence-based optimization of adjunctive care. And thus, this represents the first study to provide a culturally adapted instrument specifically designed to capture patient experiences with adjunctive orthodontic modalities in the region, marking an important step toward advancing patient-centered orthodontic research and practice.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study is self-funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupplementary data are available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was part of a randomized clinical trial that registered at ClinicalTrials.gov on 26February 2025 (Registration number: NCT06847880). The Ethics Committee of the College of Dentistry at the University of Baghdad approved the study under reference number 1014 in January 21, 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants, or their legal guardians in the case of minors, provided written informed consent to participate in the study and for the publication of anonymized data in scientific reports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGroves RM, Fowler FJ Jr, Couper MP, Lepkowski JM, Singer E, Tourangeau R. Survey methodology. 2nd ed. Wiley; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeVellis RF, Thorpe CT. Scale development: Theory and applications. 5th ed. 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J Nurs Scholarsh. 2007;39(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1547-5069.2007.00161.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1547-5069.2007.00161.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Patient-reported outcomes, Questionnaire validation, Orthodontic acceleration, Cross-cultural adaptation","lastPublishedDoi":"10.21203/rs.3.rs-9226251/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9226251/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to develop and validate a patient-reported questionnaire to comprehensively assess perceptions during adjunctive orthodontic therapy, ensuring methodological rigor and cross-cultural applicability.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e \u003cp\u003eA structured questionnaire was developed, consisting of 21 items investigating the emotional, physical, and functional domains. A multi-phase validation process was then implemented. Orthodontic experts (n\u0026thinsp;=\u0026thinsp;12) evaluated the content validity using Lynn\u0026rsquo;s criteria. In addition, both the orthodontic experts and 30 patients assessed face validity to ensure clarity, readability, and relevance. Based on expert consensus, the questionnaire was refined, expanded to 22 items, and subjected to a second round of validation. To guarantee cross-cultural applicability, the instrument was translated into Arabic by a certified bureau, using forward and back-translation. Reliability was examined using Cronbach\u0026rsquo;s alpha to measure internal consistency across domains.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe questionnaire demonstrated exceptional content validity (S-CVI\u0026thinsp;=\u0026thinsp;1.00), perfect face validity (100% agreement), and acceptable internal consistency reliability (Cronbach\u0026rsquo;s alpha 0.722 for pain/discomfort items; 0.708 for pain/function items; 0.750 for psychosocial items). The instrument successfully captured multidimensional aspects of patient perception, including pain intensity, analgesic use, functional difficulties, and psychosocial consequences. The translation ensured linguistic accuracy and cultural adaptability in English and Arabic.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis validated bilingual questionnaire provides a reliable tool for assessing patient perceptions of adjunctive orthodontic acceleration techniques. It offers a practical framework for integrating patient perspectives into orthodontic research/clinical protocols. Its methodological strength and cross-cultural adaptability establish a valuable reference for future patient-centered investigations. Importantly, it represents the first questionnaire dedicated to adjunctive orthodontic methods.\u003c/p\u003e","manuscriptTitle":"Validation of a Patient-Reported Questionnaire on Adjunctive Methods to Accelerate Orthodontic Tooth Movement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 11:14:10","doi":"10.21203/rs.3.rs-9226251/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0e7c3d8a-1199-46bb-bb71-a262ba1ccaca","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T08:56:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 11:14:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9226251","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9226251","identity":"rs-9226251","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}