Persian Translation and Validation of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8)

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Methods The translation process followed internationally recognized guidelines for cross-cultural adaptation, as recommended by ISPOR. One hundred Persian-speaking SCL wearers were recruited 6 using simple sampling. Participants completed the Persian version of CLDEQ-8. Data analysis was 7 performed using SPSS (version 27) and jMetrik (version 4.1.1). Results A total of 100 SCL wearers with a mean age of 26.20 ± 7.61 years participated. Cronbach’s α for internal consistency was 0.868. The average inter-item correlation was 0.452 (range: 0.244 to 0.739). Principal Component Analysis (PCA) revealed two components explaining 66.512% of the variance, with all items loading above 0.50. Rasch analysis showed patient reliability, patient separation, item separation, and item reliability of 0.87, 2.54, 1.43, and 0.67, respectively. Conclusion The Persian version of CLDEQ-8 demonstrated good reliability and validity, supporting its use in clinical and research settings for evaluating dry eye symptoms in SCL users. Contact Lens Dry Eye Questionnaire-8 Persian psychometric evaluation reliability validity Figures Figure 1 INTRODUCTION Dry eye disease (DED) is a multifactorial disorder of the ocular surface characterized by a loss of tear film homeostasis, which may lead to symptoms such as ocular discomfort, dryness, visual disturbances, and tear film instability. Among the various risk factors, contact lens (CL) wear has been strongly associated with both the development and worsening of dry eye symptoms. Studies have shown that CL users experience significantly more frequent and intense symptoms of dryness compared to non-users [1]. These symptoms not only cause discomfort but can negatively impact visual performance and quality of life. Importantly, discomfort due to DED is a leading cause of contact lens discontinuation [2]. Therefore, timely and accurate assessment of DED symptoms in CL wearers is essential for clinical management, patient satisfaction, and long-term lens compliance. To evaluate DED symptoms in CL users, the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) was developed as a short, specific, and validated instrument that quantifies both the frequency and intensity of symptoms in this population [3]. The questionnaire has been widely used in clinical research and translated into several languages, including Greek [4], Japanese [5], and Portuguese [6] demonstrating its adaptability across cultures. Despite its global utility, a validated Persian version of the CLDEQ-8 has not been available, limiting its use among Persian-speaking populations. Culturally adapted and validated tools are crucial to ensure accurate symptom assessment across diverse populations. This study aimed to translate and validate the CLDEQ-8 in Persian to fill this gap. SUBJECTS AND METHODS This was a prospective cross-sectional validation study. The study adhered to the principles of the Declaration of Helsinki, and written informed consent was obtained from all participants. This study approved by the Ethics Committee of Mashhad University of Medical Sciences (Code: IR.MUMS.FHMPM.REC.1403.0). The CLDEQ-8, composed of 8 items with a score range from 0 to 37, was translated into Persian following the internationally recognized guidelines by the ISPOR Task Force for Translation and Cultural Adaptation [7]. Initially, three bilingual optometrists fluent in English and Persian independently translated the original English version into Persian. These translations were reviewed by an expert panel of optometrists, ophthalmologists, methodologists, and linguistic specialists. Cultural and conceptual adaptations were applied where necessary to ensure clarity and relevance. The preliminary Persian version was then back-translated into English by two native English speakers proficient in Persian. These back-translations were compared with the original English version to ensure semantic equivalence. Revisions were made based on discrepancies, and the finalized Persian CLDEQ-8 was prepared. Ten experts evaluated the necessity, clarity, simplicity, and relevance of each item using a 4-point Likert scale. Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated. Items with CVR < 0.62 were considered non-essential, while items with CVI < 0.70 were subject to revision or removal, as recommended by Lawshe [8] and Polit and Beck [9]. A total of 100 SCL users aged 18–48 years with Persian as their mother tongue were enrolled through simple random sampling. Participants were required to be full-time, adapted bilateral SCL wearers. Exclusion criteria included current ocular infection, history of ocular surgery, chemical or thermal ocular burns, systemic diseases, pregnancy or lactation, smoking, more than 6 hours per day computer use, and use of medications known to cause dry eye. Inability to read or complete the questionnaire was also an exclusion criterion. All statistical analyses were performed using SPSS software version 27.0 (SPSS Inc., Chicago, IL) and jMetrik version 4.1.1. Reliability was assessed by computing Cronbach’s alpha () to determine internal consistency. Inter-item correlations were also analyzed to examine the extent to which individual items measured the same underlying construct [10]. Construct validity was evaluated using Exploratory Factor Analysis (EFA) and Principal Component Analysis (PCA) with varimax rotation. Items with factor loadings greater than 0.50 were considered to load significantly onto a factor [11]. Rasch analysis was conducted to assess item fit, person and item reliability, and item difficulty levels. The Rasch model evaluates how well the data fit a unidimensional model and provides item-person maps and fit statistics (WMS and UMS) [12]. RESULTS A total of 100 Persian-speaking SCL wearers participated in the study. The mean age of participants was 26.20 ± 7.61 years (range: 18–48). The mean spherical equivalent was 2.68 ± 1.36 diopters (range: -0.50 to -6.75). The majority of participants were female (78%), and most had undergraduate or graduate-level education (90%). The CVR and CVI for all 8 items were within acceptable ranges. As shown in Table 1 , all items achieved CVR values ≥ 0.70 and CVI values ≥ 0.80, indicating good content validity. Table 1 CVR and CVI for each item Item CVR CVI Q1A 1.0 1.0 Q1B 0.7 0.8 Q2A 1.0 1.0 Q2B 0.8 0.8 Q3A 0.8 1.0 Q3B 0.7 0.8 Q4 0.7 0.8 Q5 0.7 1.0 CVR: Content Validity Ratio, CVI: Content Validity Index The internal consistency of the Persian CLDEQ-8 was high, with a Cronbach's alpha of 0.868. The average inter-item correlation was 0.452, with individual item correlations ranging from 0.244 to 0.739, suggesting strong consistency among items. PCA identified two components with eigenvalues > 1, which together explained 66.512% of the total variance (Table 2 ). Factor loadings for all items were above 0.50 (Table 3 ), indicating each item contributed meaningfully to one of the two underlying factors. Items Q1A, Q1B, Q2A, and Q2B loaded more strongly on the first factor, while items Q3A, Q3B, Q4, and Q5 aligned more with the second factor. Table 2 Principle component analysis (PCA) Component Initial eigenvalues Extraction sums of squared loadings Rotation sums of squared loadings Total % of variance Cumulative % Total % of variance Cumulative % Total % of variance Cumulative % 1 4.187 52.343 52.343 4.187 52.343 52.343 2.692 33.645 33.645 2 1.133 14.169 66.512 1.133 14.169 66.512 2.629 32.866 66.512 3 0.771 9.636 76.148 4 0.693 8.665 84.813 5 0.489 6.108 90.921 6 0.342 4.274 95.196 7 0.251 3.141 98.337 8 0.133 1.663 100.00 Table 3 Rotated component matrix due to PCA Item Component 1 2 Q1A 0.620 0.535 Q1B 0.728 0.235 Q2A 0.815 0.181 Q2B 0.889 0.187 Q3A 0.093 0.866 Q3B 0.417 0.706 Q4 0.340 0.634 Q5 0.159 0.755 Based on measures from the Rasch model, Table 4 shows the final JMLE (joint maximum likelihood estimation) item statistics. For difficulty, a positive value indicates a harder item, and a negative value indicates an easier item. WMS (weighted mean square) and UMS (unweighted mean square) for all items are in the range of acceptable fit. Rasch statistics (Table 4 ) confirmed acceptable item fit with patient reliability = 0.87, patient separation = 2.54, item separation = 1.43, and item reliability = 0.67. Table 4. JMLE category statistics Item Difficulty Std. err WMS UMS Category Threshold Std. err Q1A -0.13 0.15 0.70 0.73 0 1 2 3 4 -2.89 0.33 -0.80 0.26 1.72 0.40 1.97 0.77 Q1B -0.17 0.12 1.20 1.13 0 1 2 3 4 5 -2.90` 0.34 -0.82 0.27 0.45 0.31 1.15 0.42 2.12 0.78 Q2A -0.08 0.14 1.01 0.94 0 1 2 3 4 -2.68 0.31 -0.57 0.26 0.84 0.34 2.41 0.76 Q2B -0.15 0.12 0.97 0.90 0 1 2 3 4 5 -2.92 0.33 -0.15 0.28 -0.54 0.30 1.67 0.43 1.94 0.77 Q3A -0.20 0.16 1.06 1.11 0 1 2 3 4 -3.63 0.37 -0.20 0.25 2.07 0.44 1.77 0.78 Q3B 0.05 0.13 0.81 0.79 0 1 2 3 4 5 -3.67 0.36 -0.13 0.27 0.05 0.32 1.62 0.51 2.13 1.04 Q4 0.08 0.15 1.06 1.12 0 1 2 3 4 -3.25 0.32 -0.41 0.26 0.85 0.37 2.80 1.03 Q5 0.60 0.14 1.16 1.10 0 1 2 3 4 5 -2.19 0.26 -0.45 0.29 0.77 0.43 1.60 0.73 0.28 0.98 These results confirm that the Persian CLDEQ-8 meets psychometric standards for reliability and item performance. The item-person map (Fig. 1 ) further supports the distribution of item difficulties across varying levels of symptom severity. DISCUSSION This study aimed to translate and validate the Persian version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and to evaluate its psychometric properties in a sample of soft contact lens (SCL) wearers. The findings indicate that the Persian CLDEQ-8 is a reliable and valid instrument for assessing dry eye symptoms in this population. The internal consistency of the questionnaire, measured by Cronbach’s alpha (0.868), demonstrates a high degree of reliability. This value is consistent with previous studies conducted in other languages, including the original English version (α = 0.87) [3], the Japanese version (α = 0.89) [5], the Greek version (α = 0.84) [4], and the Portuguese version (α = 0.88) [6]. These similarities suggest that the translated version maintains the internal coherence of the original questionnaire across different cultural contexts. The average inter-item correlation (0.452) and the range of correlations (0.244–0.739) also confirm that the items are moderately to strongly relate and are measuring the same construct. This supports the structural integrity of the questionnaire. The results of principal component analysis (PCA) revealed two main components with eigenvalues greater than 1, accounting for a cumulative 66.512% of the total variance. This finding is in line with the factor structures reported in prior validations [4–6]. All items showed strong factor loadings (> 0.50), confirming that the Persian CLDEQ-8 items represent a cohesive set of symptoms related to contact lens-related dry eye. The grouping of items Q1A through Q2B under one factor, and Q3A through Q5 under a second factor, mirrors the bifactor structure observed in the Japanese and Portuguese versions [5, 6]. Rasch analysis further supported the construct validity and item performance of the Persian CLDEQ-8. Patient reliability (0.87) and patient separation (2.54) were within acceptable limits and comparable to values reported in the literature [12]. Item reliability (0.67) and separation (1.43) also indicated acceptable levels of differentiation among the items. The item difficulty levels, as reflected in the Rasch person-item map, suggested a good distribution across the spectrum of symptom severity, affirming that the questionnaire can differentiate between patients with mild, moderate, and severe symptoms. One of the strengths of this study was the use of a comprehensive translation and cultural adaptation process, following internationally accepted ISPOR guidelines [7], which ensured conceptual and linguistic accuracy. Additionally, the use of multiple methods to assess validity, including content validity, factor analysis, and Rasch modeling, provided a robust evaluation of the questionnaire’s psychometric properties. Nevertheless, some limitations should be acknowledged. First, the sample size, although adequate for exploratory factor analysis, was relatively small for subgroup analyses (e.g., gender or lens modality). Second, the study included only SCL users, limiting the generalizability of findings to other types of contact lenses, such as rigid gas permeable or hybrid lenses. Third, responsiveness to clinical change over time was not assessed and should be explored in future longitudinal studies. In conclusion, the Persian version of the CLDEQ-8 exhibits strong psychometric properties and is a valid and reliable tool for assessing dry eye symptoms among Persian-speaking soft contact lens wearers. Its use in clinical and research settings can facilitate better diagnosis, monitoring, and management of contact lens-related dry eye in Persian-speaking populations. Declarations Acknowledgement This work was supported by Mashhad University of Medical Sciences (Grant code: 4021506). No financial disclosure. The authors report no conflicts of interest. Statements and Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. All authors contributed to the study conception and design. Material preparation and data collection were performed by Samira Hassanzadeh and Fatemeh Zandi. analysis was performed by Maliheh Karimpour. The first draft of the manuscript was written by Maliheh Karimpour and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Author Contribution All authors contributed to the study conception and design. Material preparation and data collection were performed by Samira Hassanzadeh and Fatemeh Zandi. analysis was performed by Maliheh Karimpour. The first draft of the manuscript was written by Maliheh Karimpour and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement This work was supported by Mashhad University of Medical Sciences (Grant code: 4021506). No financial disclosure. The authors report no conflicts of interest. References Nichols KK, Redfern RL, Jacob JT, et al (2013) The TFOS International Workshop on Contact Lens Discomfort: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci 54: TFOS14–19. Dumbleton K, Woods CA, Jones LW, et al (2013) The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 39:93–99. Chalmers RL, Begley CG, Caffery B (2012) Validation of the 8-item Contact Lens Dry Eye Questionnaire. Eye Contact Lens 38:20–25. Papas EB, Chen E, Tilia D, et al (2023) Validation of the Greek version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye 46:101456. Sasaki Y, Uchino M, Kawashima M, et al (2019) Validation of the Japanese version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Jpn J Ophthalmol 63:237–243. Ferreira N, Figueiredo A, Silva R, et al (2021) Translation and validation of the Portuguese version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye 44:101408. Wild D, Grove A, Martin M, et al (2005) Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health 8:94–104. Lawshe CH. A (1975) quantitative approach to content validity. Pers Psychol 28:563–575. Polit DF, Beck CT (2006) The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health 29:489–497. Piedmont RL (2014) Inter-item Correlations. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer. Sellbom M, Tellegen A (2019) Factor analysis in psychological assessment research: Common pitfalls and recommendations. Psychol Assess 31:1428. Costela FM, Pesudovs K, Sandberg MA, et al (2020) Validation of a vision-related activity scale for patients with retinitis pigmentosa. Health Qual Life Outcomes 18:1–11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 Feb, 2026 Reviewers agreed at journal 26 Jan, 2026 Reviewers invited by journal 14 Jan, 2026 Editor assigned by journal 31 Dec, 2025 Submission checks completed at journal 31 Dec, 2025 First submitted to journal 30 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":70349,"visible":true,"origin":"","legend":"\u003cp\u003ePerson item-map for 8 survey items. The items are listed below the graph. Patient ability estimates are presented on the right, from the highest ability level at the top to the lowest ability level at the bottom.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8481918/v1/7a8bf55e6a3967823108a6b6.png"},{"id":100614318,"identity":"1f2f2fca-9648-4a8e-a127-4e9189cde2b3","added_by":"auto","created_at":"2026-01-19 17:18:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":657068,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8481918/v1/90cd9bc4-aeb8-4d3b-a574-10e3284a182e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Persian Translation and Validation of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8)","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDry eye disease (DED) is a multifactorial disorder of the ocular surface characterized by a loss of tear film homeostasis, which may lead to symptoms such as ocular discomfort, dryness, visual disturbances, and tear film instability. Among the various risk factors, contact lens (CL) wear has been strongly associated with both the development and worsening of dry eye symptoms. Studies have shown that CL users experience significantly more frequent and intense symptoms of dryness compared to non-users [1].\u003c/p\u003e \u003cp\u003eThese symptoms not only cause discomfort but can negatively impact visual performance and quality of life. Importantly, discomfort due to DED is a leading cause of contact lens discontinuation [2]. Therefore, timely and accurate assessment of DED symptoms in CL wearers is essential for clinical management, patient satisfaction, and long-term lens compliance.\u003c/p\u003e \u003cp\u003eTo evaluate DED symptoms in CL users, the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) was developed as a short, specific, and validated instrument that quantifies both the frequency and intensity of symptoms in this population [3]. The questionnaire has been widely used in clinical research and translated into several languages, including Greek [4], Japanese [5], and Portuguese [6] demonstrating its adaptability across cultures.\u003c/p\u003e \u003cp\u003eDespite its global utility, a validated Persian version of the CLDEQ-8 has not been available, limiting its use among Persian-speaking populations. Culturally adapted and validated tools are crucial to ensure accurate symptom assessment across diverse populations. This study aimed to translate and validate the CLDEQ-8 in Persian to fill this gap.\u003c/p\u003e"},{"header":"SUBJECTS AND METHODS","content":"\u003cp\u003eThis was a prospective cross-sectional validation study. The study adhered to the principles of the Declaration of Helsinki, and written informed consent was obtained from all participants. This study approved by the Ethics Committee of Mashhad University of Medical Sciences (Code: IR.MUMS.FHMPM.REC.1403.0).\u003c/p\u003e \u003cp\u003e The CLDEQ-8, composed of 8 items with a score range from 0 to 37, was translated into Persian following the internationally recognized guidelines by the ISPOR Task Force for Translation and Cultural Adaptation [7]. Initially, three bilingual optometrists fluent in English and Persian independently translated the original English version into Persian. These translations were reviewed by an expert panel of optometrists, ophthalmologists, methodologists, and linguistic specialists. Cultural and conceptual adaptations were applied where necessary to ensure clarity and relevance.\u003c/p\u003e \u003cp\u003eThe preliminary Persian version was then back-translated into English by two native English speakers proficient in Persian. These back-translations were compared with the original English version to ensure semantic equivalence. Revisions were made based on discrepancies, and the finalized Persian CLDEQ-8 was prepared.\u003c/p\u003e \u003cp\u003eTen experts evaluated the necessity, clarity, simplicity, and relevance of each item using a 4-point Likert scale. Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated. Items with CVR\u0026thinsp;\u0026lt;\u0026thinsp;0.62 were considered non-essential, while items with CVI\u0026thinsp;\u0026lt;\u0026thinsp;0.70 were subject to revision or removal, as recommended by Lawshe [8] and Polit and Beck [9].\u003c/p\u003e \u003cp\u003eA total of 100 SCL users aged 18\u0026ndash;48 years with Persian as their mother tongue were enrolled through simple random sampling. Participants were required to be full-time, adapted bilateral SCL wearers. Exclusion criteria included current ocular infection, history of ocular surgery, chemical or thermal ocular burns, systemic diseases, pregnancy or lactation, smoking, more than 6 hours per day computer use, and use of medications known to cause dry eye. Inability to read or complete the questionnaire was also an exclusion criterion.\u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using SPSS software version 27.0 (SPSS Inc., Chicago, IL) and jMetrik version 4.1.1.\u003c/p\u003e \u003cp\u003eReliability was assessed by computing Cronbach\u0026rsquo;s alpha () to determine internal consistency. Inter-item correlations were also analyzed to examine the extent to which individual items measured the same underlying construct [10].\u003c/p\u003e \u003cp\u003eConstruct validity was evaluated using Exploratory Factor Analysis (EFA) and Principal Component Analysis (PCA) with varimax rotation. Items with factor loadings greater than 0.50 were considered to load significantly onto a factor [11].\u003c/p\u003e \u003cp\u003eRasch analysis was conducted to assess item fit, person and item reliability, and item difficulty levels. The Rasch model evaluates how well the data fit a unidimensional model and provides item-person maps and fit statistics (WMS and UMS) [12].\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 100 Persian-speaking SCL wearers participated in the study. The mean age of participants was 26.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61 years (range: 18\u0026ndash;48). The mean spherical equivalent was 2.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36 diopters (range: -0.50 to -6.75). The majority of participants were female (78%), and most had undergraduate or graduate-level education (90%).\u003c/p\u003e \u003cp\u003eThe CVR and CVI for all 8 items were within acceptable ranges. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, all items achieved CVR values\u0026thinsp;\u0026ge;\u0026thinsp;0.70 and CVI values\u0026thinsp;\u0026ge;\u0026thinsp;0.80, indicating good content validity.\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\u003eCVR and CVI for each item\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCVI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eCVR: Content Validity Ratio, CVI: Content Validity Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe internal consistency of the Persian CLDEQ-8 was high, with a Cronbach's alpha of 0.868. The average inter-item correlation was 0.452, with individual item correlations ranging from 0.244 to 0.739, suggesting strong consistency among items.\u003c/p\u003e \u003cp\u003ePCA identified two components with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1, which together explained 66.512% of the total variance (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Factor loadings for all items were above 0.50 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), indicating each item contributed meaningfully to one of the two underlying factors. Items Q1A, Q1B, Q2A, and Q2B loaded more strongly on the first factor, while items Q3A, Q3B, Q4, and Q5 aligned more with the second factor.\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\u003ePrinciple component analysis (PCA)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComponent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInitial eigenvalues\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eExtraction sums of squared loadings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eRotation sums of squared loadings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% of variance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCumulative %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e% of variance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCumulative %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e% of variance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCumulative %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e33.645\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e32.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e66.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c10\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c10\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.921\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c10\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c10\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c10\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c10\" namest=\"c5\"\u003e\u0026nbsp;\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\u003eRotated component matrix due to PCA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eComponent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.755\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\u003eBased on measures from the Rasch model, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the final JMLE (joint maximum likelihood estimation) item statistics. For difficulty, a positive value indicates a harder item, and a negative value indicates an easier item. WMS (weighted mean square) and UMS (unweighted mean square) for all items are in the range of acceptable fit. Rasch statistics (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) confirmed acceptable item fit with patient reliability\u0026thinsp;=\u0026thinsp;0.87, patient separation\u0026thinsp;=\u0026thinsp;2.54, item separation\u0026thinsp;=\u0026thinsp;1.43, and item reliability\u0026thinsp;=\u0026thinsp;0.67.\u003c/p\u003e\n \u003ctable style=\"width:467.75pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 467.75pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:justify;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eTable 4. JMLE category statistics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0.7in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eItem\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eDifficulty\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eStd. err\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eWMS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45.95pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eUMS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eCategory\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eThreshold\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eStd. err\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 0.7in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eQ1A\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 61.3pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e-0.13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 59.05pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 50.05pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 45.95pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 54.2pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e-2.89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New 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style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eQ2B\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 61.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e-0.15\u003c/span\u003e\u003c/p\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 45.95pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 54.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp 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none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e-2.92\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e-0.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e-0.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan 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5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 0.7in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003eQ3A\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n 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150%;font-family:\"Times New Roman\";color:black;'\u003e1.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 54.2pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e-3.63\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.37\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e-0.20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.25\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New 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style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.85\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.37\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e2.80\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e1.03\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 0.7in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp 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rowspan=\"6\" style=\"width: 54.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp 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none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e-2.19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e-0.45\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.43\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e1.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height: 150%;font-family:\"Times New Roman\";color:black;'\u003e0.73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 74.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;height: 12.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:12.75pt;margin-left:67.5pt;text-align:center;text-indent:0in;line-height:150%;font-size:16px;font-family:\"Times New Roman\",serif;color:black;margin:0in;'\u003e\u003cspan style='font-size:14px;line-height:150%;font-family:\"Times New Roman\";color:black;'\u003e0.98\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThese results confirm that the Persian CLDEQ-8 meets psychometric standards for reliability and item performance. The item-person map (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) further supports the distribution of item difficulties across varying levels of symptom severity.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to translate and validate the Persian version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and to evaluate its psychometric properties in a sample of soft contact lens (SCL) wearers. The findings indicate that the Persian CLDEQ-8 is a reliable and valid instrument for assessing dry eye symptoms in this population.\u003c/p\u003e \u003cp\u003eThe internal consistency of the questionnaire, measured by Cronbach\u0026rsquo;s alpha (0.868), demonstrates a high degree of reliability. This value is consistent with previous studies conducted in other languages, including the original English version (α\u0026thinsp;=\u0026thinsp;0.87) [3], the Japanese version (α\u0026thinsp;=\u0026thinsp;0.89) [5], the Greek version (α\u0026thinsp;=\u0026thinsp;0.84) [4], and the Portuguese version (α\u0026thinsp;=\u0026thinsp;0.88) [6]. These similarities suggest that the translated version maintains the internal coherence of the original questionnaire across different cultural contexts.\u003c/p\u003e \u003cp\u003eThe average inter-item correlation (0.452) and the range of correlations (0.244\u0026ndash;0.739) also confirm that the items are moderately to strongly relate and are measuring the same construct. This supports the structural integrity of the questionnaire.\u003c/p\u003e \u003cp\u003eThe results of principal component analysis (PCA) revealed two main components with eigenvalues greater than 1, accounting for a cumulative 66.512% of the total variance. This finding is in line with the factor structures reported in prior validations [4\u0026ndash;6]. All items showed strong factor loadings (\u0026gt;\u0026thinsp;0.50), confirming that the Persian CLDEQ-8 items represent a cohesive set of symptoms related to contact lens-related dry eye. The grouping of items Q1A through Q2B under one factor, and Q3A through Q5 under a second factor, mirrors the bifactor structure observed in the Japanese and Portuguese versions [5, 6].\u003c/p\u003e \u003cp\u003eRasch analysis further supported the construct validity and item performance of the Persian CLDEQ-8. Patient reliability (0.87) and patient separation (2.54) were within acceptable limits and comparable to values reported in the literature [12]. Item reliability (0.67) and separation (1.43) also indicated acceptable levels of differentiation among the items. The item difficulty levels, as reflected in the Rasch person-item map, suggested a good distribution across the spectrum of symptom severity, affirming that the questionnaire can differentiate between patients with mild, moderate, and severe symptoms.\u003c/p\u003e \u003cp\u003e One of the strengths of this study was the use of a comprehensive translation and cultural adaptation process, following internationally accepted ISPOR guidelines [7], which ensured conceptual and linguistic accuracy. Additionally, the use of multiple methods to assess validity, including content validity, factor analysis, and Rasch modeling, provided a robust evaluation of the questionnaire\u0026rsquo;s psychometric properties.\u003c/p\u003e \u003cp\u003eNevertheless, some limitations should be acknowledged. First, the sample size, although adequate for exploratory factor analysis, was relatively small for subgroup analyses (e.g., gender or lens modality). Second, the study included only SCL users, limiting the generalizability of findings to other types of contact lenses, such as rigid gas permeable or hybrid lenses. Third, responsiveness to clinical change over time was not assessed and should be explored in future longitudinal studies.\u003c/p\u003e \u003cp\u003eIn conclusion, the Persian version of the CLDEQ-8 exhibits strong psychometric properties and is a valid and reliable tool for assessing dry eye symptoms among Persian-speaking soft contact lens wearers. Its use in clinical and research settings can facilitate better diagnosis, monitoring, and management of contact lens-related dry eye in Persian-speaking populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Mashhad University of Medical Sciences (Grant code: 4021506). No financial disclosure. The authors report no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements and Declarations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by Samira Hassanzadeh and Fatemeh Zandi. analysis was performed by Maliheh Karimpour. The first draft of the manuscript was written by Maliheh Karimpour and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by Samira Hassanzadeh and Fatemeh Zandi. analysis was performed by Maliheh Karimpour. The first draft of the manuscript was written by Maliheh Karimpour and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eThis work was supported by Mashhad University of Medical Sciences (Grant code: 4021506). No financial disclosure. The authors report no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNichols KK, Redfern RL, Jacob JT, et al (2013) The TFOS International Workshop on Contact Lens Discomfort: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci 54: TFOS14\u0026ndash;19. \u003c/li\u003e\n\u003cli\u003eDumbleton K, Woods CA, Jones LW, et al (2013) The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 39:93\u0026ndash;99. \u003c/li\u003e\n\u003cli\u003eChalmers RL, Begley CG, Caffery B (2012) Validation of the 8-item Contact Lens Dry Eye Questionnaire. Eye Contact Lens 38:20\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003ePapas EB, Chen E, Tilia D, et al (2023) Validation of the Greek version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye 46:101456. \u003c/li\u003e\n\u003cli\u003eSasaki Y, Uchino M, Kawashima M, et al (2019) Validation of the Japanese version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Jpn J Ophthalmol 63:237\u0026ndash;243. \u003c/li\u003e\n\u003cli\u003eFerreira N, Figueiredo A, Silva R, et al (2021) Translation and validation of the Portuguese version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye 44:101408. \u003c/li\u003e\n\u003cli\u003eWild D, Grove A, Martin M, et al (2005) Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health 8:94\u0026ndash;104. \u003c/li\u003e\n\u003cli\u003eLawshe CH. A (1975) quantitative approach to content validity. Pers Psychol 28:563\u0026ndash;575. \u003c/li\u003e\n\u003cli\u003ePolit DF, Beck CT (2006) The content validity index: are you sure you know what\u0026rsquo;s being reported? Critique and recommendations. Res Nurs Health 29:489\u0026ndash;497. \u003c/li\u003e\n\u003cli\u003ePiedmont RL (2014) Inter-item Correlations. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer. \u003c/li\u003e\n\u003cli\u003eSellbom M, Tellegen A (2019) Factor analysis in psychological assessment research: Common pitfalls and recommendations. Psychol Assess 31:1428. \u003c/li\u003e\n\u003cli\u003eCostela FM, Pesudovs K, Sandberg MA, et al (2020) Validation of a vision-related activity scale for patients with retinitis pigmentosa. Health Qual Life Outcomes 18:1\u0026ndash;11.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Contact Lens Dry Eye Questionnaire-8, Persian, psychometric evaluation, reliability, validity","lastPublishedDoi":"10.21203/rs.3.rs-8481918/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8481918/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe purpose of this study was to translate the CLDEQ-8 into Persian and evaluate its psychometric properties among soft contact lens (SCL) wearers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e The translation process followed internationally recognized guidelines for cross-cultural adaptation, as recommended by ISPOR. One hundred Persian-speaking SCL wearers were recruited 6 using simple sampling. Participants completed the Persian version of CLDEQ-8. Data analysis was 7 performed using SPSS (version 27) and jMetrik (version 4.1.1).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 100 SCL wearers with a mean age of 26.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61 years participated. Cronbach\u0026rsquo;s α for internal consistency was 0.868. The average inter-item correlation was 0.452 (range: 0.244 to 0.739). Principal Component Analysis (PCA) revealed two components explaining 66.512% of the variance, with all items loading above 0.50. Rasch analysis showed patient reliability, patient separation, item separation, and item reliability of 0.87, 2.54, 1.43, and 0.67, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Persian version of CLDEQ-8 demonstrated good reliability and validity, supporting its use in clinical and research settings for evaluating dry eye symptoms in SCL users.\u003c/p\u003e","manuscriptTitle":"Persian Translation and Validation of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 15:38:30","doi":"10.21203/rs.3.rs-8481918/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-03T23:16:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164537638736527896150552338042024794986","date":"2026-01-26T16:06:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T14:05:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-31T07:17:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-31T07:15:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Ophthalmology","date":"2025-12-30T13:33:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"372ec861-960b-4c02-bd37-614c80d2fda1","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T15:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 15:38:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8481918","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8481918","identity":"rs-8481918","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}