N = 381 patients with all items completed are included in this analysis; NA = Not Applicable Items in the "sleep disturbance," "somnolence," and "sleep adequacy" dimensions of the MOS-Sleep had item-scale correlations ranging from 0.47 to 0.76 (Table 3).
While the relation between pain severity and mean score was monotonic for the "sleep disturbance," the "sleep adequacy" dimensions and for the sleep problems index, the trend was less clear for "awaken short of breath or with headache," "snoring" and "somnolence" dimensions.
The "sleep adequacy" dimension reached the threshold value only for German and Polish versions.
Only the results for the "sleep adequacy" dimension were the least satisfactory, with Cronbach's alpha reaching the recommended threshold value of 0.70 only for the German and Polish language versions.
Item discrimination criterion across dimensions was satisfied, except for item 12 of the "sleep adequacy" dimension of the Australian, Hungarian and UK English versions, and item 4 of the South African, item 6 of the "somnolence" dimension of the German and South African and item 3 of the "sleep disturbance" dimension of the Hungarian version.
Similarly, the MOS-Sleep dimensions discriminated between patients with different level of pain: the higher the mean pain score at baseline, the higher the mean scores of the dimensions "awaken short of breath or headache," "somnolence" and "sleep disturbance," and of the sleep problems index; the lower the mean score of the "sleep adequacy" dimension.
Another issue to be addressed in future studies is the adequacy of the dimensions to other sections of a scientific work, such as introduction and conclusion.
In studies conducted in the Spanish PHC environment, the need for training and adequacy of staff dimension is highlighted, emphasizing the imbalance between nursing staff and GPs, with poorer figures in nurses.
Besides, Sancho-Viudes et al. (2002) in the PHC environment in Mallorca identified - as problems to be solved - the poor adequacy of staff dimension compared to the population to be cared for, the need for updating clinical guides and protocols, the lack of specific training in community nursing, and the subsequent need for a specialization in community nursing [ 47].
Patient ratings of each item concerning the four dimensions of adequacy of content, clarity of wording, usefulness, and level of anxiety, expressed on a 3-point Likert scale, are depicted in Figures 1, 2, 3, and 4, respectively.
In successive rounds, our panelists received the complete questionnaire together with a scale on which they had to assess the degree of adequacy of the items and dimensions proposed (1 = not adequate; 2 = hardly adequate; 3 = adequate; 4 = quite adequate; 5 = totally adequate).
