A Comparison of Psychometric Properties Between Internet and Paper Versions of Two Depression Instruments (BDI-II and MADRS-S) Administered to Clinic Patients Computer-assisted self-assessment in persons with severe mental illness. Consistencies and discrepancies in self- and observer-rated anxiety scales A comparison of an electronic version of the SF-36 General Health Questionnaire to the standard paper version Internet Versus Mailed Questionnaires: A Randomized Comparison The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application Methodological Issues in Internet-Mediated Research: A Randomized Comparison of Internet Versus Mailed Questionnaires Electronic pain questionnaires: A randomized, crossover comparison with paper questionnaires for chronic pain assessment The MOS 36-Item Short Form Health Survey: reliability, validity, and preliminary findings in schizophrenic outpatients. Longer response scales improved the acceptability and performance of the Nottingham Health Profile. Reliability and Validity of Assessing User Satisfaction With Web-Based Health Interventions The use of research questionnaires with hearing impaired adults: online vs. paper-and-pencil administration Psychometric Properties of the PTSD Checklist—Civilian Version Psychometric Comparison of the PHQ-9 and BDI-II for Measuring Response during Treatment of Depression Comparison of Internet-Based and Paper-Based Questionnaires in Taiwan Using Multisample Invariance Approach Score equivalence of electronic and paper versions of the Social Difficulties Inventory (SDI-21): a randomised crossover trial in cancer patients Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients
Background Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes . However , many clinicians do not use self-report measures systematic ally in their clinical practice . Internet-based question naires could facilitate administration , but the psychometric properties of the online version of an instrument should be explored before implementation . The recommendation from the International Test Commission is to test the psychometric properties of each question naire separately . Objective Our objective was to compare the psychometric properties of paper- and -pencil versions and Internet versions of two question naires measuring depressive symptoms . Methods The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden . Participants completed the  Beck Depression Inventory ( BDI-II )  and the  Montgomery-Åsberg Depression Rating Scale — Self-rated ( MADRS-S )  , both on paper and on the Internet . The order was r and omized to control for order effects . Symptom severity in the sample ranged from mild to severe depressive symptoms . Results Psychometric properties of the two administration formats were mostly equivalent . The internal consistency was similar for the Internet and paper versions , and significant correlations were found between the formats for both MADRS-S ( r = .84 ) and the BDI-II ( r = .89 ) . Differences between paper and Internet total scores were not statistically significant for either question naire nor for the MADRS-S question dealing with suicidality ( item 9 ) when analyzed separately . The score on the BDI-II question about suicidality ( item 9 ) was significantly lower when administered via the Internet compared with the paper score , but the difference was small ( effect size , Cohen ’s [ d ] = 0.14 ) . There were significant main effects for order of administration on both question naires and significant interaction effects between format and order . This should not , however , pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made . Conclusions The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinical ly meaningful way . The full BDI-II also seems to retain its properties when transferred ; however , the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study . The use of online question naires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save re sources BACKGROUND It has been difficult to improve care for severe mental illness ( SMI ) in usual care setting s because clinical information is not reliably and efficiently managed . Methods are needed for efficiently collecting this information to evaluate and improve health care quality . Audio computer-assisted self-interviewing ( ACASI ) can facilitate this data collection and has improved outcomes for a number of disorders , suggesting the need to test its accuracy and reliability in people with SMI . METHOD Ninety patients with DSM-IV schizophrenia or schizoaffective disorder ( N = 45 ) or bipolar disorder ( N = 45 ) recruited between Oct. 15 , 2002 , and July 1 , 2003 , were r and omly assigned to 1 of 2 study groups and completed 2 st and ardized symptom surveys ( Revised Behavior and Symptom Identification Scale and the symptom severity scale of the Schizophrenia Outcomes Module 2 ) 20 minutes apart in a crossover study design . Half of the patients first completed the scales via an in-person interview , and the other half first completed the scales via an  ACASI survey self-administered through an Internet browser using a touchscreen developed to meet the cognitive needs of people with SMI . We evaluated attitudes toward ACASI  , underst and ing of the ACASI survey , internal consistency , correlations between the ACASI and interview modes , concurrent validity , and a possible administration mode bias . RESULTS All ACASI and in-person interview scales had similar internal reliability , high correlations ( r = 0.78 - 1.00 ) , and mean scores similar enough as not to be different at p < .05 . A large majority rated the ACASI survey as easier , more enjoyable , more preferable if monthly completion of a survey were required , and more private , and 97 % to 99 % perfectly answered questions about how to use it . CONCLUSION ACASI data collection is reliable among people with bipolar disorder and schizophrenia and could be a valuable tool to improve their care Summary The Marks-Sheehan anxiety scales are the only scales where self-ratings and observer ratings are perfectly matched by the number , the content and the scaling of the items . Therefore these scales are an excellent tool to investigate the compatibility and to study different structures in self- and observer ratings . This was done by using the data material on the Marks-Sheehan scales of the Cross National Collaborative Panic Study . In this study 1168 out patients who met the DSM-III criteria for panic disorder were r and omly allocated either to alprazolam , imipramine or placebo treatment . Our results show that the Marks-Sheehan scales are highly comparable to other established rating scales . Both scales have a similar stable and consistent factor pattern for somatic symptoms but not for psychic symptoms of anxiety . Our results provide empirical evidence that the low consistencies between self- and observer ratings reported so far can be improved by using a rating scale which matches up item by item for self- and observer ratings . However , other sources of disagreement can only be solved by more elaborated item descriptions and training of patients as well as raters to obtain a better compatibility between self- and observer rating scales Because of its sound psychometric properties the SF-36 General Health Question naire is used throughout the world , yet it is difficult to analyse and score . Using a newly developed software package , onto which any question naire can be loaded , we developed an electronic version of the SF-36 General Health Question naire . The purpose of this study is test the effect of the electronic mode of administration on the measurement properties of the SF-36 . In a r and omised cross-over design study 79 healthy individuals and 36 chronic pain patients completed both electronic and paper versions of the SF-36 . Seventy-one percent preferred the electronic SF-36 , 7 % stated no preference , and 22 % preferred the paper version . Completion time for the electronic SF-36 was slightly less , and there were no missing or problematical responses , whereas 44 % of participants had at least one missing or problematical response in the paper version . Data entry and auditing time was 8 hours . There was less than 4 % inter-version difference for any of the SF-36 sub-scales . The electronic SF-36 was well accepted and slightly quicker to complete than the paper version . We conclude that the electronic SF-36 is equivalent in performance and more effective than the paper version Background The use of Internet-based question naires for collection of data to evaluate patient education and other interventions has increased in recent years . Many self-report instruments have been vali date d using paper- and -pencil versions , but we can not assume that the psychometric properties of an Internet-based version will be identical . Objectives To look at similarities and differences between the Internet versions and the paper- and -pencil versions of 16 existing self-report instruments useful in evaluation of patient interventions . Methods Participants were recruited via the Internet and volunteered to participate ( N=397 ) , after which they were r and omly assigned to fill out question naires online or via mailed paper- and -pencil versions . The self-report instruments measured were overall health , health distress , practice mental stress management , Health Assessment Question naire ( HAQ ) disability , illness intrusiveness , activity limitations , visual numeric for pain , visual numeric for shortness of breath , visual numeric for fatigue , self-efficacy for managing disease , aerobic exercise , stretching and strengthening exercise , visits to MD , hospitalizations , hospital days , and emergency room visits . Means , ranges , and confidence intervals are given for each instrument within each type of question naire . The results from the two question naires were compared using both parametric and non-parametric tests . Reliability tests were given for multi-item instruments . A separate sample ( N=30 ) filled out identical question naires over the Internet within a few days and correlations were used to assess test-retest reliability . Results Out of 16 instruments , none showed significant differences when the appropriate tests were used . Construct reliability was similar within each type of question naire , and Internet test-retest reliability was high . Internet question naires required less follow-up to achieve a slightly ( non-significant ) higher completion rate compared to mailed question naires . Conclusions Among a convenience sample recruited via the Internet , results from those r and omly assigned to Internet participation were at least as good as , if not better than , among those assigned mailed question naires , with less recruitment effort required . The instruments administered via the Internet appear to be reliable , and to be answered similarly to the way they are answered when they are administered via traditional mailed paper question naires Background Semi-structured interview scales for psychosis are the gold st and ard approach to assessing psychotic and other symptoms . However , such assessment s have limitations such as recall bias , averaging , insensitivity to change and variable interrater reliability . Ambulant , real-time self-report assessment devices may hold advantages over interview measures , but it needs to be shown that the data thus collected are valid , and the collection method is acceptable , feasible and safe . We report on a monitoring system for the assessment of psychosis using smartphone technology . The primary aims were to : i ) assess validity through correlations of item responses with those on widely accepted interview assessment s of psychosis , and ii ) examine compliance to the procedure in individuals with psychosis of varying severity . Methods A total of 44 participants ( acute or remitted DSM-4 schizophrenia and related disorders , and prodromal ) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-r and om times , each day , for one week . Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data . Results Compliance as defined by completion of at least 33 % of all possible data -points over seven days was 82 % . In the 36 compliant participants , 5 items ( delusions , hallucinations , suspiciousness , anxiety , hopelessness ) showed moderate to strong ( rho 0.6 - 0.8 ) associations with corresponding items from interview rating scales . Four items showed no significant correlation with rating scales : each was an item based on observable behaviour . Ambulant ratings showed excellent test-retest reliability and sensitivity to change . Conclusions Ambulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purpose s. Further evaluation required over longer assessment periods , in clinical trials and service setting Background The majority of Internet-mediated studies use measures developed as paper- and -pencil measures or face-to-face-delivered material . Previous research suggests that the equivalence between online and offline measures must be demonstrated rather than assumed . Objective The objective of this study was to explore the equivalence 4 measures completed in an online or offline setting . Methods A sample of students ( n = 1969 ) was r and omly assigned to complete 4 popular scales ( the SF-12v2 , the Hospital Anxiety and Depression Scale ( HADS ) , the Fatigue Symptom Inventory , and a single-item fatigue measure ) either online or by mail survey ( pencil and paper ) . The response rate was 52.51 % ( n = 1034 ) and comparable between the online and offline groups . Results Significant differences were noted in fatigue levels between the online and offline group ( P = .01 ) as measured by the Fatigue Symptom Inventory , with the online sample demonstrating higher levels of fatigue . Equivalency was noted for the SF-12v2 , the Hospital Anxiety and Depression Scale , and the single-item fatigue measure . Internal consistency was high except for the SF-12v2 . The SF-12v2 may not be an ideal measure to use for remote administration . Conclusions Equivalency of the Hospital Anxiety and Depression Scale ( HADS ) and the Physical Component Score and Mental Component Score of the SF-12v2 for online and offline data were demonstrated . Equivalency was not demonstrated for the Fatigue Symptom Inventory . Explanations for the difference in fatigue score between the online and offline sample s are unclear . Research that seeks to match sample s and control for extraneous online and offline variables is called for , along with exploration of factors that may mediate the completion of question naires or alter the respondents ’ relationship with the same , to enhance progress in this area & NA ; Electronic question naires for pain assessment are becoming increasingly popular . There have been no published reports to establish the equivalence or psychometric properties of common pain question naires administered via desktop computers . This study compared responses to paper ( P ) and touch screen electronic ( E ) versions of the Short‐Form McGill Pain Question naire ( SF‐MPQ ) and Pain Disability Index ( PDI ) , while examining the role of computer anxiety and experience , and evaluating patient acceptance . In a r and omized , crossover design 189 chronic pain patients completed P and E versions of the SF‐MPQ and PDI , and self‐ratings of anxiety , experience , relative ease and preference . Psychometric properties were highly similar for P and E question naires . For the SF‐MPQ , 60 % or more of subjects gave equivalent responses on individual descriptors and PPI scale , with 80 % rating within ±1 point for an 11‐point VAS . Correlations for the SF‐MPQ scales ranged from 0.68 to 0.84 . For the PDI , 60 % or more of subjects responded within ±1 point on individual questions , and the total score correlation was 0.67 . Comparison of mean difference scores revealed no significant differences between modes for any of the question naire items or scores . Anxiety and experience scores showed no significant associations through correlations and high/low comparisons . Although nearly half of subjects reported no computer training , anxiety ratings were low , and considerably more subjects rated the E question naires as easier and preferred . Findings are consistent with test‐retest reliability data , and support the validity and acceptance of electronic versions of the SF‐MPQ and PDI OBJECTIVES The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey ( SF-36 ) as a written , self-administered survey in out patients with chronic schizophrenia . METHODS Thirty-six schizophrenic out patients completed a written and oral form of the SF-36 . A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology . Cognitive functioning and academic achievement were also assessed . Internal consistency , test-retest reliability , concurrent and discriminative validity of the oral and written versions were determined . RESULTS The SF-36 in both forms was shown to have good internal consistency , stability , and concurrent validity . The mental health SF-36 subscales had poor discriminant validity , compared with the physical functioning scale that demonstrated good discriminant validity . CONCLUSIONS The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated . The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs OBJECTIVE To test alternative response formats for the Nottingham Health Profile ( NHP ) , in terms of acceptability , score distributions , and measurement properties . STUDY DESIGN AND SETTING S R and omized trial of four response formats for the NHP : original " yes/no " format , a 3-point similarity format ( " applies completely/in part/not at all " ) , a 5-point intensity format ( " completely true " to " completely false " ) , and a 5-point frequency format ( " all the time " to " never " ) . Respondents were patients discharged from a hospital . We compared scores distributions , reliability coefficients , correlations with dimension-specific numerical scales , and patient ratings of the instrument . RESULTS Response rates were similar for the four versions . The original response format had the fewest fully completed question naires , and the largest ceiling effects . Internal consistency and test-retest coefficients were acceptable for all versions , but were higher for the two 5-point formats . Correlations reflecting convergent and discriminant validity were higher for the longer response formats than for the original version . The frequency format received the highest ratings from patients , particularly from the sicker and older subgroups . CONCLUSIONS The psychometric performance and patient acceptability of the NHP can be improved by using a 5-point frequency response format instead of the original dichotomous response format Background The perspective of users should be taken into account in the evaluation of  Web-based health interventions . Assessing the users ’ satisfaction with the intervention they receive could enhance the evidence for the intervention effects . Thus , there is a need for valid and reliable measures to assess satisfaction with Web-based health interventions . Objective The objective of this study was to analyze the reliability , factorial structure , and construct validity of the Client Satisfaction Question naire adapted to Internet-based interventions ( CSQ-I ) . Methods The psychometric quality of the CSQ-I was analyzed in user sample s from 2 separate r and omized controlled trials evaluating Web-based health interventions , one from a depression prevention intervention ( sample 1 , N=174 ) and the other from a stress management intervention ( sample 2 , N=111 ) . At first , the underlying measurement model of the CSQ-I was analyzed to determine the internal consistency . The factorial structure of the scale and the measurement invariance across groups were tested by multigroup confirmatory factor analyses . Additionally , the construct validity of the scale was examined by comparing satisfaction scores with the primary clinical outcome . Results Multigroup confirmatory analyses on the scale yielded a one-factorial structure with a good fit ( root-mean-square error of approximation = .09 , comparative fit index = .96 , st and ardized root-mean-square residual = .05 ) that showed partial strong invariance across the 2 sample s. The scale showed very good reliability , indicated by McDonald omegas of .95 in sample 1 and .93 in sample 2 . Significant correlations with change in depressive symptoms ( r=−.35 , P<.001 ) and perceived stress ( r=−.48 , P<.001 ) demonstrated the construct validity of the scale . Conclusions The proven internal consistency , factorial structure , and construct validity of the CSQ-I indicate a good overall psychometric quality of the measure to assess the user ’s general satisfaction with Web-based interventions for depression and stress management . Multigroup analyses indicate its robustness across different sample s. Thus , the CSQ-I seems to be a suitable measure to consider the user ’s perspective in the overall evaluation of Web-based health interventions Background When evaluating hearing rehabilitation , it is reasonable to use self-report question naires as outcome measure . Question naires used in audiological research are developed and vali date d for the paper- and -pencil format . As computer and Internet use is increasing , st and ardized question naires used in the audiological context should be evaluated to determine the viability of the online administration format . The aim of this study was to compare administration of question naires online versus paper- and pencil of four st and ardised question naires used in hearing research and clinic . We included the Hearing H and icap Inventory for the Elderly ( HHIE ) , the International Outcome Inventory for Hearing Aids ( IOI-HA ) , Satisfaction with Amplification in Daily Life ( SADL ) , and the Hospital Anxiety and Depression Scale ( HADS ) . Methods A cross-over design was used by r and omly letting the participants complete the question naires either online or on paper . After 3 weeks the participants filled out the same question naires again but in the other format . A total of 65 hearing-aid users were recruited from a hearing clinic to participate on a voluntary basis and of these 53 completed both versions of the question naires . Results A significant main effect of format was found on the HHIE ( p < 0.001 ) , with participants reporting higher scores on the online format than in the paper format . There was no interaction effect . For the other question naires were no significant main or interaction effects of format . Significant correlations between the two ways of presenting the measures was found for all question naires ( p<0.05 ) . The results from reliability tests showed Cronbachs α ’s above .70 for all four question naires and differences in Cronbachs α between administration formats were negligible . Conclusions For three of the four included question naires the participants ’ scores remained consistent across administrations and formats . For the fourth included question naire ( HHIE ) a significant difference of format with a small effect size was found . The relevance of the difference in scores between the formats depends on which context the question naire is used in . On balance , it is recommended that the administration format remain stable across assessment points We examined the psychometric properties of the  PTSD Checklist ( PCL ) , a self-report instrument design ed to assess symptoms of posttraumatic stress disorder . Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments design ed to assess various forms of psychopathology ( e.g. , depression , general anxiety , PTSD ) . Ninety participants returned for readministration of selected measures . Findings provided support for psychometric properties of the PCL  , including internal consistency , test – retest reliability , convergent validity , and discriminant validity . Additional strengths of the PCL are discussed The Patient Health Question naire-9 Item ( PHQ-9 ) and Beck Depression Inventory – II ( BDI-II ) are frequently used measures of depression severity , but little is known about their relative psychometric properties . The authors assessed psychometric properties of both measures during treatment for depression . The  PHQ-9  and  BDI-II  scores from 172 depressed participants in two r and omized controlled trials of treatment for depression were assessed and combined . Tests of internal consistency ( Cronbach 's α ) , factor analyses , correlational analyses , estimates of clinical ly significant change , and effect sizes ( Cohen 's d ) were calculated after treatment and follow-up . Both scales demonstrated adequate internal consistency at pre- and posttreatment ( PHQ-9 α = .74 and .81 ; BDI-II α = .87 and .90 , respectively ) . Factor analysis failed to confirm the one-factor model previously reported for the PHQ-9 , but two factors evidence d good fit for the BDI-II . Both scales converged more with each other than with the Sheehan Disability Scale at pre- but not at posttreatment . Responsiveness to change of PHQ-9 and BDI-II was similar at both posttreatment and follow-up . The consistency of agreement on indices of clinical significance was fair to moderate , but the BDI-II categorised a greater proportion of participants with severe depression than the PHQ-9 . The BDI-II and PHQ-9 demonstrated adequate reliability , convergent/discriminant validity , and similar responsiveness to change . Differences were found in how they categorised severity . Pending the results of further studies , the attributes of the PHQ-9 , of being shorter and based on the diagnostic criteria for depression , may indicate an advantage over the BDI-II This study examines whether the Internet-based question naire is psychometrically equivalent to the paper-based question naire . A r and om sample of 2,400 teachers in Taiwan was divided into experimental and control groups . The experimental group was invited to complete the electronic form of the Chinese version of Center for Epidemiologic Studies Depression Scale ( CES-D ) placed on the Internet , whereas the control group was invited to complete the paper-based CES-D , which they received by mail . The multi sample invariance approach , derived from structural equation modeling ( SEM ) , was applied to analyze the collected data . The analytical results show that the two groups have equivalent factor structures in the CES-D. That is , the items in CES-D function equivalently in the two groups . Then the e quality of latent mean test was performed . The latent means of " depressed mood , " " positive affect , " and " interpersonal problems " in CES-D are not significantly different between these two groups . However , the difference in the " somatic symptoms " latent means between these two groups is statistically significant at alpha = 0.01 . But the Cohen 's d statistics indicates that such differences in latent means do not apparently lead to a meaningful effect size in practice . Both CES-D question naires exhibit equal validity , reliability , and factor structures and exhibit a little difference in latent means . Therefore , the Internet-based question naire represents a promising alternative to the paper-based question naire Purpose The  Social Difficulties Inventory  ( SDI-21 ) assesses everyday problems experienced by cancer patients , including difficulties with self-care , work and relationships . Early development and psychometric evaluation studies have vali date d the SDI-21 for computer administration . However , several recent studies have administered the SDI-21 on paper . We sought to test the score equivalence of electronic and paper versions of the SDI-21 . Methods A r and omised two-arm crossover trial in a sample of cancer patients with varied diagnoses . Patients completed  electronic ( via the internet ) and paper versions of the SDI-21 , with half r and omly assigned to complete the electronic version first ( n = 51 ) and half the paper version first ( n = 60 ) . Patients were asked to complete both versions at home , within 2 weeks . Analyses were performed for the SDI-21 summary score and three subscales . Results Score distributions and internal reliabilities for the paper and electronic versions were highly similar . There were no significant differences between mean summary or subscale scores for the two administration modes . All mean score differences ( all < 0.25 of a scale point ) were well below the SDI-21 ’s established minimally important differences , and all 95 % confidence intervals were narrow and included zero . Intraclass correlations between paper and electronic scores were uniformly high and significant ( all ≥0.85 ) and above the st and ard acceptable level of reliability . Conclusions Paper and electronic versions of the SDI-21 can be considered equivalent and used interchangeably . This is important because , despite the growth of electronic formats , paper versions are currently still necessary to ensure inclusive use of the SDI-21 with representative sample Background and Purpose — This study compared the psychometric properties of 3 clinical balance measures , the  Berg Balance Scale ( BBS ) , the Balance subscale of the Fugl-Meyer test ( FM-B ) , and the Postural Assessment Scale for Stroke Patients ( PASS ) , in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset . Methods — One hundred twenty-three stroke patients were followed up prospect ively with the 3 balance measures 14 , 30 , 90 , and 180 days after stroke onset ( DAS ) . Reliability ( interrater reliability and internal consistency ) and validity ( concurrent validity , convergent validity , and predictive validity ) of each measure were examined . A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity . Results — The FM-B and BBS showed a significant floor or ceiling effect at some DAS points , whereas the PASS did not show these effects . The BBS , FM-B , and PASS all had good reliability and validity for patients at different recovery stages after stroke . The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but , as expected , only a low level of responsiveness at 90 to 180 DAS . The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset , 14 to 30 DAS . Conclusions — All 3 measures tested showed very acceptable levels of reliability , validity , and responsiveness for both clinicians and research ers . The PASS showed slightly better psychometric characteristics than the other 2 measures
When digital versions of self-report symptom scales are compared to pen and paper versions , most scales show high interformat reliability .
This supports the reliability of results obtained in psychotherapy research on the Internet and the comparability of the results to traditional psychotherapy research .
BACKGROUND Research on Internet-based interventions typically use digital versions of pen and paper self-report symptom scales .
However , adaptation into the digital format could affect the psychometric properties of established self-report scales .
Several studies have investigated differences between digital and pen and paper versions of instruments , but no systematic review of the results has yet been done .
OBJECTIVE This review aims to assess the interformat reliability of  self-report symptom  scales used in digital or online psychotherapy research .