Validation of the Wisconsin upper respiratory symptom survey-24, Chinese version

Figures & data

Table 1. Demographics of the study participants who had common cold during May 2018 to February 2019 visited Guangdong provincial hospital of Chinese medicine, China.

Variable	Value
Number of participants	300
Age, years
Mean (SD)	28.4 (9.3)
Gender, no./total (%)
Female	210 (70)
Ethnicity, no./total (%)
Han	298 (99.3)
Education, highest, no./total (%)
High school or less educated	76 (25.4)
College degree	121 (40.3)
Graduate degree	103 (34.3)
Tobacco use, no./total (%)
Current	31 (10.3)
Past	2 (0.7)
Nonsmoker	267 (89)
Comorbidities/disease history, no./total (%)
No	289 (96.3)
Yes	11(3.7) 3 pharyngitis, 2 anaemia and 1 chronic
	Bronchitis, 1 hypertension 1 hypothyroidism and 1
	Optic neuritis, 1 calculus of kidney and 1
	Appendicitis
Time from first symptom to enrolment (hours)
Mean (SD)	20.8 (14.6)
Inter-quartile range	24–30
Maximum body temperature before enrolment
Mean (SD)	37.3 (0.7)
≤37.2 °C, no./total (%)	181 (60.3)
37.3–38 °C, no./total (%)	77 (25.7)
38.1–39 °C, no./total (%)	35 (11.7)
>39 °C, no./total (%)	7 (2.3)
Having taken medicine before enrolment, no.
No medicine	140
Chinese medicine	115
Antipyretic analgesics	31
Antivirals	27
Antihistamine	3
Other	6

Table 2. The WURSS-24-C item and summary descriptive statistics.

Day	N	Mean (SD)	Min	Max
1	300	54.11 (30.28)	4	137
2	300	49.82 (27.67)	0	130
3	300	41.74 (27.39)	0	108
4	298	30.89 (27.14)	0	125
5	290	21.00 (22.05)	0	123
6	264	13.78 (18.35)	0	112
7	223	10.16 (15.67)	0	82
8	168	8.79 (14.55)	0	87
9	119	8.41 (14.23)	0	71
10	81	8.02 (12.73)	0	66
11	57	7.70 (12.83)	0	66
12	41	9.59 (14.47)	0	66
13	32	10.63 (14.03)	0	45
14	27	7.96 (10.33)	0	30

Data shown represent the average and the range of the total score from Day 1 to 14.

Figure 1. The 4-domains model fit confirmatory factor analysis (CFA) for the WURSS-24-C. Chi-square = 1673.47, df = 203, p value = .0000. GFI: goodness of fit index; AGFI: adjusted goodness of fit index; NNFI: non-normed fit index; CFI: comparative fit index; SRMR: standardized root mean square residual; RMSEA: root mean square error of approximation.

Table 3. The factor loading of WURSS-24-C items.

Item	Symptom	1	2	3	4
1	Runny nose	–	–	0.867	–
2	Plugged nose	–	–	0.759	–
3	Sneezing	–	–	0.812	–
4	Sore throat	–	–	–	0.721
5	Scratchy throat	–	–	–	0.798
6	Cough	–	–	–	0.686
7	Hoarseness	–	–	–	0.654
8	Head congestion	–	0.563	–	–
9	Chest congestion	–	0.552	–	–
10	Feeling tired	0.505	0.586	–	–
11	Headache	–	0.786	–	–
12	Body aches	–	0.812	–	–
13	Fever	–	0.687	–	–
14	Think clearly	0.693	–	–	–
15	Sleep well	0.636	–	–	–
16	Breath easily	0.426	–	0.664	–
17	Walk/climb stairs	0.828	–		–
18	Accomplish daily activities	0.868	–	–	–
19	Work outside the home	0.864	–	–	–
20	Work inside the home	0.839	–	–	–
21	Interact with others	0.845	–	–	–
22	Live your personal life	0.843	–	–	–
Definition of the 4 domains		Activity and	Systemic	Nasal	Throat
		function	symptom	symptom	symptom
	Cronbach’s α	0.943	0.859	0.882	0.849

Only those with factor loads greater than 0.4 are listed.

Figure 2. The average daily score of WURSS-24-C and SF-8 from Day 1 to 14. Sample size diminishes as participants’ colds resolve, from N = 300 on Day 1 to N = 27 on Day 14. The centre of the notched boxes is the median summed score for that day. The top of the notched boxes indicates the 25 and 75% percentiles, respectively. The notches portray the median ±1.57 (interquartile range = IQR)/N⁻² and thus can be compared to assess difference at the p = .05 level of significance. The ends of the vertical lines indicate the last actual data point within 1.5 (IQR) from the 25%ile and 75%ile. The symbols above and below these lines are actual outlying data points.

Figure 3. The scatterplot correlations of the WURSS-24-C with SF-8. Data shown represent Days 2–4, where sample size was N = 300, N = 300 and N = 298, respectively. The WURSS-24 correlated more statistically with physical than mental health, yielding Pearson correlation coefficient of −0.780 for SF-8 physical health and −0.721 for SF-8 mental health.

Table 4. Frequency, severity and minimal important difference of WURSS-24 Items.

Item	Symptom	Frequency%	Severity	MID
1	How sick	100.0	4.11 (1.20)	−1.14
2	Runny nose	85.0	3.31 (1.57)	−0.88
3	Plugged nose	87.7	3.50 (1.58)	−0.95
4	Sneezing	84.3	3.10 (1.54)	−0.91
5	Sore throat	85.7	3.34 (1.57)	−0.95
6	Scratchy throat	83.3	2.84 (1.54)	−0.73
7	Cough	82.7	3.18 (1.68)	−0.67
8	Hoarseness	75.3	2.81 (1.67)	−0.74
9	Head congestion	83.7	2.80 (1.68)	−0.75
10	Chest congestion	59.0	2.03 (1.57)	−0.41
11	Feeling tired	98.0	3.37 (1.56)	−1.06
12	Headache	83.7	2.70 (1.71)	−0.73
13	Body aches	68.0	2.36 (1.48)	−0.61
14	Fever	60.7	2.19 (1.40)	−0.58
15	Think clearly	86.3	2.54 (1.42)	−0.76
16	Sleep well	91.7	2.99 (1.51)	−0.93
17	Breathe easily	84.0	3.10 (1.65)	−0.83
18	Walk/climb stairs	84.3	2.49 (1.52)	−0.73
19	Accomplish daily activities	81.0	2.24 (1.41)	−0.67
20	Work outside the home	81.7	2.60 (1.57)	−0.73
21	Work inside the home	78.3	2.22 (1.44)	−0.61
22	Interact with others	79.3	2.40 (1.45)	−0.67
23	Live your personal life	77.7	2.29 (1.32)	−0.63

The last item in the WURSS-24-C which assesses global change (change since yesterday) was not included.

Frequency: Scored above zero at least once in first 7 d of monitoring.

Severity: mean ± SD; averaged over the first 3 d; calculated only for those with symptom present all 3 d. To weight each person’s responses equally, data were first averaged within-person-over-time, then averaged among participants.

MID: Minimal important difference: mean day-to-day change for those indicating minimal improvement.

Data availability statement

The datasets generated or analysed during this study are not publicly available due to limitations of ethical approval involving the patient data and anonymity but are available from the corresponding author on reasonable request.