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Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi

Yıl 2020, Cilt: 10 Sayı: 2, 187 - 193, 31.05.2020
https://doi.org/10.33631/duzcesbed.654679

Öz

Amaç: Toplum
genelinde sıklıkla görülebilen ve bireylerde kısıtlılık tablosu oluşturabilen
boyun ağrısının, değerlendirilmesi ve takibinde son durum ölçeklerinin
kullanımı büyük önem arz etmektedir. Hasta temelli bu ölçeklerden biri olarak
karşımıza çıkan Bournemouth Boyun Anketi, boyun ağrılı hastalarda ağrı ve özrün
yanı sıra biyopsikososyal özellikleri de değerlendirmektedir. Bu çalışmanın
amacı Bournemouth Boyun Anketi’nin psikometrik özelliklerinin belirlenmesidir.



Gereç ve
Yöntemler:

Çalışmaya 73 boyun ağrılı birey dâhil olmuş ve analizler için katılımcılar
Bournemouth Boyun Anketi ile birlikte Boyun Özür İndeksi, Boyun Ağrısı
Özürlülük Skalası ve Kısa Form 36 anketlerini doldurmuşlardır. Otuz bir
katılımcı ise test-tekrar test analizi için Bournemouth Boyun Anketi’ni 48 saat
sonra tekrar tamamlamıştır.



Bulgular: Yapılan
analizler sonucu anketin iç tutarlılık Cronbach alfa değerinin 0,853,
test-tekrar test sınıf içi korelasyon katsayısı değerinin ise 0,932 olduğu
bulunmuştur. Bu değerler anketin yüksek bir güvenirliğe sahip olduğuna işaret
etmektedir. Gerçekleştirilen Pearson korelasyon analizi sonucunda Bournemouth
Boyun Anketi’nin Boyun Özür İndeksi (r=0,718) ve Boyun Ağrısı Özürlülük Skalası
(r=0,763) ile çok iyi düzeyde, Kısa Form 36’nın ilgili parametreleriyle
((-0,440)-(-0,594)) ise iyi düzeyde ilişkili olduğu görülmüştür. Anketin
bileşen sayısının belirlenmesi için yapılan açıklayıcı faktör analizi sonucu
anketin tek faktörlü bir yapıya sahip olduğu bulunmuştur.



Sonuç: Bu çalışma
sonucunda Bournemouth Boyun Anketi’nin yeterli psikometrik özelliklere sahip
olduğu ve boyun ağrılı hastalarda kullanımının uygun olduğu bulunmuştur.

Kaynakça

  • 1. Zhang ZC, Jia ZY, Cheng YJ, Wang F, Yang YL, Li M, et al. Cross-cultural adaptation and validation of the Simplified-Chinese version of neck bournemouth questionnaire for patients in mainland China. Spine. 2019; 44(7): E438-44.
  • 2. Yang H, Haldeman S, Nakata A, Choi B, Delp L, Baker D. Work-related risk factors for neck pain in the US working population. Spine. 2015; 40(3): 184-92.
  • 3. Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, et al. The prevalence, patterns, and predictors of chiropractic use among US adults. Spine. 2017; 42(23): 1810-6.
  • 4. Groeneweg R, Assen L, Kropman H, Leopold H, Mulder J, Smits EBC, et al. Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial. Chiropr & Manual Ther. 2017; 25(1): 1-12.
  • 5. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006; 15(6): 834-48.
  • 6. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017; 358: j3221.
  • 7. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015; 90(2): 284-99.
  • 8. López I, Sollano VE, Corral T. Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability. Disabil Rehabil. 2018; 40(21): 2495-504.
  • 9. Martel J, Dugas C, Lafond D, Descarreaux M. Validation of the French version of the bournemouth questionnaire. J Can Chiropr Assoc. 2009; 53(2): 102-10.
  • 10. Deyo RA, Battie M, Beurskens A, Bombardier C, Croft P, Koes B, et al. Outcome measures for low back pain research: a proposal for standardized use. Spine. 1998; 23(18): 2003-13.
  • 11. Parks K, Crichton K, Goldford R, McGill S. A comparison of lumbar range of motion and functional ability scores in patients with low back pain: assessment for range of motion validity. Spine. 2003; 28(4): 380-4.
  • 12. Kose G, Hepguler S, Atamaz F, Oder G. A comparison of four disability scales for Turkish patients with neck pain. J Rehabil Med. 2007; 39(5): 358-62.
  • 13. Bicer A, Yazici A, Camdeviren H, Erdogan C. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disabil Rehabil. 2004; 26(16): 959-62.
  • 14. Telci EA, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagli N. The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine. 2009; 34(16): 1732-5.
  • 15. Jordan A, Manniche C, Mosdal C, Hindsberger C. The copenhagen neck functional disability scale: a study of reliability and validity. J Manipulative Physiol Ther. 1998; 21(8): 520-7.
  • 16. Jordan A, Bendix T, Nielsen H, Hansen FR, Høst D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial. Spine. 1998; 23(3): 311-8.
  • 17. Bolton JE, Humphreys BK. The bournemouth questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. J Manipulative Physiol Ther. 2002; 25(3): 141-8.
  • 18. Bolton JE, Breen AC. The bournemouth questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther. 1999; 22(8): 503-10.
  • 19. Yılmaz O, Gafuroğlu Ü, Yüksel S. Translation, reliability, and validity of the Turkish version of the neck bournemouth questionnaire. Turk J Phys Med Rehabil. 2019; 65(1): 59-66.
  • 20. Kaergaard A, Andersen JH, Rasmussen K, Mikkelsen S. Identification of neck-shoulder disorders in a 1 year follow-up study. Validation of a questionnaire-based method. Pain. 2000; 86(3): 305-10.
  • 21. Berg A, Suhonen R, Idvall E. A survey of orthopaedic patients’ assessment of care using the individualised care scale. J Orthop Nurs. 2007; 11(3-4): 185-93.
  • 22. Arslan S, Şener DK, Cangür Ş. Pediatri hemşireliği öğrencileri klinik rahatlık ve endişe değerlendirme aracının geçerlik ve güvenirliği. DÜ Sağlık Bil Enst Derg. 2018; 8(2): 61-6.
  • 23. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7): 409-15.
  • 24. Wheeler AH, Goolkasian P, Baird AC, Darden BV. Development of the neck pain and disability scale: item analysis, face, and criterion-related validity. Spine. 1999; 24(13): 1290.
  • 25. Pinar R. Reliability and construct validity of the SF-36 in Turkish cancer patients. Qual Life Res. 2005; 14(1): 259-64.
  • 26. Ware Jr, John E, Sherbourne CD. The mos 36-item short-form health survey (sf-36): I. Conceptual framework and item selection. Med Care. 1992; 30(6): 473-83.
  • 27. Korkmaz S, Goksuluk D, Zararsiz G. MVN: An r package for assessing multivariate normality.R J. 2014; 6(2): 151-62.
  • 28. Zinbarg RE, Revelle W, Yovel I, Li W. Cronbach’s α, Revelle’s β, and McDonald’s ω H: Their relations with each other and two alternative conceptualizations of reliability. Psychometrika. 2005; 70(1): 123-33.
  • 29. Zinbarg RE, Yovel I, Revelle W, McDonald RP. Estimating generalizability to a latent variable common to all of a scale's indicators: A comparison of estimators for ωh. Appl Psychol Meas. 2006; 30(2): 121-44.
  • 30. Andresen EM. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil. 2000; 81: 15-20.
  • 31. Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003; 56(8): 730-5.
  • 32. Terwee CB, Bot SD, Boer MR, Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007; 60(1): 34-42.
  • 33. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995; 4(4): 293-30.
  • 34. Feise RJ, Menke JM. Functional rating index: a new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine. 2001; 26(1): 78-87.
  • 35. Hyland ME. A brief guide to the selection of quality of life instrument. Health Qual Life Outcomes. 2003; 1(1): 24.
  • 36. Hair JF, Black Wc, Babin Bj, Anderson Re. Multivariate data analysis. 7th ed. New York: Pearson; 2010.
  • 37. Soklic M, Peterson C, Humphreys BK. Translation and validation of the German version of the Bournemouth questionnaire for neck pain. Chiropr & Manual Ther. 2012; 20(1): 2.
  • 38. World Health Organization. The international classification of functioning, disability and health (ICF). Geneva: WHO; 2001.
  • 39. Geri T, Signori A, Gianola S, Rossettini G, Grenat G, Checchia G, et al. Cross-cultural adaptation and validation of the neck bournemouth questionnaire in the Italian population. Qual Life Res. 2015; 24(3): 735-45.
  • 40. Hogg JS, Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, et al. The burden and determinants of neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009; 32(2): 46-60.
  • 41. Terwee CB, Schellingerhout JM, Verhagen AP, Koes BW, Vet HC. Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review. J Manipulative Physiol Ther. 2011; 34(4): 261-72.
  • 42. Allen MJ, Yen WM. Introduction to measurement theory. Long Grove: Waveland Press; 2002.
  • 43. Ghasemi F, Yoosefinejad AK, Pirouzi S, Ghaem H. Evaluating the cross-cultural adaptation, reliability, and validity of the Persian versions of the copenhagen neck function disability scale and neck bournemouth questionnaire. Spine. 2019; 44(2): E126-32.

Investigation of Psychometric Properties of the Bournemouth Neck Questionnaire

Yıl 2020, Cilt: 10 Sayı: 2, 187 - 193, 31.05.2020
https://doi.org/10.33631/duzcesbed.654679

Öz

Aim: The use
of the outcome measurements in the evaluation and follow-up of neck pain, which
can be seen frequently in society and create a table of limitations in
individuals, is of great importance. The Bournemouth Neck Questionnaire, one of
the patient-related questionnaires, evaluates pain and disability as well as
biopsychosocial features in patients with neck pain. The aim of this study was
to determine the psychometric characteristics of the Bournemouth Neck Questionnaire.



Materials and Methods: The study included 73 subjects with neck pain and for
analyses participants filled Bournemouth Neck Questionnaire with Neck
Disability Index, Neck Pain Disability Scale and Short Form 36. For test-retest
analysis 31 participants completed the Bournemouth Neck Questionnaire again
after 48 hours.



Results: As a
result of the analyses, the internal consistency Cronbach alpha value of the
questionnaire was 0.853 and the test-retest intraclass correlation coefficient
was 0.932. These values indicate that the questionnaire has a high level of
reliability.
As a
result of Pearson’s correlation analysis, the Bournemouth Neck Questionnaire
was very-good correlated with the Neck Disability Index (r=0.718) and Neck Pain
Disability Scale (r=0.763) and good with the related parameters of Short Form
36 ((-0.440)-(-0.594)).
According to explanatory factor analysis conducted to
determine the number of components of the questionnaire, it was found that the
questionnaire had one factorial structure.



Conclusion: In conclusion, it was found that Bournemouth
Neck Questionnaire had sufficient psychometric features and appropriate to use
for patients with neck pain.

Kaynakça

  • 1. Zhang ZC, Jia ZY, Cheng YJ, Wang F, Yang YL, Li M, et al. Cross-cultural adaptation and validation of the Simplified-Chinese version of neck bournemouth questionnaire for patients in mainland China. Spine. 2019; 44(7): E438-44.
  • 2. Yang H, Haldeman S, Nakata A, Choi B, Delp L, Baker D. Work-related risk factors for neck pain in the US working population. Spine. 2015; 40(3): 184-92.
  • 3. Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, et al. The prevalence, patterns, and predictors of chiropractic use among US adults. Spine. 2017; 42(23): 1810-6.
  • 4. Groeneweg R, Assen L, Kropman H, Leopold H, Mulder J, Smits EBC, et al. Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial. Chiropr & Manual Ther. 2017; 25(1): 1-12.
  • 5. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006; 15(6): 834-48.
  • 6. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017; 358: j3221.
  • 7. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015; 90(2): 284-99.
  • 8. López I, Sollano VE, Corral T. Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability. Disabil Rehabil. 2018; 40(21): 2495-504.
  • 9. Martel J, Dugas C, Lafond D, Descarreaux M. Validation of the French version of the bournemouth questionnaire. J Can Chiropr Assoc. 2009; 53(2): 102-10.
  • 10. Deyo RA, Battie M, Beurskens A, Bombardier C, Croft P, Koes B, et al. Outcome measures for low back pain research: a proposal for standardized use. Spine. 1998; 23(18): 2003-13.
  • 11. Parks K, Crichton K, Goldford R, McGill S. A comparison of lumbar range of motion and functional ability scores in patients with low back pain: assessment for range of motion validity. Spine. 2003; 28(4): 380-4.
  • 12. Kose G, Hepguler S, Atamaz F, Oder G. A comparison of four disability scales for Turkish patients with neck pain. J Rehabil Med. 2007; 39(5): 358-62.
  • 13. Bicer A, Yazici A, Camdeviren H, Erdogan C. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disabil Rehabil. 2004; 26(16): 959-62.
  • 14. Telci EA, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagli N. The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine. 2009; 34(16): 1732-5.
  • 15. Jordan A, Manniche C, Mosdal C, Hindsberger C. The copenhagen neck functional disability scale: a study of reliability and validity. J Manipulative Physiol Ther. 1998; 21(8): 520-7.
  • 16. Jordan A, Bendix T, Nielsen H, Hansen FR, Høst D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial. Spine. 1998; 23(3): 311-8.
  • 17. Bolton JE, Humphreys BK. The bournemouth questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. J Manipulative Physiol Ther. 2002; 25(3): 141-8.
  • 18. Bolton JE, Breen AC. The bournemouth questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther. 1999; 22(8): 503-10.
  • 19. Yılmaz O, Gafuroğlu Ü, Yüksel S. Translation, reliability, and validity of the Turkish version of the neck bournemouth questionnaire. Turk J Phys Med Rehabil. 2019; 65(1): 59-66.
  • 20. Kaergaard A, Andersen JH, Rasmussen K, Mikkelsen S. Identification of neck-shoulder disorders in a 1 year follow-up study. Validation of a questionnaire-based method. Pain. 2000; 86(3): 305-10.
  • 21. Berg A, Suhonen R, Idvall E. A survey of orthopaedic patients’ assessment of care using the individualised care scale. J Orthop Nurs. 2007; 11(3-4): 185-93.
  • 22. Arslan S, Şener DK, Cangür Ş. Pediatri hemşireliği öğrencileri klinik rahatlık ve endişe değerlendirme aracının geçerlik ve güvenirliği. DÜ Sağlık Bil Enst Derg. 2018; 8(2): 61-6.
  • 23. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7): 409-15.
  • 24. Wheeler AH, Goolkasian P, Baird AC, Darden BV. Development of the neck pain and disability scale: item analysis, face, and criterion-related validity. Spine. 1999; 24(13): 1290.
  • 25. Pinar R. Reliability and construct validity of the SF-36 in Turkish cancer patients. Qual Life Res. 2005; 14(1): 259-64.
  • 26. Ware Jr, John E, Sherbourne CD. The mos 36-item short-form health survey (sf-36): I. Conceptual framework and item selection. Med Care. 1992; 30(6): 473-83.
  • 27. Korkmaz S, Goksuluk D, Zararsiz G. MVN: An r package for assessing multivariate normality.R J. 2014; 6(2): 151-62.
  • 28. Zinbarg RE, Revelle W, Yovel I, Li W. Cronbach’s α, Revelle’s β, and McDonald’s ω H: Their relations with each other and two alternative conceptualizations of reliability. Psychometrika. 2005; 70(1): 123-33.
  • 29. Zinbarg RE, Yovel I, Revelle W, McDonald RP. Estimating generalizability to a latent variable common to all of a scale's indicators: A comparison of estimators for ωh. Appl Psychol Meas. 2006; 30(2): 121-44.
  • 30. Andresen EM. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil. 2000; 81: 15-20.
  • 31. Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003; 56(8): 730-5.
  • 32. Terwee CB, Bot SD, Boer MR, Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007; 60(1): 34-42.
  • 33. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995; 4(4): 293-30.
  • 34. Feise RJ, Menke JM. Functional rating index: a new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine. 2001; 26(1): 78-87.
  • 35. Hyland ME. A brief guide to the selection of quality of life instrument. Health Qual Life Outcomes. 2003; 1(1): 24.
  • 36. Hair JF, Black Wc, Babin Bj, Anderson Re. Multivariate data analysis. 7th ed. New York: Pearson; 2010.
  • 37. Soklic M, Peterson C, Humphreys BK. Translation and validation of the German version of the Bournemouth questionnaire for neck pain. Chiropr & Manual Ther. 2012; 20(1): 2.
  • 38. World Health Organization. The international classification of functioning, disability and health (ICF). Geneva: WHO; 2001.
  • 39. Geri T, Signori A, Gianola S, Rossettini G, Grenat G, Checchia G, et al. Cross-cultural adaptation and validation of the neck bournemouth questionnaire in the Italian population. Qual Life Res. 2015; 24(3): 735-45.
  • 40. Hogg JS, Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, et al. The burden and determinants of neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009; 32(2): 46-60.
  • 41. Terwee CB, Schellingerhout JM, Verhagen AP, Koes BW, Vet HC. Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review. J Manipulative Physiol Ther. 2011; 34(4): 261-72.
  • 42. Allen MJ, Yen WM. Introduction to measurement theory. Long Grove: Waveland Press; 2002.
  • 43. Ghasemi F, Yoosefinejad AK, Pirouzi S, Ghaem H. Evaluating the cross-cultural adaptation, reliability, and validity of the Persian versions of the copenhagen neck function disability scale and neck bournemouth questionnaire. Spine. 2019; 44(2): E126-32.
Toplam 43 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Gürkan Günaydın 0000-0003-3432-6431

Yayımlanma Tarihi 31 Mayıs 2020
Gönderilme Tarihi 3 Aralık 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 10 Sayı: 2

Kaynak Göster

APA Günaydın, G. (2020). Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(2), 187-193. https://doi.org/10.33631/duzcesbed.654679
AMA Günaydın G. Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi. DÜ Sağlık Bil Enst Derg. Mayıs 2020;10(2):187-193. doi:10.33631/duzcesbed.654679
Chicago Günaydın, Gürkan. “Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, sy. 2 (Mayıs 2020): 187-93. https://doi.org/10.33631/duzcesbed.654679.
EndNote Günaydın G (01 Mayıs 2020) Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 2 187–193.
IEEE G. Günaydın, “Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi”, DÜ Sağlık Bil Enst Derg, c. 10, sy. 2, ss. 187–193, 2020, doi: 10.33631/duzcesbed.654679.
ISNAD Günaydın, Gürkan. “Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/2 (Mayıs 2020), 187-193. https://doi.org/10.33631/duzcesbed.654679.
JAMA Günaydın G. Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi. DÜ Sağlık Bil Enst Derg. 2020;10:187–193.
MLA Günaydın, Gürkan. “Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 10, sy. 2, 2020, ss. 187-93, doi:10.33631/duzcesbed.654679.
Vancouver Günaydın G. Bournemouth Boyun Anketi’nin Psikometrik Özelliklerinin İncelenmesi. DÜ Sağlık Bil Enst Derg. 2020;10(2):187-93.