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Int J Gen Med. 2017 Sep 4;10:249-273. doi: 10.2147/IJGM.S140224. eCollection 2017.

Empirical validation of the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire for suspected Lyme disease.

Author information

1
Department of Psychology, State University of New York at New Paltz, New Paltz, NY.
2
Hudson Valley Healing Arts Center, Hyde Park, NY, USA.

Abstract

PURPOSE:

Lyme disease is spreading worldwide, with multiple Borrelia species causing a broad range of clinical symptoms that mimic other illnesses. A validated Lyme disease screening questionnaire would be clinically useful for both providers and patients. Three studies evaluated such a screening tool, namely the Horowitz Multiple Systemic Infectious Disease Syndrome (MSIDS) Questionnaire. The purpose was to see if the questionnaire could accurately distinguish between Lyme patients and healthy individuals.

METHODS:

Study 1 examined the construct validity of the scale examining its factor structure and reliability of the questionnaire among 537 individuals being treated for Lyme disease. Study 2 involved an online sample of 999 participants, who self-identified as either healthy (N=217) or suffering from Lyme now (N=782) who completed the Horowitz MSIDS Questionnaire (HMQ) along with an outdoor activity survey. We examined convergent validity among components of the scale and evaluated discriminant validity with the Big Five personality characteristics. The third study compared a sample of 236 patients with confirmed Lyme disease with an online sample of 568 healthy individuals.

RESULTS:

Factor analysis results identified six underlying latent dimensions; four of these overlapped with critical symptoms identified by Horowitz - neuropathy, cognitive dysfunction, musculoskeletal pain, and fatigue. The HMQ showed acceptable levels of internal reliability using Cronbach's coefficient alpha and exhibited evidence of convergent and divergent validity. Components of the HMQ correlated more highly with each other than with unrelated traits.

DISCUSSION:

The results consistently demonstrated that the HMQ accurately differentiated those with Lyme disease from healthy individuals. Three migratory pain survey items (persistent muscular pain, arthritic pain, and nerve pain/paresthesias) robustly identified individuals with verified Lyme disease. The results support the use of the HMQ as a valid, efficient, and low-cost screening tool for medical practitioners to decide if additional testing is warranted to distinguish between Lyme disease and other illnesses.

KEYWORDS:

Babesia; Borrelia burgdorferi; Lyme disease; MSIDS; Multiple Systemic Infectious Disease Syndrome; PTLDS; Post-Treatment Lyme Disease Syndrome; factor analysis

Conflict of interest statement

Disclosure Dr Phyllis R Freeman is a senior researcher and Dr Richard Horowitz is an owner and medical practitioner at the Hudson Valley Healing Arts Center, which specializes in the treatment of Lyme disease. Dr Richard Horowitz is also an author of the 2013 book, Why Can’t I Get Better? Solving the Mystery of Lyme and Chronic Disease and the 2017 book How Can I Get Better? An Action Plan for Treating Resistant Lyme & Chronic Disease from St. Martin’s Press. The authors report no other conflicts of interest in this work.

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