Rasch analysis of 24-, 18- and 11-item versions of the Roland-Morris Disability Questionnaire

Purpose  The aim of this study was to examine fit of the original 24-item Roland-Morris Disability Questionnaire and three short-form versions to a Rasch model with particular attention to targeting of item difficulty and to differential item functioning. Methods  Cross-sectional survey of 140 people with low back pain seeking physiotherapy treatment. Data were analysed using a dichotomous Rasch model. Results  All versions showed adequate overall data fit to the Rasch model, with few misfitting items. Person separation was around 0.85 for all versions. Item 5 (use a handrail to get upstairs) showed differential item functioning by age. Targeting of persons of high ability was poor and short-form versions also had poor targeting of persons of low ability. Items of similar difficulty clustered in the centre of the logit scale. Conclusion  Although the Roland data fit the Rasch model, there were insufficient items of higher difficulty to sufficiently evaluate disability in persons with mild disability. Short-form versions also lacked items of lower difficulty.

Rasch Analysis of Patient- and Parent-Reported Outcome Measures in the International Consortium for Health Outcomes Measurement Standard Set for Cleft Lip and Palate

ObjectivesThe aim of this study was to evaluate the psychometric performance of the patient- and parent-reported measures in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Care, and to identify ways of improving concept coverage.MethodsData from 714 patients with cleft lip and/or palate, aged 8 to 9, 10 to 12.5, and 22 years were collected between November 2015 and April 2019 at Erasmus University Medical Center, Boston Children’s Hospital, Duke Children’s Hospital, and from participating sites in the CLEFT-Q Phase 3 study. The Standard Set includes 9 CLEFT-Q scales, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, the Child Oral Health Impact Profile–Oral Symptoms Scale (COHIP-OSS), and the Intelligibility in Context Scale (ICS). Targeting, item-fit statistics, thresholds for item responses, and measurement precision (PSI) were analyzed using Rasch measurement theory.ResultsThe proportion of the sample to score within each instruments range of measurement varied from 69% (ICS) to 92% (CLEFT-Q teeth and COHIP-OSS). Specific problems with individual items within the NOSE and COHIP-OSS questionnaires were noted, such as poor item fit to the Rasch model and disordered thresholds (6 of 10). Reliability measured with PSI was above 0.82 for the ICS and all but one CLEFT-Q scale (speech distress). PSIs were lowest for the COHIP-OSS (0.43) and NOSE questionnaire (0.35).ConclusionThe patient- and parent-reported components within the facial appearance, psychosocial function, and speech domains are valid measures; however, the facial function and oral health domains are not sufficiently covered by the CLEFT-Q eating and drinking, NOSE, and COHIP-OSS, and these questionnaires may not be accurate enough to stratify cleft-related outcomes.     

The Development and Validation of a Multidimensional Sum-Scaling Questionnaire to Measure Patient-Reported Outcomes in Acute Respiratory Tract Infections in Primary Care: The Acute Respiratory Tract Infection Questionnaire

ObjectivePatient-reported outcomes are seldom validated measures in clinical trials of acute respiratory tract infections (ARTIs) in primary care. We developed and validated a patient-reported outcome sum-scaling measure to assess the severity and functional impacts of ARTIs.MethodsQualitative interviews and field testing among adults with an ARTI were conducted to ascertain a high degree of face and content validity of the questionnaire. Subsequently, a draft version of the Acute Respiratory Tract Infection Questionnaire (ARTIQ) was statistically validated by using the partial credit Rasch model to test dimensionality, objectivity, and reliability of items. Test of known groups’ validity was conducted by comparing participants with and without an ARTI.ResultsThe final version of the ARTIQ consisted of 38 items covering five dimensions (Physical-upper, Physical-lower, Psychological, Sleep, and Medicine) and five single items. All final dimensions were confirmed to fit the Rasch model, thus enabling sum-scaling of responses. The ARTIQ scores in participants with an ARTI were significantly higher than in those without ARTI (known groups’ validity).ConclusionA self-administered, multidimensional, sum-scaling questionnaire with high face and content validity and adequate psychometric properties for assessing severity and functional impacts from ARTIs in adults is available to clinical trials and audits in primary care.     

A cross-diagnostic validation of an instrument measuring participation in everyday occupations: The Occupational Gaps Questionnaire (OGQ)

Abstract

The aim of this study was to validate the Occupational Gaps Questionnaire (OGQ) when used in samples of people with acquired brain injuries (ABI), stroke, stress-related disorders, concussion, and persons receiving rehabilitation after ABI to investigate whether the OGQ could be used as a generic scale. A total of 601 individuals answered the OGQ at various time points after illness/injury. A Rasch analysis was performed on the data to evaluate evidence of internal scale validity and person response validity, and the capability of the OGQ to separate people into different levels of participation in everyday occupations. The results provided evidence that the OGQ is a valid measure across different diagnostic groups. A generic version of the OGQ can separate at least two levels of perceived occupational gaps and is therefore recommended as a screening tool to be used by occupational therapists working with different diagnostic groups.     

Construct Validity of the Swedish Version of the Revised Piper Fatigue Scale in an Oncology Sample—A Rasch Analysis

ObjectivesFatigue is a common and distressing symptom in cancer patients due to both the disease and its treatments. The concept of fatigue is multidimensional and includes both physical and mental components. The 22-item Revised Piper Fatigue Scale (RPFS) is a multidimensional instrument developed to assess cancer-related fatigue. This study reports on the construct validity of the Swedish version of the RPFS from the perspective of Rasch measurement.MethodsThe Swedish version of the RPFS was answered by 196 cancer patients fatigued after 4 to 5 weeks of curative radiation therapy. Data from the scale were fitted to the Rasch measurement model. This involved testing a series of assumptions, including the stochastic ordering of items, local response dependency, and unidimensionality. A series of fit statistics were computed, differential item functioning (DIF) was tested, and local response dependency was accommodated through testlets.ResultsThe Behavioral, Affective and Sensory domains all satisfied the Rasch model expectations. No DIF was observed, and all domains were found to be unidimensional. The Mood/Cognitive scale failed to fit the model, and substantial multidimensionality was found. Splitting the scale between Mood and Cognitive items resolved fit to the Rasch model, and new domains were unidimensional without DIF.ConclusionsThe current Rasch analyses add to the evidence of measurement properties of the scale and show that the RPFS has good psychometric properties and works well to measure fatigue. The original four-factor structure, however, was not supported.     

The CDI-DaySyms: Content Development of a New Patient-Reported Outcome Questionnaire for Symptoms of Clostridium difficile Infection

Objectives

To develop a patient-reported outcome (PRO) questionnaire for symptoms of Clostridium difficile infection (CDI) following the US Food and Drug Administration PRO guidelines.

个人健康状况评估问卷信度和效度评价

目的 评价个人健康状况评估问卷的信度与效度。方法应用自行编制的个人健康状况评估问卷对湖北省3 187名18～55岁居民的健康状态进行测量,采用探索性因素分析和信效度检验方法评价该问卷的信度和效度。结果 通过探索性因素分析,确定个人健康状况评估问卷由躯体心理和社会适应、疲劳评定、睡眠质量评定3个分量表组成;其中躯体心理和社会适应量表共包括社会支持、精力、疼痛等7个因子共30个条目,方差贡献率为55.37%;疲劳评定量表包括疲劳症状1个因子共4个条目,方差贡献率为67.94%;睡眠质量评定量表包括睡眠质量1个因子共5个条目,方差贡献率为41.95%;躯体心理和社会适应、疲劳评定、睡眠质量评定各分量表的Cronbach'sα系数分别为0.8750、0.842、0.643,3个分量表得分与简明健康调查问卷(SF-36)得分的同时效度系数分别为0.633、0.363、0.457(均P<0.01),该问卷具有较好的信度和效度。结论 个人健康状况评估问卷具有较好的信度和效度,可作为中国成人亚健康状态的测评工具。     

Psychometric Development of the Individualized Retinopathy-Dependent Quality of Life Questionnaire (RetDQoL)

Objectives:  Psychometric development of the Retinopathy-Dependent Quality of Life (RetDQoL) questionnaire in a cross-sectional study of 207 German patients with diabetic retinopathy. Forty patients (19%) also had clinically significant macular edema.
Methods:  Principal component analyses identified factor structure, and Cronbach's alpha assessed internal consistencies. Construct validity was examined by testing the additional impact of macular edema and expected relationships of RetDQoL scores with visual impairment, stage of diabetic retinopathy, subscales of the SF-12, and scores of the Retinopathy Treatment Satisfaction Questionnaire (RetTSQ). Analyses were conducted using the RetDQoL's AWI score (average weighted impact of diabetic retinopathy on 26 life domains) and its two overview items (present QoL in general and retinopathy-specific QoL). Content validity was investigated using an open-ended question to identify any additional items needed.
Results:  A forced one-factor solution of the 26 specific weighted impact ratings showed all items except working life (applicable to 27%) to load >0.55, and Cronbach's alpha was 0.96, showing very high reliability. Greater impairment, worse diabetic retinopathy, and macular edema were associated with greater negative impact on scores. AWI correlated as expected more highly with retinopathy-specific QoL ( r  = 0.71, P  < 0.01) than with present QoL ( r  = 0.28, P  < 0.01). RetDQoL scores correlated moderately with SF-12 subscales ( r  = 0.22–0.51, P  < 0.01) and RetTSQ scores ( r  = 0.27–0.51, P  < 0.01). For six domains, >60% of patients reported no impact. No additional domains were needed.
Conclusions:  The RetDQoL is valid and reliable for patients with diabetic retinopathy with or without macular edema. It may be shortened if findings are confirmed cross-culturally.     

Reliability of the Rasch Food Safety Practices scale

A reduced version of the Rasch Food Safety Practices scale [Fischer, A. R. H., Frewer, L. J., & Nauta, M. J. (2006). Towards improving food safety in the domestic environment: a multi-item Rasch scale for the measurement of the safety efficacy of domestic food handling practices. Risk Analysis, 26(5), 1323–1338] was investigated to establish its reliability and robustness. A second set of survey data were collected using the reduced Rasch scale. We discuss the reliability and robustness of the original Rasch scale in terms of the second analysis. In general, the results of the reduced scale provided results that were very similar to those obtained in the original study. In both studies the goodness of fit of the different items was stable. The range of the difficulty parameters was smaller in this study than in the previous one, which may be attributed to methodological causes. The high level of similarity of the key parameters shows that the Rasch scale is reliable and robust.     

Valid Outcome Measures in Care for Older People: Comparing the ASCOT and the ICECAP-O

Background

Limited health care budgets and population aging result in a need to compare care services on their benefits and costs. Because services for older people often aim to improve multiple life aspects, valid measures are needed to examine their benefits on individuals’ health and well-being simultaneously. Two measures may meet this end: the Adult Social Care Outcomes Toolkit (ASCOT) and the ICEpop CAPability measure for Older people (ICECAP-O).

Repeatability of a Rasch Model of the AQ20 over Five Assessments

Rasch analysis is now used widely to assess the measurement properties of health status questionnaires. This study tested the stability of the AQ20 – a dichotomous-response measure of health status in asthma, using parameters estimated by a Rasch model. One hundred forty-four asthma patients completed the AQ20 on five occasions over 3 months. At visit 1, two items showed significant misfit and were deleted. At each visit, the overall mean item–person and item–trait interaction statistics from the remaining 18 items (AQ18) were very similar. The repeatability of the item calibrations was excellent (intraclass correlation coefficient 0.95), despite the patients’ health having changed (repeated-measures ANOVA: FEV₁ and AQ18 score p<0.0001). Tests of differential item functioning (DIF) over time showed that one item increased in severity. This item refers to ability to garden, and changes in response patterns could be related to seasonal changes over the study period. We conclude that this study has highlighted the usefulness of multiple repeat assessments which allow items to be tested for DIF over time. This is important as inclusion of ‘time-dependent’ items in a questionnaire may reduce the reliability of the instrument.     

From Translation to Version Management: A History and Review of Methods for the Cultural Adaptation of the EuroQol Five-Dimensional Questionnaire

The EuroQol five-dimensional (EQ-5D) questionnaire is used worldwide as a patient-reported outcome (PRO) instrument for the measurement and valuation of health. Several variants of the instrument now exist, including versions with three and five levels of severity and one for respondents aged 8 to 14 years. From the outset, a demand for new language versions of the EQ-5D questionnaire meant that there was a need to implement standardized procedures, which ensured that such versions were produced following international recommendations for the cultural adaptation of patient-reported outcomes. The availability of new variants and formats of the instrument, such as telephone-administered or electronic formats, complicated the task of providing and controlling the quality of cultural adaptations. Although cultural adaptations of the instrument are widely used, the procedures currently used to produce them have not been widely disseminated. The present article therefore describes the evolution of the production of other language versions of the instrument from the earliest days of simultaneous production and translation of the EQ-5D questionnaire to the more recent, broader-based strategy of version management. We describe current adaptation procedures and innovations within those procedures. We also describe how version management is organized within the EuroQol Group, review aspects related to quality control, and provide an overview of the number of currently available language versions for each variant of the EQ-5D questionnaire: three-level, five-level, and youth versions. We conclude by discussing some of the relevant issues related to cultural adaptation for frequently used instruments such as the EQ-5D questionnaire.     

Development and Rasch analysis of the Assessment of Computer-Related Skills

The purpose of this study is to evaluate the internal scale validity, person response validity, and reliability of the newly developed Assessment of Computer-Related Skills (ACRS). Data from 32 healthy adult participants who performed two to three computer tasks were analysed to determine how well the participants fitted the many-faceted Rasch (MFR) model of the ACRS, as well as how well the ACRS skill items and tasks (a) fitted the MFR model of the ACRS, (b) matched the expectations for hierarchical ordering of their difficulties, and (c) differentiated persons into different levels of ability. Results indicated that with three skill items removed, the remaining 34 skill items, 8 computer tasks, and 30 participants demonstrated goodness-of-fit to the MFR model of the ACRS. The skills and tasks appeared to have logical hierarchical ordering and differentiated participants into at least three levels of ability. The findings affirmed the internal scale validity, person response validity and reliability of the ACRS for assessing persons’ computer abilities. Future studies using a larger sample that includes individuals with disabilities and with difficulties with computer use are needed to further evaluate the validity and reliability of the ACRS.     

Assessing Emotional Functioning with Increased Power: Relative Validity of a Customized EORTC Short Form in the International ACTION Trial

Objectives

There is a need to improve the assessment of emotional functioning (EF). In the international Advance Care Planning: an Innovative Palliative Care Intervention to Improve Quality of Life in Cancer Patients - a Multi-Centre Cluster Randomized Clinical Trial (ACTION) trial involving patients with advanced cancer, EF was assessed by a customized 10-item short form (EF10). The EF10 is based on the European Organisation for Research and Treatment of Cancer (EORTC) EF item bank and has the potential for greater precision than the common EORTC Quality of Life Questionnaire Core 30 four-item scale (EF4). We assessed the relative validity (RV) of EF10 compared with EF4.

Further Validation and Responsiveness Assessment of the Herpes Outbreak Impact Questionnaire and Herpes Symptom Checklist

Objective:  The Herpes Outbreak Impact Questionnaire (HOIQ) and Herpes Symptom Checklist (HSC) are patient-completed questionnaires for assessing genital herpes outbreaks. This report describes the validation of paper-and-pencil versions of the scales and responsiveness assessments in an Australian clinical trial.
Methods:  Acceptability of the language of the original UK versions was tested with Australians. The HOIQ and HSC were then field-tested with patients. The new versions were validated using patients' daily responses to the questionnaires in a famciclovir study.
Results:  The HOIQ and HSC were readily adapted into Australian English and were acceptable to patients. Psychometric sample: N = 151; 81 (54%) male; mean age 39.9 ± 11.6 years; mean outbreaks 5.1 ± 3.0 per year. Internal consistency was good (alphas at outbreak 1 ranged 0.84–0.90 HOIQ and 0.73–0.87 HSC). Rasch analysis showed item stability over time. Correlations between HOIQ and HSC ranged from 0.46 to 0.60. Both scales distinguished outbreak healing presence or absence at day 6 ( P  = 0.001), and the HOIQ scale distinguished between symptom severity groups ( P  < 0.001). Scale scores declined significantly over study duration, exhibiting large effect sizes.
Conclusions:  The paper-and-pencil HOIQ and HSC were reliable, valid, and responsive in a clinical trial setting. These instruments are recommended for use in clinical studies.     

200例开放性手外伤分析

目的探讨手外伤的早期处理方法。方法收集2007年1月～2009年6月在本院治疗的200例手外伤患者,在伤后0.5～12h进行手术治疗,术后进行康复治疗,观察其疗效。结果所有患者均成功手术,经康复治疗后,6个月后复诊,手的总主动活动度及皮肤感觉均较治疗前有明显好转,P<0.01。结论对开放性手外伤患者应根据伤情选择手术方法,早期正确处理,并配合术后功能锻炼能最大限度改善和保留手的功能。