TY - JOUR A1 - Prodinger, Birgit A1 - Küçükdeveci, AA A1 - Kutlay, S A1 - Elhan, AH A1 - Kreiner, S A1 - Tennant, A T1 - Cross-diagnostic scale-banking using Rasch analysis: Developing a common reference metric for generic and health condition-specific scales in people with rheumatoid arthritis and stroke. JF - Journal of Rehabilitation Medicine N2 - Abstract Objectives: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions. Design: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ), and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model. Participants: Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke. Results: Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created. Conclusion: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0). Keywords: FIM; Functional Independence Measure; HAQ; Health Assessment Questionnaire; WHODAS 2.0; World Health Organization Disability Assessment Schedule; outcome assessment; rheumatoid arthritis; stroke; psychometrics. KW - FIM; Functional Independence Measure; HAQ; Health Assessment Questionnaire; WHODAS 2.0; World Health Organization Disability Assessment Schedule; outcome assessment; rheumatoid arthritis; stroke; psychometrics. Y1 - 2020 UR - https://doi.org/10.2340/16501977-2736 ER - TY - JOUR A1 - Prodinger, Birgit A1 - O'Connor, R.J. A1 - Stucki, G. A1 - Tennant, A. T1 - Establishing score equivalence of the Functional Independence Measure (FIM™) motor scale and the Barthel Index, utilising the International Classification of Functioning, Disability and Health (ICF) and Rasch Measurement Theory JF - Journal of Rehabilitation Medicine N2 - Introduction: Two widely used outcome measures to assess functioning in neurological rehabilitation are the Functional Independence Measure (FIM™) and the Barthel Index. The current study aims to establish the equivalence of the total score of the FIM™ motor scale and the Barthel Index through the application of the International Classification of Functioning, Disability and Health, and Rasch measurement theory. Methods: Secondary analysis of a large sample of patients with stroke, spinal cord injury, and multiple sclerosis, undergoing rehabilitation was conducted. All patients were assessed at the same time on both the FIM™ and the Barthel Index. The International Classification of Functioning, Disability and Health Linking Rules were used to establish conceptual coherency between the 2 scales, and the Rasch measurement model to establish an exchange of the total scores. Results: Using the FIM™ motor scale, items from both scales linked to the International Classification of Functioning, Disability and Health d4 Mobility or d5 Self-care chapters. Their co-calibration satisfied the assumptions of the Rasch model for each of 3 diagnostic groups. A ceiling effect was observed for the Barthel Index when contrasted against the FIM™ motor scale. Conclusion: Having a Rasch interval metric to transform scores between the FIM™ motor scale and Barthel Index is valuable for monitoring functioning, meta-analysis, quality audits and hospital benchmarking. KW - International Classification of Functioning KW - Disability and health KW - ICF KW - Outcome measures KW - Patient outcome assessment Y1 - 2017 UR - https://doi.org/10.2340/16501977-2225 VL - 49 IS - 5 SP - 416 EP - 422 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Tennant, A. A1 - Stucki, G. A1 - Cieza, A. A1 - Üstün, T.B. T1 - Harmonizing routinely collected health information for strengthening quality management in health systems: requirements and practice JF - Journal of Health Services Research & Policy N2 - Objective Our aim was to specify the requirements of an architecture to serve as the foundation for standardized reporting of health information and to provide an exemplary application of this architecture. Methods The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) served as the conceptual framework. Methods to establish content comparability were the ICF Linking Rules. The Rasch measurement model, as a special case of additive conjoint measurement, which satisfies the required criteria for fundamental measurement, allowed for the development of a common metric foundation for measurement unit conversion. Secondary analysis of data from the North Yorkshire Survey was used to illustrate these methods. Patients completed three instruments and the items were linked to the ICF. The Rasch measurement model was applied, first to each scale, and then to items across scales which were linked to a common domain. Results Based on the linking of items to the ICF, the majority of items were grouped into two domains, Mobility and Self-care. Analysis of the individual scales and of items linked to a common domain across scales satisfied the requirements of the Rasch measurement model. The measurement unit conversion between items from the three instruments linked to the Mobility and Self-care domains, respectively, was demonstrated. Conclusions The realization of an ICF-based architecture for information on patients’ functioning enables harmonization of health information while allowing clinicians and researchers to continue using their existing instruments. This architecture will facilitate access to comprehensive and consistently reported health information to serve as the foundation for informed decision-making. KW - Decision making KW - Health classification KW - Health status measurement KW - Information standards KW - Quality management Y1 - 2016 UR - https://doi.org/10.1177/1355819616636411 VL - 21 IS - 4 SP - 223 EP - 228 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Ballert, C.S. A1 - Brinkof, M. W. G. A1 - Tennant, A. A1 - Post, M. W. M. T1 - Metric properties of the Spinal Cord Independence Measure - Self Report in a community survey JF - Journal of Rehabilitation Medicine N2 - Objective: The Spinal Cord Independence Measure – Self Report (SCIM-SR) is a self-report instrument for assessing functional independence of persons with spinal cord injury. This study examined the internal construct validity and reliability of the SCIM-SR, when administered in a community survey, using the Rasch measurement model. Methods: Rasch analysis of data from 1,549 individuals with spinal cord injury who completed the SCIM-SR. Results: In the initial analysis no fit to the Rasch model was achieved. Items were grouped into testlets to accommodate the substantial local dependency. Due to the differential item functioning for lesion level and degree, spinal cord injury-specific sub-group analyses were conducted. Fit to the Rasch model was then achieved for individuals with tetraplegia and complete paraplegia, but not for those with incomplete paraplegia. Comparability of ability estimates across sub-groups was attained by anchoring all sub-groups on a testlet. Conclusion: The SCIM-SR violates certain assumptions of the Rasch measurement model, as shown by the local dependency and differential item functioning. However, an intermediate solution to achieve fit in 3 out of 4 spinal cord injury sub-groups was found. For the time being, therefore, it advisable to use this approach to compute Rasch-transformed SCIM-SR scores. KW - Functional status KW - Independence KW - Psychometrics KW - Reliability KW - Spinal cord injury Y1 - 2016 UR - https://doi.org/10.2340/16501977-2059 VL - 48 IS - 2 SP - 149 EP - 164 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Hammond, A. A1 - Tennant, A. A1 - Prior, Y. A1 - Tyson, S. T1 - Revisiting the disabilities of the arm, shoulder and hand (DASH) and QuickDASH in rheumatoid arthritis JF - BMC Musculoskeletal Disorder N2 - Background Limitations in upper limb functioning are common in Musculoskeletal disorders and the Disabilities of the Arm, Shoulder and Hand scale (DASH) has gained widespread use in this context. However, various concerns have been raised about its construct validity and so this study seeks to examine this and other psychometric aspects of both the DASH and QuickDASH from a modern test theory perspective. Methods Participants in the study were eligible if they had a confirmed diagnosis of Rheumatoid Arthritis (RA). They were mailed a questionnaire booklet which included the DASH. Construct validity was examined by fit to the Rasch measurement model. The degree of precision of both the DASH and QuickDASH were considered through their Standard Error of Measurement (SEM). Results Three hundred and thirty-seven subjects with confirmed RA took part, with a mean age of 62.0 years (SD12.1); 73.6% (n = 252) were female. The median standardized score on the DASH was 33 (IQR 17.5–55.0). Significant misfit of the DASH and QuickDASH was observed but, after accommodating local dependency among items in a two-testlet solution, satisfactory fit was obtained, supporting the unidimensionality of the total sets and the sufficiency of the raw (ordinal or standardized) scores. Conclusion Having accommodated local response dependency in the DASH and QuickDASH item sets, their total scores are shown to be valid, given they satisfy the Rasch model assumptions. The Rasch transformation should be used whenever all items are used to calculate a change score, or to apply parametric statistics within an RA population. Significance and innovations Most previous modern psychometric analyses of both the DASH and QuickDASH have failed to fully address the effect of a breach of the local independence assumption upon construct validity. Accommodating this problem by creating ‘super items’ or testlets, removes this effect and shows that both versions of the scale are valid and unidimensional, as applied with a bi-factor equivalent solution to an RA population. The Standard Error of Measurement of a scale can be biased by failing to take into account the local dependency in the data which inflates reliability and thus making the SEM appear better (i.e. smaller) than the true value without bias. KW - disabilities of the arm, shoulder and hand Y1 - 2019 UR - https://doi.org/10.1186/s12891-019-2414-6 VL - 20 IS - 1 SP - 41 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Coenen, Michaela A1 - Hammond, Alison A1 - Küçükdeveci, Ayşe A. A1 - Tennant, Alan T1 - Scale Banking for Patient-Reported Outcome Measures That Measure Functioning in Rheumatoid Arthritis: A Daily Activities Metric JF - Arthritis Care & Research N2 - Objective Functioning is an important outcome for the management of rheumatoid arthritis (RA). Heterogeneity of respective patient-reported outcome measures (PROMs) challenges direct comparisons between their results. This study aimed to standardize reporting of such PROMs measuring functioning in RA to facilitate comparability. Methods Common-item nonequivalent group design with the Health Assessment Questionnaire (HAQ) as a common scale across data sets from various countries (including the UK, Turkey, and Germany) to establish a common metric was used. Other PROMs included are the physical function items of the Multidimensional HAQ (MDHAQ), the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the World Health Organization Disability Assessment Schedule II (WHODAS II), the Medical Outcomes Study Short Form 36 (SF-36) health survey, and 4 short forms (20, 10, 6, and 4 physical function items) from the Patient-Reported Outcomes Measurement Information System. As the HAQ includes mobility, self-care, and domestic life items, this study focuses on these 3 domains. PROMs were described using standard error of measurement (SEM) and smallest detectable difference (SDD). A Rasch measurement model was used to create the common metric. Results The range of the SEM was 0.2 (MDHAQ) to 7.4 (SF-36 health survey physical functioning domain). The SDD revealed a range from 9.7% (WOMAC rating scale) to 33.5% (WHODAS physical functioning domain). PROMs co-calibration revealed fit to the Rasch measurement model. A transformation table was developed to allow exchange between PROM scores. Conclusion Scores between the daily activity PROMs commonly used in RA can now be compared. Factors such as SEM and SDD help to determine the choice of a PROM in clinical practice and research. KW - rheumatoid arthritis KW - patient-reported outcome measures Y1 - 2022 UR - https://doi.org/10.1002/acr.24503 VL - 74 IS - 4 SP - 579 EP - 587 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Coenen, M A1 - Hammond, A A1 - Küçükdeveci, AA A1 - Tennant, A T1 - Scale-Banking for Patient Reported Outcome Measures (PROMs) Measuring Functioning in Rheumatoid Arthritis: A Daily Activities Metric JF - Arthritis Care & Research N2 - Objective: Functioning is an important outcome for rheumatoid arthritis (RA) management. Heterogeneity of respective patient-reported outcome measures (PROMs) challenges direct comparisons between their results. This study aimed to standardize reporting of such PROMs measuring functioning in RA to facilitate comparability. Methods: Common Item Non-Equivalent Groups Design (NEAT) with the Health Assessment Questionnaire (HAQ) as a common scale across data sets from various countries (incl. UK, Turkey and Germany) to establish a common metric. Other PROMs included are the Physical Function items of the Multidimensional Health Assessment Questionnaire (MDHAQ), Disabilities of Arm, Shoulder and Hand (DASH), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0), and four short forms (20, 10, 6, and 4 physical function items) from the Patient-Reported Outcomes Measurement Information System (PROMIS). As the HAQ includes mobility, self-care and domestic life items, this study focuses on these three domains. PROMs were described using Standard Error of Measurement (SEM) and Smallest Detectable Difference (SDD). Rasch Measurement model was used to create the common metric. Results: Range of SEM is 0.2 (MDHAQ) to 7.4 (SF36-PF). SDD revealed a range from 9.7 % (WOMAC-RAT) to 33.5 % (WHODAS-PF). PROMs co-calibration revealed fit to the Rasch measurement model. A transformation table was developed to allow exchange between PROMs scores. Discussion: Scores between the Daily Activity PROMs commonly used in RA can now be compared. Factors such as SEM and SDD help determine choice of PROM in clinical practice and research. Keywords: Common metric; DASH; Disability and Health; HAQ; International Classification of Functioning; Multidimensional HAQ; PROMIS-SF; Rasch measurement model; Scale banking; WHODAS 2.0; WOMAC. KW - Common metric; DASH; Disability and Health; HAQ; International Classification of Functioning; Multidimensional HAQ; PROMIS-SF; Rasch measurement model; Scale banking; WHODAS 2.0; WOMAC. Y1 - 2020 UR - https://doi.org/10.1002/acr.24503 VL - Online ahead of print ER - TY - JOUR A1 - Prodinger, Birgit A1 - Coenen, Michaela A1 - Hammond, Alison A1 - Küçükdeveci, Ayse A. A1 - Tennant, Alan T1 - Scale-Banking for Patient Reported Outcome Measures (PROMs) Measuring Functioning in Rheumatoid Arthritis: A Daily Activities Metric JF - Arthritis Care & Research N2 - Objective: Functioning is an important outcome for rheumatoid arthritis (RA) management. Heterogeneity of respective patient-reported outcome measures (PROMs) challenges direct comparisons between their results. This study aimed to standardize reporting of such PROMs measuring functioning in RA to facilitate comparability. Methods: Common Item Non-Equivalent Groups Design (NEAT) with the Health Assessment Questionnaire (HAQ) as a common scale across data sets from various countries (incl. UK, Turkey and Germany) to establish a common metric. Other PROMs included are the Physical Function items of the Multidimensional Health Assessment Questionnaire (MDHAQ), Disabilities of Arm, Shoulder and Hand (DASH), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0), and four short forms (20, 10, 6, and 4 physical function items) from the Patient-Reported Outcomes Measurement Information System (PROMIS). As the HAQ includes mobility, self-care and domestic life items, this study focuses on these three domains. PROMs were described using Standard Error of Measurement (SEM) and Smallest Detectable Difference (SDD). Rasch Measurement model was used to create the common metric. Results: Range of SEM is 0.2 (MDHAQ) to 7.4 (SF36-PF). SDD revealed a range from 9.7 % (WOMAC-RAT) to 33.5 % (WHODAS-PF). PROMs co-calibration revealed fit to the Rasch measurement model. A transformation table was developed to allow exchange between PROMs scores. Discussion: Scores between the Daily Activity PROMs commonly used in RA can now be compared. Factors such as SEM and SDD help determine choice of PROM in clinical practice and research. KW - Common metric KW - DASH KW - HAQ KW - International Classification of Functioning KW - Multidimensional HAQ KW - PROMIS-SF KW - Rasch measurement model KW - Scale banking KW - WHODAS 2.0 KW - WOMAC Y1 - 2020 UR - https://doi.org/10.1002/acr.24503 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Tennant, A. A1 - Stucki, G. T1 - Standardized reporting of functioning information on ICF-based common metrics JF - European Journal of Physical and Rehabilitation Medicine N2 - BACKGROUND: In clinical practice and research a variety of clinical data collection tools are used to collect information on people’s functioning for clinical practice and research and national health information systems. Reporting on ICF-based common metrics enables standardized documentation of functioning information in national health information systems. The objective of this methodological note on applying the ICF in rehabilitation is to demonstrate how to report functioning information collected with a data collection tool on ICF-based common metrics. We first specify the requirements for the standardized reporting of functioning information. Secondly, we introduce the methods needed for transforming functioning data to ICF-based common metrics. Finally, we provide an example. METHODS: The requirements for standardized reporting are as follows: 1) having a common conceptual framework to enable content comparability between any health information; and 2) a measurement framework so that scores between two or more clinical data collection tools can be directly compared. The methods needed to achieve these requirements are the ICF Linking Rules and the Rasch measurement model. Using data collected incorporating the 36-item Short Form Health Survey (SF-36), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Stroke Impact Scale 3.0 (SIS 3.0), the application of the standardized reporting based on common metrics is demonstrated. RESULTS: A subset of items from the three tools linked to common chapters of the ICF (d4 Mobility, d5 Self-care and d6 Domestic life), were entered as “super items” into the Rasch model. Good fit was achieved with no residual local dependency and a unidimensional metric. A transformation table allows for comparison between scales, and between a scale and the reporting common metric. CONCLUSIONS: Being able to report functioning information collected with commonly used clinical data collection tools with ICF-based common metrics enables clinicians and researchers to continue using their tools while still being able to compare and aggregate the information within and across tools. KW - International Classification of Functioning, Disability and Health KW - Rehabilitation KW - Delivery of health care Y1 - 2018 UR - https://doi.org/10.23736/S1973-9087.17.04784-0 VL - 54 IS - 1 SP - 110 EP - 117 ER - TY - JOUR A1 - Maritz, R. A1 - Tennant, A. A1 - Fellinghauer, C. A1 - Stucki, G. A1 - Prodinger, Birgit T1 - The Extended Barthel Index (EBI) can Be Reported as a Unidimensional Interval-Scaled Metric – A Psychometric Study JF - Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin N2 - Background: The Extended Barthel Index (EBI), consisting of the original Barthel Index plus 6 cognitive items, provides a tool to monitor patients’ outcomes in rehabilitation. Whether the EBI provides a unidimensional metric, thus can be reported as a valid sum-score, remains to be examined. Objective: To examine whether the EBI can be reported as unidimensional interval-scaled metric for neurological and musculoskeletal rehabilitation. Methods: Rasch analysis of a calibration sample of 800 cases from neurological or musculoskeletal rehabilitation in 2016 in Switzerland. Results: In the baseline analysis no fit to the Rasch Model was achieved. When accommodating local dependencies with a testlet approach satisfactory fit to the Rasch Model was achieved, and an interval scale transformation table was created. Conclusion: The results support the reporting of adapted EBI total scores for both rehabilitation groups by applying the interval scaled transformation table presented in this study. N2 - Hintergrund: Der Erweiterte Barthel Index (EBI), der den Barthel Index um 6 kognitive Items ergänzt, ist ein Assessmentinstrument für die Rehabilitation. Ob der EBI eine eindimensionale Metrik liefert und somit als valider Gesamtscore berichtet werden kann, ist unklar. Ziel: Untersuchung ob der EBI für die neurologische und muskuloskelettale Rehabilitation als eindimensionale intervallskalierte Metrik berichtet werden kann. Methode: Rasch-Analyse einer Stichprobe von 800 neurologischen und muskuloskelettalen Rehapatienten aus der Schweiz. Ergebnisse: In der Basisanalyse wurde keine Übereinstimmung mit den Annahmen des Rasch-Modells erreicht. Nachdem lokale Item-Abhängigkeiten mit 2 Testlets angepasst wurden, wurde die Übereinstimmung erreicht und eine intervallskalierte Transformationstabelle erstellt. Konklusion: Die Ergebnisse unterstützen die Verwendung eines angepassten EBI Gesamtscores für beide Rehabilitationsgruppen unter Anwendung der intervallskalierten Transformationstabelle. KW - activities of daily living KW - assessment instruments KW - outcome assessment KW - rehabilitation KW - Rasch model KW - quality management Y1 - 2019 UR - https://doi.org/10.1055/a-0820-4642 VL - 29 IS - 04 SP - 224 EP - 232 ER -