Measurement Qualities of a Self-Report and Therapist-Scored Functional Capacity Instrument Based on the Dictionary of Occupational Titles

Abstract

Studies provide convincing arguments to support the development of functional capacity instruments based on the Dictionary of Occupational Titles (DOT). The purpose of this study is to investigate the item-level measurement qualities of a newly developed DOT-based functional capacity instrument for clients undergoing rehabilitation treatment for back pain. Client and therapist ratings were collected on 124 clients from 27 rehabilitation sites using the newly developed Occupational Rehabilitation Data Base (ORDB) functional capacity instrument. Rasch analysis was used to investigate: (1) unidimensionality, (2) hierarchical item difficulty continuum, (3) rater severity, and 4) person-item match. Overall, the functional capacity scale of the ORDB showed good measurement qualities. All items, except the Handling item fit the Rasch measurement model. Because of high fit statistics and loading on factors independent from the remainder of the items, the "handling" item was removed, from further analyses. Separate client-rated and therapist-rated instruments retained good item-level psychometrics. While client and therapist items showed similar item-difficulty hierarchical structures, clients had a tendency to be more severe in their rating and the correlation between client and therapist ratings was relatively low, 0.32. These findings suggest that Handling items should not be included as a DOT measure for clients with back pain. While the above psychometric study supports using client or therapist ratings as independent instruments, the lack of concordance between these ratings requires further investigation.