Unidimensionality Assumption Research Articles

The Stroke Upper and Lower Extremity Physical Function Measures Were Supported for Score Reliability, Validity, and Administration Efficiency for Patients Poststroke.

The aims of this study were to (1) evaluate the suitability of newly developed items for calibration into 2 item banks for stroke upper extremity (SUE) and stroke lower extremity (SLE) physical function patient-reported outcome measures (PROMs) and (2) assess score reliability and validity and PROM administration efficiency based on computerized adaptive testing (CAT). A retrospective longitudinal study involving patients poststroke who were treated in outpatient rehabilitation clinics responded to 28 and 25 region-specific candidate items addressing tasks related to upper or lower extremity physical function, respectively. Item response theory model assumptions of unidimensionality, local independence, item fit, and presence of differential item functioning were evaluated. CAT-generated scores were assessed for reliability, validity, and administration efficiency, and 10-item short forms were assessed for reliability. Cohorts consisted of 2017 patients with stroke involving the upper extremity and 2107 patients with stroke involving the lower extremity (mean age [SD]: SUE = 62 [14] and SLE = 63 [14]; range = 14-89). Two solutions (SUE: 28-item; SLE: 24-item) supported unidimensionality and fit to the item response theory model, with reliability estimates >0.93 for all administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways, with better outcomes observed for patients who were younger, were male, had less chronicity, and had fewer comorbidities. The SUE and SLE, respectively, had 1% and 0.3% floor effects and 4.3% and 1.1% ceiling effects. Change score effect sizes were 0.5 (SUE) and 0.6 (SLE). Simulated CAT scores required an average of 6 (SUE) and 5.6 (SLE) items (median = 5). The stroke upper extremity and stroke lower extremity PROM scores were reliable, valid, and efficient and had moderate change effect sizes for assessing physical function as perceived by patients poststroke with upper and lower extremity impairments. Scores had negligible floor and acceptable ceiling effects. Based on these results, the stroke PROMs are suitable for research and routine clinical practice. As item response theory-based measures, these PROMs support clinical practice guideline recommendations for the use of outcome measures in neurologic physical therapy and the administration of condition-specific functional questions with low response burden for patients. The 10-item short forms offer a feasible alternative administration mode when CAT administration is not available.

Developing a common metric using current scales for assessing functioning in patients with knee osteoarthritis.

Various scales exist to assess different domains of functioning in knee osteoarthritis (OA). This study aimed to explore whether it is possible to develop a common metric (CM) from the frequently used scales to assess functioning in knee OA. The methodological study evaluated 411 patients (81 males, 330 females; mean age: 61.8±10.5 years; range, 41 to 88 years) with knee OA. Data from the Health Assessment Questionnaire, Oxford Knee Score, Medical Outcomes Study Short Form 36, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Arthritis Index, and the Nottingham Health Profile were used, and the items focusing on self-care, mobility, and domestic activity domains based on the activities and participation component of the International Classification of Functioning, Disability, and Health were included. Concurrent calibration was performed to combine the items of the scales. The CM parameters were estimated using the Rasch measurement model. Reliability was assessed using the person separation index. The CM was utilized to generate a transformation table to convert the scale scores to each other based on the reference metric score. Each scale fitted the Rasch model. Item invariance was achieved for the CM (p=0.775). The CM had a person separation index of 0.827. Age, sex, and disease duration did not cause difference in item functions. The CM satisfied the assumptions of unidimensionality and local independence. A reliable CM was created from the commonly used scales to measure functioning in individuals with knee OA. Thus, clinicians and researchers can refer to the transformation table to directly compare scores of those scales and use them interchangeably.

Psychometric properties and general population reference values for PROMIS Global Health in Hungary

ObjectivesPatient-Reported Outcomes Measurement Information System–Global Health (PROMIS-GH) is a widely used generic measure of health status. This study aimed to (1) assess the psychometric properties of the Hungarian PROMIS-GH and to (2) develop general population reference values in Hungary.MethodsAn online cross-sectional survey was conducted among the Hungarian adult general population (n = 1700). Respondents completed the PROMIS-GH v1.2. Unidimensionality (confirmatory factor analysis and bifactor model), local independence, monotonicity (Mokken scaling), graded response model fit, item characteristic curves and measurement invariance were examined. Spearman’s correlations were used to analyse convergent validity of PROMIS-GH subscales with SF-36v1 composites and subscales. Age- and gender-weighted T-scores were computed for the Global Physical Health (GPH) and Global Mental Health (GMH) subscales using the US item calibrations.ResultsThe item response theory assumptions of unidimensionality, local independence and monotonicity were met for both subscales. The graded response model showed acceptable fit indices for both subscales. No differential item functioning was detected for any sociodemographic characteristics. GMH T-scores showed a strong correlation with SF-36 mental health composite score (rs = 0.71) and GPH T-scores with SF-36 physical health composite score (rs = 0.83). Mean GPH and GMH T-scores of females were lower (47.8 and 46.4) compared to males (50.5 and 49.3) (p < 0.001), and both mean GPH and GMH T-scores decreased with age, suggesting worse health status (p < 0.05).ConclusionThis study established the validity and developed general population reference values for the PROMIS-GH in Hungary. Population reference values facilitate the interpretation of patients’ scores and allow inter-country comparisons.

Rasch Calibration and Differential Item Functioning (DIF) Analysis of the Indonesian National Assessment Program-Language (INAP-L)

This study aimed to evaluate the psychometric properties of the INAP-L instrument by applying the Rasch model. The psychometric evaluation includes item calibration and differential item functioning (DIF) assessment. Participants in this study were 6153 high school students (2326 boys and 3827 girls) aged 14-19 years (mean age = 15.76, SD = 0.78) from 280 schools spread across 34 provinces in Indonesia. The results of the Rasch model analysis show that the assumptions of unidimensionality and local independence are met. The internal consistency analysis of the INAP-L instrument (PSR = 0.80; Ordinal α = 0.81) and item-person targeting showed quite good results. At the item level, it was discovered that four of the forty items did not fit the Rasch model. Meanwhile, the gender-based DIF analysis revealed that all items were free from gender DIF and that two out of forty items showed DIF based on school type. It can be concluded that the INAP-L instrument has good psychometric properties. Furthermore, multilevel analysis was performed to determine the effect of clustering in the data, and it was discovered that INAP-L has a multilevel data structure with ICC = 0.185 and a design effect &gt; 2.00. This means that future research on the relationship among variables on the INAP-L score must consider a multilevel approach. Even though the developer has already published an interim report on INAP-L, the findings of this study can be used as a reference in improving the instrument before conducting INAP-L in the future.

Rasch Analysis of Joint Replacement Version for Hip Disability and Osteoarthritis Outcome in Individuals With Advanced Osteoarthritis of Hip Awaiting Total Hip Arthroplasty Surgery

ObjectiveThe objective of this study was to examine measurement properties of the Joint replacement version for Hip Disability and Osteoarthritis Outcome Score (HOOS-JR) using Rasch analysis in patients with osteoarthritis of hip (HOA). DesignCross-sectional clinical measurement SettingPatient outcomes database at a tertiary care hospital ParticipantsConvenience sampling of patients with HOA scheduled for total hip arthroplasty (N=327) Outcome Measures and AnalysisThe data for pre-surgery assessments for patients with HOA were extracted from an existing database. Variables extracted included HOOS-JR scores, demographic information (age, sex), health-related data, and anthropometric variables. The assumptions of Rasch model such as the test of fit, fit residuals, ordering of item thresholds, factor structure, DIF, internal consistency and Pearson separation index were examined for the HOOS-JR scores. ResultsThe HOOS-JR showed adequate overall fit to the Rasch model, logically ordered response thresholds, no floor or ceiling effects, and high internal consistency (Cronbach's alpha of 0.91). The HOOS-JR did not satisfy the assumption of unidimensionality, albeit the violation of this assumption was marginal (6.12% over 5%). Person-item threshold distribution (difference between person and item means were equal to 0.92 which was less than 1 logit unit) confirmed that the HOOS-JR scores were well targeted. ConclusionsGiven that the violation of unidimensionality for HOOS-JR was marginal, we recommend further studies to validate this finding. Results broadly support the use of HOOS-JR for assessing hip health in patients with HOA.

Reliability, Validity, and Efficiency of an Item Response Theory-Based Balance Confidence Patient-Reported Outcome Measure.

The aims of this study were to calibrate the original 16 items from the Activities-specific Balance Confidence (ABC) Scale to create an item response theory (IRT)-based item bank and scoring metric of balance confidence (BC) and to assess psychometric properties of a computerized adaptive test (BC-CAT) and 6-item short-form (BC-SF) administration modes. This retrospective study included data from patients who were treated in outpatient rehabilitation clinics and assessed for balance impairments by responding to the full ABC Scale at intake. IRT model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning (DIF) were evaluated. BC-CAT-generated scores were assessed for reliability, validity, and administration efficiency, and the newly developed BC-SF was assessed for reliability. Total cohort included 20,354 patients (mean age [SD] = 66 [16] y; range = 14-89). All 16 items were retained in the final item bank based on support for unidimensionality and fit to the IRT model. No items demonstrated DIF. Reliability estimates were 0.95, 0.96, and 0.98 for the BC-SF, BC-CAT, and the full item bank, respectively. Scores discriminated among patient groups in clinically logical ways. After controlling for scores at intake, better outcomes were achieved for patients who were younger, had more acute symptoms, exercised more, and had fewer comorbidities. Scores were responsive to change with a moderate effect size, with negligible floor and ceiling effects. CAT scores were generated using an average of 4.7 items (median = 4) and correlated highly with full-bank scores (Pearson correlation coefficient = 0.99). The IRT-based BC patient-reported outcome measure (PROM) was reliable, valid, moderately responsive to change, and efficient, with excellent score coverage. The measure is suitable for research and routine clinical administration using the BC-CAT or BC-SF administration modes. The full ABC Scale can be administered for increased clinical content when appropriate. The newly developed BC patient-reported outcome measure (PROM) was reliable and valid for assessing perceived balance confidence. In addition, the BC PROM has efficient administration modes with low patient response burden, which enhances feasibility and use during routine clinical practice in busy rehabilitation settings. This study supports a transition to PROMs that are based on modern measurement approaches to achieve the combined benefits of high accuracy and efficiency.

The use of measurement frameworks to explore the qualities of test items

&lt;span lang="EN-US"&gt;Psychometricians and researchers have grown increasingly concern about students’ performance. It is noteworthy from observation in the selected university of education in Nigeria that many of these students do not attend lectures for general courses particularly EDU 222 (tests and measurement) due to overcrowded lecture halls, the classroom climate factor, and other latent factors, such as exam conditions, test anxiety among others. Consequently therefore, students’ performance in EDU 222 does not significantly correlate with these challenges. The characteristics of the item parameter of the Tests and Measurement achievement test at the selected University of Education in Ogun State, Nigeria, were therefore examined in this study using measurement theories. The study employed an ex-post facto research of non-experimental design. Purposive sampling was used to select 6,203 second-year undergraduates offering EDU 222 for the 2018/2019 academic year. To analysis students’ responses to 30 multiple-choice questions on tests and measurement, factor analysis, item calibration, an independent sample t-test with a significance threshold of 0.05 were utilized with empirical reliability of 0.64. The results showed the test items satisfied the three-parameter logistics model and uni-dimensionality assumption. The findings also showed that the item response theory (IRT) eliminated 7 items due to guessing, while the classical test theory (CTT) eliminated 13 items. The test is prone to guessing, thus, helps pupils do better on the exam. To establish parameter estimates during test development, higher education institutions (HEIs) should employ the use of IRT.&lt;/span&gt;

Rasch analysis of the International Personality Item Pool Big Five Markers Questionnaire: Is longer better?

The 50-item International Personality Item Pool version of the Big Five Markers (IPIP-BFM) is an open-source and widely used measure of the big five personality traits. A short version of this measure (IPIP-BFM-25) has been developed using the classical test theory approach. No study was performed to examine the psychometric properties of a longer and shorter version of IPIP-BFM Indonesia using modern test theory. This study aimed to evaluate the psychometric properties of the Indonesian version of IPIP-BFM as well as IPIP-BFM-25 using Rasch analysis. The analysis was conducted in order to test their dimensionality, rating scale functioning, item properties, person responses, targeting, reliability, and item bias on 1003 Indonesian samples. The findings showed that both IPIP-BFM and IPIP-BFM-25 Indonesia have some adequate psychometric properties, especially regarding category function, item properties, reliability, and item bias. However, the emotional stability and intellect scales did not meet the assumption of unidimensionality, and all items on the scales were too easy to endorse by participants. In general, longer measures outperformed shorter measures in terms of person separation and reliability. Further testing and refinement must be conducted.

Validation of the Comprehensive Inventory of Mindfulness Experiences (CHIME) in English Using Rasch Methodology

ObjectivesAlthough mindfulness has been studied for multiple decades, psychometric research has yet to agree upon the optimal way to measure the mindfulness construct. Prior research has identified eight distinct aspects of mindfulness that were not adequately captured by any of the available measures. Hence, the Comprehensive Inventory of Mindfulness Experiences (CHIME) was developed. The CHIME contains 37 items and was originally developed in the German language. The CHIME has demonstrated excellent psychometric properties in both German and Dutch, but so far, no English version has been validated. The purpose of the present study was to investigate the psychometric characteristics of the translated English-language CHIME scale using Rasch methodology.MethodThe current study utilized Partial Credit Rasch analysis to evaluate the psychometric characteristics of the English CHIME. The sample included responses from 620 participants from the general population residing in the USA. The validity of the English CHIME was examined by correlating its scores with various measures of mindfulness and psychological functioning.ResultsInitial Rasch analysis of the English CHIME showed poor model fit, local dependency, and evidence against the assumption of unidimensionality. Several minor modifications, that involved creating super-items, were required to fit the Rasch model (χ2(45)=31.99, p=0.93). This model displayed evidence of unidimensionality, invariance across personal factors, and a high reliability (PSI=0.92). Ordinal-interval transformation tables were produced, which increase the English CHIME’s precision of measurement. The English CHIME’s external validity was established by moderate–high correlations with other measures of mindfulness and various measures of psychological functioning.ConclusionsThe results of this study provide evidence for the validity of the English CHIME scale, which can be used to assess the overarching construct of mindfulness.

Test results with and without blueprinting: Psychometric analysis using the Rasch model

IntroductionThe test blueprint bridges the teaching, learning, and assessment processes. It describes what to measure in which learning domain and at what competency level. We used Rasch analysis to compare the test results and item response patterns of two uro-reproductive tests. The Fall-2020 (Test one) exam was developed without a test blueprint, while the Fall-2021 (Test two) exam used a test blueprint. MethodsThe study analyzed data from 143 Sultan Qaboos University medical students who passed the course in fall 2020 and fall 2021. 25 MCQs were chosen at random. Psychometric analysis was performed using the Rasch model. Means, measurement errors, and reliability indices were calculated. Rasch's dichotomous model computed PCAR for unidimensionality, local item independence, person separation estimate, and fit statistics for item conformity. ResultsBoth tests exhibited non-significant variations in test scores, person separation indices (PSI), and item reliability. On test two, item separation measures showed three difficulty levels. Unidimensionality assumptions were validated in both tests. Test one items 16 and 18 were 0.53 intercorrelated, indicating response dependence. Both tests produced acceptable infit statistics, with 8 items in test one and 6 in test two unfitting for the outfit range (0.7--1.3). Test two ICC had a wider range of item difficulty. The item-person map showed that students' abilities are greater than item difficulties in both tests, with a wider range of abilities in test two. ConclusionsPsychometrically sound tests require test blueprints. The Rasch model analyzes test psychometrics effectively. Test score accuracy, item differentiation, and item independence improved with blueprinting. Creating a test with a high correlation between item difficulty and student ability reduced score measuring errors. General research should examine blueprinting methods and educational milestones.

Screening for mental health and its correlates in criminal justice settings: is the inclusion of general personality and antisocial traits leading to biased estimation?

ABSTRACT Replication in the social sciences is a necessary but oft-forgotten reality. In the Australian context, cross-cultural replication is an uncommon and relatively scarce practice. This study provides the first detailed analysis of the Corrections Mental Health Screen (Male) in an Australian setting. Using data for a national sample of 620 male police detainees interviewed as part of the Drug Use Monitoring in Australia (DUMA) program, our objective is to examine the scale’s item-level characteristics in a cross-cultural context, as well as to explore the consequences of a violation of the assumption of unidimensionality. Our results confirm that all 12 items of the CMHS-M are significantly correlated and exhibit strong internal consistency, although several items are relatively uninformative in these Australian data. The item measuring prior experience of psychiatric hospitalisation is particularly uninformative, while items which measure general psychological and antisocial traits (such as the lack of empathy, impulsivity, and interpersonal conflict) are likely to confound measurement in criminal justice settings. A two-dimensional model proves to be a superior fit and has implications for the estimation of the relationship between mental health, crime, and race.

Testing the social mindfulness paradigm: Longitudinal evidence of its unidimensionality, reliability, validity, and replicability in a sample of health care providers.

Social mindfulness is a relatively new concept in psychological research and is attracting increasing attention. Recent studies have provided evidence of its relevance with regard to prosocial behavior and empathy, but also concerning individual well-being and psychological health. In such studies, social mindfulness has been assessed using the social mindfulness paradigm by Van Doesum and colleagues, which is the standard measure of social mindfulness to date. However, evidence is scarce or lacking with regard to whether this measurement approach is unidimensional, whether it produces (test-retest) reliable and valid measurements, and whether its associations with personality and empathy are replicable. To test these assumptions, we assessed a sample of 265 participants currently working in health care professions on social mindfulness, several concepts of empathy, and the HEXACO personality dimensions longitudinally at two measurement occasions. The results supported the assumption of unidimensionality of the measure. Partial support was found for its reliability, validity, and replicability. Test-retest reliability was acceptable, but the associations with personality and empathy turned out weaker than expected. The social mindfulness paradigm is an interesting approach toward understanding social mindfulness, meaning mindfulness of other people's needs. Potential directions for the further development of the social mindfulness paradigm and its network of relations, especially to empathy, are discussed.

Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models.

The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data. Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n=98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points. The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points. Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.

A multilevel, multidimensional scale for measuring housing insecurity in slums and informal settlements

Housing insecurity is a pervasive challenge in the cities and urban areas of low-and middle-income countries, particularly in the informal settlements where a disproportionately high number of urban residents live. Despite this persistent challenge and its impact on health and well-being, there are scarce comprehensive, standardized, and validated instruments for measuring housing insecurity in these regions. Therefore, our objectives were to develop and validate a housing insecurity scale for slums and informal settlements in the global South. Using a complementary set of qualitative and quantitative techniques, we developed the scale from data collected from three slums in Ghana (N = 1036) on housing deprivations and characteristics, slum severity, resource insecurity, health outcomes, and socio-demography. Following item generation, domain identification, and content validation, we identified a set of 28 items, which were tested for tetrachoric and Biserial correlations. We then extracted an optimal number of factors and tested for dimensionality using confirmatory factor analysis and second-order confirmatory factor analysis. This was followed by tests of reliability, external validity, unidimensionality of sub-scales, local independence, invariant item ordering, and monotonicity. The resultant scale is a multilevel, multidimensional scale comprising 17 items that subdivide into three sub-scales: lack of essential utility (α = 0.63), built environment deficiency (α = 0.80), and tenancy challenges (α = 0.82). The composite scale is reliable, with a coefficient alpha of 0.83. Criterion concurrent and predictive validity, convergent and discriminant validity, and known group comparisons supported the validity of the scale. Assumptions of sub-scale unidimensionality, local independence, invariant item ordering, and monotonicity were verified. This is one of the few comprehensively validated scales developed to measure housing insecurity in slums and informal settlements in the global South. It can be used to test different hypotheses on the impact of housing insecurity on several environmental and health outcomes; assess and plan clinical, programmatic and policy interventions; and aid in tracking progress made on the Sustainable Development Goal 11. • A novel scale for measuring housing insecurity in urban slums in the global south • Housing insecurity is multidimensional consisting of three domains and 17 items. • The housing insecurity measure was assessed to be reliable and validated. • Housing insecurity increases slum severity and other forms of resource insecurity. • We can now assess the causes and effects of housing insecurity in urban slums.

Differential Item Functioning of the Jaw Functional Limitation Scale

To assess the differential item functioning (DIF) of the Jaw Functional Limitation Scale (JFLS) due to gender, age, and language (English vs Spanish). JFLS data were collected from a consecutive sample of 2,115 adult dental patients from HealthPartners dental clinics in Minnesota. Participants with missing data were excluded, and analyses were performed using data from 1,678 participants. Whether the item response theory (IRT) model assumptions of essential unidimensionality and local independence held up for the JFLS was examined. Then, using Samejima's graded response model, the IRT log-likelihood ratio approach was used to detect DIF. The magnitude and impact of DIF based on Raju's noncompensatory DIF (NCDIF) cutoff value of 0.096, Cohen's effect sizes, and test (or scale) characteristic curves were also assessed. Essential unidimensionality was confirmed, but locally dependent items were found on the JFLS. A few items were flagged with statistically significant DIF after adjustment for multiple comparisons. The NCDIF indices associated with all DIF items were < 0.096, and they had small effect sizes of ≤ 0.2. The differences between the expected scores shown in the test characteristic curves were little to none. The present results support the use of the JFLS summary score to obtain psychometrically robust score comparisons across English- and Spanish-speaking, male and female, and younger and older dental patients. Overall, the magnitude of DIF was relatively small, and the practical impact minimal.

Two is Better than One? Testing a Deductive MARPOR-based Left-Right Index on Western Europe (1999-2019)

Most of the existing indexes measuring parties’ left-right positions through Manifesto Project (MARPOR) data, including the ‘RILE’, share a partially or fully inductive nature and an underlying assumption of left-right unidimensionality. However, as the structure of party competition in contemporary Western Europe has been recently moving away from traditional ‘left-libertarian/right-authoritarian’ patterns, the inductive and unidimensional characteristics of such instruments may hinder the quality of their measurements. In this article, I introduce and develop a new left-right instrument, which is wholly deductive and relies on an explicit linkage with theoretical sources in the conceptualisation of economic and cultural left and right as the basis for the subsequent index operationalisation through the justified selection of MARPOR items. After deriving the individual deductive economic and cultural left-right scores and employing them in the mathematical formalisation of a synthetic left-right measure to be compared with existing unidimensional instruments, I perform a comparison between the new left-right index and the RILE. Both instruments are empirically tested on a dataset made covering the 20-year period between 1999 and 2019 in 16 Western European countries, for a total of 72 elections and 474 party-election combinations. More specifically, the statistical probes take the form of rank correlation analyses between the election-specific left-right rankings of each index and those provided by the external benchmark of the “Chapel Hill Expert Survey” (CHES). Results are mixed and indicate that, whilst more traditional patterns of competition seem to still apply across the board in pre-Great-Recession years, the new left-right index is a more valid measure of parties’ left-right positions both in the ‘turbulent times’ of the 2010s and in the vast majority of the areas across the region. This is especially true in Southern Europe, for which the RILE is known to be particularly problematic. Hence, this work calls for further discussion on the different patterns of Western European party competition across space and time, as well as differentiated and context-specific deductive left-right measurement.

New Item-response Theory-based Dizziness Impact Measures Were Reliable, Valid, and Efficient

<h3>Research Objectives</h3> Calibrate items from the Dizziness Handicap Inventory (DHI) patient-reported outcome measure (PROM) to create an item response theory (IRT)-based item bank and assess its reliability, validity, and efficiency using computerized adaptive test (CAT) and short form (SF) administration modes. <h3>Design</h3> A retrospective cohort including data from patients assessed for dizziness. <h3>Setting</h3> Outpatient rehabilitation. <h3>Participants</h3> Total cohort consisted of 28,815 adult patients [69% female; mean age (SD) 60 (18)] treated in 976 clinics from 49 states (USA) for either vertigo, brain injury, or neck impairments who responded to all 25 DHI items at intake. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> IRT model assumptions of local independence, unidimensionality, item fit, and absence of differential item functioning (DIF) were evaluated. CAT and SF T-scores (mean=50, SD=10) were assessed for reliability, validity, and administration efficiency. Score known-groups validity was assessed for the ability to discriminate among patient groups by demonstrating expected differing levels of dizziness impact. Floor and ceiling effects were assessed, and responsiveness was evaluated using an effect-size statistic. <h3>Results</h3> Three unidimensional item sets were identified, creating 3 distinct PROMs to assess functional (DF; 13 items), positional (DP; 4 items), and emotional (DE; 6 items) status (higher score=lower impact). Each item fit its IRT model. Reliability estimates were 0.72 to 0.92. Except for DIF by age group for DF and DE, no items were flagged for DIF, with negligible DIF impact. Scores discriminated between patient groups in clinically expected ways. Floor and ceiling effects were acceptable (< 15%) excepting a floor effect for the positional PROM (21.4%). Effect sizes were large (>0.8). A CAT was developed for DF, administering an average of 8.3 items (median=9, range 5 to 10). <h3>Conclusions</h3> The 3 dizziness PROMs demonstrated moderate to high reliability, were valid, highly responsive to change; thus, they are suitable for routine clinical administration. <h3>Author(s) Disclosures</h3> Dr. Kallen consults for Net Health Systems, Inc., that owns the Focus on Therapeutic Outcomes (FOTO) Patient Outcomes system that gathers and manages the data analyzed. The authors have no other conflicts to declare.

Reliability, Validity and Efficiency of an Item Response Theory-based Balance Confidence Patient Reported Outcome Measure

<h3>Research Objectives</h3> To calibrate items from the original 16-item Activities-Specific Balance Confidence (ABC) Scale to create an item response theory (IRT)-based item bank and scoring metric and assess its reliability, validity, and efficiency using computerized adaptive test (CAT) and short form (SF) administration modes. <h3>Design</h3> Retrospective cohort; data from patients assessed for balance impairments. <h3>Setting</h3> Outpatient rehabilitation. <h3>Participants</h3> Cohort of 20,354 adult patients [60% female; mean age (SD) 66 (16)] treated for orthopedic and neurological conditions in 822 clinics (44 states; USA) who completed the ABC Scale at intake. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> An IRT-based patient-reported outcome measure (PROM) was developed based on the original 16 ABC items, examining assumptions of local independence, unidimensionality, item fit, and absence of differential item functioning (DIF). CAT and SF T-scores (mean=50, SD=10) were assessed for reliability, validity, and administrative efficiency. Known-groups validity, floor and ceiling effects and responsiveness were evaluated. <h3>Results</h3> All original 16 items were retained in the model, supporting the ABC Scale's unidimensionality and item-fit. A short form was created selecting 6 items that provided the most statistical information at targeted score levels. Reliability estimates were >= 0.95 for both administration modes. Scores discriminated between patient groups in clinically expected ways. Negligible floor and ceiling effects and no item DIF were observed. Change score effect size was medium (0.58). Simulated CAT scores were generated using an average of 4.7 items (median=4, range 4 to 10) and correlated highly with scores derived from the full bank (r=0.99). <h3>Conclusions</h3> The IRT-based balance confidence PROM was reliable, valid, moderately responsive to change, and efficient, with excellent score coverage. The presentation will address optimizing the use of the CAT, SF, and the full ABC Scale, depending on clinical and research purposes. <h3>Author(s) Disclosures</h3> Dr. Kallen consults for Net Health Systems, Inc., the company that owns the Focus on Therapeutic Outcomes (FOTO) Patient Outcomes system that gathers and manages the data analyzed in this manuscript. Dr. Myers is the developer of the ABC Scale. The authors have no other conflicts to declare.

PSYCHOMETRIC ANALYSIS OF SENIOR SECONDARY SCHOOL CERTIFICATE EXAMINATION (SSCE) 2017 NECO ENGLISH LANGUAGE MULTIPLE CHOICE TEST ITEM IN KWARA STATE USING ITEM RESPONSE THEORY

The study determined the dimensionality of 2017 National Examinations Council (NECO) English Language multiple-choice test item and estimated the item parameter indices (discrimination, difficulty, guessing and carelessness) using four parameter logistic model. The ex-post facto design was employed for the study. The population for the study comprised all candidates/test-takers who enrolled and sat for June/July Senior School Certificate Examination (SSCE) 2017 NECO English Language Examination in Kwara State, Nigeria with 12,000 samples purposively selected from sixteen Local Government Area in the State. The research instruments used for the study were Optical Marks Record Sheets for the NECO June/July 2017 English Language objectives items. The responses of the testees were scored dichotomously. The data collected were calibrated using four parameters logistic model. The results showed that the 2017 English Language multiple-choice item among SSCE students in Kwara State does not violate the assumption of unidimensionality. Also, the results showed that only two items (i.e., items 11 and 16) were able to satisfy the rule of thumb while the remaining 98 items were poor because they violated the rule of thumb in one way or the other.

Psychometric properties and CAT performance of the PROMIS pediatric sleep disturbance, sleep-related impairment, and fatigue item banks in Dutch children and adolescents.

This study's aim is to evaluate the psychometric properties of the pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance (SD), sleep-related impairment (SRI), and fatigue item banks in Dutch children and adolescents since they are yet to be validated in this population. Children and adolescents aged 8-18 years old (n = 1,325), representative of the Dutch general population, were invited. The following psychometric properties of both item banks were assessed: structural validity by fitting a graded response model (GRM) for which assumptions were checked and assessing item fit, reliability, and efficiency for the full-length item bank, short forms, and computerized adaptive test (CAT). Mean T scores and cutoff scores for mild, moderate, and severe scores were determined. A total of 527 children (response rate 39.7%) were included. SD did not meet the assumption of unidimensionality. The SRI and fatigue item banks showed sufficient structural validity. Three items showed GRM misfit; SRI item w026c and fatigue items 3224R1r and 4191R1r. Both item banks measured reliable (> .90) at the mean of the population and 2SD in the clinical direction. CATs outperformed short forms in efficiency. Mean T scores for the Dutch population were: SRI 47.5 (SD = 10.0) and fatigue 39.8 (SD = 12.4). Cutoffs included SRI minimal ≥ 34.7, moderate ≥ 55.6, severe ≥ 63.2 and fatigue minimal ≥ 23.9, moderate ≥ 49.9, severe ≥ 61.3. PROMIS pediatric SRI and fatigue item banks, short forms, and CAT showed sufficient structural validity and reliability in the Dutch population. Dutch reference values are provided. More research is needed for the PROMIS SD item bank. (PsycInfo Database Record (c) 2022 APA, all rights reserved).