Continuum Of Difficulty Research Articles

One Tube Does Not Fit All: Parent Experiences and Decision-Making for Choosing a Nasogastric Tube or Gastrostomy for Their Child During Allogeneic Bone Marrow Transplant

Background: Children undergoing bone marrow transplant (BMT) are at risk of developing malnutrition. A feeding tube becomes a requirement for most children to meet their nutritional and medication requirements. Two tubes are typically used: nasogastric tube (NGT) or gastrostomy. At the UK center where this study took place, parents are offered a choice between these tubes. Objective: This qualitative data collection in a mixed methods study explored why parents choose either tube and their experiences of using it. Methods: Parents participated in 2 semistructured interviews. First, on admission to explore why they chose either tube. Second, 1–2 months postdischarge to explore their experience of using the tube. Interviews took place over 18 months. Transcripts were thematically analyzed. Results: Sixteen parents whose child had an NGT, 17 a gastrostomy, were interviewed. Choice was experienced across a continuum of difficulty and freedom. Many parents deferred to the expertise of professionals; others felt they were the experts in their child. Influential factors in decision-making included expected duration of need, the child’s age and activity, cosmetic differences, balancing gastrostomy surgery against NGT dislodgement, lay advice, healthcare professionals’ recommendations and prior tube feeding experiences. Conclusions: Parents valued choice appreciating 1 feeding tube might not suit every child. Implications for Practice: Choice of a gastrostomy or NGT should be offered to children prior to BMT. What is Foundational: Parents navigate a complex decision-making process when choosing a feeding tube for their child. Healthcare professionals can facilitate informed decision-making through collaborative discussions, inclusion of peer support, and provision of balanced information.

A Difficulty-Informed Approach to Developing Language Assessment Literacy for Classroom Purposes

Abstract For pre-service teacher education, it would be helpful to know how difficult certain aspects of language testing and assessment are for students. Such information could serve different pedagogical purposes including program design and lesson sequencing. This paper, situated in the context of pre-service teacher education at the University of Vienna, Austria, presents an approach to developing language assessment literacy (LAL) which takes account of the difficulty of language assessment. To obtain empirical difficulty estimates, the items of a LAL test for pre-service teachers of English were converted into statements of ability, knowledge, and understanding and then calibrated by means of multi-facet Rasch analysis based on performance data from 420 students. Qualitative content analysis was used to identify clusters among the calibrations, thus characterizing the difficulty continuum. The findings show a clear progression which can offer a basis for the design of teacher education programs. I first report on the process of generating the difficulty estimates. Then I describe the resulting difficulty continuum with particular emphasis on classroom-based assessment. Finally, I suggest design principles for difficulty-informed assessment courses, illustrating how they could be implemented in the teacher education program at the University of Vienna.

Child engagement in daily life measure V2: validation of psychometric properties for children with cerebral palsy

Purpose Measurement development is a reiterative process requiring refinements and revalidation. The purpose of this study was to examine structural validity and reliability of the Child Engagement in Daily Life Measure (Version 2) for parents of children with cerebral palsy (CP) across a broader age span. Methods Participants were 1054 parents of children with CP 1.5–11 years of age. Parents completed the Child Engagement in Daily Life measure that consists of the Participation in Family and Recreational Activities domain (11 items) and the Performance of Self-care Activities domain (18 items) as part of two longitudinal studies related to outcomes for children with CP. Results Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty for both frequency of participation in family and recreational activities and performance of self-care activities. Test–retest reliability was good to excellent: ICC = 0.78 for frequency of participation, ICC = 0.68 for enjoyment of participation, and ICC = 0.97 for self-care. Conclusions Evidence supports reliability and validity of the Child Engagement in Daily Life Measure (Version 2) for parent-report of their children’s participation in family and recreational activities and performance of self-care activities for children with CP 1.5–12 years of age. IMPLICATIONS FOR REHABILITATION Participation in family and recreational activities and performance of self-care activities of children with cerebral palsy can be assessed using the concise parent-report Child Engagement in Daily Life Measure V2. Knowledge of the continuum of difficulty of the frequency of participation in family and recreational activities and performance of self-care activities can assist practitioners in progressing service plans. Practitioners are encouraged to use the measure to guide discussions with parents and children on areas to focus services to support participation in family and recreational activities and performance of self-care activities.

Validity and reliability of eight-grade digital culture test in light of item response theory

The purpose of this study is to construct a digital culture test in light of the Item Response Theory and to investigate its psychometric properties. The study sample consisted of six hundred fifty (650) male and female students in the eighth grade from the Directorate of Education and Teaching of Salt District. To obtain the results, the descriptive approach was used. The results showed that the items have acceptable indicators of discrimination and extend on the continuum of difficulty adequately. The validity and reliability of the test were verified by using several methods, including content validity and internal consistency. The study findings showed that most of the test items fit the assumptions of the two-parameter logistic model. The results also displayed statistically significant differences in the arithmetic means of the digital culture test due to gender in favor of female students. Moreover, the outcomes presented statistically significant differences attributed to the education sector variable favoring the private sector.
 Keywords: Digital Culture Test, IRT, Psychometric Properties, Teaching.

Cochlear Implant Quality of Life (CIQOL): Development of a Profile Instrument (CIQOL-35 Profile) and a Global Measure (CIQOL-10 Global).

Purpose Valid, reliable, and efficient patient-reported outcome measures are needed to quantify quality of life (QOL) outcomes after cochlear implantation to supplement information obtained from performance-based outcomes. We previously developed the Cochlear Implant Quality of Life (CIQOL) item bank to serve as the source of items for subsequent instruments. This study reports the development and psychometric properties for 2 of these new instruments, the CIQOL-35 Profile and the CIQOL-10 Global. Method Cochlear implant (CI) users referred from the CIQOL Development Consortium (n = 371), consisting of 20 CI centers across the United States, provided responses to the 81-item CIQOL item bank, which are grouped into 6 QOL domains (communication, emotional, entertainment, environment, listening effort, and social). Responses to the 81 CIQOL items were analyzed using item response theory to determine individual item difficulty, discrimination, and model fit to select the set of items for the profile instrument and global measure that would optimize their measurement characteristics. Results The 35-item CIQOL-35 Profile instrument assesses outcomes represented in the 6 domains of the CIQOL final item pool. The 10-item CIQOL-10 Global measure produces a single, overall QOL score. After ensuring the upper and lower ends of the item difficulty continuum were represented (item difficulty range: -2.48 to 2.47), the items with the highest discrimination ability for each domain were selected for the CIQOL-35 Profile instrument (discrimination range: 0.67-1.37). Items were selected for the CIQOL-10 Global measure in a similar manner. Conclusion The CIQOL-35 Profile and CIQOL-10 Global instruments provide psychometrically sound and efficient measures that can be used to assess QOL in adult CI users in both clinical and research settings. Supplemental Material https://doi.org/10.23641/asha.9745010.

Towards the Definition of Linguistic Metrics for Evaluating Text Readability

The frequency of linguistic units and patterns (linguistic metrics) is specific to each language and varies depending on text complexity. In this study we investigate a number of measures that can contribute to determine text complexity/difficulty and be obtained automatically. The variables considered come primarily from counts of phonological units and patterns (e.g. word size, number of prosodic words and clitics, rare syllable types, exceptional stress patterns and rare segment classes), some of which being also informative of texts’ morphological and syntactic complexity and semantic density. We compared the linguistic metrics in a large sample of Portuguese medicine package leaflets (PL), a sample of PL from the medicines that belong to the three most consumed therapeutic groups, and two samples of more common texts (composed of journalistic and oral texts). For each indicator, oral texts, in particular texts produced by speakers with lower levels of education, showed the lowest values in a difficulty continuum, and frequently PL showed the highest values in that continuum, indicating that PL may be less readable than the other types of texts analysed.

Validation of the Mandarin Version of the Vocabulary Size Test

This article provides preliminary validity evidence for the shorter Mandarin version of the Vocabulary Size Test (VST) under the content aspect, technical quality, substantive and generalizability aspect of Messick’s (1995) construct validity framework. The shorter version with 177 Chinese university students in three proficiency levels indicates that the test enjoys a high level of validity both from the perspective of classical test theory and item response theory. A one-way ANOVA and detailed statistics of Rasch analyses demonstrate that the test could effectively distinguish learners from different proficiency levels. The first eight levels of the VST generally display an ascending difficulty continuum except that some loan words in the seventh and the eighth level prove to be problematic in assessing Chinese learners’ vocabulary size accurately. The generalizability aspect of construct validity is demonstrated in that there is no item bias for learners of the same proficiency group in terms of gender. Compared with the results of other studies either on monolingual or bilingual version, this research attempts to justify the appropriateness of the Mandarin version and calls for cautious applications of the test instrument on Chinese learners.

Normative Performance on the Brief Smell Identification Test (BSIT) in a Multi-Ethnic Bilingual Cohort: A Project FRONTIER Study1

The Brief Smell Identification Test (BSIT) is a commonly used measure of olfactory functioning in elderly populations. Few studies have provided normative data for this measure, and minimal data are available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the BSIT in a sample of English- and Spanish-speaking Hispanic and non-Hispanic Whites. A Rasch analysis was also conducted to identify the items that best discriminated between varying levels of olfactory functioning, as measured by the BSIT. The total sample included 302 older adults seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Hierarchical regression analyses revealed that BSIT scores require adjustment by age and gender, but years of education, ethnicity, and language did not significantly influence BSIT performance. Four items best discriminated between varying levels of smell identification, accounting for 59.44% of total information provided by the measure. However, items did not represent a continuum of difficulty on the BSIT. The results of this study indicate that the BSIT appears to be well-suited for assessing odor identification deficits in older adults of diverse backgrounds, but that fine-tuning of this instrument may be recommended in light of its items’ difficulty and discrimination parameters. Clinical and empirical implications are discussed.

Computer Adaptive Language Tests (CALT) Offer a Great Potential for Functional Testing. Yet, Why Don't They?

Computer adaptive language testing (CALT) is a relatively new computer based testing approach which offers substantial advantages such as 1) the ability for examinees to pace themselves, the ability 2) to individualize tests, 3) to make tests shorter, 4) to promote a more positive attitude toward tests, 5) to report test results immediately, 6) to measure tests with precision, and 7) to improve test security. CALT tailors tests to the student's level of language ability. The item sequencing of CALT is based on a continuum of difficulty; items are calibrated according to their difficulty index. CALT tests are administered according to pre-established indexes of increment and decrement. However, CALT cannot test the multidimensional nature of language, and as such it fails to fit and to assess its communicative and functional nature. This article proposes to replace multiple choice and cloze formats and to apply the potential of CALT to live-action simulations. With adaptive live-action simulations, students could be assessed on their ability to function in situations that would adapt to the examinee's level of proficiency. With this in mind, computer adaptive task based language assessment could very well be the next generation of CALT.

The Relationship Between Response Time and Diagnostic Accuracy

Psychologists theorize that cognitive reasoning involves two distinct processes: System 1, which is rapid, unconscious, and contextual, and System 2, which is slow, logical, and rational. According to the literature, diagnostic errors arise primarily from System 1 reasoning, and therefore they are associated with rapid diagnosis. This study tested whether accuracy is associated with shorter or longer times to diagnosis. Immediately after the 2010 administration of the Medical Council of Canada Qualifying Examination (MCCQE) Part II at three test centers, the authors recruited participants, who read and diagnosed a series of 25 written cases of varying difficulty. The authors computed accuracy and response time (RT) for each case. Seventy-five Canadian medical graduates (of 95 potential participants) participated. The overall correlation between RT and accuracy was -0.54; accuracy, then, was strongly associated with more rapid RT. This negative relationship with RT held for 23 of 25 cases individually and overall when the authors controlled for participants' knowledge, as judged by their MCCQE Part I and II scores. For 19 of 25 cases, accuracy on each case was positively related to experience with that specific diagnosis. A participant's performance on the test overall was significantly correlated with his or her performance on both the MCCQE Part I and II. These results are inconsistent with clinical reasoning models that presume that System 1 reasoning is necessarily more error prone than System 2. These results suggest instead that rapid diagnosis is accurate and relates to other measures of competence.

Becoming a better preceptor: The clinic as classroom

Becoming a better preceptor: The clinic as classroom

Evaluating Plyometric Exercises Using Time to Stabilization

Plyometric exercises are frequently used in strength and conditioning and rehabilitation programs because the landing phase of these exercises requires dynamic stabilization. This study examined the differences in landing stability of a variety of plyometric exercises by assessing time to stabilization (TTS), its reliability, and sex differences therein. Forty-nine men and women performed a variety of plyometric exercises thought to represent a continuum of difficulty of dynamic stabilization during landing. Plyometric exercises included line hops, cone hops, squat jumps, tuck jumps, countermovement jumps, dumbbell countermovement jumps, and single leg countermovement jumps, each performed for 3 repetitions on a force platform. A 2-way mixed analysis of covariance with repeated measures for plyometric exercise type was used to evaluate the main effects for plyometric exercise type and the interaction between plyometric exercise type and sex for TTS. Subject jumping ability was evaluated as a covariate. Results revealed significant main effects for plyometric exercise type (p < or = 0.001) and for the interaction between plyometric exercise type and sex (p = 0.002). Bonferroni adjusted post hoc analysis demonstrated differences in TTS between a number of plyometric exercises for men and women. Reliability analysis revealed intraclass correlation coefficients ranging from 0.51 to 0.86 with no significant difference between trials (p > 0.05). Practitioners who use plyometrics to train dynamic stability should create programs that progress the intensity of the exercises based on the results of this study. This study also demonstrated that TTS is moderately to highly reliable for a variety of jumping conditions for both men and women.

Assessing Elbow Assessment, past, Present and Future

The state of elbow assessment is reviewed using a timeline of past, present and future. Empirical evidence is provided supporting the conclusions made in recent years that patient self-assessed evaluation of elbow function is valid, consistent and reliable. This form of assessment is so robust that it does not appear to matter whether the scale is composed of four, five or seven categories or even a visual analogue scale per item. The raw scores are not linear but can be constructed as such using Rasch modelling. Items included in any one scale have been identified as being on a continuum of difficulty, and the continuum itself can be considered as a ‘ruler’ of difficulty. Finally, the health of the elbow cannot be summarized as just one domain. We suggest that health of the elbow be considered by an expert panel (BESS) where the concepts of pain, function and impairment are fitted to the International Classification of Functioning, Disability and Health framework, so that a standardized assessment regime is available on a national basis.

Bilingual health literacy assessment using the Talking Touchscreen/la Pantalla Parlanchina: Development and pilot testing

Objective Current health literacy measures are too long, imprecise, or have questionable equivalence of English and Spanish versions. The purpose of this paper is to describe the development and pilot testing of a new bilingual computer-based health literacy assessment tool. Methods We analyzed literacy data from three large studies. Using a working definition of health literacy, we developed new prose, document and quantitative items in English and Spanish. Items were pilot tested on 97 English- and 134 Spanish-speaking participants to assess item difficulty. Results Items covered topics relevant to primary care patients and providers. English- and Spanish-speaking participants understood the tasks involved in answering each type of question. The English Talking Touchscreen was easy to use and the English and Spanish items provided good coverage of the difficulty continuum. Conclusion Qualitative and quantitative results provided useful information on computer acceptability and initial item difficulty. After the items have been administered on the Talking Touchscreen (la Pantalla Parlanchina) to 600 English-speaking (and 600 Spanish-speaking) primary care patients, we will develop a computer adaptive test. Practice implications This health literacy tool will enable clinicians and researchers to more precisely determine the level at which low health literacy adversely affects health and healthcare utilization.

Measuring Attentional Ability in Older Adults

Although deficits in visual attention are often postulated as an important component of many declines in cognitive processing and functional outcomes in older adults, surprisingly little emphasis has been placed on evaluating psychometric instruments with which individual differences in visual attention ability can be assessed. This article reports the development and beginning psychometric evaluation of DriverScan, a change detection measure of attentional search for older adults. A constrained graded response model is used to approximate response speed and accuracy with categories of immediate, delayed, or no response. DriverScan items are shown to have excellent reliability over the studied sample, and the distribution of items is shown to adequately cover the difficulty continuum and to be maximally sensitive at distinguishing individuals with lower than average abilities (i.e., individuals with attention deficits). Item design features representing goaldirected and stimulus-driven attentional processing significantly predict item difficulty as hypothesized.

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

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.

Dr. Klin Replies

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Klin RepliesAMI KLIN, Ph.D., AMI KLINSearch for more papers by this author, Ph.D., New Haven, Conn.Published Online:1 May 2004https://doi.org/10.1176/appi.ajp.161.5.933-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Dr. Loddo’s speculation is that the critical variable accounting for variable results in the visual scanning of faces by individuals with autism is “level of difficulty.” Paradigms using static faces as stimuli are associated with more normative patterns of visual scanning because they place a lower level of stress on the “capacity of the mental apparatus.” In contrast, paradigms using dynamic (i.e., video) stimuli place added burden, and therefore, individuals with autism move their attention to “segmentary scanning of lower and/or peripheral parts of the face…in order to keep inputs at a processable level.” His hypothesis is that these paradigms stay in a continuum of difficulty, and he theorized some values for the various paradigms as well. His hypothesis is not one of overwhelming affective burden (e.g., too much arousal) but one of overwhelming cognitive burden. Although this is a possibility, we, and apparently other research groups, have no evidence to support or contradict this hypothesis. It is an empirical question that would require some measurement of “burden on mental processes.” What we can state, however, is that there is evidence to suggest that typically developing children as young as 4 days old prefer to look at eyes that are looking at them and that by 3 months of age, they are preferentially looking at people’s eyes (rather than mouths). Also, in nature, babies do not look at static faces but at dynamic faces moving and talking to them. Therefore, there is some evidence that the level of burden on mental capacities that viewing complex social stimuli exposes people to cannot be too overwhelming. More important, however, we have at present no evidence that looking at static faces in behavioral and neuroimaging experiments and looking at naturalistic social approaches (or our research group’s attempt to simulate such situations in our eye-tracking laboratory), in fact, correspond to the same behavioral/cognitive demands and can be mapped onto the same neural systems. This is why our research effort has been to allow for great complexity in the stimuli used in our paradigms while developing highly sophisticated ways of measuring viewers’ eye-scanning responses to those stimuli. Typically, researchers have reduced paradigm complexity in order to avoid confounds because measurements were relatively crude. The eye-tracking technology and the methods that we have developed to analyze eye-tracking data give us an opportunity to change this.Dr. Loddo’s hypothesis that “in autism a central system of integration of brain functions is at fault, and the consequent reduced web of activation excludes higher abilities, such as the recognition of complex (social) cues” has partial merit. Indeed, one of the speculations in structural and functional neuroimaging research, as well as the relatively recent findings of possible accelerated head growth in the first 2 years, is that there is reduced connectivity in the brains of individuals with autism. However, one wonders about how much complexity is involved in the scanning of social cues (from a brain integration perspective) when human babies—not to mention members of lower phyletic scales—use these forms of exposure as avenues of socialization (manifested in affiliative behavior and subsequent social cognitive development). FiguresReferencesCited byDetailsCited ByAUTISM AND RELATED DISORDERS Volume 161Issue 5 May 2004Pages 933-a-934 Metrics PDF download History Published online 1 May 2004 Published in print 1 May 2004

Development of materials for the clinical assessment of speech recognition: the speech sound pattern discrimination test.

The purpose of this investigation was to evaluate the validity and reliability of materials designed for an assessment procedure capable of making meaningful distinctions in speech recognition ability among individuals having mild-to-moderate hearing losses. Sets of phonetic contrasts were presented within sentence contexts to 53 listeners (22 normal hearing, 31 hearing impaired) in 4 listening conditions (quiet and with background competition at signal-to-noise ratios of +5, 0, and -5 dB). The listeners were asked to discriminate pairs of sentences (e.g., "The man hid the dog" and "The man hit the dog") using same-different judgments. Their performances were analyzed in a manner enabling comparisons among items in terms of the classification of phonetic contrasts. Listener performance was also compared to performance on a set of independent variables, including the W-22 and QuickSIN speech tests, high-frequency hearing loss, speech reception threshold, listener age, and others. Results indicated that the new materials distinguished the normal-hearing from the hearing-impaired group and that listener performance (a) declined about 17% for each 5 dB decrement in SNR and (b) was influenced by the phonetic content of items in a manner similar to that reported by G. A. Miller and P. E. Nicely (1955). The performances of the hearing-impaired listeners were much more strongly related to high-frequency hearing loss, listener age, and other variables than were their performances on either the W-22 or QuickSIN tests. These findings are discussed with specific reference to the use of a mathematical model (i.e., the Rasch model for person measurement) for scaling items along a continuum of difficulty. The mathematical model and associated item difficulty values will serve as the basis for construction of a clinically useful computerized, adaptive test of speech recognition ability known as the Speech Sound Pattern Discrimination Test (Bochner, J., Garrison, W., Palmer, L., MacKenzie, D., & Braveman, A., 1997).

Exploring the Process of Inference Generation in Sarcasm: A Review of Normal and Clinical Studies

This article evaluates two theoretical accounts of how sarcasm is understood; the traditional model, which asserts that listeners derive a counterfactual inference from the sarcastic comment, and relevance theory, which asserts that listeners recognize sarcasm as a scornful echo of a previous assertion. Evidence from normal speakers provides only partial support for both theories. Evidence from brain-injured populations suggests that aspects of the pragmatic process can be arrested in ways not predicted by either theory. It is concluded that sarcasm is more effortful to process than nonsarcastic comments and that inferences about the facts of the situation and the mental state of the speaker (e.g., attitudes, knowledge, and intentions) are important to comprehending sarcasm. It is questioned whether inferences about mental state are relatively more difficult for brain-injured subjects and, if so, whether this is a continuum of difficulty or reflects reliance upon different cognitive processes.

Comparative analyses of English as a Second Language reading comprehension data

Item responses on a multiple-choice reading comprehension test from 88 ESL subjects were submitted to classical test item analyses and the Rasch one-parameter latent trait model. The Rasch model identified more misfitting items than the classical item analyses and allowed the researchers to plot the reading comprehension items at their calibrated positions along the lines of the latent trait. The trait was defined at the easy end by items that assess literal comprehension and inference of explicit details and at the difficult end by items that assess multiple string inferences. The Rasch model also indicated that additional items were needed at both ends of the difficulty continuum, if subjects in those ranges are to be discriminated properly.