High Ceiling Effects Research Articles

EuroQol (EQ-5D-5L) Validity in Assessing the Quality of Life in Adults With Asthma: Cross-Sectional Study

BackgroundThe EuroQol-5 Dimension (EQ-5D), developed in 1990, is a most widely used generic tool to measure the health-related quality of life (HRQoL) and considered suitable for patients with asthma. In 2009, the EuroQol Group developed a new EQ-5D version to overcome limitations related to its consistently reported high ceiling effect. To enhance the sensitivity for assessing the HRQoL in further patient populations, the number of responses of EQ-5D was increased from 3 to 5 levels (EQ-5D-5L). Moreover, the availability of well-defined requirements for its Web-based administration allows EQ-5D-5L use to monitor the HRQoL in electronic health (eHealth) programs. No study has evaluated the metric properties of the new EQ-5D-5L in patients with asthma yet.ObjectiveThis study aims to examine the distribution, construct validity, and reliability of the new EQ-5D-5L questionnaire administered online to adults with asthma.MethodsWe evaluated patients with asthma (age: 18-40 years) from a primary care setting in France and England, who self-completed the EQ-5D-5L questionnaire online. The inclusion criteria were persistent asthma defined as >6 months of prescribed inhaled corticosteroids and long-acting beta-agonists or inhaled corticosteroids alone during the 12 months prior to inclusion. The EQ-5D index was obtained by applying the English preference value set for the new EQ-5D-5L and the French 3L-5L crosswalk value set. Both value sets produced single preference-based indices ranging from 1 (best health state) to negative values (health states valued as worse than death), where 0=death, allowing the calculation of quality-adjusted life years. Responses to dimensions and index distribution, including ceiling and floor effects, were examined. The construct validity was assessed by comparing the means of known groups by analyses of variance and calculation of effect sizes.ResultsOf 312 patients answering the baseline Web-based survey, 290 completed the EQ-5D-5L (93%). The floor effect was null, and the ceiling effect was 26.5% (74/279). The mean EQ-5D-5L index was 0.88 (SD 0.14) with the English value set and 0.83 (SD 0.19) with the French 3L-5L crosswalk value set. In both indices, large effect sizes were observed for known groups defined by the Asthma Control Questionnaire (1.06 and 1.04, P<.001). Differences between extreme groups defined by chronic conditions (P=.002 and P=.003 for the English value set and French 3L-5L crosswalk value set, respectively), short-acting beta-agonists (SABAs) canisters in the last 12 months (P=.02 and P=.03), or SABA use during the previous 4 weeks (P=.03 and P=.01) were of moderate magnitude with effect sizes around 0.5.ConclusionsThe new EQ-5D-5L questionnaire has an acceptable ceiling effect, a good construct validity based on the discriminant ability for distinguishing among health-related known groups, and high reliability, supporting its adequacy for assessing the HRQoL in patients with asthma. EQ-5D-5L completion by most Web-based respondents supports the feasibility of this administration form.

An Overview and Predictors of Achieving the Postoperative Ceiling Effect of the WOMAC Score Following Total Knee Arthroplasty

BackgroundTo describe the ceiling effect for the components of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and identify preoperative independent predictors for patients who achieve maximal scores (ceiling effect) after total knee arthroplasty (TKA). MethodsA retrospective cohort of 2589 patients undergoing a primary TKA were identified from an established arthroplasty database. Patient demographics, WOMAC and Short Form 12 (SF-12) scores were collected preoperatively and 1 year postoperatively. Logistic regression analysis was used to identify independent preoperative predictors of patients achieving ceiling scores. ResultsThe ceiling effect was 26.8% (n = 695) for the pain score, 6.4% (n = 165) for the function score, and 21.2% (n = 548) for the stiffness score. Lower body mass index (P = .001), absence of gastric ulceration (P = .04), absence of anemia (P = .02), absence of depression (P = .004), and absence of back pain (P < .001) and better preoperative WOMAC pain and SF-12 physical (P = .01) and mental (P < .001) scores were associated with a ceiling WOMAC pain score. Male gender (P = .03), lower body mass index (P = .040), absence of gastric ulceration (P = .004), and absence of back pain (P < .001) and better preoperative SF-12 physical (P = .02) scores were associated with a ceiling WOMAC function score. Male gender (P = .001), absence of back pain (P < .001), and better preoperative WOMAC stiffness score (P = .005) and SF-12 mental (P = .001) scores were associated with a ceiling WOMAC stiffness score. ConclusionThe WOMAC pain and stiffness components demonstrated a high ceiling effect but in contrast the functional score had a low ceiling effect. The absence of back pain was a common predictive factor for all 3 components and had the greatest impact upon the likelihood of achieving a ceiling score.

Psychometric testing of the health-related quality of life measurement, SF-36v2, in the general population of Thailand

ABSTRACT Background: The SF-36v2 is commonly used instrument worldwide. Nevertheless, it lacks the evidence of psychometric testing and health-related quality of life (HRQoL) level among the general Thai population. Therefore, this study aimed to investigate the psychometric performance and to evaluate the HRQoL level and the factors associated with it in the general Thai population. Methods: Cross-sectional research was conducted with 600 Thai subjects. Various psychometric properties were investigated including ceiling/floor effects, item-scale and scale levels validity using correlations, principal component analysis (PCA), and internal consistency. Multiple regression was used to assess the impact of demographic factors on the HRQoL level. Results: Cronbach’s alpha ranged from 0.703 to 0.858. These eight SF-36v2 scales had a high ceiling effect while no floor effects were observed except for Bodily pain and General health. Correlations between the eight scales and two summary components, and item-scale correlations supported the hypotheses. Physical and Mental Health components were identified by PCA. Multiple regression revealed that having chronic diseases diminished HRQoL level. Conclusions: These preliminary results confirmed that the Thai SF-36v2 was a valid and reliable instrument. Having chronic diseases diminished the HRQoL level. Further study investigating subjects in different severity and impact of other factors on HRQoL level is encouraged.

Danish Translation, Cultural Adaptation and Validation of the Shared Decision Making Questionnaire - Patient Version (SDM-Q-9-Pat)

Aims and objectives: No validated version of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in Danish is available. The aim of the study was to translate, culturally adapt and psychometrically test a Danish version of the SDM-Q-9 in 2 patient groups: elderly patients from outpatient gynecology clinics and a group of younger patients from an outpatient sports clinic.Method: The SDM-Q-9, patient version, was translated into Danish through a standardized forward-backward translation performed by 4 independent translators, followed by cognitive interviewing of 11 outpatients from the 2 patient groups. The process was adjusted by an expert panel. The psychometric testing was performed at 5 Danish hospital departments. Reliability (internal consistency) was estimated by Cronbach’s alpha. Construct validity was determined by confirmatory and explanatory factor analysis.Results: A total of 268 patients (218 gynecological and 50 knee patients) were included. The scale had high reliability (Cronbach’s alpha of 0.94). A high ceiling effect was found (44% with the highest rating). None of the tested models in the confirmatory analysis had a good fit. The explanatory factor analysis for the whole sample yielded a unidimensional factor, which explained 91% of variances with high factor loadings of more than 0.7.Conclusion: The Danish version of the SDM-Q-9 is a well-accepted, reliable and - despite the challenges of a high ceiling effect - valid instrument in the tested populations. Further psychometrical testing in other populations is necessary as well as research with other convergent instruments to demonstrate consistency over time and between patient groups.

Translation and validation of the Transition Readiness Assessment Questionnaire (TRAQ)

ObjectiveTo translate and validate the Brazilian Portuguese version of the Transition Readiness Assessment Questionnaire in a population of adolescents and young adults with chronic rheumatologic disorders. This questionnaire evaluates the patient's readiness for making the transition from the pediatric health service to adult care. MethodsThe four-phase methodology for the translation and validation of generic questionnaires was followed, including translation, back-translation, pilot testing and clinical validation of the final tool. The confirmatory factor analysis was used for clinical validation and the Cronbach's alpha coefficient was used to assess the overall internal consistency of the final tool. ResultsA total of 150 patients with a mean age of 17.0 years (SD=2.2 years, range 14–21 years) were enrolled for the final tool validation. Of those, 71 patients had juvenile systemic lupus erythematosus (47.3%), 64 had juvenile idiopathic arthritis (42.7%), and 15 had juvenile dermatomyositis (10%). During the confirmatory factor analysis, the dimension “Talking with providers” consisting of two questions, was considered as not fitting the translated questionnaire due to a very high ceiling effect and was therefore excluded. All other translated items favorably contributed to the overall consistency of the final tool; removing that dimension did not result in a substantial increase in Cronbach's alpha, which was 0.776. ConclusionsThe Brazilian Portuguese version of the Transition Readiness Assessment Questionnaire was validated in a population of transitional patients with chronic rheumatologic disorders, after one dimension from the original questionnaire was excluded. It is a non-specific disease questionnaire; thus, it can be used to evaluate the transition readiness of Brazilian patients with other chronic diseases.

A comparison of the responsiveness of EQ-5D-5L and the QOLIE-31P and mapping of QOLIE-31P to EQ-5D-5L in epilepsy

ObjectiveTo investigate the responsiveness of and correlation between the EQ-5D-5L and the QOLIE-31P in patients with epilepsy, and develop a mapping function to predict EQ-5D-5L values based on the QOLIE-31P for use in economic evaluations.MethodsThe dataset was derived from two clinical trials, the ZMILE study in the Netherlands and the SMILE study in the UK. In both studies, patients’ quality of life using the EQ-5D-5L and QOLIE-31P was measured at baseline and 12 months follow-up. Spearman’s correlations, effect sizes (EF) and standardized response means (SRM) were calculated for both the EQ-5D-5L and QOLIE-31P domains and sub scores. Mapping functions were derived using ordinary least square (OLS) and censored least absolute deviations models.ResultsA total of 509 patients were included in this study. Low to moderately strong significant correlations were found between both instruments. The EQ-5D-5L showed high ceiling effects and small EFs and SRMs, whereas the QOLIE-31P did not show ceiling effects and also showed small to moderate EFs and SRMs. Results of the different mapping functions indicate that the highest adjusted R2 we were able to regress was 0.265 using an OLS model with squared terms, leading to a mean absolute error of 0.103.ConclusionsResults presented in this study emphasize the shortcomings of the EQ-5D-5L in epilepsy and the importance of the development of condition-specific preference-based instruments which can be used within the QALY framework. In addition, the usefulness of the constructed mapping function in economic evaluations is questionable.

Establishing benchmark EQ-5D-3L population health state utilities and identifying their correlates in Gansu Province, China.

Despite a flurry of cost utility analyses conducted in the Chinese population in recent years, a standard set of health state utilities (HSUs) for the Chinese population is lacking. The aims of this study were to (1) determine benchmark age- and sex-specific HSUs for a Chinese population, and (2) assess key correlates of HSUs in this population. Quality-of-life was evaluated using the validated EQ-5D-3L questionnaire. HSUs were calculated using data collected from Gansu Province (n=9833). Overall differences in HSUs were analysed using linear regression and a two-tailed p value <0.05 was determined to be statistically significant. The minimal difference in weighted index was set at 0.074. HSUs decreased with age in both males and females. Living in the non-capital areas, being separated/divorced/widowed or never married, being never educated, diagnosed with chronic disease, and no regular physical activity were associated with lower HSUs. HSUs for women were lower than for men in univariate regression analysis; however, no differences were found after adjusting for other covariates. In addition, the difference in HSU reached the level of minimal difference in weighted index for participants with chronic disease. HSUs for those who were diagnosed with chronic disease were 0.098 (0.092-0.104) lower than those without chronic disease. This study reports HSUs for a Chinese population in Gansu and investigates the key correlates of HSUs in this population. In addition, the use of EQ-5D-3L in assessing population health is limited given the high ceiling effect and skewed HSUs.

Development and Validation of a Novel Generic Health-related Quality of Life Instrument With 20 Items (HINT-20).

ObjectivesFew attempts have been made to develop a generic health-related quality of life (HRQoL) instrument and to examine its validity and reliability in Korea. We aimed to do this in our present study.MethodsAfter a literature review of existing generic HRQoL instruments, a focus group discussion, in-depth interviews, and expert consultations, we selected 30 tentative items for a new HRQoL measure. These items were evaluated by assessing their ceiling effects, difficulty, and redundancy in the first survey. To validate the HRQoL instrument that was developed, known-groups validity and convergent/discriminant validity were evaluated and its test-retest reliability was examined in the second survey.ResultsOf the 30 items originally assessed for the HRQoL instrument, four were excluded due to high ceiling effects and six were removed due to redundancy. We ultimately developed a HRQoL instrument with a reduced number of 20 items, known as the Health-related Quality of Life Instrument with 20 items (HINT-20), incorporating physical, mental, social, and positive health dimensions. The results of the HINT-20 for known-groups validity were poorer in women, the elderly, and those with a low income. For convergent/discriminant validity, the correlation coefficients of items (except vitality) in the physical health dimension with the physical component summary of the Short Form 36 version 2 (SF-36v2) were generally higher than the correlations of those items with the mental component summary of the SF-36v2, and vice versa. Regarding test-retest reliability, the intraclass correlation coefficient of the total HINT-20 score was 0.813 (p<0.001).ConclusionsA novel generic HRQoL instrument, the HINT-20, was developed for the Korean general population and showed acceptable validity and reliability.

A comparison of the ceiling effect between Berg Balance Scale and Mini-BESTest in a group of balance trained community-dwelling older adults

IntroductionThe aim of the study was to examine the ceiling effect of Berg Balance Scale (BBS) and Mini-BESTest (MBT) and to determine the most difficult items of the two scales in a group of functionally fit older adults.MethodsThe total of 26 community-dwelling older adults were enrolled to the study. Their functional status and agility were evaluated with the 10-meter walk test and Four-Square Step Test, respectively, followed by the BBS and MBT. The descriptive statistics were used for data analysis.ResultsThe participants’ functional status and agility were higher than the reported normative values for the age group. The results of BBS indicated a very high ceiling effect; as many as 73.1% of participants obtained the highest score. When tested by MBT, only 3.8% reached the highest score of the scale. The ceiling effect difference between BBS and MBT was statistically significant (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The most difficult item was 360° turning for BBS and Timed Up and Go test with a cognitive task for MBT.ConclusionsThe MBT presents a significantly smaller ceiling effect and is therefore more suitable for assessing balance even for balance trained older adults. The most difficult items of the two scales, i.e. 360° turning and Timed Up and Go test with a cognitive task, may be used as a short screening tool.

Psychometric Evaluation of a Treatment Acceptance Measure for Use in Patients Receiving Treatment via Subcutaneous Injection

Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, significantly reduces low-density lipoprotein cholesterol, but requires subcutaneous injections rather than oral pills. To measure patients' acceptance of this treatment modality, a new patient-reported outcome, the Injection-Treatment Acceptance Questionnaire (I-TAQ), was developed. To psychometrically evaluate the I-TAQ with patients at high risk of cardiovascular events receiving alirocumab. The 22-item, 5-domain I-TAQ was administered cross-sectionally to 151 patients enrolled in alirocumab clinical trials. Item response distributions, factor and multitrait analyses, interitem correlations, correlations with an existing measure of acceptance (convergent validity), and comparison of known-groups were performed to assess the I-TAQ's psychometric properties. Completion rates were high, with no patients missing more than two items and 91.4% missing no data. All items displayed high ceiling effects (>30%) because of high treatment acceptance. Factor analysis supported the a priori hypothesized item-domain structure with good fit indices (root mean square error approximation = 0.070; comparative fit index = 0.988) and high factor loadings. All items demonstrated item convergent validity (item-scale correlation ≥0.40), except for the side effects domain, which was limited by small numbers (n = 46). Almost all items correlated most highly with the domain to which they were assigned (item discriminant validity). Internal reliability was acceptable for all domains (Cronbach α range 0.72-0.88) and convergent validity was supported by a logical pattern of correlations with the Chronic Treatment Acceptance Questionnaire. These findings provide initial evidence of validity and reliability for the I-TAQ in patients treated with subcutaneous alirocumab. The I-TAQ could prove to be a valuable patient-reported outcome for therapies requiring subcutaneous injection.

Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department: implications for selection of clinical outcome measures.

BackgroundAssessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED).MethodsParticipants were 61 patients aged 65 years and above admitted to an ED. The self-reported measure used was the Barthel-20; the performance-based measures were Timed Up and Go (TUG); 30s-Chair Stand Test (30s-CST) and Assessment of Motor and Process Skills (AMPS) with the two scales; motor and process. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability.ResultsThe correlation between the Barthel-20 and the TUG was moderate (r = −0.64). The correlation between the Barthel-20 and the AMPS motor was also moderate (r = 0.53). The correlation between the Barthel-20 and the 30s-CST was fair (r = 0.45). The correlation between Barthel-20 and the AMPS process was non-significant. The results were affected by high ceiling effect (Barthel-20).ConclusionSelf-reported and performance-based measures seem to assess different aspects of functional ability. Thus, the two methods provide different information, and this highlight the importance of supplementing self-reported measures with performance-based measures when assessing functional ability in elderly patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0376-1) contains supplementary material, which is available to authorized users.

AB022. Validity of the five-level new version of the EQ-5D in asthma patients

Background A previous study evaluating the psychometric properties of the traditional EQ-5D in asthmatic patients showed a high ceiling effect (59% of patients with perfect health) questioning its usefulness in these patients. Therefore, the EuroQol Group developed a new EQ-5D version increasing the number of responses from 3 to 5 levels. This new version, the EQ-5D-5L, has never been tested in asthmatic patients. The aim of this study is to examine the distribution and construct validity of the new EQ-5D-5L in a European cohort of asthmatic adolescents and adults.

Utility of paediatric quality of life and revised illness perception questionnaires in adolescents with sickle cell disease

ABSTRACTQuality of life (QOL) and illness perceptions are important considerations when managing adolescents with sickle cell disease (SCD). This study aims to assess the psychometric properties of the SCD-specific paediatric quality of life (PedsQL™-SCD) and the revised illness perception questionnaires (IPQ-R) in Jamaican adolescents with SCD. One hundred and fifty Jamaican adolescents (M: 74, F: 76; mean age 16.1 ± 1.9 years, range: 13–19 years) completed the IPQ-R, PedsQL™-SCD (teen and parent forms) and a knowledge questionnaire. Socio-demographic and clinical data were also collected and the latter were used to create a severity index. Instruments’ structure, feasibility, reliability and construct validity were assessed. The Cronbach’s alpha for the 24-item knowledge questionnaire was 0.85; IPQ-R domains from 0.56 to 0.79 (except ‘treatment control’: 0.34); PedsQL teen-form domains from 0.70 to 0.93 and PedsQL parent-form domains from 0.72 to 0.95. All scales and subscales had low floor effects but some teen subscales yielded high ceiling effects. The SCD-specific scale and subscales showed high sensitivity as they varied significantly by severity of illness. Factor analysis of causal items on IPQ-R yielded a three-factor structure, explaining a total variance of 52.1%. The factors could be labelled as ‘psychological’, ‘physical’ and ‘innate/behavioural risk factors’. The teen QOL scores had significant negative correlations with the severity score (r: −0.46, p-value <0.001); IPQ identity domain (r: −0.42, p-value <0.001); IPQ consequences subscale (r: −0.36, p-value <0.001); IPQ cyclical timeline subscale (r: −0.31, p-value <0.001) and IPQ emotional representation subscale (r: −0.29, p-value <0.01). The severity index also had significant correlation with the QOL parent form (r: −0.44, p-value <0.001); IPQ identity domain (r: 0.43, p-value <0.01) and IPQ consequences domain (r: 0.35, p-value <0.001).In conclusion, both the IPQ-R and PedsQL™-SCD demonstrate robust psychometric properties in adolescents with SCD. Continuing longitudinal study will provide further assessment of the instruments such as ‘responsiveness to change’.

Musical ability is associated with enhanced auditory and visual cognitive processing.

BackgroundMusical ability has always been linked to enhanced cognitive and intellectual skills. We were interested in the relation between musical ability and short-time cognitive processing as measured by event-related potentials, in particular in visual processing, since previous studies have already suggested such a link for acoustic cognitive processing. We measured auditory and visual event-related potentials as elicited by an oddball paradigm in 20 healthy subjects (10 musicians and 10 non-musicians; 10 female; mean age 24 ± 2 years). In addition, the Seashore test and a test developed by the authors to detect relevant amusia, the latter one with a high ceiling effect, were also applied.ResultsThe most important finding was that there is a significant linear correlation between musical ability as measured by these tests and the P3 latencies of both the auditory and visual event-related potentials. Furthermore, musicians showed shorter latencies of the event-related potentials than non-musicians.ConclusionsWe conclude that musical ability as measured by neuropsychological tests is associated with improved short-time cognitive processing both in the auditory and, surprisingly, also in the visual domain.

Psychometric properties of the EQ-5D-5L in Thai patients with chronic diseases.

Due to the problem of high ceiling effects of the EQ-5D-3L, the EQ-5D-5L was developed. However, little was known about the full psychometric properties of the EQ-5D-5L. Thus, this study aimed to evaluate its practicality, reliability, validity, and responsiveness in Thai patients with chronic diseases. One thousand one hundred and fifty-six adults taking a medicine at least 3months were identified from three university hospitals in Bangkok, Thailand, between July 2014 and March 2015. Practicality was evaluated by administration times and ceiling effects. Test-retest reliability was assessed using weighted kappa and intraclass correlation coefficients (ICCs). Validity was tested with correlations between the EQ-5D-5L and WHOQoL-BREF and SF-12v2, and known-groups validity. Responsiveness was measured with standardized effect sizes (SES). The mean administration time was approximately 2min, and the ceiling effect of the EQ-5D-5L index was 13.6%. The weighted kappa values and ICC of the EQ-5D-5L were 0.48-0.61 and 0.82, respectively. Similar dimensions of the EQ-5D-5L had higher correlations with those of WHOQoL-BREF and SF-12v2. As expected, elderly, female, low-educated, unemployed, higher number of comorbidities and medicines, patients' perception of poor disease control, and having an adverse drug reaction tended to have poorer EQ-5D-5L scores. The SES of EQ-5D-5L index and EQ-VAS were considered small (0.33-0.42) for the improved group. For the worsened group, the SES of the EQ-5D-5L index were considered small (-0.29) but that of the EQ-VAS considered large (-0.82). The EQ-5D-5L was practical, reliable, valid, and responsive in Thai patients with chronic diseases.

Development of the web-based Spanish and Catalan versions of the Euroqol 5D-Y (EQ-5D-Y) and comparison of results with the paper version.

BackgroundThe objectives of the study were to develop web-based Spanish and Catalan versions of the EQ-5D-Y, and to compare scores and psychometric properties with the paper version.MethodsWeb-based and paper versions of EQ-5D-Y were included in a cross-sectional study in Palafolls (Barcelona), Spain and administered to students (n = 923) aged 8 to 18 years from 2 primary and 1 secondary school and their parents. All students completed both the web-based and paper versions during school time with an interval of at least 2 h between administrations. The order of administration was randomized. Participants completed EQ-5D-Y, a measure of mental health status (the Strengths and Difficulties Questionnaire), and sociodemographic variables using a self-administered questionnaire. Parents questionnaire included parental level of education and presence of chronic conditions in children. Missing values, and floor and ceiling effects were compared between versions. Mean score differences were computed for the visual analogue scale (VAS). Percentage of agreement, kappa index (k) and intraclass correlation coefficient (ICC) were computed to analyze the level of agreement between web-based and paper versions on EQ-5D-Y dimensions and VAS. Known groups validity was analyzed and compared between the two formats.ResultsParticipation rate was 77 % (n = 715). Both formats of EQ-5D-Y showed low percentages of missing values (n = 2, and 4 to 9 for web and paper versions respectively), and a high ceiling effect by dimension (range from 79 % to 96 %). Percent agreement for EQ-5D-Y dimensions on the web and paper versions was acceptable (range 89 % to 97 %), and k ranged from 0.55 (0.48-0.61, usual activities dimension) to 0.75 (0.68-0.82, mobility dimension). Mean score difference on the VAS was 0.07, and the ICC for VAS scores on the two formats was 0.84 (0.82-0.86). Both formats showed acceptable ability to discriminate according to self-perceived health, reporting chronic conditions, and mental health status.ConclusionsThe digital EQ-5D-Y showed almost identical VAS scores and acceptable levels of agreement on dimensions. Both formats demonstrated acceptable levels of construct validity. Availability of the Spanish and Catalan web-version will facilitate its use in HRQOL assessment and in economic evaluation.

Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score

Background:The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood.Purpose:To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index.Results:All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good.Conclusion:The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior in all psychometric aspects examined in this study. Future research should investigate the LE CAT for wider use in different populations.

Differential Item Functioning of the Oswestry Low Back Pain Questionnaire Between Participants With and Without Low Back Pain

Differential item functioning (DIF) based on Rasch model can be used to examine whether the items function similarly across different groups and identify items that appear to be too easy or difficult after controlling for the ability levels of the compared groups. The Oswestry low back pain disability (Oswestry) has traditionally been proved as an effective instrument measuring disability resulting from low back pain (LBP). In this study, DIF method was used to explore whether items on the Oswestry perform similarly across two different groups (participants with LBP and no LBP). A series of Rasch analyses on the 10 items of the Oswestry were performed using Winstepsⓡ software. Forty-two participants with back pain were recruited from 3 rehabilitation hospitals in Gainesville, Florida. Another 42 participants with no LBP were recruited from several public places in the rehabilitation hospitals. Based on the DIF analysis across the two groups, several items were found to have an uniform DIF. Participants with no LBP had more difficulty on lifting and personal care items and participants with LBP had more difficulty on sleeping and social life items. For non-LBP group, a high ceiling effects (83% of participants with non-LBP) was detected, which was not be able to be effectively measured with the Oswestry items. Although 4 items of the Oswestry function differently across the two groups, all items of the Oswestry were well targeted the LBP group.

Is there a common factor for vision?

In cognition, common factors play a crucial role. For example, different types of intelligence are highly correlated, pointing to a common factor, which is often called g. One might expect that a similar common factor would also exist for vision. Surprisingly, no one in the field has addressed this issue. Here, we provide the first evidence that there is no common factor for vision. We tested 40 healthy students’ performance in six basic visual paradigms: visual acuity, vernier discrimination,two visual backward masking paradigms, Gabor detection, and bisection discrimination. One might expect that performance levels on these tasks would be highly correlated because some individuals generally have better vision than others due to superior optics,better retinal or cortical processing, or enriched visual experience. However, only four out of 15 correlations were significant, two of which were nontrivial. These results cannot be explained by high intraobserver variability or ceiling effects because test–retest reliability was high and the variance in our student population is commensurate with that from other studies with well sighted populations. Using a variety of tests (e.g., principal components analysis, Bayes theorem, test–retest reliability), we show the robustness of our null results. We suggest that neuroplasticity operates during everyday experience to generate marked individual differences. Our results apply only to the normally sighted population (i.e., restricted range sampling). For the entire population, including those with degenerate vision, we expect different results.

Reliability, Validity, and Item Response of the Medical Outcomes Study Social Support Score Among Incarcerated Women

Female incarcerations in the United States have increased dramatically in the past decade. While many female inmates suffer from comorbid substance abuse and mental health issues, they often lack social supports and resources that can help female inmates successfully reintegrate back into community. However, the characteristics of social support of incarcerated women have not been fully explored. Using the Rasch model, we examined the MOS social support measure in 271 female inmates in a large urban jail. The findings showed that the MOS social support items did not fully capture variability of item response. The Rasch analyses also showed a high ceiling effect, implying that the measure may be less than optimal for detecting upward change in this population. It is important to utilize reliable and valid instruments in order to capture attributes in incarcerated individuals as their life experience and context require an additional adjustment to existing instruments.