Redundant Items Research Articles

The Original and Short Versions of the Activities-Specific Balance Confidence (ABC) Scale in Community-Dwelling Older Adults: Clinical Implications Based on Scale Agreement, Internal Consistencies, and Associations With Self-Rated Health.

Balance confidence assessment in older adults has implications for falls prevention and quality of life. It remains unclear whether the original Activities-specific Balance Confidence Scale (ABC-16) or the shortened 6-item scale (ABC-6) is recommended clinically. This study examined ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) in community-dwelling older adults. Secondary analysis of an existing dataset (N = 77) was performed. Scale association and agreement were assessed with a Spearman ρ correlation (rs), intraclass correlation coefficient, 95% limits of agreement (LoA), and Bland-Altman plot. Cronbach α values were calculated to determine internal consistencies. Separate multiple linear regression models with SRH as the outcome and ABC-6 and ABC-16 scores as primary predictors were estimated and subsequently used to conduct Hotelling t test. Participants were primarily female (80.5%) with a median age of 68 years living in the metro Detroit area. The ABC-6 and ABC-16 were closely associated [rs = 0.97, P < .001; intraclass correlation coefficient (2,1) = 0.80] but demonstrated discrepancy (95% LoA range of -3.9 to +18.2; mean difference = 7.2 points in the direction of the ABC-16). Cronbach α values were 0.95 (ABC-16) and 0.89 (ABC-6). Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2 = 0.36) in SRH compared with model 2 (ABC-16 = primary predictor; R2 = 0.29). Hotelling t test [t(74) = 2.4, P = .008] found that the predicted values from the ABC-6 model were significantly more highly correlated with SRH than those from the ABC-16 model. Despite a high correlation between the ABC-16 and ABC-6, the 2 scales showed limited agreement and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 may be preferable to the ABC-16 for balance confidence assessment in older adults living in cold weather, urban, or well-resourced areas.

Measurement Invariance of the Short Home Attachment Scale: A Cross-Cultural Study.

The home environment is a particularly significant part of life that is supposed to satisfy inhabitants’ needs, form their identity, and contribute to psychological wellbeing. The construct of home attachment is especially relevant for students as a most mobile social group. This study is devoted to the validation of the Short Home Attachment Scale (SHAS) in a student sample from five countries (Armenia, India, Indonesia, Russia, and Ukraine). A total of 1,349 (17–26 years; Mage = 19.82, SDage = 2.14; 78% females) university students participated in the study and filled in the 14 items of HAS. In order to avoid redundant items with high error covariances damaging the model, a new scale—the SHAS was developed by eliminating seven items. The shortened scale has satisfactory structure validity in terms of model fit in all countries except Indonesia; internal reliability values were acceptable in all countries. Measurement invariance across countries was tested with Multi-Group Confirmatory Factor Analysis (MG CFA) and Alignment Analysis. MG CFA confirmed both configurational and metric invariance. The invariance of item factor loadings, as well as item intercepts, was also confirmed by the Alignment Analysis. The mean scores varied across cultures, with the highest in India and the lowest in Russia. The final version of SHAS is a valid, reliable tool that may be recommended for use in cross-cultural research. However, the SHAS factor structure robustness in the Indonesian population should be investigated thoroughly.

Evaluation and validation of a patient-reported quality-of-life questionnaire for Parkinson\u2019s disease

BackgroundParkinson’s disease (PD) is a chronic, progressive illness with a profound impact on the health-related quality of life (HRQoL). Disease-specific patient-reported HRQoL measures, such as PDQ-39 and its short version PDQ-8, are increasingly used in clinical practice to address the consequences of PD on everyday life. Due to limitations in the content, especially in non-motor symptoms and sleep disturbances of PDQ-8, PDQoL7, a 7-item, short-term, self-reported, PD-specific HRQoL questionnaire was developed.MethodsA representative sample of 60 adults with idiopathic PD completed the PDQoL7 questionnaire and the existing validated PDQ-8 and EQ-5D-5L questionnaires (all in Greek).ResultsPDQoL7 summary index strongly correlated with PDQ-8 (rs = 0.833, P < 0.001) and EQ-5D-5L (rs = − 0.852, P < 0.001). The correlation between PDQoL7 and EQ-5D-5L was statistically significantly stronger compared to PDQ-8 and EQ-5D-5L (rs = − 0.852 vs rs = − 0.789 respectively, P < 0.001). The internal consistency of PDQoL7 was not affected by item deletion (positive item to total correlations: 0.29–0.63). No redundant items (with inter-item correlation coefficients greater than 0.80) were identified. Cronbach’s α for PDQoL7 was comparable to PDQ-8 (0.804 versus 0.799 respectively). As PDQoL7 had three-dimensional structure, omega coefficient analysis confirmed its reliability (omega total: 0.88; omega hierarchical: 0.58).ConclusionsPDQoL7 is an acceptable, easy to use, valid and reliable tool for the determination of HRQoL in PD patients that is potentially more comprehensive than PDQ-8 based on the available evidence. PDQoL7 could allow for a more thorough evaluation of the impact of PD and contribute to guiding healthcare decisions. This will be confirmed in subsequent analysis on larger patient cohorts.

The Development and Initial Validation of the Adult Coping Inventory

There are few psychometrically sound measures of coping in adults. Widely used measures of coping have highly unstable sub-scale analyses, were developed on homogenous samples, and are outdated. The scarcity of empirically derived instruments is concerning given that coping skills are linked to a variety of positive and negative physical and mental health outcomes (e.g., substance use, depression). Thus, the aim of the current study was to develop a psychometrically sound measure of coping in adults: the Adult Coping Inventory (ACI). The study consisted of three phases: The aim of Phase 1 was to generate an initial item pool. After eliminating redundant items, 124 items remained. The purpose of Phase 2 was to eliminate items based on item frequency and factor loadings. A diverse sample of 526 adults participated in the study. Following item generation and elimination, an exploratory factor analysis produced a 57-item, five-factor model of coping which included the following subscales: Problem Solving, Mindfulness, Maladaptive Coping, Social Support, and Avoidance. Overall, reliability of the ACI was excellent and the internal consistency of the factors ranged from adequate to excellent. Evidence of convergent, concurrent, and incremental validity of the questionnaire was also established. Results provide initial support for the psychometric properties of the ACI.

The Hemophilia Joint Health Score version 2.1 Validation in Adult Patients Study: A multicenter international study

BackgroundThe Hemophilia Joint Health Score (HJHS) was developed and validated to detect arthropathy in children. Additional evidence is required to show validity in adults. We studied the convergent and discriminant construct validity of the HJHS version 2.1(HJHSv2.1) in adults with hemophilia. A secondary aim was to define age‐related normative adult HJHSv2.1 reference values. MethodsWe studied 192 adults with hemophilia, and 120 healthy adults in four age‐matched groups—18 to 29, 30 to 40, 41 to 50, and >50 years—at nine centers. Trained physiotherapists scored the HJHS and World Federation of Hemophilia (WFH) joint score. Health history, the Functional Independence Scale of Hemophilia (FISH), Hemophilia Activities List (HAL), and Short‐Form McGill Pain Questionnaire (SF‐MPQ) were also collected. ResultsThe median age was 35.0 years. Of participants with hemophilia, 68% had severe, 14% moderate, and 18% mild disease. The HJHS correlated strongly with WFH score (Spearman’s rho [rs] = .95, P < .001). Moderate correlations were seen between the FISH (rs = .50, P < .001) and SF‐MPQ Present Pain Intensity (rs = .50, P < .001), while a modest correlation was found with the HAL (rs = −.37, P < .001). The HJHS significantly differentiated between age groups (Kruskal‐Wallis T = 35.02, P < .001) and disease severity in participants with hemophilia. The HJHS had high internal reliability (Cronbach’s α = .88). We identified duration of swelling as a redundant item in the HJHS. ConclusionsThe HJHS shows evidence of strong convergent and discriminant construct validity to detect arthropathy in adults with hemophilia and is well suited for use in this population.

Development of a formative feedback tool for transanal total mesorectal excision.

Transanal total mesorectal excision (TaTME) is a novel procedure in the treatment of rectal cancer. Current training models for TaTME suggest a period of proctored cases, but no structured feedback tool exists to guide operators during the learning phase. The objective of this study therefore was to develop a formative feedback tool for the critical steps of the transanal portion of TaTME. A two-round Delphi study by TaTME experts was conducted to determine the items to be included in the formative feedback tool. Participants rated each step from a prepared list using a Likert scale from 1 (Not relevant) to 5 (Very relevant) with the option to suggest additional steps. Responses to the first round were presented in the second round, where participants rated the revised list of steps. Consensus was defined as > 80% of participants rating the step as 4 or 5 (out of 5). Items were combined when appropriate to avoid redundancy. Rating anchors describing performance (on a 5-point scale) were then developed for each step. The final tool was recirculated and participants rated the finished product on its feasibility and usefulness. Twenty-six TaTME experts were contacted for participation. Fifteen experts (58%) participated in the first round of the study, and eleven (42%) participated in the second round. The majority (14, 93%) had completed fellowship training in colorectal surgery. The first round of the Delphi study contained 34 items, and 32 items met inclusion criteria after the second round. Redundant items were combined into 15 items that comprised the final tool. Out of eight respondents to the feasibility survey, all believed the feedback tool enhances the feedback of learners and would use it for training purposes if available. This work describes the development of a novel consensus-based formative feedback tool specific to TaTME.

Social, Systemic, Individual-Medical or Cultural? Questionnaire on the Concepts of Disability Among Teacher Education Students

The individual-medical concept of disability, whereby disability is believed to be caused by some intractable impairment, is perhaps the most widely held view in society. However, other concepts exist with which teachers in inclusive schools should be familiar (e.g., social, systemic), to better inform teacher behavior, attitudes and understanding. We therefore developed an instrument to capture education students’ concepts of disability. We constructed the questionnaire according to four theoretical models of disability (individual-medical, social, systemic, and cultural concepts), which are commonly used in inclusive teacher education, and validated this on a sample of 775 education students. Additionally, we administered the Attitudes towards Inclusion Scale (AIS) and measured key demographic variables. The instruments, data and analysis code used are available online at https://osf.io/dm4cs/. After dropping redundant items, a shortened form of the questionnaire contained 16 items, with satisfactory psychometric values for scales pertaining to four concepts of disability (CFI = 0.963, TLI = 0.955, RMSEA = 0.037, SRMR = 0.039). These four concepts of disability showed small correlations with the AIS, indicating that our questionnaire measured an independent construct. The more experience education students had with disability and the more courses they had attended on inclusive education, the more likely they were to agree with the social concept of disability. The questionnaire shows promise in measuring concepts of disability and might be used to stimulate students’ critical reflection during teacher education.

Software Information Hiding Algorithm Based on Palette Icon of PE File

PE (Portable executable) file is a standard format for executable file and is applied extensively. PE file has diversity, uncertainty of file size, complexity of file structure and singleness of file format, which make PE file easy to be a carrier of information hiding, especially for that of large hiding capacity. A novel software information hiding algorithm is proposed, which makes full use of display characteristics of palette icon of portable executable file. In this algorithm, the information is embedded into the transparent area of the icon by taking advantage of the redundant color items in the palette. The experimental results show that after embedding the information, the size of the icon remains unchanged, that is, the size of the resource section will not change, and the size of the PE file will not change. On the other hand, the icon with embedded data can be correctly analyzed and displayed without any distortion. PE file can run normally, and does not affect the performance of the program, so the algorithm has good concealment. The algorithm selects an index value whose color is black according to rules in the XOR bitmap, these index values are encoded for information hiding, its complexity is low. At the same time, we can further improve the hiding capacity by adding one or more icons to PE file.

Quality assessment of Brazilian fast-food business services

This paper aims to measure the quality of service provided by fast-food companies from the Brazilian university students' perspectives. A questionnaire was conducted based on ServQual, and a five-point Likert scale was used to assess the expectations and perceptions of the items analysed. Multivariate analyses were applied to treat redundant items, eliminate those that briefly explain the data variability, and determine new categorisations. As a result, it was noticed that expectations were not met on any dimensions or items. The reliability and tangibility dimensions obtained the worst performance and need special attention since they can mostly negatively impact customer loyalty and overall satisfaction. The terms 'fast order delivery', 'quick table cleaning' and 'efficient supplying' were the worst assessed within these dimensions and might require more improvements. After the multivariate analyses, the proposed conceptual model remained with three previous dimensions (empathy, responsiveness, and reliability), and three new dimensions emerged (convenience, aesthetics, and assurance). This work contributes to the literature by identifying the most critical aspects and items and the integration of ServQual and multivariate analyses to treat and reorganise the items and dimensions of quality in fast-food services.

Rasch Validation and Comparison of the Mini-BESTest and S-BESTest in Individuals With Stroke.

The purpose of this study was to compare the psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) and S-BESTest and to evaluate which is more suitable for use in clinical settings for individuals with stroke. This multicenter retrospective cross-sectional study investigated 115 individuals with stroke (mean age, 70.8 y [SD = 11.2 y]) who were able to stand without physical assistance. All individuals were examined with the BESTest and with the Mini-BESTest and S-BESTest scored based on the BESTest results. The data were analyzed using a Rasch analysis (partial credit model). The Mini-BESTest results revealed a correctly functioning rating scale, good fit of the data to the model (apart from 1 overfit item), good reliability for both persons and items (6 statistically detectable levels of balance ability), local dependence between 1 item pair, and essential unidimensionality. The S-BESTest results demonstrated disordered rating scale thresholds (1 response option required collapsing), good fit of the data to the model (apart from 1 underfit item), good reliability for both persons and items (5 statistically detectable levels of balance ability), local dependence between 2 item pairs, and essential unidimensionality. The analyses confirmed that the reliability of the S-BESTest was good and unidimensional and that the test provides several improved points, such as item redundancy and local independence of items. Nevertheless, the Mini-BESTest results supported previous findings as a whole and were better than those from the S-BESTest. Rasch analysis demonstrated that the Mini-BESTest was a better balance assessment scale than the S-BESTest for individuals with stroke based on its psychometric properties. The Mini-BESTest may serve as a useful scale for assessing balance in individuals with stroke, and a keyform plot and strata may help clinical decision-making in terms of interpreting scores and goal setting.

Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults

Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p<.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.

Reliability and Confirmatory Factor Analysis (CFA) of a Paper- Versus App-Administered Resilience Scale in Scottish Youths: Comparative Study.

BackgroundAdequately measuring resilience is important to support young people and children who may need to access resources through social work or educational settings. A widely accepted measure of youth resilience has been developed previously and has been shown to be suitable for vulnerable youth. While the measure is completed by the young person on paper, it has been designed to be worked through with a teacher or social worker in case further clarification is required. However, this method is time consuming and, when faced with large groups of pupils who need assessment, can be overwhelming for schools and practitioners. This study assesses app software with a built-in avatar that can guide young persons through the assessment and its interpretation.ObjectiveOur primary objective is to compare the reliability and psychometric properties of a mobile software app to a paper version of the Child and Youth Resilience measure (CYRM-28). Second, this study assesses the use of the CYRM-28 in a Scottish youth population (aged 11-18 years).MethodsFollowing focus groups and discussion with teachers, social workers, and young people, an avatar was developed by a software company and integrated into an android smartphone app designed to ask questions via the device’s inbuilt text-to-voice engine. In total, 714 students from 2 schools in North East Scotland completed either a paper version or app version of the CYRM-28. A cross-sectional design was used, and students completed their allocated version twice, with a 2-week period in between each testing. All participants could request clarification either from a guidance teacher (paper version) or from the in-built software glossary (app version).ResultsTest and retest correlations showed that the app version performed better than the paper version of the questionnaire (paper version: r303=0.81; P<.001; 95% CI 0.77-0.85; app version: r413=0.84; P<.001; 95% CI 0.79-0.89). Fisher r to z transformation revealed a significant difference in the correlations (Z=–2.97, P<.01). Similarly, Cronbach α in both conditions was very high (app version: α=.92; paper version: α=.87), suggesting item redundancy. Ordinarily, this would lead to a possible removal of highly correlated items; however, our primary objective was to compare app delivery methods over a pen-and-paper mode and was hence beyond the scope of the study. Fisher r to z transformation revealed a significant difference in the correlations (Z=–3.69, P<.01). A confirmatory factor analysis supported the 3-factor solution (individual, relational, and contextual) and reported a good model fit (χ215=27.6 [n=541], P=.24).ConclusionsALEX, an avatar with an integrated voice guide, had higher reliability when measuring resilience than a paper version with teacher assistance. The CFA reports similar structure using the avatar when compared against the original validation.

Psychometric properties of the traditional Chinese version of the 20-item Decisional Balance Scale

ABSTRACT Background Precise evaluation of decisional balance status of victims with substance use disorder is essential for individualized treatment plans. Decisional Balance Scale (DBS) has been proven useful for this purpose. We translated DBS to traditional Chinese (CDBS) and examined the psychometric properties. Methods A total of 173 outpatients with heroin or methamphetamine use disorder completed CDBS. We performed exploratory factor analysis to explore the structure of CDBS. We also examined internal consistency, item analysis, and test–retest reliability. The validity was tested by comparing respondents’ scoring (1) in different stages of change and (2) before/after group psychotherapy. Results The CDBS had identical structure as the original DBS. Two subscales (“Pros” and “Cons” of using drugs) were identified and each composed of 10 items. Item analysis revealed no redundant items. The Cronbach’s alpha for the Pros and Cons subscales were 0.903 and 0.884, whereas the test–retest reliability were 0.372 and 0.431, respectively. Respondents in advanced stage of change and completing group psychotherapy had decreased Pros scores and increased Cons scores. Conclusions The validity and reliability of the CDBS were fair, though the test–retest reliability was lower than expected. The results supported CDBS to assess motivation of outpatients with illicit drug use disorder.

Axiomatization of the counting rule for cost-sharing with possibly redundant items.

For cost allocation problems with an existing set of indivisible public resources with heterogeneous individual needs and non-rivalry access, an axiomatization is provided for the allocation rule that proportionally charges agents for a given resource with respect to their counting liability indices. The main result we obtain holds in the class of cost allocation rules that are additive in cost and simply combines a new independence property together with the well-known axioms of consistency and independence of supplementary items.

Dimensionality, Item Response Theory, Effect Size Attenuation, and Test Bias Analyses of the Self-Importance of Moral Identity Scale (SIMIS)

The extent to which morality and being a moral person are important to one’s identity is most commonly assessed using Aquino and Reed’s (2002) Self-Importance of Moral Identity Scale (SIMIS). This study provided detailed psychometric examinations of the structure and discrimination levels of the SIMIS in a large (N = 2108) and heterogeneous sample. Results indicated that the SIMIS is clearly 2-dimensional, as expected. The Internalization and Symbolization subscales provided sufficient, and sometimes high levels of test information across the latent trait continuums. There were no redundant items and no bias based on gender. The most notable, albeit minor, shortcomings were that there are too many response options and that test information (discrimination power) was diminished at high levels of the Internalization latent trait continuum, apparently due to skewness. The fluctuating levels of measurement precision resulted in slightly greater attenuations in effect sizes for Internalization than for Symbolization across data for 31 other measures. The present findings from a large dataset and a variety of modern, revealing statistical methods provided relatively consistent, favorable findings for the measure.

Evaluation of the Psychometric Properties of the Burn Specific Health Scale-Brief: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study.

The Burn Specific Health Scale-Brief (BSHS-B) is a commonly used burn-specific health outcome measure that includes 40 items across nine subscales. The objective of this study was to use both classical and modern psychometric methods to evaluate psychometric properties of the BSHS-B. Data were collected postburn injury by a multisite federally funded project tracking long-term outcomes. We examined dimensionality, local dependence, item fit, and functioning of response categories, homogeneity, and floor and ceiling effects. Items were fit to Item Response Theory models for evaluation. A total of 653 adults with burn injury completed the BSHS-B. Factor analyses supported unidimensionality for all subscales, but not for a total score based on all 40 items. All nine of the subscales had significant ceiling effects. Six item pairs displayed local dependence suggesting redundance and 11 items did not fit the Item Response Theory models. At least 15 items have too many response options. Results identified numerous psychometric issues with the BSHS-B. A single summary score should never be used for any purpose. Psychometric properties of the scale need to be improved by removing redundant items, reducing response categories, and modifying or deleting problematic items. Additional conceptual work is needed to, at a minimum, revise the work subscale and optimally to revisit and clearly define the constructs measured by all the subscales. Additional items are needed to address ceiling effects.

Adaptation and Psychometric Evaluation of the Parenting Concerns Questionnaire-Advanced Disease.

When patients with advanced cancer have minor children (age < 18), their health-related quality of life is closely linked to their concerns about the impact of progressive illness and death on their children. The Parenting Concerns Questionnaire (PCQ), a validated measure for parents with cancer, does not capture the full range of concerns in advanced cancer. The aim of this was study was to adapt and establish psychometrics for the PCQ for advanced disease (PCQ-AD). After generating an initial item-bank, we conducted concept elicitation interviews with clinicians (n = 8) and cognitive interviews with patients (n = 23) for face validity. New items addressed concerns about impact of parental death, making every moment count, communication, and financial impact of cancer on children. We administered 21 candidate items to 151 parents with advanced cancer. We conducted confirmatory factor analysis (CFA), calculated internal consistency, and assessed convergent and known-groups validity. We removed 8 redundant items due to residual covariation between items. CFA of the 13-item PCQ-AD demonstrated satisfactory fit (CFI = 0.971, TLI = 0.966, RMSEA = 0.081) and high internal consistency (Cronbach's alpha = 0.94, composite reliability = 0.95). The PCQ-AD demonstrated convergent validity and known-groups validity; patients with poor functional status reported higher scores than patients with better functional status (Cohen's d = 0.56, p = 0.002). Adaptation of the PCQ yielded the addition of constructs important in advanced cancer. The PCQ-AD appears to be a reliable and valid measure of parenting concerns in advanced cancer, but future studies are needed to examine measure performance in diverse populations and responsiveness of the PCQ-AD to interventions.

A novel patient-reported outcome instrument assessing the symptoms of paroxysmal nocturnal hemoglobinuria, the PNH-SQ

BackgroundPatient-reported outcome measures (PROs) used to measure symptoms of patients with paroxysmal nocturnal hemoglobinuria (PNH) in trials do not measure PNH symptoms comprehensively and do not assess daily fluctuations in symptoms. Following a literature review and consultation with a PNH expert, we drafted the PNH Symptom Questionnaire (PNH-SQ) and a patient-centric conceptual model of PNH symptoms and impacts. We then interviewed 15 patients with PNH to assess comprehensiveness of symptom capture from the patient perspective and to cognitively debrief the PNH-SQ. Patient interview data were also used to finalize the PNH conceptual model.ResultsParticipants mentioned 27 signs or symptoms of PNH spontaneously or after being probed; 93% reported experiencing ≥ 1 PNH symptom. Concept saturation was reached for all PNH symptoms. Further, interviews confirmed the instrument captured the most common PNH symptoms, including fatigue (87%), abdominal pain (60%), and difficulty swallowing (47%), with fatigue ranked as the most bothersome symptom. The interviews demonstrated that participants understood the items of the PNH-SQ (90–100%); considered the symptoms relevant (> 50– > 90%); the recall period appropriate (> 80–100%); and the response options suitable (> 80–100%). Participants also suggested changes regarding item redundancy and relevance; this feedback was used to finalize the instrument.ConclusionsThe finalized PNH-SQ assesses the presence and severity of 10 symptoms—abdominal pain, chest discomfort, difficulty sleeping, difficulty swallowing, difficulty thinking clearly, fatigue, headache, muscle weakness, pain in the legs or back, and shortness of breath—over 24 h. The PNH-SQ is a content-valid questionnaire suitable for assessing daily symptom presence and severity in PNH clinical trials.

Shortening the Haemophilia Activities List (HAL) from 42 items to 18 items.

IntroductionThe Haemophilia Activities List (HAL) was developed to measure activities and participation in persons with haemophilia (PWH). Shortening the questionnaire may facilitate use of the HAL.AimThe aim of this study was to determine which items of the HAL are redundant, to construct a shorter version of the HAL, and to determine the construct validity of the HALshort.MethodsA secondary analysis was performed on pooled data of two published studies using the HAL (seven domains, 42 items, optimum score: 100) in adults with haemophilia A/B. Data were divided into a derivation (62%) and a validation set (38%). Redundant items were identified by evaluation of: floor and ceiling effects, proportions of missing and ‘not applicable’ responses, inter‐item correlations, component loadings in an exploratory factor analysis, internal consistency, and item‐total correlations. Correlations with the SF‐36 and EQ‐5D‐5L were used to determine construct validity of the HALshort.ResultsData on 680 PWH were evaluated. In the derivation dataset (n = 420), median age was 30 years (range 18–80), 43% had severe haemophilia and 61% received prophylaxis. Median (IQR) HAL sum score was 65.0 (55.7–88.8). The stepwise procedure resulted in a HALshort of 18 items with a median sum score of 63.3 (54.4–86.7). Construct validity was similar for the HAL and HALshort in the validation dataset (n = 260).ConclusionThis clinimetric study resulted in a >50% shortening of the HAL. The 18‐item HALshort reduces patient burden and is expected to capture the information on activities and participation. The HALshort needs further validation.

Estimating the Stability of Psychological Dimensions via Bootstrap Exploratory Graph Analysis: A Monte Carlo Simulation and Tutorial

Exploratory Graph Analysis (EGA) has emerged as a popular approach for estimating the dimensionality of multivariate data using psychometric networks. Sampling variability, however, has made reproducibility and generalizability a key issue in network psychometrics. To address this issue, we have developed a novel bootstrap approach called Bootstrap Exploratory Graph Analysis (bootEGA). bootEGA generates a sampling distribution of EGA results where several statistics can be computed. Descriptive statistics (median, standard error, and dimension frequency) provide researchers with a general sense of the stability of their empirical EGA dimensions. Structural consistency estimates how often dimensions are replicated exactly across the bootstrap replicates. Item stability statistics provide information about whether dimensions are unstable due to misallocation (e.g., item placed in the wrong dimension), multidimensionality (e.g., item belonging to more than one dimension), and item redundancy (e.g., similar semantic content). Using a Monte Carlo simulation, we determine guidelines for acceptable item stability. After, we provide an empirical example that demonstrates how bootEGA can be used to identify structural consistency issues (including a fully reproducible R tutorial). In sum, we demonstrate that bootEGA is a robust approach for identifying the stability and robustness of dimensionality in multivariate data.