Person Separation Index Research Articles

Cross-cultural adaptation and measurement properties of the Arabic version of the ABILHAND-Kids scale

Purpose: To cross-culturally adapt the ABILHAND-Kids into Arabic and to examine its measurement properties in children with cerebral palsy.Materials and methods: The Cross-cultural adaption of the ABILHAND-Kids into Arabic language included forward translation, backward translation, expert committee followed by preliminary testing. Structural validity using Rasch analysis, internal consistency, test–retest reliability, measurement error, and construct validity of the Arabic ABILHAND-Kids were examined in children with cerebral palsy (N = 154; 54% male, mean age 7.4 years).Results: Rasch analysis did not support the structural validity of the Arabic ABILHAND-Kids mainly due to response dependency. Removal of two items addressed the issue of the response dependency and resulted in a unidimensional scale meeting the requirement of the Rasch model. The scale had excellent internal consistency (Person Separation Index = 0.93) and excellent test–retest reliability (intraclass correlation coefficient = 0.98). The results supported 86% of the predefined hypotheses regarding correlation of the Arabic ABILHAND-Kids with the manual ability classification system, gross motor function classification system and the functional independence measure for children.Conclusion: The Arabic ABILHAND-Kids demonstrated adequate evidence supporting its structural validity as a unidimensional measure along with evidence supporting its internal consistency, test–retest reliability and construct validity as a measure of manual ability in children with cerebral palsy.Implications for rehabilitationThe Arabic ABILHAND-Kids is a reliable and valid measure of manual ability in children with cerebral palsy.The Arabic ABILHAND-Kids can be used to quantify manual ability in children with cerebral palsy in clinical practice and for research purposes.

The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis.

Secondary analysis of retrospective data. The aim of this study was to further validate the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) using Rasch analysis. Two rehabilitation centers in Canada. Data were collected as part of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) initiative. The SCIPUS was completed within 72 h of inpatient admission. Persons admitted for initial rehabilitation in two inpatient spinal cord rehabilitation programs were included in the project. Data from 886 participants were analyzed, approximately 60% of whom were males. Rasch analyses demonstrated that the SCIPUS, in its current format did not meet criteria required for true measurement. A transformed version of the SCIPUS obtained by deletion of misfitting items and modification of the response scales improved fit to the model and showed preliminary evidence of unidimensionality. The person separation index, however indicated that the scale requires further adjustments of its scoring options. In its original form, the SCIPUS does not meet the requirements of the Rasch model and its total score should be used cautiously. However, following some adjustments to the items such as addressing DIF between sites to insure a standardized assessment across sites and adding response options to some of the items, interval-scale measurement should be possible.

Reliability and Validity of the Turkish Version of the Fremantle Back Awareness Questionnaire

Cross-cultural adaptation and psychometric analysis. To develop the Turkish version of the Fremantle Back Awareness Questionnaire (FreBAQ-T) and to evaluate its psychometric properties. There is a growing interest in the role that the disturbance of body perception may lead to long-lasting pain problems such as chronic low back pain (CLBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple and low-cost way of evaluating disturbed back awareness in people with CLBP. The FreBAQ was translated from English into Turkish using the forward-backward-forward method. One hundred four participants with low back pain completed the FreBAQ-T. The FreBAQ-T was repeated in 15 participants after 1 week to establish test-retest reliability. Although internal and external construct validity was investigated using Rasch analysis and Spearman correlation coefficient, respectively; reliability was evaluated in terms of internal consistency by Cronbach alpha and Person Separation Index. All items of the FreBAQ-T were found to fit the Rasch Model (chi-square 6.17 [df = 9], P = 0.723). The internal construct validity was good, overall mean item fit residual was -0.305 (standard deviation: 0.369) and mean person fit residual was -0.290 (standard deviation: 1.349). The reliability was good with Cronbach alpha of 0.87 and Person Separation Index of 0.82. When the test-retest was examined via differential item functioning by time, none of the items showed differential item functioning. The FreBAQ-T is a valid, reliable, and unidimensional scale for patients with CLBP. This scale will allow assessing back-specific perception in the Turkish population with CLBP. 3.

Psychometric evaluation of an interview-administered version of the WHOQOL-BREF questionnaire for use in a cross-sectional study of a rural district in Bangladesh: an application of Rasch analysis

BackgroundThis study aimed to validate the psychometric properties of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire for use in a rural district of Bangladesh.MethodsThis cross-sectional study recruited a multi-stage cluster random sample of 2425 participants from the rural district Narail of Bangladesh in May–July 2017. Rasch analysis was carried out using the sampled participants, as well as multiple validation random sub-samples of 300 participants, to validate four domains of the WHOQOL-BREF questionnaire: physical, psychological, social and environmental.ResultsThe original WHOQOL-BREF appeared to be a poor fit for both sampled and sub-sampled group of participants in Narail district in all underlying domains: physical, psychological, social and environmental. Two items (sleep and work capacity) from the physical domain, two items (personal belief and negative feelings) from the psychological domain and three items (home environment, health care and transport) from the environment domain were excluded for goodness of fit of the Rasch model. The social domain exhibited reasonably reliable fitness while fulfilling all the assumptions of the Rasch model. A modified version of the WHOQOL-BREF questionnaire using five-items for the physical ( {upchi}_{(20)}^2 = 36.47, p = 0.013, Person Separation Index (PSI) = 0.773), four-items for the psychological ( {upchi}_{(16)}^2 = 28.30, p = 0.029, PSI = 0.708) and five-items for the environmental ( {upchi}_{(20)}^2 = 36.97, p = 0.011, PSI = 0.804) domain was applied, which showed adequate internal consistency, reliability, unidimensionality, and similar functioning for different age-sex distributions.ConclusionsThe modified WHOQOL-BREF questionnaire translated into Bengali language appeared to be a valid tool for measuring quality of life in a typical rural district in Bangladesh. Despite some limitations of the modified WHOQOL-BREF questionnaire, further application of Rasch analysis using this version or an improved one in other representative rural areas of Bangladesh is recommended to assess the external validity of the outcomes of this study and to determine the efficacy of this tool to measure the quality of life at the national rural level.

Abstract 94: SCAR-Q: International Results and Why Individuals Report the Need for Scar Revision Surgery

PURPOSE: Millions of scars are formed annually with wide-ranging effects on the quality of life of the individual. Currently, there is no internationally validated, rigorously tested PRO measure (‘PROM’) that can be used to assess scar outcomes of all major etiologies in both children and adults. Nor, do we currently understand why patients may seek scar revision surgery. The purpose of this study is to describe the international field-test of seven clinics in four countries, the psychometric properties of the PROM, and the independent risk factors of patients requiring scar revision surgery. METHODS: Between March, 2017 and April, 2018 data were collected from 7 outpatient clinics in New Zealand, Chile, Canada, and the USA. Participants completed a questionnaire booklet with demographic and clinical questions as well as the preliminary SCAR-Q (Appearance, Symptom, and Psychosocial Impact). Rasch Measurement Theory (RMT) analysis was conducted examining item response options, item fit statistics, dependency, targeting, stability, and person separation index. In addition, Cronbach’s alpha and intraclass correlation coefficient were completed to examine reliability. In addition, a multivariable regression analysis was completed to examine independent risk factors for patients self-reporting the need for scar revision surgery. RESULTS: 773 patients were consented and 731 patients completed the survey results in full. Participants were aged 8–88 years with predominantly surgical scars (n=354, 48.4%), traumatic (n=199, 27.2%), and burn scars (n=184, 25.1%). Analysis led to the refinement of the SCAR-Q scales: Appearance, Symptoms, and Psychosocial Impact from 48 items to the final 29 items. RMT analysis showed ordered thresholds for response options, 25 items had fit residuals within the required range, and residual correlations were found only with one pair of items. Reliability was high, with Person Separation Index values of 0.90, 0.82, 0.84, Cronbach alpha values 0.96, 0.91, 0.95 and Intraclass Correlation Coefficient values of 0.92, 0.94. 0.88 respectively. Finally, having a health condition (OR 2.032; 0.944, 4.370), perceiving that one scars badly (OR 2.631, 1.195–5.792), a prior scar revision surgery (0.253; 0.127–0.672), and scoring poorly on the SCAR-Q Psychosocial Impact scale (OR 0.339; 0.171–0.672) were independent risk factors for reporting the need for future scar revision surgery. CONCLUSION: This RMT analysis showed that the 3 SCAR-Q scales performed well in this international, field-test sample, with good to excellent reliability. The SCAR-Q represents a rigorously developed PROM that can be used to evaluate scars in research, clinical care, and quality improvement initiatives. In addition, this study suggests that patients with the listed independent risk factors may require heightened attention and clinical care. These individuals may require more scar symptom management, psychosocial support in the case of social work or in severe cases a psychiatry referral, and/or scar treatment to help alleviate their appearance related concerns.

Rasch analysis of the Neck Bournemouth Questionnaire: Turkish version, validity, and reliability study

Background/aimThe multidimensional evaluation of patients with chronic neck pain is important for planning the treatment program. The aim of this study was to investigate the validity and reliability of the Turkish version of the Neck Bournemouth Questionnaire (NBQ).Materials and methods The internal construct validity of the NBQ was examined by the fit of the data to the Rasch measurement model. External validity of the NBQ was evaluated by testing for expected associations of Rasch transformed NBQ score with the corresponding variables through the process of convergent validity. The reliability of the NBQ in terms of both internal consistency and test-retest reliability was assessed by the person separation index (PSI) and differential item functioning (DIF) by time effect.ResultsIt was determined that the questionnaire has 2 factors. None of the items of Factor 1 (F1) and Factor 2 (F2) showed DIF. The reliability of F1 (Cronbach’s alpha = 0.89, PSI = 0.87) and F2 (Cronbach’s alpha = 0.77, PSI = 0.87) was good with Cronbach’s alpha and PSI. There was a good correlation between NBQ/F1 and the Neck Disability Index (NDI) (r = 0.673) and Neck Pain and Disability Scale (NPDS) (r = 0.709). Also, there was a correlation between NBQ/F2 and the Beck Depression Inventory (BDI) (r = 0.552) and Beck Anxiety Inventory (BAI) (r = 0.410).ConclusionThe Turkish version of the Neck Bournemouth Questionnaire is valid and reliable.

Rasch analysis of the UK Functional Assessment Measure in a sample of patients with traumatic brain injury from the UK national clinical database.

To determine whether the UK Functional Assessment Measure (UK FIM+FAM) fits the Rasch model in patients with complex disability following traumatic brain injury. Psychometric evaluation including preliminary exploratory and confirmatory factor analyses followed by Rasch analysis. A multicentre UK national cohort of 1,956 patients admitted for specialist rehabilitation following traumatic brain injury. The suitability of the Partial Credit Model was confirmed by the likelihood-ratio test (χ2 (df86) =7,325.0, p < 0.001). Exploratory and confirmatory factor analyses supported 3 factors (Motor, Communication, Psychosocial). Rasch analysis of the full scale incorporating the 3 factors as super-items resulted in an acceptable overall model fit (χ2 (df24)=36.72, p = 0.05) and strict uni-dimensionality when tested on a sub-sample of n = 320. These results were replicated in a full sample (n = 1,956) showing uni-dimensionality and good reliability with Person Separation Index = 0.81, but item trait interaction was significant due to the large sample size. No significant differential item functioning was observed for any personal factors. Neither uniform re-scoring of items nor exclusion of participants with extreme scores improved the model fit. The UK FIM+FAM scale satisfies the Rasch model reasonably in traumatic brain injury. A conversion table was produced, but its usefulness in clinical practice requires further exploration and clinical translation.

Applying modern measurement approaches to constructs relevant to evidence-based practice among Canadian physical and occupational therapists

BackgroundEvidence-based practice (EBP) is a complex process. To quantify it, one has to also consider individual and contextual factors using multiple measures. Modern measurement approaches are available to optimize the measurement of complex constructs. This study aimed to develop a robust measurement approach for constructs around EBP including practice, individual (e.g. knowledge, attitudes, confidence, behaviours), and contextual factors (e.g. resources).MethodsOne hundred eighty-one items arising from 5 validated EBP measures were subjected to an item analysis. Nominal group technique was used to arrive at a consensus about the content relevance of each item. Baseline questionnaire responses from a longitudinal study of the evolution of EBP in 128 new graduates of Canadian physical and occupational therapy programmes were analysed. Principles of Rasch Measurement Theory were applied to identify challenges with threshold ordering, item and person fit to the Rasch model, unidimensionality, local independence, and differential item functioning (DIF).ResultsThe nominal group technique identified 70/181 items, and modified Delphi approach identified 68 items that fit a formative model (2 related EBP domains: self-use of EBP (9 items) and EBP activities (7 items)) or a reflective model (4 related EBP domains: attitudes towards EBP (17 items), self-efficacy (9 items), knowledge (11 items) and resources (15 items)). Rasch analysis provided a single score for reflective construct. Among attitudes items, 65% (11/17) fit the Rasch model, item difficulties ranged from − 7.51 to logits (least difficult) to + 5.04 logits (most difficult), and person separation index (PSI) = 0.63. Among self-efficacy items, 89% (8/9) fit the Rasch model, item difficulties ranged from − 3.70 to + 4.91, and PSI = 0.80. Among knowledge items, 82% (9/11) fit the Rasch model, item difficulties ranged from − 7.85 to 4.50, and PSI = 0.81. Among resources items, 87% (13/15) fit the Rasch model, item difficulties ranged from − 3.38 to 2.86, and PSI = 0.86. DIF occurred in 2 constructs: attitudes (1 by profession and 2 by language) and knowledge (1 by language and 2 by profession) arising from poor wording in the original version leading to poor translation.ConclusionsRasch Measurement Theory was applied to develop a valid and reliable measure of EBP. Further modifications to the items can be done for subsequent waves of the survey.

Development of the BODY-Q Chest Module Evaluating Outcomes following Chest Contouring Surgery.

Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome instrument designed for weight loss and/or body contouring. In this article, the authors describe the development of a new module for masculinizing chest contouring surgery. Qualitative methods were used to develop the BODY-Q Chest Module, which was subsequently field-tested in Canada, the United States, The Netherlands, and Denmark between June of 2016 and June of 2017. Participants were aged 16 years or older and seen for gynecomastia, weight loss, or transman chest surgery. Data were collected using either a Web-based application or paper questionnaire. Rasch measurement theory analysis was performed. The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, and 341 gender-affirming). Rasch measurement theory analysis refined a 10-item chest scale and a five-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability [i.e., person separation index and Cronbach alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale), respectively]. Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean scores for the chest and nipple scales were significantly higher (p < 0.001 on independent samples t tests) in participants who were postoperative compared with preoperative. This new BODY-Q Chest Module is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes for masculinizing chest contouring surgery.

Item Analysis for the Adapted Motivation Scale Using Rasch Model

&lt;p&gt;The aim of this study was to measure the validity and reliability of an adapted motivation scale used in second language learning. The Integrative and Instrumental motivation (IIM) was developed based on two orientations of motivation, which were integrative motivation and instrumental motivation. IIM was used to identify students’ level of motivation towards learning Chinese language as a second language (CLSL) in national school. The study presented empirical evidence of validity and reliability using the Rasch Model. Pilot study was conducted in a national school which has students enrolled for the CLSL class. There were 29 students in this pilot study. Data was analyzed using WINSTEPS version 3.72.3. The result showed the reliability of the motivation scale is 0.87 based on Cronbach’s alpha. The construct validity was determined by PT-measure correlation value (PMC) range from 0.71 to 0.86, infit and outfit MNSQ between 0.53 to 1.43 and ZSTD range from -1.1 to 1.2. In unidimensional measure, raw variance explained was at 66.4% with the unexplanined variance in the first factor was at 13.6%. Finally the fit statistics showed that person separation index, 2.79 was considered good and item separation index, 1.81was in acceptable range (Linacre,2012). Person and item reliability were at 0.89 and 0.77 respectively. The result indicated that the new instrument with 15 items-IIM after eliminated unfit items was a reliable and valid instrument to measure the motivation in learning CLSL in the context of national school.&lt;/p&gt;

Leveraging patient-reported outcomes data to inform oncology clinical decision making: Introducing the FACE-Q Head and Neck Cancer Module.

Existing patient-reported outcome measures (PROMs) used to assess patients with head and neck cancer have methodologic and content deficiencies. Herein, the development of a PROM that meets a range of clinical and research needs across head and neck oncology is described. After development of the conceptual framework, which involved a literature review, semistructured patient interviews, and expert input, patients with head and neck cancer who were treated at Memorial Sloan Kettering Cancer Center were recruited by their surgeon. The FACE-Q Head and Neck Cancer Module was completed by patients in the clinic or was sent by mail. Rasch measurement theory analysis was used for item selection for final scale development and to examine reliability and validity. Scale scores for surgical defect and adjuvant therapy were compared with the cohort average to assess clinical applicability. The sample consisted of 219 patients who completed the draft scales. Fourteen independently functioning scales were analyzed. Item fit was good for all 102 items, and all items had ordered thresholds. Scale reliability was acceptable (person separation index was >0.75 for all scales; Cronbach α values were >.87 for all scales; test-retest ranged from 0.86 to 0.96). The scales performed well in a clinically predictable way, demonstrating functional and psychosocial differences across disease sites and with adjuvant therapy. The scales forming the FACE-Q Head and Neck Cancer Module were found to be clinically relevant and scientifically sound. This new PROM now is validated and ready for use in research and clinical care.

A Rasch Analysis of the Integrated Palliative Care Outcome Scale

ContextAccurate assessment of a patient's palliative care needs is essential for the timely provision of treatment and support. The Integrated Palliative Care Outcome Scale (IPOS) is an ordinal measure possessing acceptable psychometric properties, but its ability to discriminate precisely between individual symptom levels has not been rigorously investigated. ObjectivesThe study aimed to conduct Rasch analysis of the IPOS to evaluate and enhance precision of the instrument. MethodsResponses of 300 community-dwelling palliative care patients were subjected to Rasch analysis using the partial credit model. ResultsInitial analysis supported the use of the Rasch model and acceptable reliability (person separation index = 0.77) was observed; however, unsatisfactory model fit was found. Local dependency between items was resolved through the creation of super-items, which increased model fit, reliability (person separation index = 0.80), and unidimensionality. There were no misfitting super-items or differential item functioning by age, rater, sex, or ethnicity. The IPOS showed satisfactory coverage of symptoms within the present clinical sample, with the ability to assess higher severity patients. ConclusionThe modified IPOS showed excellent reliability for a clinical measure in assessing the overall palliative care needs of a patient. The provided ordinal-to-interval conversion table accounts for unique contribution of each symptom to the overall symptom burden and easy to use without the need to modify the original IPOS format.

The CYRM-R: A Rasch-Validated Revision of the Child and Youth Resilience Measure

ABSTRACTThe Child and Youth Resilience Measure (CYRM) is one of the most popular measures of resilience. In this paper, we investigate the CYRM using Rasch analysis to explore and improve its psychometric properties, leading to a more robust measure of resilience.Cross-sectional data were obtained from a questionnaire administered to n = 408 individuals in Canada aged 11-19 who were participating in the Pathways to Resilience study. Rasch analysis was applied to these data, resulting in the production of a 17-item, 2-subscale CYRM-R, consisting of intra/interpersonal and caregiver resilience subscales. The subscales demonstrated good fit to the Rasch model by satisfying requirements of unidimensionality, good fit statistics and internal reliability, and a lack of item bias and problematic local dependency. The person separation indices also indicated that the subscales had good ability to differentiate between individuals of varying levels of resilience. In sum, the CYRM-R is a 2-subscale, 17-item Rasch-validated measure of resilience with robust psychometric properties. This revised measure is recommended for researchers and practitioners who are interested in measuring resilience across diverse cultures and contexts.

KOOS-JR Demonstrates Psychometric Limitations in Measuring Knee Health in Individuals After ACL Reconstruction.

Measurement properties of the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR) are not established in individuals after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine the extent to which the KOOS-JR measures the construct of knee health in individuals post-ACLR using Rasch analysis. The KOOS-JR will fit the Rasch model, but significant ceiling effects will be present. Cross-sectional study. Level 3. Rasch analysis of the KOOS-JR from 166 individuals 10 months post-ACLR was conducted. Unidimensionality, a key criterion of the Rasch model, was evaluated using confirmatory factor analysis. Model fit of the rating scale, items, and persons were evaluated. Mean square fit statistics ≥1.6 and standardized z-scores ≥2.0 were indicative of person or item misfit. Additionally, reliability indicators including person reliability and separation indices were examined. The KOOS-JR fit the criteria of unidimensionality. All items demonstrated model fit; however, ceiling effects were noted (n = 36; 22%). Person reliability was low (0.47). Calculation of person strata revealed that the KOOS-JR did not separate participants into more than 1 stratum. The mean person measure was 3.56 logits higher than the mean item measure, indicating that this sample is skewed toward increased knee health. Although the KOOS-JR represented a unidimensional construct with items and persons fitting the Rasch model, several limitations were noted: ceiling effects, low person reliability, and poor person differentiation. Ceiling effects indicate that many individuals in this sample experienced better knee health than the KOOS-JR items were able to measure. Evaluating the measurement properties of the KOOS-JR is necessary to determine its clinical value in sports medicine. In later stages after ACLR recovery, administration of the KOOS-JR may not be adequate.

Rasch analysis of the upper-limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper-limb subscale of the STREAM tool in an acute stroke population

ABSTRACTBackground: Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness.Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population.Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning.Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0–2), or using the response pattern (0–5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index – 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit – 22%), however, the reliability was slightly reduced (PSI – 0.806).Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population.

Development and validation of a new instrument to measure perceived risks associated with the use of tobacco and nicotine-containing products

BackgroundMaking tobacco products associated with lower risks available to smokers who would otherwise continue smoking is recognized as an important strategy towards addressing smoking-related harm. Predicting use behavior is an important major component of product risk assessment. In this context, risk perception is a possible factor driving tobacco product uptake and use. As prior to market launch real-world actual product use cannot be observed, assessing risk perception can provide predictive information. Considering the lack of suitable validated self-report instruments, the development of a new instrument was undertaken to quantify perceived risks of tobacco and nicotine-containing products by adult smokers, former smokers and never-smokers.MethodsInitial items were constructed based on a literature review, focus groups and expert opinion. Data for scale formation and assessment were obtained through two successive US-based web surveys (n = 2020 and 1640 completers, respectively). Psychometric evaluation was based on Rasch Measurement Theory and Classical Test Theory.ResultsPsychometric evaluation supported the formation of an 18-item Perceived Health Risk scale and a 7-item Perceived Addiction Risk scale: item response option thresholds were ordered correctly for all items; item locations in each scale were spread out (coverage range 75–87%); scale reliability was supported by high person separation indices > 0.93, Cronbach’s alpha > 0.98 and Corrected Item-Total Correlations > 0.88; and no differential item functioning was present. Construct validity evaluations met expectations through inter-scale correlations and findings from known-group comparisons.ConclusionsThe Perceived Risk Instrument is a psychometrically robust instrument applicable for general and personal risk perception measurement, for use in different types of products (including cigarettes, nicotine replacement therapy, potential Modified Risk Tobacco Products), and for different smoking status groups (i.e., current smokers with and without intention to quit, former smokers, never smokers).

LIMB-GIRDLE MUSCULAR DYSTROPHY I: P.13Rasch analysis of the individualised neuromuscular Quality of Life Questionnaire administered to patients with dysferlinopathy

Our objective was to assess the psychometric properties of the Individualized Neuromuscular Quality of Life Questionnaire administered to adults with dysferlinopathy. 203 patients with dysferlinopathy were recruited to participate in the Jain Foundation's International Clinical Outcomes Study for dysferlinopathy. Quality of Life Questionnaires conducted at baseline, year 1,2,3 and 4 were included. The psychometric properties of the instrument were examined using Rasch analysis. A total of 660 questionnaires were completed. 24 of 39 items displayed disordered thresholds and model misfit was identified in 19 of 39 questions (mean item fit residual 0.649, SD: 3.039). Item dependency was high (Shown in 33 pairs of items) and the mean person fit residual was estimated at -0.094 (SD: 1.703). The Person Separation Index were estimated at 0.954 and 0.915. Unidimensionality was not acceptable. The INQoL questionnaire does not appear to be a suitable measure of health-related Quality of Life in adults with dysferlinopathy.

Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire.

ABILHAND is a self-reported questionnaire assessing manual ability. It was validated and calibrated using the Rasch analysis for European stroke patients. After a stroke, performing upper limb activities of daily living is influenced by personal and environmental contextual factors. It is thus important to conduct a contextual validation to use this questionnaire outside of Europe. The aim of this study was to perform a cross cultural validation of the ABILHAND-Stroke questionnaire for post-stroke patients living in Benin, a West-African country. Observational cross-sectional study. Outpatient rehabilitation centres. 223 Beninese chronic stroke patients. The experimental questionnaire was made of 59 items evaluating manual activities. Patients had to estimate their difficulty of performing each activity according to four response categories: impossible, very difficult, difficult and easy. For construct validity analysis, patients were also evaluated with other assessment tools: Box and Block Test, the motor subscale of the Functional Independence Measure, the Stroke Impairment Assessment Set, and ACTIVLIM-Stroke. Data were analysed with the Rasch partial credit model. The response categories very difficult and difficult were merged and the number of response categories was reduced from 4 to 3 (impossible, difficult and easy). The Rasch analyses selected 16 bimanual activities that fit the Rasch model (chi square=42.35; P=0.10). The item location ranged from -1.10 to 2.24 logits. The standard error ranged from 0.15 to 0.22 logits. There is no differential item functioning between subgroups (age, sex, dexterity, affected side, time since stroke). The person separation index is 0.82. The questionnaire can measure 3 levels of manual ability, similarly to the occidental version. The ABILHAND-stroke is a Rasch validated, unidimensional and invariant questionnaire to assess manual ability among Beninese patients. The ordinal score can be transformed into linear score using a conversion table. This assessment tool is clinically relevant in Benin, a developing country, since it requires no specific equipment or training. It should promote and standardize assessments for stroke patients in clinical practice and research in this African country.

QOL-GNMD and patient reported functionning in genetic neuromuscular diseases: A new rasch tool

The “Quality of Life in genetic Neuromuscular Disease” questionnaire (QoL-gNMD) is a new patient reported outcome (PRO) measure tool specifically designed for patients with a slowly-progressive neuromuscular disease with genetic predominant muscular damage. The QoL-gNMDhas been developped in 3 domains: “Impact of Physical Symptoms”, “Self-perception” and “Activities and Social Participation”. The objective was to construct and develop a PRO tool, easy to use in clinical settings, and validated by Rasch model theories. Qol-gNMD was developed using focus groups consisting of expert patients meeting (5 focus group, n = 41, item bank) and then a quantitaive construction phase ( n = 150, principal component and RMT analysis). The french version of the QOL-gNMD (26 items) was administered to patients recruited in 9 tertiary hospitals dedicated to genetic neuromuscular diseases. Each QoL-gNMD domain is measured on a T score metric i.e. a normal distribution with a mean of 50 and a standard deviation of 10. High values represent good quality of life. Standard errors of measurement were estimated and adjusted using rasch model theories (RMT). For each QoL-gNMD domain we estimated, face validity, test retest reproducibility, concordant validity and the conditional minimum detectable changes. 315 patients were recruited for psychometric assessment. Each domain showed good psychometric properties (person separation index > 0.7, test-retest ICC > 0.7) and fitted the partial credit model (RMT). Concurrent validity was assessed using the WHOQOL-BREF. Estimated conditional MDC were calculated for each possible measure change. QoL-gNND is a rasch operational validated measure. QoL-gNMD English version is available but needs psychometric validation.

FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery.

The patient's perspective of their facial scar after skin cancer surgery influences perception of care and quality of life (QoL). Appearance satisfaction after surgery is also an important but often overlooked treatment outcome. To report the psychometric validation of the FACE-Q Skin Cancer Module consisting of five scales, measuring appearance satisfaction (Satisfaction with Facial Appearance, Appraisal of Scars), QoL (Cancer Worry, Appearance-related Psychosocial Distress) and the patient experience (Satisfaction with Information: Appearance). Participants underwent Mohs surgery for facial basal or squamous cell carcinoma or excision of early facial melanoma. Cohort 1 received a set of scales before and after surgery. Cohort 2 received the scales on two occasions in the postoperative period for test-retest reliability. Rasch measurement theory was used to select (item-reduce) the most clinically meaningful items for the scales. Reliability, validity, floor and ceiling effects and responsiveness were also analysed. Of 334 patients, 209 (response rate 62·6%) were included. Rasch analysis reduced the total scale items from 77 to 41. All items had ordered thresholds and good psychometric fit. Reliability was high (Person separation index and Cronbach's α ≥ 0·90) and scales measuring similar constructs were correlated. High floor and ceiling effects were seen for the scales. The Cancer Worry scale demonstrated responsiveness (P = 0·004). The FACE-Q Skin Cancer Module meet the requirements of the Rasch model providing linearized measurement. Discriminating between patients with minimal appearance or worry impairment may be a limitation. The scales can be used for larger validation studies, clinical practice and research.