Person Separation Research Articles

Rasch analyses of the Quick Inventory of Depressive Symptomatology Self-Report in neurodegenerative and major depressive disorders.

Symptoms of depression are present in neurodegenerative disorders (ND). It is important that depression-related symptoms be adequately screened and monitored in persons living with ND. The Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) is a widely-used self-report measure to assess and monitor depressive severity across different patient populations. However, the measurement properties of the QIDS-SR have not been assessed in ND. To use Rasch Measurement Theory to assess the measurement properties of the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) in ND and in comparison to major depressive disorder (MDD). De-identified data from the Ontario Neurodegenerative Disease Research Initiative (NCT04104373) and Canadian Biomarker Integration Network in Depression (NCT01655706) were used in the analyses. Five hundred and twenty participants with ND (Alzheimer's disease or mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia and Parkinson's disease) and 117 participants with major depressive disorder (MDD) were administered the QIDS-SR. Rasch Measurement Theory was used to assess measurement properties of the QIDS-SR, including unidimensionality and item-level fit, category ordering, item targeting, person separation index and reliability and differential item functioning. The QIDS-SR fit well to the Rasch model in ND and MDD, including unidimensionality, satisfactory category ordering and goodness-of-fit. Item-person measures (Wright maps) showed gaps in item difficulties, suggesting poor precision for persons falling between those severity levels. Differences between mean person and item measures in the ND cohort logits suggest that QIDS-SR items target more severe depression than experienced by the ND cohort. Some items showed differential item functioning between cohorts. The present study supports the use of the QIDS-SR in MDD and suggest that the QIDS-SR can be also used to screen for depressive symptoms in persons with ND. However, gaps in item targeting were noted that suggests that the QIDS-SR cannot differentiate participants falling within certain severity levels. Future studies would benefit from examination in a more severely depressed ND cohort, including those with diagnosed clinical depression.

Measuring Gatekeeper Instructor Comfort to Inform Suicide Prevention Train-The-Trainer Recruitment & Training in Agricultural Communities

ABSTRACT Farmers experience psychological distress and suicide at consistently higher rates than workers in other industries. A gatekeeper is an individual who has been trained to recognize warning symptoms of possible suicidal ideations in others. Gatekeeper programs are recognized by the federal Substance Abuse and Mental Health Services Administration as a best practice for suicide prevention. While gatekeeper programs offer promise to addressing the increasing worldwide suicide rate, how to develop these networks in communities with largely ingrained stigma and taboo related to mental health and suicide remains unanswered. Three of this study’s researchers were part of the development and pilot of an agricultural community gatekeeper program and questioned how gatekeeper instructor psychological comfort could be conceptualized and operationalized for the purpose of informing gatekeeper instructor recruitment and training. After a thorough review of the literature, the researchers constructed a conceptual developmental model of gatekeeper instructor comfort and created a Gatekeeper Instructor Comfort Measure instrument which was then piloted with Kentucky K-12 and university agricultural educators. The researchers of this study employed the Rasch model to determine whether the developmental model of gatekeeper instructor comfort held together empirically. Infit and outfit mean squares (0.73 to 1.33) indicate that the items measure one construct, or are unidimensional, while person reliability and separation statistics indicate that the Gatekeeper Instructor Comfort Measure is composed of enough items to differentiate respondents into almost four strata of gatekeeper comfort. The Gatekeeper Instructor Comfort Measure’s fit to the Rasch model indicates that the instrument meets the requirements of invariant measurement and should serve as a useful measure for other researchers. The instrument’s item difficulty hierarchy also serves as a guide for those training gatekeepers on how to target different gatekeeper outcomes sequentially or developmentally. Researchers recommend restructuring item responses to enable greater discrimination between categories and then piloting the instrument again with a more diverse sample. The revised measure could be used pre- and post-gatekeeper instructor training to determine the impact of training on gatekeeper comfort.

Development of a Short Form Assessment Combining the Fugl-Meyer Assessment–Upper Extremity and the Wolf Motor Function Test for Evaluating Stroke Recovery

ObjectiveTo use Rasch methodologies to combine the items of the Fugl-Meyer Assessment–Upper Extremity (FMA-UE, motor skill) and the Wolf Motor Function Test (WMFT, motor function) onto a single measurement metric and create an FMA-UE+WMFT short form. DesignSecondary analysis of preintervention data from 2 upper extremity stroke rehabilitation trials. Confirmatory factor analysis and Rasch rating scale analysis were first applied to examine the properties of the pooled item bank and then item response theory methodologies were used to develop the short form. Confirmatory factor analysis and Rasch analysis were then applied to the short form to examine the dimensionality and measurement properties. SettingOutpatient academic medical research center. ParticipantsData from 167 participants who completed the FMA-UE and WMFT (rating scale score) were pooled (N=167). Participants were eligible if they had a stroke ≥3 months prior and had upper extremity (UE) hemiparesis and excluded if they had severe UE hemiparesis, severe UE spasticity, or UE pain. InterventionNot applicable. Main Outcome MeasuresThe dimensionality and measurement properties of the pooled 30-item FMA-UE and the 15-item WMFT and short form were examined. ResultsFive items from the pool of 45 items were misfit and were removed. The 40-item pool demonstrated adequate measurement properties. A 15-item short form was then developed and met rating diagnostic scale criteria. All items on the 15-item short form met the Rasch fit criteria, and the assessment met criteria for reliability (Cronbach alpha=.94), separation (person separation = 3.7), and strata (number of strata = 5). ConclusionsItems from the FMA-UE and WMFT can be pooled to create a psychometrically sound 15-item short form.

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

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

Psychometric testing of the British-English Long-Term Conditions Job Strain Scale, Long-Term Conditions Work Spillover Scale and Work-Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions.

The aims were to validate linguistically British-English versions of the Long-Term Conditions Job Strain Scale (LTCJSS), Long-Term Conditions Work Spillover Scale (LTCWSS) and Work-Health-Personal Life Perceptions Scale (WHPLPS) in rheumatoid arthritis, axial spondyloarthritis, osteoarthritis and fibromyalgia (FM). The three scales were forward translated and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work (e.g., Workplace Activity Limitations Scale [WALS]) and condition-specific health scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. The questionnaire was completed by 831 employed participants: 68% women, 53.5 (SD 8.9) years of age, with condition duration 7.7 (SD 8.0) years. The LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 satisfied Rasch model requirements, but Part 3 did not. A Rasch transformation scale and Reference Metric equating scales with the WALS were created. Concurrent validity was generally good (rs = 0.41-0.85) for the three scales, except the WHPLPS Part 3. Internal consistency (Person Separation Index values) was consistent with group use in all conditions, and individual use except for the LTCWSS and WHPLSP Parts 1 and 2 in FM. Test-retest reliability was excellent, with intraclass coefficients (2,1) of 0.80-0.96 for the three scales in the four conditions. Reliable, valid versions of the British-English LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 are now available for use in the UK.

E038 A common measure of the impact of glucocorticoids in patients with inflammatory and autoimmune conditions - the Steroid PRO: A cross-cultural validation study with Rasch models

Abstract Background/Aims Systemic glucocorticoids are key in the management of life- and organ-threatening rheumatic diseases, but have wide-ranging adverse effects of concern to patients and clinicians. We aimed to validate a Patient Reported Outcome (PRO) measure (the Steroid PRO) for assessing the impact of glucocorticoids on health-related quality of life (HRQoL) in patients receiving glucocorticoids for rheumatic disease. Methods This was a cross-sectional study of adults from the UK, USA, Australia and New Zealand, taking glucocorticoids for a rheumatic disease. An online survey was conducted at two time points: Time 1: (i) demographics - age, gender, country, ethnicity, educational level; (ii) clinical information - diagnosis, glucocorticoid dose; (iii) 40 candidate items for the Steroid-PRO, developed in a previous qualitative study; (iv) EQ5D-5L. Time 2 (optional, completed 3-5 days later): (i) the Steroid PRO candidate items; (ii) a condition change question. The survey was distributed via social media and patient organisations. After descriptive analysis, iterative testing with Rasch measurement model and exploratory factor analysis (EFA) informed item reduction and established structural validity, reliability and unidimensionality of the final Steroid-PRO. Item reduction was based on clinical importance, lack of fit to the Rasch model, and redundancy. Evidence of discriminative validity of the Steroid-PRO was established by comparing its scores for participants receiving lower dose glucocorticoid (up to 10 mg) versus higher dose (>10 mg). Intraclass correlation (ICC) between Time 1 and Time 2 was calculated for patients who reported ‘no change’ compared with 3-5 days ago. Results A total of 946 patients returned complete responses at Time 1 (Time 2: 447 responses). They were from UK, n = 743 (78.5%); USA, n = 139 (14.7%); Australia, n = 59 (6.2%). Their mean age was 57.6 (SD = 13.6); 833 (88%) were women. They were treated for inflammatory arthritis (n = 194), connective tissue disease and/or vasculitis (n = 398), and giant cell arteritis and/or polymyalgia rheumatica (n = 341). A total of 25 items were removed due to floor effects and lack of fit to the Rasch model. The remaining 15 items showed a satisfactory fit to the model. EFA suggested a scale structure with four domains: Participation (4 items), Appearance (3 items), Psychological (5 items), and Treatment concerns (3 items). This 4-domain structure was supported by the Rasch model, confirming construct validity; χ2=47.82 (DF = 36), p = 0.899; and reliability (Person Separation Index, PSI=0.757). Patients on a lower glucocorticoid dose had lower Steroid-PRO domain scores than those receiving higher dose (discriminant validity). ICC between Time 1 and Time 2 ranged from 0.892 to 0.942 (95%CI 0.868 to 0.953) suggesting excellent (test-retest) reliability. Conclusion The final Steroid-PRO is a 15-item, valid and reliable 4-domain scale measuring the impact of glucocorticoid therapy on HRQoL of people with rheumatic diseases. Disclosure S. Bridgewater: Grants/research support; S.B. has received funding for research from Vifor Pharma. M. Ndosi: Grants/research support; M.N. has received funding for research from Vifor Pharma. J. Dawson: None. P. Richards: None. C. Silverthorne: None. E. Dures: Grants/research support; E.D. has received funding for research from Vifor Pharma. S. Goodman: Consultancies; S.G. reports consultancy for UCB. Grants/research support; S.G. has received research support from Novartis. Other; S.G. has given talks for NYU, Case Western, ACR Rheumatology Courses. C. Hill: None. S.L. Mackie: Consultancies; S.L.M. has provided consultancy on behalf of her institution for Roche/Chugai, Sanofi, AbbVie, AstraZeneca. Grants/research support; S.L.M. has been an investigator on clinical trials for Sanofi and GSK, as a research grant co-applicant, S.L.M. has received research funding (partial salary support) from Vifor, paid to her institution. Other; S.L.M. has given talks on behalf of her institution for Pfizer, Vifor and UCB. In all cases fees were paid to her institution and no personal fees were received, S.L.M. was supported by Roche to attend EULAR2019 and by Pfizer to attend ACR2021 virtually. J.C. Robson: Consultancies; J.C.R. reports: Consultancy for Vifor Pharma. Grants/research support; Funding for research from Vifor Pharma. Other; Speaking fees from Vifor Pharma.

AN ALGEBRAIC THINKING SKILL TEST IN PROBLEM-SOLVING FOR SEVENTH GRADERS

Diagnostic tests have been developed previously to measure algebraic thinking skills; however, the tests do not specifically address algebraic problem-solving. Thus, an Algebraic Thinking Test (ATT) Instrument was developed to measure algebraic thinking skills in problem-solving involving linear equations. ATT comprises nine open-ended questions with three algebraic thinking constructs: Generalized Arithmetic, Functions and Modeling. Generalized arithmetic involves students in efficient calculation and generalization; functional involves identifying number patterns, while modelling involves solving open-ended problems, identifying similarities, and performing calculations involving variables. This study is meant to determine the quality of ATT instruments through the validity and reliability analysis using the Rasch Measurement Model. The sample consisted of 120 seventh graders aged 12 to 13, selected from two secondary schools in the Tuaran district, Malaysia. The instrument was found to have a strong dimensionality and high construct validity. The reliability of Cronbach Alpha (KR-20) demonstrated a value of .90 (very high), and item and respondent reliability of .98 (excellent) and .86 (good), respectively, with an item separation index of 6.29 and 2.45 for the person separation index. ATT has good validity and high reliability in measuring algebraic thinking skills among seventh graders in secondary schools. Keywords: algebraic thinking skills, linear equations, problem-solving, Rasch analysis, validity and reliability

:Duty to Self: Moral, Political, and Legal Self-Relation

:<i>Duty to Self: Moral, Political, and Legal Self-Relation</i>

Rasch development and validation of the "Medellín Dry Eye Inventory" (ME·Dry), an instrument to measure multidimensional quality of life compromise in patients with dry eye disease.

Dry eye disease (DED) is a common condition that affects the quality of life. There is a great need for better-developed scales that comply with Rasch model requirements. Prospective study including patients with DED. A series of focus groups were performed to determine the best items to be included. A Rasch modeling methodology was used to validate the Medellín Dry Eye Inventory (ME·Dry). After iterative analysis and scale modification, a final version of the scale was attained which complied with the Rasch analysis expectations. Correlation between the different subscales of the ME·Dry and the Ocular Surface Disease Index (OSDI) was evaluated through Spearman correlation. A total of 166 patients with DED were included. Rasch modeling demonstrated an excellent behavior for the ME·Dry, including four subscales: Symptoms, Triggers, Activity Limitation, and Emotional Compromise. Infit and Outfit parameters were all between 0.50 and 1.50, with excellent category utilization. Person and item separation and reliability were excellent for all subscales. There was a need for a category collapsing for the Emotional Compromise subscale. There was a strong correlation between the different subscales of the ME·Dry except for the Emotional Compromise subscale, which seems to be independent. The ME·Dry is a reliable scale, complying with the Rasch model expectations, that allows for a reliable measurement of quality of life compromise in patients with DED. Emotional compromise secondary to DED does not seem to correlate with disease severity as assessed by the other quality-of-life subscales.

Analysis of Computational Thinking Instrument for High School Student Using Rasch Model

This study is aimed-to construct and analyze the Computational Thinking Instrument at Physics subject using Rasch Measurement Model. The instrument was developed by the researcher to assess students’ computational thinking in Grade Eleventh in high school on heat and transfer topics under STEM Quartet Integrated Learning. The type of the instrument is a multiple choice with multiple-choice reasoning. This test consists of 13 questions to measure five concepts of Computational Thinking which are abstraction, decomposition, algorithm, evaluation, and generalization. The test was tried out on 120 students (87 female and 33 male aged 16-18 years old) in West Java and Banten. The item of the questions on the test was analyzed using Winstep 5.3.2.0. The reliability of the Instrument can be shown at the Cronbach’s alpha, Item Reliability, Person Reliability, Item Separation, and Person Separation. The result shows that Cronbach’s alpha (KR-20) is 0.75 which means the instrument has high reliability. The value of the item reliability is 0.95 and person reliability is 0.72. This means that although the consistency of student in answering questions is sufficient, the instrument has high reliability. The values of the item and person separation are 1.61 and 4.43 which means that the instrument has great separation. The validity of the instrument can be seen in unidimensionality and item fit order. The unidimensionality shows that the value of Raw Variance Explain by Measure is 32.8%, the Unexplained variance 1-5 contrast is below 15% and the eigenvalues are also below 3%. Overall, 8 of 13 items of the test meet 3 criteria of the item fit order, then 5 items have 2 of 3 criteria of the item fit order. We can conclude that this Instrument is reliable and valid. Then, the instrument can be used to measure students’ computational thinking on heat and transfer topics

Rasch and Confirmatory Factor Analyses of the Arabic Version of the Psychological Empowerment Scale (PsyES): A Multicultural Approach for Measurable Sustainability

This research is focused on the well-known notion of workplace motivation known as psychological empowerment and how this may be used regarding sustainability. This research aimed to use Rasch and confirmatory factor analyses to examine the multidimensionality, reliability, and model fit of the Arabic version of the psychological empowerment scale (PsyES). A total of 579 male and female employees participated in this study. The participants were from the Jazan region, Saudi Arabia. PsyES’s four constructs (meaning, competence, self-determination, and impact) and their dimensionalities were confirmed using Rasch and AMOS analyses. A total of 323 women (55.8%) and 256 men (44.2%) provided data. Most respondents were married (74.8%), followed by those who were never married (21.1%), divorced (3.1%), and widowed (1.0%). The final multidimensional scale model adequately fits the data (chi-square/df (cmin/df) = 3.55, comparative fit index = 0.97, root mean square error of approximation = 0.066, and standardized RMR = 0.035) according to the AMOS results. This multidimensional nature of PsyES was further confirmed using the Rasch model. The person and item separation indices were more than 1.5, and the Rasch analysis revealed 39 persons with a misfit. The modified rating scale’s functioning was confirmed by the item characteristic curve. The MnSq and Zstd values did not deviate from the two recognized limits or indicate that the data were consistent with the Rasch model based on the recommended indicators. This is the first study of its kind to find PsyES useful as a screening tool for psychological empowerment in its Arabic version. Its four dimensions are a valid and reliable measurement tool that can be used in many measurable areas of sustainability.

Improving a Leadership Scale: Applying Rasch Analysis to Student Pharmacists’ Attitudes and Beliefs About Leadership

ObjectiveLeadership development is necessary for student pharmacists to become pharmacist leaders, but no readily usable standard measurement of student attitudes toward and beliefs about leadership exists. To assess the reliability and validity evidence for using the Leadership Attitudes and Beliefs Scale (LABS-III), originally developed and validated in Malaysia, for use with student pharmacists in the United States. MethodsThe 2-unit leadership course was piloted among second- and third-year students in a public college of pharmacy with a 4-year doctor of pharmacy curriculum. The participating students completed the LABS-III during the first and last classes as part of a quality improvement measure for course enhancement. Rasch analysis was then used to assess the reliability and validity evidence for the LABS-III. ResultsA total of 24 students participated in the pilot course. The pre and postcourse surveys had 100% and 92% response rates, respectively. After Rasch analysis model fit was achieved, the item separation for the 14 nonextreme items was 2.19 with an item reliability of 0.83. The person separation index was 2.16 with a person reliability of 0.82. ConclusionThe Rasch analysis revealed that the number of LABS-III items should be decreased and that the 3-point response scale should be used to improve functionality and use in classroom settings for PharmD students in the United States. Further research is needed to augment the reliability and validity evidence of the modified instrument for use at other United States colleges of pharmacy.

ОСОБЛИВОСТІ ЗЕМЕЛЬНОЇ ПРАВОСУБ’ЄКТНОСТІ ГРОМАДЯН УКРАЇНИ, ІНОЗЕМЦІВ ТА ОСІБ БЕЗ ГРОМАДЯНСТВА

The article is devoted to the legal status of natural persons in land law. The purpose of the study is to study the land legal personality of citizens of Ukraine, foreigners and stateless persons, and to determine its features. The concept of "legal entity" and its structure in the theory of law are revealed. The concept of land legal personality has been formed, which should be understood as the legally guaranteed opportunities to have land rights and obligations, acquire them, use them and fulfill them. Features of land legal personality that distinguish it from civil legal personality are highlighted. The components of legal personality are legal capacity and legal capacity. It was determined that land legal capacity is the ability to have rights and obligations regarding land, land legal capacity is the ability of a natural person to acquire land rights for himself by his actions and exercise them independently, as well as the ability to create land obligations for himself by his actions and fulfill them independently and bear responsibility in case of their non-fulfilment. The positions of scientists regarding the definition of land legal personality of natural persons, in particular, regarding the separation of land procedural legal personality have been studied. Based on the analysis of the legislation of Ukraine, it has been proven that the land legal personality of citizens of Ukraine, foreigners and stateless persons differs in its scope. Citizens of Ukraine have the largest range of rights and responsibilities regarding land. In particular, the right to acquire a land plot, including from agricultural land, which is given priority in the state. At the same time, there are certain restrictions on the composition and amount of land that can be owned by citizens of Ukraine, as stated in the article. Peculiarities of land legal personality of foreign citizens and stateless persons are considered. Restrictions on acquiring ownership of agricultural lands are specified.

Validation and Enhancement of the 6-Item Nature-Relatedness Scale Using Rasch Analysis

This study examines psychometric properties of the 6-item Nature-Relatedness Scale (NR-6) using Rasch analysis. Nature relatedness is an important indicator of several markers of human and ecological well-being, and the NR-6 is a common convenient measure. In addition, the NR-6 is an ordinal scale with limited suitability for use with parametric statistics due to inconsistency with fundamental measurement principles. The current Rasch analysis employed the partial credit model using a sample (n = 450) collected from the United States. Initial analysis showed local dependency, low reliability, and poor fit to the Rasch model. The best model fit (χ2[24] = 29.30, p = 0.209) and reliability (Person Separation Index = 0.74) were achieved through combining locally dependent items, reducing measurement error. These findings support the psychometric strength of the NR-6 given the use of the included ordinal-to-linear conversion table, providing improvement without altering the original scale format.

Translation and cross-cultural adaptation of the Brazilian version of the PM-Scale: A specific measure of participation after stroke

BackgroundThe PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French. ObjectiveTo translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version. MethodsThe translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale. ResultsThe final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05). ConclusionThe Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

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

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

Predicting patient deterioration by nurse intuition: The development and validation of the nurse intuition patient deterioration scale

IntroductionEarly warning scores based on vital signs are used in hospitals to estimate patient deterioration and to initiate an adequate and timely response when necessary. These scores show acceptable performance in predicting patient outcomes. However, they tend to generate many false positives leading to an increased workload in clinical practice. Additionally, nurses feel a tension between the application of an early warning score and their own clinical judgement. Nurse intuition is often included as an extra call criterion next to an early warning score. It is therefore important to investigate its predictive value. The aim of this study was to develop and validate a Nurse Intuition Patient Deterioration Scale (NIPDS). MethodsThe NIPDS was developed using the latest evidence after which relevant items were selected by an expert panel. The scale was tested in a prospective observational study in 2 surgical and 2 medical wards in a Belgian hospital. Data were collected from December 1st, 2019 until March 31st, 2020. A NIPDS registration was done at each patient admission and whenever the attending nurse felt worried. The studied outcomes were urgent physician assistance call, resuscitation team call, patient death, and unplanned transfer to intensive/medium care. Psychometric analyses and scale optimisation were carried out using Rasch modelling techniques. Finally, the scale's accuracy and an optimal threshold were determined. ResultsThe scale item content validity index is 0.88 indicating that the selected items should be included in the instrument according to the expert panel. Item-total score correlation coefficients range between 0.573 (item 9 – pain) and 0.874 (item 6 – behaviour). The Person Separation Index is 0.814 indicating satisfactory discriminatory power. An overall fit of the NIPDS data to the Rasch model was confirmed. Rasch modelling showed that the item ‘pain’ signalled misfit. Furthermore, the person-item map showed disordered items which were corrected in the final model. The AUROC to predict an event within 24 h after registration was 0.957 (95% CI 0.932–0.982; p < 0.001) indicating excellent model performance. DiscussionThe results showed that the NIPDS is a valid and accurate instrument to predict events in surgical and medical patients. It showed better performance compared to an existing score estimating nurse intuition. In practice, the NIPDS could be used by nurses to estimate clinical deterioration in addition to an early warning score. It remains unclear if the combination of NIPDS with an early warning score could reduce workload without losing accuracy and this should be explored in future research. Tweetable abstractNewly developed nurse intuition scale, which uses clinical cues to estimate deterioration in hospitalised patients, is brief and performs well in predicting physician assistance, resuscitation team calls, patient death and unplanned transfer to intensive or medium care.

Rasch validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in community-dwelling adults

BackgroundWith the ongoing global COVID-19 pandemic and the recent political divide in the United States (US), there is an urgent need to address the soaring mental well-being problems and promote positive well-being. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) measures the positive aspects of mental health. Previous studies confirmed its construct validity, reliability, and unidimensionality with confirmatory factor analysis. Six studies have performed a Rasch analysis on the WEMWBS, and only one evaluated young adults in the US. The goal of our study is to use Rasch analysis to validate the WEMBS in a wider age group of community-dwelling adults in the US.MethodsWe used the Rasch unidimensional measurement model 2030 software to evaluate item and person fit, targeting, person separation reliability (PSR), and differential item functioning (DIF) for sample sizes of at least 200 persons in each subgroup.ResultsAfter deleting two items, the WEMBS analyzed in our 553 community-dwelling adults (average age 51.22 ± 17.18 years; 358 women) showed an excellent PSR = 0.91 as well as person and item fit, but the items are too easy for this population (person mean location = 2.17 ± 2.00). There was no DIF for sex, mental health, or practicing breathing exercises.ConclusionsThe WEMWBS had good item and person fit but the targeting is off when used in community-dwelling adults in the US. Adding more difficult items might improve the targeting and capture a broader range of positive mental well-being.

Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire.

Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ. This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ. A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of thefour response options could be evaluated. The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization. Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.

Establishing conversion of the 16-item Informant Questionnaire on Cognitive Decline in the Elderly scores into interval-level data across multiple samples using Rasch methodology.

The 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) is a well-validated and widely-used measure of cognitive changes (CCs) among older adults. This study aimed to use Rasch methodology to establish psychometric properties of the IQCODE-16 and validate the existing ordinal-to-interval transformation algorithms across multiple large samples. A Partial Credit Rasch model was employed to examine psychometric properties of the IQCODE-16 using data (n=918) from two longitudinal studies of participants aged 57-99 years: the Older Australian Twins Study (n=450) and the Canberra Longitudinal Study (n=468), and reusing the Sydney Memory and Ageing Study (MAS) sample (n=400). Initial analyses indicated good reliability for the IQCODE-16 (Person Separation Index range: 0.82-0.90). However, local dependency was identified between items, with several items showing misfit to the model. Replicating the existing Rasch solution could not reproduce the best Rasch model fit for all samples. Combining locally dependent items into three testlets resolved all misfit and local dependency issues and resulted in the best Rasch model fit for all samples with evidence of unidimensionality, strong reliability, and invariance across person factors. Accordingly, new ordinal-to-interval transformation algorithms were produced to convert the IQCODE-16 ordinal scores into interval data to improve the accuracy of its scores. The findings of this study support the reliability and validity of the IQCODE-16 in measuring CCs among older adults. New ordinal-to-interval conversion tables generated using samples from multiple independent datasets are more generalizable and can be used to enhance the precision of the IQCODE-16 without changing its original format. An easy-to-use converter has been made available for clinical and research use.