Unidimensional Instrument Research Articles

Psychometric evaluation of the Patient Assessment of Chronic Illness Care instrument using Item analysis according to the Rasch model.

The Patient Assessment of Chronic Illness Care (PACIC) instrument assesses patient care in alignment with the chronic care model. The aim of the study was to comprehensively validate the PACIC using the Rasch model. A special focus was placed on the investigation of local dependence (LD), differential item functioning (DIF) and targeting. This secondary analysis utilized data of 760 patients with a diagnosis of diabetes who had participated in the Swiss CoDiab-VD cohort study. The psychometric properties of the French PACIC-version were evaluated using the Rasch model. DIF was investigated in relation to age, gender, education, year of recruitment into the CoDiab-VD cohort study, type of diabetes and whether patients got an injectable antidiabetic drug or not. The initial analysis of the PACIC revealed poor fit to the Rasch model (χ2 -p < 0.001) with response dependency being the most prominent problem. After combining the items into two testlets (testlet 1: Items 1-11; testlet 2: Items 12-20), good overall model fit was found (χ2 -p = 0.77) as well as good reliability (Person Separation Index = 0.85) and targeting. DIF with regard to whether patients got an injectable antidiabetic drug or not was found for testlet 2. However, the size of this DIF was regarded as not being substantial. The PACIC is a well-targeted, reliable unidimensional instrument to assess patient care in alignment with the chronic care model in patients with diabetes. It is free of substantial DIF. The PACIC-20 sum score can hence be used in clinical practice for individual diagnostic. For evaluation purposes like assessment of change or group evaluations, the usage of the interval-scale level person parameters is recommended as it permits using parametric statistical analyses and provides a more accurate picture about the actual amount of change.

Psychometric Evaluation of a Patient Experience Questionnaire (PEQ) for Outpatient Appointments: Analysis Using Data from a U.K. National Health Service Audiology Department.

The Audiology Department at the Royal Surrey NHS Foundation Trust (RSFT), United Kingdom, developed a patient experience questionnaire (PEQ) to assess and compare patients' experiences of attending a wide range of appointments (e.g., hearing assessment, hearing aid fitting, hearing aid review, tinnitus therapy, balance assessment, and balance rehabilitation). The aim of this study was to assess the psychometric properties of the PEQ. The PEQ is a unidimensional instrument with four items that assess a patient's experience of an outpatient appointment. Retrospective cross-sectional study. Patients attending appointments for audiology services at RSFT between January and March 2020. All patients (n = 656) attending appointments for audiology services at RSFT during randomly selected days between January and March 2020 were given the questionnaire to complete themselves (PEQ-self) or to complete on their child's behalf (PEQ-parent). The factor structures for the PEQ-self and PEQ-parent were assessed separately, using confirmatory factor analysis. A multiple-causes, multiple-indicators (MIMIC) model was fitted to explore potential bias due to gender and age. Internal consistency was assessed using Cronbach's α. The bivariate correlations between PEQ scores and other variables were evaluated using the nonparametric Spearman correlation coefficient. Floor and ceiling effects were assessed using the distribution of total scores. Confirmatory factor analysis revealed that a one-factor model gave a close fit to the data for both the self and parent versions. Cronbach's α for the total score was 0.77 for the PEQ-self and 0.86 for the PEQ-parent. The MIMIC model showed no significant direct effects of age or gender for either version. Both the PEQ-self and PEQ-parent questionnaire can be reliably used to measure patients' experiences of outpatient audiology appointments. Future studies should aim to assess the psychometric properties of the PEQ-self and PEQ-parent for a range of outpatient appointments other than audiology.

Development and validation of a patient-reported outcome in systemic sclerosis: the Hand scleroDerma lived Experience (HAnDE) scale.

Hand involvement in systemic sclerosis (SSc) is at the core of the disease, with a substantial impact on both functional aspects and quality of life. There is no patient-reported outcome (PRO) scale globally assessing hand involvement in SSc. To develop and validate a PRO scale, the Hand scleroDerma lived Experience (HAnDE) scale, to assess the lived experience of hand involvement in patients with SSc. This was an exploratory sequential mixed-methods study with two phases: (i) PRO development through an inductive process to analyse the structure of lived experience, involving 21 patients with SSc; and (ii) PRO validation by assessing the psychometric properties of the scale among 105 patients with SSc. Phase 1 enabled us to generate the 18-item provisional scale. From Phase 2, the mean (SD) total score of the scale was 29·16 (16·15). The item reduction process retained 16 items with five levels of answers (range 0-64). Internal consistency of the 16-item version was excellent (Cronbach's alpha = 0·946). Construct validity was very good, principal component analysis pointing towards a unidimensional instrument, with one factor explaining 56% of the variance, and concurrent validity being confirmed: Cochin Hand Function Scale r = 0·66; Health Assessment Questionnaire - Disability index r = 0·58; Hospital Anxiety and Depression Scale, anxiety r = 0·51, depression r = 0·4; Mouth Handicap in Systemic Sclerosis scale r = 0·61; 36-Item Short Form Health Survey, physical component r = -0·48, mental component r = -0·46; and Kapandji score r = -0·46. The correlations were statistically significant (P < 0·05). We propose, for future trials and clinical practice in SSc, a new PRO, the HAnDE scale, that assesses all the dimensions - functional, aesthetic, relational, existential and emotional - of the lived experience of hand involvement in SSc.

Avaliação preliminar das propriedades psicométricas do Fat Talk Questionnaire em uma amostra de mulheres jovens

Fat Talk (FT) is a term used to describe a behavior characterized by speech, thinking, and derogatory feelings towards one's own body and the body of another person. It is predominant in females and is related to worse body image and worse self-esteem. The Fat Talk Questionnaire (FTQ) is an instrument previously adapted cross-culturally for young women in Brazil. The aim of this study was to carry out a preliminary assessment of its psychometric properties. The FTQ was applied to 99 young females (18 to 19 years and 11 months), along with sociodemographic questions, the Rosenberg Self-Esteem Scale (RSS) and the Body Shape Questionnaire (BSQ8) to assess convergent validity (through the test Pearson’s correlation). Confirmatory factor analysis was performed using the structural equation model with the allocation sampling technique. Internal consistency was assessed using Cronbach's Alpha and MacDonald’s Omega. The structural equation model supported a one-dimensional scale (x2/gl = 1.62; CFI = 0.953; TLI = 0.935 and RMSEA = 0.079 [95%CI: 0.051-0.176]). The instrument presented an α-Cronbach of 0.89 [95%CI: 0.85-0.92] and an ω-MacDonald of 0.89; there was a high correlation with the BSQ8 (0.70) and a mean correlation (0.42) with the RSS. The instrument presented an adequate internal consistency, the confirmatory factor analysis of the FTQ supported a unidimensional instrument with satisfactory factor loadings, and a correlation was found between more Fat Talk behavior with greater concern with body shape and worse self-esteem.

Structural and Predictive Validity of the Spanish Short Version of Utrecht Work Engagement Scale in Educational Institutions Workers.

In this paper, we evaluate the factorial validity of the Spanish short version of the Utrecht Work Engagement Scale (UWES-9) and assess its predictive validity with respect to self-assessed work performance. A total of 229 employees from educational institutions in Ecuador participated. Using a model comparison analysis, the unidimensional model exhibited an excellent goodness of fit, χ2 = 26.176 (24), p = .344; CFI =1.000; TLI = 1.000; RMSEA = .020; SRMR = .034; it was not improved by more complex models, Three-factor model: χ2 = 22.148 (21), p = .391; CFI =1.000; TLI = 1.000; RMSEA = .016; SRMR = .033. Two-factor model: χ2 = 26.080 (23), p = .297; CFI = 1.000; TLI = 1.000; RMSEA = .025; SRMR = .034). Therefore, it is justified as a unidimensional instrument of work engagement. However, upon analyzing the correlation patterns of the overall score and the work engagement dimensions in relation to the task performance, contextual performance, and counterproductive behaviors, we conclude that, while the unidimensional model exhibits a good fit, the three-factor theoretical approach is substantively superior in that it maintains differential predictive validity for each theoretical dimension.

Preliminary assessment of the psychometric properties of the Fat Talk Questionnaire in a sample of young women

Fat Talk (FT) is a term used to describe a behavior characterized by speech, thinking, and derogatory feelings towards one's own body and the body of another person. It is predominant in females and is related to worse body image and worse self-esteem. The Fat Talk Questionnaire (FTQ) is an instrument previously adapted cross-culturally for young women in Brazil. The aim of this study was to carry out a preliminary assessment of its psychometric properties. The FTQ was applied to 99 young females (18 to 19 years and 11 months), along with sociodemographic questions, the Rosenberg Self-Esteem Scale (RSS) and the Body Shape Questionnaire (BSQ8) to assess convergent validity (through the test Pearson’s correlation). Confirmatory factor analysis was performed using the structural equation model with the allocation sampling technique. Internal consistency was assessed using Cronbach's Alpha and MacDonald’s Omega. The structural equation model supported a one-dimensional scale (x2/gl = 1.62; CFI = 0.953; TLI = 0.935 and RMSEA = 0.079 [95%CI: 0.051-0.176]). The instrument presented an α-Cronbach of 0.89 [95%CI: 0.85-0.92] and an ω-MacDonald of 0.89; there was a high correlation with the BSQ8 (0.70) and a mean correlation (0.42) with the RSS. The instrument presented an adequate internal consistency, the confirmatory factor analysis of the FTQ supported a unidimensional instrument with satisfactory factor loadings, and a correlation was found between more Fat Talk behavior with greater concern with body shape and worse self-esteem.

Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain

PurposeTo verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain.MethodsIndividuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach’s alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC).ResultsExploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach’s alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC.ConclusionFABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.

Validation of the Acceptance and Action Questionnaire-II in the general Spanish population

Acceptance and Commitment Therapy states that Experiential Avoidance contributes to the development of psychological issues. The Acceptance and Action Questionnaire-II measures Experiential Avoidance. The objective of the current study is to perform a validation of the Acceptance and Action Questionnaire-II in the general Spanish population. A sample of 964 participants from all over Spain was used (M = 43.43 years; SD = 15.27). The psychometric properties of the questionnaire were examined according to Classical Test Theory. In addition, assessments were made of participants’ personality, Emotional Intelligence, Anxiety, and Depression, and the influence of sex and age on Experiential Avoidance was examined. The Acceptance and Action Questionnaire-II is a unidimensional instrument, with excellent reliability (α = .93) and adequate evidence of validity. Differences were observed based on sex, with women scoring higher, and based on age, with lower scores in the older age groups. The Acceptance and Action Questionnaire-II is a valid, reliable instrument for use in the general Spanish population.

Construct validity of the Clinical Dementia Rating Scale to assess the level of cognitive decline by informants

AbstractBackgroundClinical Dementia Rating Scale (CDR) is one of the most used assessment scales in the care of dementia but it still lacks a detailed analysis of construct validity. We aimed to analyze evidences of construct validity of the CDR to assess the level of cognitive decline by informants.MethodWe analyzed 650 records of elderly subjects belonging to the Brazilian Biobank for Aging Studies. A trained nurse fulfilled the CDR during the clinical interview with a knowledgeable next‐of‐kin, after informed consent. We considered each domain of the CDR as one item. Exploratory (EFA) and Confirmatory factor analysis (CFA) were performed. We used Robust Unweighted Least Squares with promax rotation, with a bootstrapping of 1.000 cases, and Parallel Analysis. Sample adequacy was tested by the Kaiser‐Meyer‐Olkin and Bartlett sphericity tests. UniCo, ECV and Mireal tested the dimensionality. Factor loading ≥ 0.50 and communalities ≥ 0.40 were indicators of good factor solution. In CFA we tested: Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non‐Normed Fit Index (NNFI), Comparative Fit Index (CFI ), and Weighted Root Mean Square Residual (WRMR). Reliability was tested by standardized Chronbach’s Alpha, Ordinal McDonald’s Ômega and GLB. For the analysis, we used Factor 10.10.3.ResultSample was composed by 55.5% of females, the mean age of the sample was 68.7±11.3 years and 78.8% of the participants were cognitively normal (CDR = 0). KMO was 0.86 and Bartlett was &lt;0.001. Total explained variance was 84.6%. Parallel analysis showed only one dimension and values of UniCo (0.994); ECV (0.919) and MIREAL (0.279) confirmed the unidimensionality of the structure. Factor loadings ranged from 0.846 to 0.945 and communalities from 0.716 to 0.894. Memory was the item with the higher factor loading and communality. All the goodness of fit indexes confirmed the structure of CDR. Indicators of reliability were also very good (Table 1).ConclusionCDR is a unidimensional instrument composed by six items that together explain 84.6% of the ‘level of cognitive decline’. Results indicated that the CDR has very good evidence of construct validity and reliability and can be used to assess the level of cognitive decline by informants.

Validating a SMIIL:) Development and initial validation of a Scale Measuring the Impact of Interprofessional Learning (SMIIL)

ABSTRACT Design and evaluation of interprofessional learning (IPL) in pre-qualification education lacks customization. In response to this, the Scale Measuring the Impact of Interprofessional Learning (SMIIL) was developed to facilitate the context-driven evaluation of IPL interventions in the undergraduate setting. Items of this scale reflect common IPL themes and align to levels one to three of the modified Kirkpatrick’s model. This scale was piloted in a cohort of 787 BMBS (Bachelor of Medicine Bachelor of Surgery) students at a medical school in the South West of England. A response rate of 22.7% was achieved despite the disruption of face-to-face data collection during the Covid-19 lockdown (March to July 2020). Descriptive statistics, factor analysis, and Cronbach’s Alpha were used to validate and refine the scale. The resultant SMIIL is a unidimensional instrument comprised of 17 items with an acceptable internal consistency (Cronbach’s α = 0.80). Further research is required to develop the scale fully and validate it by involving different cohorts of pre-qualification healthcare students in multiple localities and varying styles of IPL interventions.

Psychometric performance of the brief Francis scale of attitude towards Christianity (Francis-4) in Mexican university students

ABSTRACT The brief Francis scale of attitude towards Christianity (Francis-4) psychometric performance in Mexico is unknown. The objective was to evaluate the dimensionality, homogeneity, gender differential item functioning (DIF), and nomological validity of Francis-4. 1,108 university students between 18 and 60 years of age were evaluated; 80.4% were women (n = 891). CFA was performed with the following fit indicators: chi-square, RMSEA, CFI, TLI, and McDonald’s omega were calculated. For nomological validity, the mean and standard deviation according to gender were compared with Student’s t-test. Gender DIF was quantified with Kendall’s tau-b. The CFA revealed the following goodness-of-fit coefficients: chi-square = 25.45, df = 2, p = .001, RMSEA = .10, 90% CI .07 – .14, CFI = .99, TLI = .99, and SRMR = .01. Cronbach’s alpha of .97 and McDonald’s omega were .97. Scores were significantly higher in women than in men (M = 8.9, SD = 5.4 versus M = 7.6, t = 3.15, p = .002). Kendall’s tau ranged from .07 to .09 indicating absence of gender DIF. Francis-4 is a unidimensional instrument with nomological validity, high internal consistency, and absence of gender DIF. It is recommended to evaluate its performance in other populations.

Knowledge about osteoarthritis: Development of the Hip and Knee Osteoarthritis Knowledge Scales and protocol for testing their measurement properties

Objectives1) Develop unidimensional instruments to measure osteoarthritis (OA) knowledge among people with hip or knee OA, and 2) assess the structural validity, internal consistency, cross-cultural validity/measurement invariance, test-retest reliability, and measurement error of the Hip Osteoarthritis Knowledge Scale (HOAKS) and the Knee Osteoarthritis Knowledge Scale (KOAKS). MethodsDraft HOAKS and KOAKS were developed and refined following best-practice (COSMIN) guidelines with involvement of consumer research partners. Measurement properties of the HOAKS and KOAKS will be assessed through an online survey. The survey will include the novel HOAKS or KOAKS, the current short form of the Hip or Knee injury and Osteoarthritis Outcome Score (HOOS-12/KOOS-12), and items that gather demographic and OA characteristics and explore self-rated OA knowledge. People will be eligible to participate if aged 18 years and older, can communicate in English, and have either hip or knee OA as diagnosed by a health professional or by meeting diagnostic criteria. We aim to obtain 400 complete HOAKS or KOAKS responses and 100 complete HOAKS or KOAKS retest responses one week after initial completion. Rasch analysis will estimate structural validity, internal consistency and cross-cultural validity/measurement invariance. Assessment will include test-retest reliability (intraclass correlation coefficient) and absolute measurement error (standard error of measurement; smallest detectable change). ConclusionThis study will produce robust unidimensional instruments to measure hip and knee OA knowledge. We anticipate that the HOAKS and KOAKS scales will be useful in clinical and research settings to identify knowledge gaps or evaluate interventions designed to improve knowledge.

Using Contemporary Psychometric Methods to Construct and Validate Scores on a Short-Form Version of the Psychological Strain Scales

Background: The 40-item Psychological Strain Scales (PSS) was developed to measure four dimensions of psychological strains based on the Strain Theory of Suicide. Although the PSS has been increasingly used in recent years, the dimensionality and scoring of the PSS remained to be thoroughly examined using the Item Response Theory (IRT) approach. Methods: Data came from a large sample of 11,412 Chinese undergraduate students. A bifactor-IRT model, specifying one general strain factor and four specific strains factors, was examined for fit to the sample data. A detailed item analysis, with analysis of the differential item functioning (DIF) of the items across gender, was undertaken to evaluate the dimensionality of the PSS. The associations among the PSS scale scores with scores on the concurrent measures, assessing psychache and suicidal behaviors, were examined. Results: IRT-derived specific bifactor indices showed that the PSS was unidimensional, and thus the PSS total scores should be reported. Unidimensional subset of 5 items identified (Item 9, Item 12, Item 14, Item 16, and Item 20), using bifactor-IRT modeling and incremental validation, were selected to construct a potential short form of the PSS (PSS-SF). The PSS-SF scale scores demonstrated strong psychometric properties and associations with scores on the concurrent measures assessing relevant constructs. Limitations: This study used cross-sectional data from a non-clinical sample of Chinese undergraduate students. Conclusions: The PSS-SF should be considered as a unidimensional instrument with potential in enhancing our understanding and measurement of psychological strains with reduced response burden.

Screening Performance of the Korean Version of the Gambling Problem Severity Subscale of the Canadian Adolescent Gambling Index (CAGI GPSS)

The CAGI GPSS is the only instrument that was specifically developed to measure adolescent problem gambling. The purpose of this study is to evaluate the screening performance of the Korean version of the CAGI GPSS. The Korean version of the CAGI GPSS was validated with 1456 adolescents in South Korea. The results indicated that the Korean version of the CAGI GPSS was a unidimensional instrument, like its English version, and that it showed satisfactory internal consistency reliability and convergent validity. The Korean version of the CAGI GPSS demonstrated optimal performances at a cut-off score of 5. The cut-off score of 5 found in this study should be used to identify adolescents in school settings who had gambling problems. However, the sensitivity and specificity results should be interpreted with caution, because the adolescents included in the reference group might not represent all adolescents with gambling problems. Further evaluation is needed to heighten the values of the Korean version of the CAGI GPSS.

Psychometric Properties of the Pain Self-Efficacy Questionnaire Using Nigerian University Students with Chronic Pain

This study was set to determine the psychometric properties of the pain self-efficacy questionnaire among Nigerian university students with chronic pain. A sample size of 256 Nigerian university students with chronic pains was used. The construct validation of the PSEQ was done using exploratory factor analysis while the internal consistency and stability reliability indices were estimated using Cronbach Alpha method. The study found that the items of the PSEQ correlated positively with each other (r = 0.72) and PSEQ is a unidimensional instrument with good internal consistency reliability. By implication, the Nigerian version of PSEQ demonstrated good psychometric properties as already indicated in English language, Portuguese and Dutch versions. Thus, usage of the PSEQ on Nigerian university students with chronic pain will help then to find out the level of adjust in their academic pursuit.

The responsiveness and predictive validity of the de Morton Mobility Index in geriatric rehabilitation

Introduction The de Morton Mobility Index (DEMMI) is a unidimensional clinical instrument proven reliable and valid for measuring mobility in the elderly, but its responsiveness has not been evaluated when applying the methodology recommended by COSMIN. Purpose To evaluate the responsiveness and the predictive validity of the DEMMI. Materials and methods Elderly people, referred for municipality-based rehabilitation, were consecutively included. Eight hypotheses regarding the relationship between the change scores in the DEMMI and other functional measures of mobility were tested by assessing the participants before and after rehabilitation. Three months after completing the rehabilitation, the participants’ functional status was evaluated. Results 250 elderly people (mean age 85 years, 63% women) were included. The change scores in the DEMMI and the other measures correlated (r = 0.422 to 0.547), but only three out of the eight hypotheses were confirmed. A DEMMI score of less than 48 and less than 67 can predict inability of ambulating close to the participant’s residence and using public transport, respectively. Conclusions We found a moderate responsiveness and a high predictive validity of the DEMMI score. The DEMMI appears to be an appropriate instrument for monitoring change in mobility and predicting functional status among elderly patients undergoing rehabilitation. Implications for rehabilitation The de Morton Mobility Index (DEMMI) is a clinical instrument for measuring mobility. This study shows that the DEMMI was responsive to change in mobility and predicted disability among a diverse group of elderly individuals referred to rehabilitation after hospital discharge. The DEMMI is applicable as an outcome measure in trials investigating the effect of rehabilitation and for clinical decision-making concerning geriatric rehabilitation.

Nonsense on Stilts - Part 1: The ICER 2020-2023 Value Assessment Framework for Constructing Imaginary Worlds.

Previous commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the lack of credibility in modeled claims for cost-effectiveness and associated recommendations for pricing and access by the Institute for Clinical and Economic Review (ICER). The principal objection to ICER reports has been that their modeled claims fail the standards of normal science: they are best seen as pseudoscience. The purpose of this latest commentary is to provide a critique of the recently released ICER 2020 Value Assessment Framework (VAF). Although ICER has taken upon itself the pole position in health technology assessments and recommendations for product pricing in the US health care system, the incremental, lifetime cost-per-QALY modeling methodology should not be taken seriously. The creation of imaginary modeled worlds, built entirely from assumption, fails the demarcation test between science and pseudoscience. The ICER evidence reports are best seen as the health technology assessment equivalent of 'intelligent design' in counterpoint to 'natural selection'. It is surprising, therefore, that health care decision makers should take ICER's recommendations seriously as providing 'approximate information' for formulary decision making. What is not appreciated is that the claims made by ICER lack credibility, are impossible to evaluate and lack the ability to be replicated across treatment settings. Indeed, the models presented under the guise of a 'state of the art' value assessment were never intended to support evaluable claims. We have no idea and will never know if they are right or if they are wrong. ICER's position becomes even more untenable once the models presented are assessed in detail. Without in any way supporting the ICER methodology, it is worth noting that all too often ICER's claims for incremental QALYs in specific models are based upon what appears to be, from the limited evidence presented, a casual and ad hoc assemblage of utility scores from diverse constructs. This is a critical weakness given the role attributed by ICER to the modeled cost-per-QALY claims as central to ICERs imaginary value assessment. ICER also overlooks the fact that the utility scores it captures from the literature to populate its imaginary reference case world lack objectivity. They are ordinal rather than interval measures. To apply these manifest scores to time spent in a disease stage and then aggregate these over different disease stages is nonsensical. The critical issue is one of instrument development. The case made here is for the application of Rasch Measurement Theory (RMT) to construct a unidimensional instrument with interval properties, in this case from the needs fulfillment construct of quality of life (QoL). Unless an instrument meets RMT standards in its development, the logic of Rasch modeling to achieve fundamental measurement standards means that other scales are, by definition, ordinal. It is absurd to 'assume' they are interval. RMT is designed to create instruments to evaluate change and test hypotheses. In the absence of instruments that have RMT properties, the cost-per-QALY reference case modelling meme collapses. It is an analytical dead end. If we are to support a meaningful scientific program to discover new facts to support health care delivery and improve the lives of patients, caregivers and their families, then ICER should be put to one side.

Dyspnoea Assessment In Adults With End-Stage Kidney Disease: A Systematic Review.

Dyspnoea is a common, disabling symptom of people living with end-stage kidney disease (ESKD), which may persist despite optimal management. Dyspnoea assessments can be grouped according to the instruments that assess domains related to: sensory-perception (intensity, sensory quality), affective distress (unpleasantness) and impact/burden (function, quality of life). To describe dyspnoea assessment in adults with ESKD receiving renal replacement therapy (RRT). Systematic review. Five databases were searched. Primary studies reporting an assessment of dyspnoea in adults with ESKD receiving RRT were included. Studies were excluded where participants with ESKD had received palliative/conservative treatment (no dialysis) or renal transplant. Conference abstracts, protocols, commentaries and/or images were excluded. Two independent reviewers screened and extracted the data. Descriptive analysis summarised the (1) number and type of instruments used to assess dyspnoea; (2) which dyspnoea domains to be assessed and (3) rationale and context for dyspnoea assessment. From 2,234 records screened, 28 studies were eligible for inclusion (observational n = 22 and experimental n = 6). Across studies, 12 different instruments were identified (dyspnoea-specific n = 3, subscale of a comprehensive instrument n = 9). Most instruments (n = 11, 92%) assessed a single domain (intensity n = 6, unpleasantness n = 6 and impact/burden n = 5). Studies reported a rationale for measuring dyspnoea (n = 26) as either a characteristic of the participant cohort (n = 14) or as an outcome (n = 14). Surprisingly, a few primary studies reported assessment of dyspnoea in people with ESKD receiving RRT. When assessed, there was a predominance of unidimensional instruments. As dyspnoea is associated with adverse clinical outcomes, routine dyspnoea assessment may improve management and relieve suffering.

The Russian-language version of the Constructivist Epistemological Assumptions Scale: The psychometric analysis

The internal structure, reliability and construct (convergent and discriminant) validity of the Russian-language version of the Constructivist Epistemological Assumptions Scale (CEAS) developed by M. Berzonsky (1994) are examined. The sample was 207 subjects. The confirmatory factor analysis revealed that this scale cannot be viewed as a unidimensional instrument. The exploratory factor analysis allowed to reveal a conceptual core of the scale associated with the relativistic aspect of constructivism. Internal consistency and test-retest reliability of CEAS are acceptable. The obtained correlations confirm convergent and discriminant validity of the scale. It is concluded that CEAS is a more promising tool for assessing epistemological beliefs than the Attitudes about Reality Scale (AARS) by R. Unger et al.

Validation of the oral health impact profile - 14 in patients with head and neck cancer.

Background The Oral Health Impact Profile-14 (OHIP-14) was designed to assess patients’ perception of the impact of oral disorders on their quality of life (QoL). Although the OHIP-14 is now frequently used in patients with head and neck cancer, data related to its measurement properties in this population are scarce. The aim of the present study was to evaluate the reliability and validity of the OHIP-14 in a sample of Serbian patients with head and neck cancer. Material and Methods Data were available for 345 patients (257 [74.5%] males; aged 30-92 years), with head and neck cancer. All patients completed the OHIP-14 and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35. Factor analyses, internal consistency reliability (i.e., Cronbach’s α coefficient), and construct validity were analyzed. Results The factor analyses confirmed that 14 OHIP items were measuring a single underlying factor. Cronbach’s α coefficient was 0.98 and corrected item-total correlations ranged 0.77-0.93. Lower OHIP-14 scores (i.e., lower impacts on oral health) were more frequently present among patients who had only surgery as a therapeutic procedure compared to those who had surgery accompanied with radio- and chemotherapy (p< 0.01). Patients with a tumor stage 0-II also had lower OHIP-14 scores compared to those who had a tumor stage III-IV (p< 0.01). The OHIP-14 correlated significantly with the QLQ-C30 and QLQ-H&N35 scales. Conclusions As a unidimensional instrument, the OHIP-14 provides oral QoL assessments with sound internal consistency reliability and construct validity among patients with head and neck cancer. Key words:Quality of life, oral health, psychometrics, reliability, validity.