Use Of Normative Data Research Articles

Methods for Analyzing Psychotherapy Outcomes: A Review of Clinical Significance, Reliable Change, and Recommendations for Future Directions

The purpose of this article is to provide a brief review of the history, development, and current status of the concepts of clinical significance (CS) and the reliable change index (RCI). I address issues regarding the development, criticisms, and applications of CS and RCI. I review the use of normative data, cutoff points, formula adjustments, and the comparative validity of various RCI methods. An examination of the convergence of multiple domains and multiple measures demonstrates ways to further develop the concepts of reliable change and CS. Finally, I make some recommendations and implications for future research and the development of assessment tools.

Normative vibrotactile thresholds measured at five European test centres.

To compare vibrotactile thresholds between five international test centres, to determine causes of variability, and to provide normative data for use by health professionals. Vibrotactile thresholds were measured on various fingers in 1,008 subjects at 31.5 Hz (2,531 measurements) and at 125 Hz (2,807 measurements). Three centres used the up-and-down method of limits, rate of change of stimulus 3dB/s, to obtain vibrotactile thresholds. The push force on the surround was 2 N, the probe contact force was 1 N and the probe diameter was 6 mm concentric to a 10-mm diameter hole in the surround. One centre used an up-and-down method of limits with a 5-dB step and a 1.26-mm diameter probe with no surround. Another centre used a stepping algorithm, no surround, and the force on the 6-mm-diameter probe was unspecified. The 31.5-Hz thresholds and 125-Hz thresholds, expressed in dB, were similar between centres using similar methods. There were small (<5 dB) differences in vibrotactile thresholds between male and female subjects, between white-collar and blue-collar workers and between fingers. Both 31.5-Hz and 125-Hz thresholds increased with age; the mean effect of age on 31.5-Hz thresholds was approximately 2 dB over 25 years, while the effect of age on 125 Hz-thresholds was as high as 10 dB over 25 years. Vibrotactile thresholds are influenced by measurement method but can be similar at different centres if similar methods are used. Effects of measurement location and gender are often negligible. Thresholds depend on age, but over the range of ages considered, only the effect on 125-Hz thresholds is sufficient for correction; methods of correcting for age are given. These normative data may be used to assist the diagnosis of peripheral neuropathy involving vibrotactile sensation.

3MS Normative Data for Elderly African Americans

The Modified Mini-Mental State Examination (3MS) is an expanded and modified version of the Mini-Mental Status Exam (MMSE). Although the MMSE has achieved widespread clinical use as a brief cognitive screen, the utility of the measure to ascertain cognitive impairment is constrained by a limited set of abilities sampled, a narrow range of possible scores, floor and ceiling effects, and by a paucity of normative data for use with older adults from ethnically diverse backgrounds. Research demonstrates that the reliability, validity, and sensitivity of the 3MS are superior to that of the MMSE in detecting cognitive impairment. To date there has been minimal research investigating the usefulness of the 3MS with African American older adults. The current study examined the influence of demographic characteristics on the 3MS in a community-dwelling sample of 238 African American older adults (60–84 years). Age, gender, and education accounted for moderate amounts of variance in 3MS performance. Based on these results, normative tables for 3MS scores, stratified by age and with score adjustments for education and gender, are provided.

Internet-based Questionnaire Assessment: Appropriate Use in Clinical Contexts

Use of internet-mediated questionnaire assessment is growing in behavioural telehealth provision. Literature on web-based psychological testing indicates that - while tests used online should be validated for online use - such measures can be reliable and valid. However, use of normative data (especially data from paper-and-pencil samples) presents problems. Studies have shown score distributions may differ across testing media, even when comparisons are made between equivalent samples. Data from 3 different projects illustrate such (substantive) differences, and the errors that would result from using established norms to interpret internet-mediated assessments. Given representativeness issues with "internet norms", it is recommended that if online tests are used for clinical purposes, this should currently be done in a manner that does not rely on normative data.

A Verbal Learning and Memory Test for English- and Spanish-speaking Older Mexican-American Adults

Currently, there are significant limitations in word-list verbal learning and memory tests that are appropriate and have adequate normative data for use with older Latinos of Mexican descent. The purpose of this study was to derive normative data for a word-list learning test with English and Spanish versions, the Spanish English Verbal Learning Test (SEVLT), and develop statistical corrections for the effects of significant demographic variables. A large, population-based sample of 1,789 Latinos of primarily Mexican ancestry over age 60 was employed. Individual trial scores, the total number of items recalled in the learning trials, and the delayed recall trial of the SEVLT were influenced by age, education, gender, but not the language of SEVLT administration. Regression coefficients derived from demographic variables were used to adjust raw SEVLT scores in a general correction formula, and specific percentile cut-off values were identified for these adjusted scores. Normative data tables stratified on demographic variables are also presented.

The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population.

The collection of population-based normative data is a necessary step in the process of standardization of eleven American Academy of Orthopaedic Surgeons (AAOS) musculoskeletal outcomes measures. These data serve as comparative normative scores with which to assess the effectiveness of treatment regimens in clinical practice settings and to study the clinical outcomes of treatment in musculoskeletal research. With use of a panel mail methodology, self-reported data on the eleven AAOS musculoskeletal outcomes measures were collected from the general population of the United States. The overall response rate of 67.4% for the various surveys met study expectations. For the eleven measures, the range of the confidence intervals for the surveys was +/-1.6% to +/-2.3%, exceeding the +/-3% set a priori. With use of the Multitrait/Multi-Item Analysis Program, all of the scales within each of eleven measures exhibited high internal reliability as well as discriminant and convergent validity. Items within each of the scales contributed roughly equal proportions of information to the total scale scores. All eleven instruments met study expectations for providing reliable and valid normative data for use in clinical and research settings.

Comment

Andrew Porter and Mitchell Chester point out a number of positive aspects of Philadelphia's assessment and accountability program and make their case for them. A couple of aspects of the paper are particularly noteworthy. The authors' attention to decision consistency is laudable, but as Tom Kane suggested during his presentation at the Brookings conference, they probably have it wrong, and the decision inconsistency is probably much worse than a model based simply on sampling of kids suggests. But at least they are attending to the problem. Their use of normative data, which is a passing point in the paper, is an important improvement. Trying to base an accountability system solely on a priori standards, without reference to normative data, is [End Page 315] asking for trouble. The authors found that it was not defensible to use only a priori standards and did make reference to normative data.

Aging of the chromatic onset visual evoked potential.

To examine changes in the chromatic onset visual evoked potential (VEP) as a function of aging. VEP's were measured in response to chromatic sinusoidal gratings (1.0 and 0.5 cpd), selectively chosen to modulate the L-M channel and S - (L+M) channel and presented in onset-offset mode. Responses to achromatic gratings presented in a reversal mode were also measured. Twenty subjects were tested, ranging in age from 21 to 93 years. Unlike changes observed earlier in life, the general shape of the chromatic onset wave-form changed little with age; however, latencies increased significantly as a function of age. Amplitude changes revealed a decreasing trend that was not statistically significant. There was little change in the achromatic responses with age. Our results demonstrate a systematic slowing of the chromatic onset VEP with age. The gradual nature of the latency changes and the lack of dramatic and complex wave-form shape changes may allow development of age-based normative data for use in clinical settings.

The Relationship of Lumbar Flexion to Disability in Patients With Low Back Pain

Physical therapists routinely assess spinal active range of motion (AROM) in patients with low back pain (LBP). The purpose of this study was to use 2 approaches to examine the relationship between impairment of lumbar spine flexion AROM and disability. One approach relied on the use of normative data to determine when an impairment in flexion AROM was present. The other approach required therapists to make judgments of whether the flexion AROM impairment was relevant to the patient's disability. Fifteen physical therapists and 81 patients with LBP completed in the study. Patients completed the Roland-Morris Back Pain Questionnaire (RMQ), and the therapists assessed lumbar spine flexion AROM using a dual-inclinometer technique at the initial visit and again at discharge. Correlations between the lumbar flexion AROM measure and disability were low and did not vary appreciably for the 2 approaches tested. Measures of lumbar flexion AROM should not be used as surrogate measures of disability. Lumbar spine flexion AROM and disability are weakly correlated, suggesting that flexion AROM measures should not be used as treatment goals.

Handgrip strength testing: A review of the literature

Testing grip strength is a popular assessment used by occupational therapists in a range of clinical settings. It is fast, easy to perform, reliable and produces a result which is simple to record. Results of grip strength testing have been used to determine a baseline measure of performance against which change can be compared, as well as comparison of results to normative data. This article reviews the literature associated with the measurement of grip strength. It addresses the purposes of grip strength measurement; the instruments used and their reliability and accuracy; the testing position and protocol suggested for use and aspects of these which may influence results; the use of normative data and factors which influence grip strength, including age, gender and occupation; and various methods to determine level or sincerity of effort. Recommendations are made regarding these issues to enable clinicians to conduct grip strength assessments and interpret the results with confidence.

Screening for dementia with the memory impairment screen.

To validate a sensitive and specific screening test for AD and other dementias, assess its reliability and discriminative validity, and present normative data for its use in various applied settings. To improve discrimination in screening for AD and dementia, we developed the Memory Impairment Screen (MIS), a 4-minute, four-item, delayed free- and cued-recall test of memory impairment. The MIS uses controlled learning to ensure attention, induce specific semantic processing, and optimize encoding specificity to improve detection of dementia. Equivalent forms of the MIS were given at the beginning and end of the testing session to assess alternate forms reliability. Discriminative validity was assessed in a criterion sample of 483 aged individuals, 50 of whom had dementia according to Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria. The MIS had good alternate forms reliability, high construct validity for memory impairment, and good discriminative validity in terms of sensitivity, specificity, and positive predictive value. We present normative data for use in settings with different base rates (prevalences) of AD and dementia. The MIS provides efficient, reliable, and valid screening for AD and other dementias.

Normative Data and Neuropsychological Assessment. Common Problems in Clinical Practice and Research

In this paper some methodological problems related to the use of normative data in neuropsychological assessment are analysed. The difference between the concepts of normality and mastery, and the problems encountered with the adjustment of raw scores for age and education are considered. Other arguments discussed and exemplified with real data are the use of inner and outer nonparametric tolerance limits, confidence limits for individual scores, multivariate norms, and discriminant analysis.

AAEM minimonograph #47: normative data in electrodiagnostic medicine. ff.

This article reviews, without mathematics, the important principles governing the acquisition and use of normative data in electrodiagnostic medicine. Common flaws in neurophysiological normative data include vague clinical criteria for establishing freedom from disease, samples that are too small and inadequately stratified, and application of Gaussian statistics to non-Gaussian variables. Other problematic issues concern the trade-off between permissible false-positivity and false-negativity in defining the limits of normative from sample data, test-retest variability, and the use of multiple independent test measurements in each electrodiagnostic examination. The following standards for normative data are proposed: (1) standardized objective determination of freedom from disease; (2) appropriately large sample of normal subjects; (3) proportional statification of normal subjects for known relevant variables; (4) test of Gaussian fit for application of Gaussian statistics; and (5) data presentation by percentiles when Gaussian fit is in doubt. Many existing normative studies in clinical neurophysiology do not meet these standards. High-quality normative data, readily accessible, is essential for the accurate electrodiagnosis of neuromuscular diseases.

Comparing Quality of Life for People with Learning Disabilities and People who are Unemployed or Retired

This study investigates the quality of life of people who moved out of a large long‐stay hospital to ‘ordinary housing’ with support staff. A social reference group of unemployed/retired people living in the same urban area was chosen for comparison as they have similar economic status and local opportunities. Ager's Life Experiences Checklist (LEC) was completed by staff for people with learning disabilities and by the researchers in interviews with unemployed/retired people. The rationale for this method is discussed. Findings support the view that the lifestyle of people with learning disabilities, when compared with people of similar socio‐economic status, is enhanced in the domains of Home, Leisure, Opportunities and Freedom, but not in the area of Relationships. Discussion of the need for caution in interpretation is included, especially as the scores of people with learning disabilities are shown to be more like those of Ager's general population. There are pointers to the use of normative data to assist services in monitoring outcomes.

Use of Normative Data for the Selective Reminding Test

As there are multiple forms of the Selective Reminding Test, it is critical to consider the implications of using published normative data in interpretation of results as different forms of administration may not be equivalent in regards to the domain of memory assessed.

Criterion Referenced Standards for Neurornuscular Physical Fitness Tests: An Analysis

This paper analyzes the determination of the criterion referenced standards for the neuromuscular physical fitness items (sit-ups, sit-and-reach, and pullups) typically included in health related physical fitness test batteries for children and adolescents. Criterion referenced standards should be linked to some specific status on a health criterion that represents an absolute desirable level of that characteristic. Three techniques used to determine and/or validate criterion referenced standards are discussed: the use of empirical data with an established criterion test, the use of empirical data with instructed versus uninstructed groups, and the use of normative data and expert judgment. It is concluded that the existing criterion referenced standards have been derived exclusively from normative data and expert opinion. It remains unknown as to the meaning of these standards in relation to desirable and absolute levels of health.

Performance of Blind Vocational Rehabilitation Clients on the Minnesota Rate of Manipulation Tests

The effects of additional practice trials on the Displacing Test and Turning Test of the Minnesota Rate of Manipulation Tests were studied to determine whether the use of normative data from sighted persons in evaluating the motor skills of blind individuals was valid. Blind vocational rehabilitation clients (N=100) were given the MRMT after three practice trials. Contrary to what is commonly believed, they essentially scored lower than people with normal vision, their means on both tests being at the first percentile of the norms for sighted persons. “Low” or “Very Low” range scores (31st percentile or below) were obtained by 83 percent and 68 percent of the blind clients on the Displacing Test and Turning Test, respectively. Accordingly, the use of this procedure can unfairly penalize blind persons.

Norms for College Undergraduates for the Bem Sex-Role Inventory and the Wiggins Interpersonal Behavior Circle

Norms based on large random samples of introductory psychology college students are presented for the Bem Sex-Role Inventory (N = 1,133) and the Wiggins Interpersonal Behavior Circle (N = 564). The use of normative data, as compared with raw data or data standardized separately within studies, should result in more precise and meaningful measurement of subjects' locations on sex-role dimensions (i.e., instrumentality and expressiveness) by future researchers using these instruments, although norms should be updated to reflect future research results. Conventional definitions of moderately extreme and statistically extreme scores are presented for these instruments based on these norms, encouraging standardization of sample characteristics of future studies.

Manipulation of sensitivity in visual field investigation.

Sophistication of computer software and flexibility of stimulus and background luminance parameters in static perimeter design offer the opportunity for increased information in the assessment of the visual field. Relationships between dynamic ranges and resulting sensitivity gradients in a group of 10 normal 21 year old subjects using the Octopus automated perimeter, the Dicon Autoperimeter 2000 and the Friedmann VFA II are assessed. Inadequacies in the use of normative data to assess the visual field are noted. Implications for the use of dynamic range/sensitivity gradient relationships in visual field assessment without reliance on normative data are discussed.

Effectiveness of student-rating feedback for improving college instruction: A meta-analysis of findings

This article applied meta-analytic methodology to integrate findings from 22 comparisons of the effectiveness of student-rating feedback at the college level. On the average, feedback had a modest but significant effect on improving instruction. Instructors receiving mid-semester feedback averaged. 16 of a rating point higher on end-of-semester overall ratings than did instructors receiving no mid-semester feedback. This corresponded to a gain of over one-third of a standard-deviation unit, or a percentile gain of 15 points. The effects of student-rating feedback were accentuated when augmentation or consultation accompanied the ratings. Other study features, such as the length of time available to implement changes and the use of normative data, did not produce different effect sizes.